Psychological inflexibility and insomnia as serial mediators of the link between social media addiction and romantic relationship quality.

Despite overall declines in the rate of tobacco use in the United States over the past 30 years, improving quit rates among current smokers continues to be a significant public health focus given the high risk of long-term negative health outcomes. There has been extensive research evaluating a wide range of smoking cessation approaches over the past 40 years. Although there has been significant progress in the application of both clinical and public health interventions aimed at smoking cessation, researchers have concluded that the overall success rate of these interventions has not shown significant improvement. This highlights the need for new, innovative, and theory-driven approaches to both improve the overall abstinence and long-term quit rates, as well as to increase the reach of effective interventions. The utilization of mobile applications for smoking cessation and other addictive behaviors has increased over the past several years due to the low cost, ease of use, and increased availability via smartphones. While few research studies have reported on the effects of mobile behavioral-health-based interventions for smoking cessation, the results that are available have been promising. Although NCI public health initiatives (e.g. QuitGuide, QuitSTART) are currently available, they have not been evaluated for efficacy. One theory-driven approach that has shown promise for intervention development, but has yet to be examined when delivered via mobile app, is cognitive dissonance induction. Cognitive dissonance has been widely studied and applied across physical and mental health fields, but has yet to be applied via a mobile app. Prior studies have shown that increasing cognitive dissonance, which is described as discomfort that one experiences when their behavior conflicts with their personal beliefs or values, has been shown to be efficacious in treating a variety of health behaviors, including treating obesity, promoting healthy eating, reducing fears, managing chronic illness, improving safe sex practices, and preventing eating disorders. Of particular relevance, cognitive dissonance approaches have also shown success in treating substance use, reducing the initiation of smoking, and improving short-term smoking cessation outcomes. For instance, Simmons et al. found that smokers who engaged in video-taped discussions about the consequences of smoking (delivered via computer) had higher quit rates at follow-up at 1 month. Although these findings are promising, no significant long-term effects for cognitive dissonance activities for smoking cessation have been found, and the use of mobile apps for inducing cognitive dissonance has not been examined. Mobile app-based interventions offer the opportunity for a scalable approach to deliver repeated cognitive dissonance inducing activities over the course of treatment. The objective of this pilot study was to test the use of a mobile app that uses cognitive dissonance-inducing activities to aid in quitting smoking.