Table 1.

Description of ACT-Based DT-W Elements Targeting Weight Concerns.

	Sessions	Description
Psychoeducation	1	History of the promotion of smoking as a weight control strategy, physiological effects of nicotine on weight, reasons for post-cessation weight gain
Distress tolerance skills
Values	I, 1, 4, 7, 8	Identify and clarify life values as they relate to smoking vs. weight, differentiate values vs. goals
Weight concerns as triggers for smoking	I, 1	Differentiate external (e.g., people, places, situations) vs. internal (e.g., thoughts, feelings) triggers for smoking and eating, identify weight and body image concerns as internal triggers, discuss the role of these concerns in smoking cessation and relapse
Problems with efforts to control weight concerns	I, 2	Discuss past unsuccessful efforts to control or avoid weight concerns that led to resumption of smoking; understand why efforts to control/avoid weight and body image concerns are likely to maintain smoking
Acceptance	2, 6	Understand acceptance as an alternative to control/avoidance of weight concerns; participate in a mirror exposure exercise to experience these concerns fully without acting on them by smoking
Cognitive defusion	2, 6, 7	Learn to defuse weight concerns by viewing negative weight and body image thoughts as what they are (cognitive constructs that do not have to be reacted to or believed), with emphasis on weight-related rationalizations for smoking
Self as context	3	Practice taking a non-judgmental, observer perspective toward weight and body image concerns via exercises in which participants focused on breathing while observing thoughts and feelings
Values-oriented living skills
Willingness	3	Commit to non-judgmental acceptance of negative thoughts and feelings related to weight and body image concerns; address tendency to set limits on weight gain tolerance. Commit to engaging in cessation-promoting, values-oriented behavior regardless of the presence of weight and body image concerns
Being present—  Appetite awareness training	4–7	Identify that during past quit attempts, eating may have replaced smoking as a strategy to control or avoid negative emotions; practice increasing awareness and use of physiological hunger and satiety cues rather than external or emotional triggers to guide when and how much to eat; provide forms to practice monitoring appetite at home (Craighead, 2006)
Being present—  Mindful eating	5–7	Practice (with a piece of candy) paying attention to the smell, taste, and texture of food while eating; eating slowly and noticing physical sensations of hunger and fullness; removing distractions while eating (e.g., TV)
Committed action	4, 8	Identify goals and barriers with respect to quitting smoking; link values to goals; make daily commitment to values-oriented healthy living behaviors. Participants generate their own behavioral goals, which could include activities such as increasing physical activity, increasing consumption of fruits and vegetables, self-esteem building hobbies, and so forth

Note. ACT = Acceptance and Commitment Therapy; I = individual session.