Skills for quit preparation to improve self-efficacy and emotion regulation: an acceptability and feasibility study

This pilot study evaluated the acceptability, feasibility, and preliminary efficacy of the Steps to Quit Preparation (STQP) intervention, a two-week, text-based program designed to enhance smoking cessation self-efficacy among individuals with difficulties in emotion regulation. Guided by social cognitive theory, which identifies self-efficacy as a core determinant of behavior change, STQP aimed to strengthen confidence in quitting by improving emotion regulation skills before a quit attempt. Emotion regulation difficulties can heighten emotional distress and undermine coping flexibility, limiting confidence to resist urges, particularly in high-risk contexts. Participants (N = 40) were recruited nationwide and completed baseline and post-intervention assessments, along with qualitative interviews. Adherence and acceptability were high: 92.5% completed the program and nearly 90% rated it as acceptable. Participants showed significant gains in smoking cessation self-efficacy, as well as improvements in emotion regulation and distress tolerance. Although exploratory mediation analyses did not reveal significant indirect effects, these analyses provided preliminary insight into how emotion regulation processes may contribute to enhanced confidence to quit. By targeting self-efficacy prior to cessation, STQP represents an anticipatory self-regulation strategy that may strengthen readiness and resilience during the initial stages of quitting. Text-delivered emotion regulation exercises offer a scalable, low-burden approach to engage smokers who might otherwise struggle to access structured behavioral support. Future trials integrating pre-cessation self-efficacy enhancement into standard cessation treatment could clarify how such strategies improve quit rates and long-term abstinence in emotionally vulnerable populations.