Jonathan Bricker

Who they are

Bricker works at the Fred Hutchinson Cancer Center, in its public health sciences division. The institution was called the Fred Hutchinson Cancer Research Center until April 2022, when it merged with the Seattle Cancer Care Alliance and dropped the word from its name, which is why our own notes and the older literature carry the longer version.

What he does there is unusual in the way it combines two things that normally sit apart. The clinical technique is Acceptance and Commitment Therapy, which is a talking therapy with a specific and counter-intuitive instruction at its centre: when a craving arrives, do not fight it. Observe where it sits in the body, watch what it does, and let it run its course. The premise is that an urge behaves like a wave rather than a rising line, and that resistance is what gives it something to push against. Bricker's companion image is leaves on a stream. A thought is placed on a leaf and watched as it floats away, rather than either seized or refused.

The other half is trial design. Most acceptance-based work in this area is small, and Bricker's is not. He has run the technique against the standard of care at a scale that makes the comparison mean something, and the comparison is the interesting part, because the two arms embody opposite advice. His app, iCanQuit, teaches people to accept the situations in which they smoke. The National Cancer Institute's QuitGuide, built to the US clinical practice guidelines, teaches people to avoid them.

He reaches general readers by a different route. Nir Eyal draws the practical core of Indistractable's first part from him: the method for handling an internal trigger, surfing the urge, and the leaves-on-a-stream visualisation. Eyal reports that participants who learned to acknowledge and explore cravings quit at twice the rate of the American Lung Association's best-performing programme.

That figure is footnoted in Indistractable without a named study, and our notes could not trace it to a paper.* It should not be repeated as a result. It is worth setting beside the trial we can check, because the two are not the same claim. The verified comparison is against the National Cancer Institute's app rather than the American Lung Association's programme, and the margin is seven percentage points rather than a doubling. Anyone making a decision about how to stop smoking should treat the popular figure as unverified and talk to a clinician.

Key papers

No book of his is recorded in our notes, and none was found. His output is journal articles and clinical trials, so this section stands where the books table sits on other pages.

Bricker, J. B., Watson, N. L., Mull, K. E., Sullivan, B. M., & Heffner, J. L. (2020), "Efficacy of Smartphone Applications for Smoking Cessation: A Randomized Clinical Trial," JAMA Internal Medicine, published 21 September 2020. A stratified, double-blind, individually randomised trial of 2,415 adult smokers drawn from all fifty US states, comparing the acceptance-based iCanQuit against the guideline-based QuitGuide. At the twelve-month follow-up, 30-day abstinence was 28.2 per cent against 21.1 per cent, odds ratio 1.49, 95% CI 1.22 to 1.83.

Bricker, J. B., et al. (2018), "Improving quit rates of web-delivered interventions for smoking cessation: full-scale randomized trial of WebQuit.org versus Smokefree.gov," Addiction, 113, 914-923. The web-delivered predecessor, roughly 1,300 participants per arm against the National Cancer Institute's site. Its result has not been checked here and is not reported on this page.

Key ideas

Cancer risk is substantially a behavioural problem, so a cessation programme is a psychological intervention rather than only a medical one.

Urges crest and subside. A person who stays with one long enough to watch it pass has learned something that argument cannot teach them.

Acceptance against avoidance is the load-bearing contrast, and it is the thing his largest trial was built to test. The standard guidance tells smokers to stay away from the situations that trigger them. His does the opposite.

Leaves on a stream: put the thought on a leaf and watch it go.

The quit-rate figure in circulation under his name is untraced, and the trial result that can be checked is smaller and differently framed.

Concepts on this site

Surfing the Urge, the technique our notes credit to him, working within the Acceptance and Commitment Therapy tradition rather than as the author of a single paper we have traced

Time Management Is Pain Management, Eyal's premise, which borrows Bricker's acceptance move

The Indistractable Model, where that borrowing sits in the structure

The Ten-Minute Rule, Liminal Moments, Internal Triggers and Motivational Interviewing are associated with him in our notes and have no page on this site yet

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