Barriers to Building More Effective Treatments: Negative Interactions Amongst Smoking Intervention Components

Abstract

Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions suggesting that better clinical outcomes are obtained when participants receive fewer rather than more intervention components. Further, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions amongst components may account for these patterns. This paper evaluates factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity limited mechanisms, making their effects subadditive; and a tipping point phenomenon in which those near a hypothesized "tipping point" for change will benefit markedly from weak intervention while those far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions amongst components and constrain the development of more effective treatments.

Figure 1

a,b. Unpackaging Two-way Interactions Amongst Nicotine Gum, Behavioral Reduction (BR) counseling, and Motivational Interviewing (MI) on 26-week abstinence in the Motivation Study (Cook et al. 2016).

Figure 2.

Unpackaging an Interaction Amongst Medication Adherence Counseling (MAC), Automated Adherence Calls, and Medication Duration on 52 Week Abstinence In the Maintenance Study (Schlam et al 2016).