Inside the black box

The smoking cessation program "Happy Ending" has previously been evaluated in two randomized clinical trials with good results. Randomized clinical trials are first and foremost a research design to study effects which means that these studies are very limited in their description of the content of interventions and treatments. The team behind Happy Ending wanted to do something about this and share their knowledge by taking a look inside the black box. The article is now published in the Journal of Smoking Cessation.

The purpose of the article is to explain the intervention and describe how it is developed and designed. For this purpose, we used the "Intervention Mapping'' method (IM; Bartholomew, Parcel, Kok & Gottlieb, 2006). IM is used as a systematic tool to describe and develop interventions. 

The intervention is fully automated and delivered using the Internet and mobile phone. It is based on self-regulation theory, social-cognitive theory, cognitive-behavioral therapy, motivational interviewing and relapse prevention.


The order of the content is based on a reasoned chronology, modeled according to the psychological processes that people experience at certain times in a process of therapy-supported self-regulation. 

The design of the intervention is innovative in that it combines four media channels (SMS, IVR, e-mail and web) and combines ''just-in-time'' therapy and tunneling on the basis of the natural chronology of smoking cessation. The two forms of ''just-in-time'' therapy is a craving helpline (mainly aimed at negative affect) and relapse prevention based on daily assessment of smoking behavior. 

The article meets the latest demands for a more detailed description of interventions, and may inform systematic reviews and development of effective future interventions and treatments.



Bartholomew, L. K., Parcel, G. S., Kok, G. & Gottlieb, N. H. (2006). Planning health promotion programs: Intervention mapping (2nd ed.). San Fransisco, CA: Jossey-Bass.


Brendryen, H., Kraft, P. & Schalmaa, H. (2010). Looking inside the black box: Using intervention mapping to describe the development of the automated smoking cessation program 'Happy Ending'. Journal of Smoking Cessation, 5, 29-56.