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Zvolensky MJ, Bakhshaie J, Garey L, Kauffman BY, Heggeness LF, Schmidt NB. Cumulative vulnerabilities and smoking abstinence: A test from a randomized clinical trial. Behav Res Ther 2023; 162:104272. [PMID: 36746057 DOI: 10.1016/j.brat.2023.104272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Smoking cessation is often associated with socioeconomic and intrapersonal vulnerabilities such as psychopathology. Yet, most research that focuses on predicting smoking cessation outcomes tends focus on a small number of possible vulnerabilities. In a secondary data analysis, we developed and empirically evaluated a comprehensive, cumulative vulnerability risk composite reflecting psychologically based transdiagnostic processes, social determinants of health, and psychopathology. Participants were adult smokers who responded to study advertisements (e.g., flyers, newspaper ads, radio announcements) for an in-person delivered 4-session smoking cessation trial (N = 267; 47% female; Mage = 39.4, SD = 13.8). Results indicated that the decline in point prevalence abstinence (PPA) from quit week to 6-month post-quit was statistically significant (p < .001). There were statistically significant effects of cumulative risk score on the intercept (p < .001) and slope (p = .01). These findings were evident in unadjusted and adjusted (controlling for sex, treatment condition, and nicotine dependence) models. The present results indicate smokers with greater cumulative vulnerability demonstrated poorer smoking cessation outcomes. There may be clinical advantages to better understanding cumulative vulnerability among treatment-seeking smokers and other smoking populations to enhance the impact of public health efforts to reduce smoking.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Luke F Heggeness
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Barroso-Hurtado M, Suárez-Castro D, Martínez-Vispo C, Becoña E, López-Durán A. Perceived Stress and Smoking Cessation: The Role of Smoking Urges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1257. [PMID: 36674019 PMCID: PMC9859085 DOI: 10.3390/ijerph20021257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Despite the fact that perceived stress is related to abstinence smoking outcomes, no studies have investigated the mediational effect of specific tobacco-related variables on this relationship. This study aimed to explore the indirect effect of perceived stress on abstinence at the end of treatment through smoking urges. The sample comprised 260 treatment-seeking smokers (58.5% female; Mage = 46.00; SD = 11.1) who underwent psychological smoking cessation treatment. The brief version of the Questionnaire of Smoking Urges (QSU) and the Perceived Stress Scale (PSS14) were used. Mediation analyses were conducted in which smoking urges and their dimensions were potential mediators in the relationship between perceived stress and abstinence at the end of treatment. The results showed a non-significant direct effect of perceived stress on abstinence. However, a significant indirect effect was found through smoking urges (QSU-total) and, specifically, through smoking urges associated with the expectation of negative affect relief (QSU-Factor 2). A non-significant indirect effect through smoking urges related to the expectation of tobacco use as a pleasurable experience (QSU-Factor 1) was also found. Analyzing possible mediator variables could contribute to understanding previous conflicting data. These findings point to potential interest in including treatment components targeting perceived stress and smoking urges to improve the effectiveness of smoking cessation treatments.
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Affiliation(s)
- María Barroso-Hurtado
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Businelle MS, Garey L, Gallagher MW, Hébert ET, Vujanovic A, Alexander A, Kezbers K, Matoska C, Robison J, Montgomery A, Zvolensky MJ. An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38905. [PMID: 35635746 PMCID: PMC9153912 DOI: 10.2196/38905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. OBJECTIVE This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. METHODS In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. RESULTS This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. CONCLUSIONS If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38905.
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Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cameron Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
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Smits JAJ, Zvolensky MJ, Otto MW, Piper ME, Baird SO, Kauffman BY, Lee-Furman E, Alavi N, Dutcher CD, Papini S, Rosenfield B, Rosenfield D. Enhancing panic and smoking reduction treatment with D-Cycloserine: A pilot randomized clinical trial. Drug Alcohol Depend 2020; 208:107877. [PMID: 32004998 PMCID: PMC7039743 DOI: 10.1016/j.drugalcdep.2020.107877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States
| | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe St. #200, Madison, WI, 53711, United States
| | - Scarlett O Baird
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States
| | - Eunjung Lee-Furman
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Noura Alavi
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Christina D Dutcher
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | - Santiago Papini
- Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, 75206, United States
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Garey L, Peraza N, Smit T, Mayorga NA, Neighbors C, Raines AM, Schmidt NB, Zvolensky MJ. Sex differences in smoking constructs and abstinence: The explanatory role of smoking outcome expectancies. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:660-669. [PMID: 30211586 PMCID: PMC6137813 DOI: 10.1037/adb0000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Scientific evidence suggests women experience more severe problems when attempting to quit smoking relative to men. Yet, little work has examined potential explanatory variables that maintain sex differences in clinically relevant smoking processes. Smoking outcome expectancies have demonstrated sex differences and associative relations with the smoking processes and behavior, including problems when attempting to quit, smoking-specific experiential avoidance, perceived barriers to quitting, and smoking abstinence. Thus, expectancies about the consequences of smoking may explain sex differences across these variables. Accordingly, the current study examined the explanatory role of smoking-outcome expectancies (e.g., long-term negative consequences, immediate negative consequences, sensory satisfaction, negative affect reduction, and appetite weight control) in models of sex differences across cessation-related problems, smoking-specific experiential avoidance, perceived barriers to quitting, and smoking abstinence. Participants included 450 (48.4% female; Mage = 37.45, SD = 13.50) treatment-seeking adult smokers. Results indicated that sex had an indirect effect on problems when attempting to quit smoking through immediate negative consequences and negative affect reduction expectancies; on smoking-specific experiential avoidance through long-term negative consequences, immediate negative consequences, and negative affect reduction expectancies; on barriers to quitting through negative affect reduction expectancies; and on abstinence through appetite weight control expectancies. The current findings suggest that sex differences in negative affect reduction expectancies and negative consequences expectancies may serve to maintain maladaptive smoking processes, whereas appetite weight control expectancies may promote short-term abstinence. These findings provide initial evidence for the conceptual role of smoking expectancies as potential "linking variables" for sex differences in smoking variables. (PsycINFO Database Record
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Affiliation(s)
- Lorra Garey
- University of Houston, Houston, TX, United Sates
| | | | - Tanya Smit
- University of Houston, Houston, TX, United Sates
| | | | | | | | | | - Michael J. Zvolensky
- University of Houston, Houston, TX, United Sates
- The University of Texas MD Anderson Cancer Center, Houston, TX, United Sates
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Garey L, Taha SA, Kauffman BY, Manning KF, Neighbors C, Schmidt NB, Zvolensky MJ. Treatment non-response: Associations with smoking expectancies among treatment-seeking smokers. Addict Behav 2017; 73:172-177. [PMID: 28528227 DOI: 10.1016/j.addbeh.2017.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
Despite the high rate of smoking cessation treatment non-response, relatively little empirical work has examined predictors of treatment non-response. The present study sought to explore the effect of smoking outcome expectancies on treatment response in a sample of treatment-seeking adult daily smokers (N=182; 53.3% female; Mage=40.67; SD=13.63). Results indicated that expectancies for smoking to reduce negative affect were related to an increased likelihood of treatment non-response (OR=0.73, CI: 0.54, 0.98). These findings remained significant after controlling for sex, presence of Axis I disorder, tobacco-related health problems, tobacco dependence, anxiety sensitivity, and condition assignment as well as other smoking expectancy dimensions. Post hoc analyses revealed that this relation was stronger for smokers in the integrated care condition vs. the standard care condition (Interaction: OR=1.69, CI: 1.05, 2.73). Additionally, expectancies for smoking to enhance positive affect and provide sensory satisfaction were associated with an increased likelihood of treatment response in the standard care condition. The current findings suggest expectancies that smoking will alleviate negative affect may be a risk factor of smoking cessation treatment non-response. Additionally, findings provide evidence that the relation between smoking expectancies and treatment non-response may differ by smoking cessation treatment.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samar A Taha
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Kara F Manning
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Farris SG, Brown LA, Goodwin RD, Zvolensky MJ. Panic attack history and smoking topography. Drug Alcohol Depend 2017; 171:84-90. [PMID: 28033542 PMCID: PMC5263108 DOI: 10.1016/j.drugalcdep.2016.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about panic attacks and puffing topography, a behavioral index of the value of smoking reinforcement. This study examined smoking style during the course of smoking of a single cigarette among adult daily smokers with and without a history of panic attacks. METHOD Participants (n=124, Mage=43.9, SD=9.7; 44.4% female) were non-treatment seeking daily smokers. Lifetime panic attack history was assessed via diagnostic assessment; 28.2% (n=35) of the sample had a panic attack history. Participants smoked one cigarette during an ad libitum smoking trial. Puff volume, duration, and inter-puff interval were measured using the Clinical Research Support System (CReSS) pocket device. RESULTS Regression analyses revealed that panic attack status was not associated with significant differences in average puff volume, duration, or inter-puff interval. Multi-level modeling was used to examine puffing trajectories. Puff-level data revealed that there was a significant quadratic time x panic effect for puff volume and duration. Those with a panic attack history demonstrated relatively sustained levels of both puff volume and duration over time, whereas those without a history of panic attacks demonstrated an increase followed by a decrease in volume and duration over time. These effects were not accounted for by the presence of general psychopathology. DISCUSSION Smokers with a panic attack history demonstrate more persistent efforts to self-regulate the delivery of nicotine, and thus may be at risk for continued smoking and dependence. Tailored treatment may be needed to address unique vulnerabilities among this group.
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Affiliation(s)
- Samantha G. Farris
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906 USA,The Miriam Hospital, Centers for Behavioral and Preventative Medicine, 164 Summit St., Providence, RI 02906 USA,Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 USA,Corresponding author: Samantha G. Farris, Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior; 345 Blackstone Blvd, Butler Hospital, Providence, RI 02906. ; Phone: 401-455-6219; Fax: 401-455-6685
| | - Lily A. Brown
- University of Pennsylvania Perlman School of Medicine, Department of Psychiatry, 3535 Market St., Philadelphia, PA 19103
| | - Renee D. Goodwin
- Queens College, Department of Psychology and The Graduate Center, City University of New York (CUNY), 6530 Kissena Blvd., Queens, NY 11367 USA,Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 W 168th St, New York, NY 10032 USA
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Houston, TX 77204 USA,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler St., Houston, TX 77230 USA
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Treatment attrition: Associations with negative affect smoking motives and barriers to quitting among treatment-seeking smokers. Addict Behav 2016; 63:165-71. [PMID: 27518764 DOI: 10.1016/j.addbeh.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/19/2016] [Accepted: 07/30/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Pre-treatment attrition and perceived barriers for quitting are clinically important processes involved in early phases of quitting smoking. However, less is known about the constructs that may contribute to these processes such as negative affect reduction smoking motives. METHOD The current study sought to evaluate the relation between negative affect reduction smoking motives and pre-treatment attrition and perceived barriers for quitting in a sample of 425 treatment-seeking smokers (48.5% female; Mage=37.69 years; SD=13.61) enrolled in a smoking cessation study examining the efficacy of a transdiagnostic panic-smoking cessation treatment relative to a standard smoking cessation treatment. RESULTS Results indicated that greater negative affect reduction smoking motives was associated with an increased likelihood of treatment initiation (odds ratio=1.49, CI: 1.09, 2.04). Additionally, negative affect reduction smoking motives was associated with greater perceived barriers for cessation among pre-treatment drop-outs and treatment initiators. CONCLUSIONS This initial investigation provides evidence for the possible clinical utility in addressing negative affect reduction smoking motives during early stages of quitting. Additionally, such findings could potentially inform the development of personalized, early stages of quitting interventions for smoking cessation.
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Farris SG, Robinson JD, Zvolensky MJ, Hogan J, Rabius V, Cinciripini PM, Karam-Hage M, Blalock JA. Panic attacks and smoking cessation among cancer patients receiving smoking cessation treatment. Addict Behav 2016; 61:32-9. [PMID: 27235990 PMCID: PMC5912332 DOI: 10.1016/j.addbeh.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Little is known about factors associated with smoking cessation in cancer patients. This study examined the impact of panic attacks on smoking abstinence likelihood among cancer patients receiving tobacco cessation treatment. METHOD The relationship of panic attacks to 7-day point-prevalence abstinence at mid-treatment, end of treatment, and 6-month post-end of treatment were examined among cancer patients (N=2255 patients; 50.1% female; Mage=54.9, SD=11.0) who received counseling and pharmacotherapy for smoking cessation. Panic attack history indexed by two questions from the Patient Health Questionnaire (PHQ). Point-prevalence abstinence was assessed via the Timeline Follow-Back. RESULTS Cancer patients with a history of panic attacks, (n=493, 21.9%) relative to those without, were less likely to be abstinent at mid-treatment (OR=0.79, CI95%=0.64-0.98) and end of treatment (OR=0.72, CI95%=0.58-0.89). After adjusting for significant covariates, panic attack history remained predictive of decreased abstinence likelihood at end of treatment (OR =0.78, CI95%=0.62-0.99). CONCLUSIONS Panic attacks may be related to poorer cessation outcome during smoking treatment among cancer patients, and may be usefully assessed and targeted for intervention.
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Affiliation(s)
- Samantha G Farris
- University of Houston, Department of Psychology, Houston, TX 77024, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02906, United States.
| | - Jason D Robinson
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX 77024, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Julianna Hogan
- Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States.
| | - Vance Rabius
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Paul M Cinciripini
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Maher Karam-Hage
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
| | - Janice A Blalock
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX 77030, United States.
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Garey L, Cheema MK, Otal TK, Schmidt NB, Neighbors C, Zvolensky MJ. The sequential pathway between trauma-related symptom severity and cognitive-based smoking processes through perceived stress and negative affect reduction expectancies among trauma exposed smokers. Am J Addict 2016; 25:565-72. [PMID: 27658236 DOI: 10.1111/ajad.12442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/03/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Smoking rates are markedly higher among trauma-exposed individuals relative to non-trauma-exposed individuals. Extant work suggests that both perceived stress and negative affect reduction smoking expectancies are independent mechanisms that link trauma-related symptoms and smoking. Yet, no work has examined perceived stress and negative affect reduction smoking expectancies as potential explanatory variables for the relation between trauma-related symptom severity and smoking in a sequential pathway model. Methods The present study utilized a sample of treatment-seeking, trauma-exposed smokers (n = 363; 49.0% female) to examine perceived stress and negative affect reduction expectancies for smoking as potential sequential explanatory variables linking trauma-related symptom severity and nicotine dependence, perceived barriers to smoking cessation, and severity of withdrawal-related problems and symptoms during past quit attempts. RESULTS As hypothesized, perceived stress and negative affect reduction expectancies had a significant sequential indirect effect on trauma-related symptom severity and criterion variables. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings further elucidate the complex pathways through which trauma-related symptoms contribute to smoking behavior and cognitions, and highlight the importance of addressing perceived stress and negative affect reduction expectancies in smoking cessation programs among trauma-exposed individuals. (Am J Addict 2016;25:565-572).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Mina K Cheema
- Department of Psychology, University of Houston, Houston, Texas
| | - Tanveer K Otal
- Department of Psychology, University of Houston, Houston, Texas
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas. .,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Pal A, Balhara YPS. A Review of Impact of Tobacco Use on Patients with Co-occurring Psychiatric Disorders. Tob Use Insights 2016; 9:7-12. [PMID: 26997871 PMCID: PMC4788174 DOI: 10.4137/tui.s32201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 12/28/2022] Open
Abstract
Consumption of tobacco has been a worldwide problem over the past few decades due to the highly prevalent tobacco-attributable complications. Tobacco use has also been found to be more prevalent in patients with psychiatric disorders. Therefore, we conducted this review about the impact of tobacco use on co-occurring psychiatric disorders. Various facets of this interaction between tobacco use among those with co-occurring psychiatric disorders have been explored. It has been found that people with psychiatric disorders have a higher chance of currently smoking tobacco and lesser chance of cessation. Tobacco use and mental disorders continue to share a complex relationship that has been further evolving after the change in the pattern of tobacco use and also the advent of newer modalities of treatment. However, at the same time, it is believed that cessation of smoking may lead to improvement in the symptoms of mental illness.
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Affiliation(s)
- Arghya Pal
- Senior Resident, Department of Psychiatry, Medical College and Hospital, Kolkata, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Center (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Farris SG, Zvolensky MJ, Norton PJ, Hogan J, Smith AH, Talkovsky AM, Garey L, Schmidt NB. Smoking-Specific Experiential Avoidance is Indirectly Associated with Trait Worry and Smoking Processes among Treatment-Seeking Smokers. Behav Med 2016; 42:254-63. [PMID: 25398072 PMCID: PMC5025255 DOI: 10.1080/08964289.2014.984650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Limited work has examined worry, or apprehensive anticipation about future negative events, in terms of smoking. One potential explanatory factor is the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (smoking-specific experiential avoidance). Participants (n = 465) were treatment-seeking daily smokers. Cross-sectional (pre-treatment) self-report data were utilized to assess trait worry, smoking-specific experiential avoidance, and four smoking criterion variables: nicotine dependence, motivational aspects of quitting, perceived barriers to smoking cessation, and severity of problematic symptoms reported in past quit attempts. Trait worry was significantly associated with greater levels of nicotine dependence, motivation to quit smoking, perceived barriers for smoking cessation, and more severe problems while quitting in the past; associations occurred indirectly through higher levels of smoking-specific experiential avoidance. Findings provide initial support for the potential role of smoking-specific experiential avoidance in explaining the association between trait worry and a variety of smoking processes.
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Affiliation(s)
- Samantha G. Farris
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204,Corresponding author: Samantha G. Farris, M.A. at the Anxiety and Health Research Laboratory/Substance Use Treatment Clinic, University of Houston, 126 Fred J. Heyne Building, Suite 104, Houston, Texas 77204-5502, United States.
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, Texas 77030
| | - Peter J. Norton
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204
| | - Julianna Hogan
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204
| | - Angela H. Smith
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204
| | - Alexander M. Talkovsky
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204
| | - Lorra Garey
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, Texas 77204
| | - Norman B. Schmidt
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306
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Farris SG, Zvolensky MJ, Otto MW, Leyro TM. The role of distress intolerance for panic and nicotine withdrawal symptoms during a biological challenge. J Psychopharmacol 2015; 29:783-91. [PMID: 25762651 PMCID: PMC6561481 DOI: 10.1177/0269881115575536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems. METHOD Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms. RESULTS The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity. CONCLUSIONS Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.
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Affiliation(s)
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael W Otto
- Department of Psychology, Boston University, Boston, MA, USA
| | - Teresa M Leyro
- Department of Psychology, Rutgers - The State University of New Jersey, New Brunswick, NJ, USA
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Farris SG, Zvolensky MJ, DiBello AM, Schmidt NB. Validation of the Avoidance and Inflexibility Scale (AIS) among treatment-seeking smokers. Psychol Assess 2015; 27:467-477. [PMID: 25642937 PMCID: PMC4684259 DOI: 10.1037/pas0000059] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Avoidance and Inflexibility Scale (AIS; Gifford et al., 2004) was derived as a smoking-specific measure of experiential avoidance. However, there has been little investigation of the psychometric proprieties of the AIS and no published work on the topic. The current study aimed to test the reliability and validity of the AIS among a sample of adult treatment-seeking daily smokers (n = 465; 48.2% female, 17.8 [SD = 9.60] cigarettes per day). The AIS was administered at 3 time points (baseline, quit-day, and 1 month postquit) as part of a larger smoking cessation trial. An exploratory factor analysis indicated a 2-factor solution, described by inflexibility and avoidance because of smoking related "thoughts/feelings" (9 items) and "somatic sensations" (4 items). Results revealed that the AIS-total and factor scores demonstrated high internal consistency and test-retest reliability. The AIS total and factor scores also displayed high convergent, discriminant, and incremental predictive validity with theoretically relevant smoking and affective variables. The present data suggest that the AIS measure appears to be a valid and reliable smoking-specific index of experiential avoidance.
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Farris SG, Zvolensky MJ, Schmidt NB. Smoking-specific experiential avoidance cognition: explanatory relevance to pre- and post-cessation nicotine withdrawal, craving, and negative affect. Addict Behav 2015; 44:58-64. [PMID: 25146128 PMCID: PMC4320024 DOI: 10.1016/j.addbeh.2014.07.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/17/2014] [Accepted: 07/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Negative-reinforcement based cognitive processes have been implicated in the maintenance of cigarette smoking. Given the expectation that smoking will attenuate aversive internal experiences, smokers may be particularly unwilling to experience or remain in contact with smoking-related distress (i.e., experiential avoidance). Yet, there is little known about a cognitive-based process termed smoking-specific experiential avoidance with regard to withdrawal, craving, or negative affect during a quit attempt. METHOD Data were collected from adult daily smokers (n = 259) participating in a larger smoking cessation trial. Pre- and post-quit experiences of nicotine withdrawal, craving, and negative affect were examined in terms of cognitive-based smoking-specific experimental avoidance, measured by the Avoidance and Inflexibility Scale (AIS). RESULTS Results indicated that baseline smoking-specific experiential avoidance was associated with greater overall levels of withdrawal, craving, and negative affect at treatment initiation (pre-cessation). Reductions in smoking-specific experiential avoidance from baseline to quit day were associated with increased likelihood of quit day abstinence. Such reductions were also predictive of lower levels of nicotine withdrawal, craving, and negative affect on quit day. Also, less reduction in experiential avoidance was associated with experiencing greater withdrawal in the early phase of quitting. DISCUSSION The impact of cognitive-based experiential avoidance pertaining to smoking impacts both pre- and post-cessation experiences in terms of negative affect, withdrawal, and smoking cravings and may represent an important treatment target.
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Affiliation(s)
- Samantha G Farris
- University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77024, United States
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77024, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, United States.
| | - Norman B Schmidt
- Florida State University, Department of Psychology, 1107 W Call St., Tallahassee, FL 32304, United States
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