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Kwan YK, Lau Y, Ang WW, Lau ST. Immediate, Short-term, Medium-term, and Long-term effects of Acceptance and Commitment Therapy for Smoking Cessation: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2024; 26:12-22. [PMID: 37578846 DOI: 10.1093/ntr/ntad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Acceptance and commitment therapy (ACT) is increasingly being studied as a treatment for smoking cessation. However, its immediate, short-, and long-term effects have rarely been reviewed. METHODS This systematic review aimed to evaluate the effectiveness of immediate, short-, medium-, and long-term smoking cessation rates in ACT and comparators at less than 3-month, 3 to 4-month, 6-, and 12-month follow-ups. Randomized controlled trials (RCTs) were searched in eight databases until April 20, 2023. We assessed the quality of RCTs and the certainty of evidence of outcomes. RESULTS Nineteen RCTs involving 7885 smokers across six countries were included. The majority (72.81%) of RCTs were graded as low risk across six domains. For complete-case outcomes, meta-analyses were conducted, and the results revealed a significant effect in favor of ACT [risk ratio: 1.70-1.80 at <3-month, 3 to 4-month, and 6 months follow-up] compared with comparators. For outcomes using missing data management, meta-analyses found an overall effect in favor of ACT, but a significant effect was found at 3 to 4-months only. However, 12-month follow-ups revealed no significant reduction in smoking cessation for both outcomes. Moderate and substantial heterogeneities were found among four meta-analyses that may lead to inaccurate estimates of effects. The certainty of evidence of all outcomes was rated as low and very low. CONCLUSION ACT may be an effective intervention for smoking cessation with immediate, short-term, and medium-term effects. Caution must be applied in the interpretation of the results due to the limited trials and low certainty of evidence. IMPLICATION ACT can be implemented adjuvant to the usual treatment for smoking cessation. Additional RCTs with follow-up data using biochemically verified measures in non-US countries are warranted.
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Affiliation(s)
- Yu Kai Kwan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Lau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Wen Wei Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Reilly ED, Wolkowicz NR, Heapy A, Ross MacLean R, Duarte BA, Chamberlin ES, Harris JI, Shirk SD, Kelly MM. Chronic pain and problematic substance use for veterans during COVID-19: the moderating role of psychological flexibility. Front Psychol 2023; 14:1173641. [PMID: 37205082 PMCID: PMC10185850 DOI: 10.3389/fpsyg.2023.1173641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Background Chronic pain and problematic substance use are commonly co-occurring and highly detrimental issues that are especially prevalent in U.S. veteran populations. Although COVID-19 made clinical management of these conditions potentially difficult, some research suggests that certain veterans with these conditions did not experience this period as negatively as others. It is thus important to consider whether resilience factors, such as the increasingly-studied process of psychological flexibility, might have led to better outcomes for veterans managing pain and problematic substance use during this time of global crisis. Methods This planned sub-analysis of a larger cross-sectional, anonymous, and nationally-distributed survey (N = 409) was collected during the first year of the COVID-19 pandemic. Veteran participants completed a short screener and battery of online surveys assessing pain severity and interference, substance use, psychological flexibility, mental health functioning, and pandemic-related quality of life. Results For veterans with chronic pain and problematic substance use, the pandemic resulted in a significant lowering of their quality of life related to meeting basic needs, emotional health, and physical health compared to veterans with problematic substance use but no chronic pain diagnosis. However, moderation analyses revealed that veterans with these comorbid conditions experienced less negative impacts from the pandemic on quality of life and mental health when they reported greater psychological flexibility. For veterans with problematic substance use only, psychological flexibility was also related to better mental health functioning, but did not significantly correlate with their quality of life. Conclusion Results highlight how COVID-19 differentially impacted veterans with both problematic substance use and chronic pain, such that this group reported particularly negative impacts of the pandemic on multiple areas of quality of life. However, our findings further emphasize that psychological flexibility, a modifiable resiliency process, also buffered against some of the negative impacts of the pandemic on mental health and quality of life. Given this, future research into the impact of natural crises and healthcare management should investigate how psychological flexibility can be targeted to help increase resiliency for veterans with chronic pain and problematic substance use.
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Affiliation(s)
- Erin D. Reilly
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Erin D. Reilly,
| | - Noah R. Wolkowicz
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Alicia Heapy
- Yale School of Medicine, New Haven, CT, United States
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven, CT, United States
| | - R. Ross MacLean
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | | | - Elizabeth S. Chamberlin
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
| | - J. Irene Harris
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - Steven D. Shirk
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Megan M. Kelly
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
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Kelly MM, DeBeer BB, Chamberlin E, Claudio T, Duarte B, Harris JI, Kennedy MA, Shirk S, Reilly ED. The effects of loneliness and psychological flexibility on veterans' substance use and physical and mental health functioning during the COVID-19 pandemic. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 26:217-226. [PMID: 36267166 PMCID: PMC9556878 DOI: 10.1016/j.jcbs.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022]
Abstract
During the COVID-19 pandemic, social isolation was a common experience as people were trying to keep themselves and others safe from infection. Veterans with problematic substance use are at particular risk of the consequences of social isolation. This study evaluated the nature of social interactions during the COVID-19 pandemic and the effects of loneliness and psychological flexibility on self-reported substance use and physical and mental health functioning among U.S. veterans who reported problematic substance use. Data from 409 veterans with self-reported substance use concerns were obtained via a cross-sectional online survey. Results showed that many veterans who engaged in problematic substance use during the COVID-19 pandemic reported a number of social supports during this period and frequent communication with others, but still felt lonelier during the pandemic. In regression analyses, higher levels of loneliness were associated with more negative impacts of the pandemic, greater substance use, and poorer physical and mental health functioning. Psychological flexibility demonstrated significant unique variance in explaining mental health functioning during the pandemic after accounting for loneliness, but not for substance use or physical functioning. For veterans with high levels of loneliness, high levels of psychological flexibility were associated with a lower negative impact on quality of life due to the pandemic, but for veterans with low levels of loneliness, differing levels of psychological flexibility were not significantly associated with the negative impact of COVID-19. Overall, loneliness and psychological flexibility appear to be highly associated with the negative impact of COVID-19 on veterans with problematic substance use.
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Affiliation(s)
- Megan M Kelly
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bryann B DeBeer
- Department of Veterans Affairs, Rocky Mountain Mental Illness, Research, Education, and Clinical Center, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Tracy Claudio
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Brooke Duarte
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Suffolk University, Boston, MA, USA
| | - J Irene Harris
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Meaghan A Kennedy
- VA Bedford Healthcare System, Bedford, MA, USA
- New England Geriatric Research, Education, and Clinical Center, Bedford, MA, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Steven Shirk
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Erin D Reilly
- Veterans Integrated Service Network 1 Mental Illness Research, Education, and Clinical Center (VISN 1 MIRECC), Bedford, MA, USA
- VA Bedford Healthcare System, Bedford, MA, USA
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Barré T, Ramier C, Mounir I, Renaud D, Menvielle L, Marcellin F, Carrieri P, Protopopescu C, Cherikh F. Examining the Relationships between Mindfulness and Tobacco Craving Factors. Subst Use Misuse 2021; 57:656-659. [PMID: 34958288 DOI: 10.1080/10826084.2021.2019782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Relationships between mindfulness and general craving have been documented. However, there is still no data regarding relationships between mindfulness and the different craving factors. METHODS Using data from an online survey among hospital workers smoking tobacco in France (n = 127), we performed linear regression models with the four craving factors as outcomes, and dispositional mindfulness as explanatory variable. RESULTS After adjusting for nicotine dependence, mindfulness was negatively associated with general craving and three out of four craving factors (emotionality, compulsivity and purposefulness, but not expectancy). CONCLUSIONS These results support the implementation of mindfulness-based interventions in the context of tobacco cessation attempt.
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Affiliation(s)
- Tangui Barré
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Clémence Ramier
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Izza Mounir
- Addictology Unit, University Hospital of Nice, Nice, France
| | - David Renaud
- Centre Mémoire de Ressources et de Recherche, Institut Claude Pompidou, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Fabienne Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Patrizia Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Camelia Protopopescu
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
| | - Faredj Cherikh
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix-Marseille University, Inserm, IRD, SESSTIM, ISSPAM, Marseille, France
- Addictology Unit, University Hospital of Nice, Nice, France
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