Distress Intolerance and Smoking Topography in the Context of a Biological Challenge

An examination of the effects of distress intolerance and rating of perceived exertion on changes in mood and anxiety following aerobic exercise among treatment-seeking smokers

Aerobic exercise is frequently used as an intervention for depression and smoking cessation because of its antidepressant and anxiolytic effects. Distress intolerance (DI) is a proposed individual difference factor that, coupled with a higher rating of perceived exertion during exercise, may significantly impact the acute mood and anxiolytic effects of exercise. The current study examined the interactive effect of maximum rating of perceived exertion (RPE) and DI on change in mood and anxiety. Treatment-seeking smokers (Mage = 45.32; 72% female) with elevated depressive symptoms completed a 1-mile treadmill walk at their preferred intensity and self-reported their RPE during the test. Analyses were conducted to examine whether there was an interactive effect of maximum RPE and DI on change in self-reported mood and anxiety from before to after the walk test. Findings indicate a significant moderating effect of RPE at lower ratings. Individuals reporting a low maximum RPE and higher DI exhibit a greater change in mood over the course of an exercise session, whereas individuals reporting a low maximum RPE and a lower DI exhibit smaller changes in mood. These results indicate that the subjective effects of exercise within a population of cigarette smokers could be improved by tailoring exercise intensity to individual characteristics. Mild to moderate-intensity exercise, as compared to high-intensity exercise, may result in greater changes in mood for individuals endorsing difficulty tolerating affective and physical distress.

Comparison of Measurement Methods for Electronic Cigarette Puff Topography

Objectives

Measurement of electronic cigarette (ECIG) puff topography provides an understanding of how product characteristics and user behavior affect nicotine delivery. However, mouthpiece-based topography devices may affect natural puffing behavior. This study was designed to compare ECIG topography measured by mouthpiece-based eTop computerized device and mouthpiece-free video recordings.

Methods

ECiG-naïve cigarette smokers (N = 18) and ECIG-experienced users (N = 25) puffed on a standardized ECIG via eTop or conventionally; both sessions were videotaped. Following overnight abstinence, participants experienced one directed (10 puffs, 30 sec IPI) and 2 ad libitum puffing bouts. Heart rate and subjective response were measured throughout sessions.

Results

No statistically significant differences between methods were observed for topography, heart rate, or abstinence-related subjective effects, and both methods were accurate and reliable. Use of a mouthpiece was perceived to alter aspects of ECIG puffing (eg, "reduce enjoyment).

Conclusions

The mouthpiece-based eTop measures ECIG topography precisely as when no mouthpiece is used, and interferes minimally with subjective ECIG experience. Reliable and valid ECIG topography measurement methods are an important regulatory tool, as they can be used to understand the interplay between product design and user behavior to predict toxicant exposure.

Momentary precipitants connecting stress and smoking lapse during a quit attempt

OBJECTIVE

Most attempts at smoking cessation are unsuccessful, and stress is frequently characterized both as a momentary precipitant of smoking lapse and a predictor of subsequent changes in other key precipitants of lapse. The current study examined longitudinal associations among stress, multiple precipitants of lapse, and lapse among smokers attempting to quit.

METHOD

Ecological momentary assessments (EMAs) were gathered from a multiethnic, gender-balanced sample of 370 adults enrolled in a smoking cessation program. EMAs (N = 32,563) assessed smoking lapse and precipitants of lapse, including stress, negative affect, smoking urge, abstinence self-efficacy, motivation to quit, difficulty concentrating, coping outcome expectancies, and smoking outcome expectancies. A multilevel structural equation model simultaneously estimated within-subject paths from stress to multiple precipitants and subsequent smoking lapse. Indirect effects of stress to smoking lapse through precipitants were computed.

RESULTS

Results indicated that increased stress was significantly associated with all precipitants of lapse, consistent with a greater risk for lapse (i.e., increased negative affect, smoking urge, difficulty concentrating, and smoking outcome expectancies and reduced abstinence self-efficacy, motivation to quit, and coping outcome expectancies). All precipitants were significantly associated with subsequent lapse. Indirect effects indicated that stress was uniquely connected to lapse through negative affect, smoking urge, abstinence self-efficacy, coping outcome expectancies, and smoking outcome expectancies.

CONCLUSIONS

Results of this study highlight the broad importance of stress for smoking lapse during a quit attempt. Smoking cessation programs should pay close attention to the role of stress in exacerbating key precipitants of lapse to improve cessation success rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Negative urgency and ad-libitum smoking topography

BACKGROUND

Negative urgency (NU), the tendency to act rashly in response to distress, is associated with negative reinforcement smoking expectancies. The study examined whether NU was associated with behavioral smoking reinforcement in the context of self-reported distress.

METHOD

Non-treatment seeking daily smokers (n = 124) completed an ad-libitum smoking trial. Puff topography, including puff volume, duration, velocity, and inter-puff interval, was averaged across the cigarette and evaluated at the puff level.

RESULTS

Multilevel models revealed a significant interaction of NU and distress as reported on the Subjective Units of Distress scale over the course of smoking in relation to puff duration and inter-puff interval. There was a significant effect of quadratic time x NU x distress on duration (b=-0.00004, p = 0.04). Smokers lower in NU reporting lower baseline distress evidenced a puff duration that decreased at a faster rate over the course of a cigarette following a quadratic function. Persistently elevated puff durations over the course of a cigarette were observed among smokers with elevated NU, regardless of basal distress. There was also a linear time x NU x distress interaction on inter-puff interval (b=-0.01, p = 0.04). Lower NU smokers, regardless of acute distress, exhibited increasing inter-puff intervals that stabilized over the course of a cigarette. Smokers with elevated NU in the context of low distress also demonstrated linearly increasing inter-puff intervals, while they demonstrated increasing intervals followed by decreasing intervals in the context of higher distress.

DISCUSSION

Trait NU in the context of acute distress may contribute to differences in puff topography.

Theoretical implications and clinical support for heart rate variability biofeedback for substance use disorders

Heart rate variability (HRV) biofeedback is an accessible, cost-effective intervention that has demonstrated clinical value for numerous physical and mental health conditions; however, research on HRV biofeedback in substance use disorders (SUD) is in its nascence. We argue that HRV biofeedback may be particularly beneficial as an adjunct treatment for SUD by targeting bodily systems that are known to be disrupted by chronic substance use and are not historically the focus of psychosocial or pharmacological SUD treatment approaches. In addition to advocating for HRV biofeedback applications in SUD, we identify several gaps within the existing experimental literature, and propose new studies that could accelerate understanding of how and for whom HRV biofeedback is most likely to promote positive behavior change.