Ecological momentary analysis of the relations among stressful events, affective reactivity, and smoking among smokers with high versus low depressive symptoms during a quit attempt

The Impact of Coping With Stressful Events on Negative Affect and Cravings Among Smokers With Mood Disorders

INTRODUCTION

Smokers with mental illness report elevated levels of stress and negative affect. Craving is often cited as a key precipitant of smoking. Coping with stress has been associated with reduced cravings among smokers attempting to quit. However, the effect of coping with stress on negative affect and craving among smokers with mental illness is not well understood. This study investigated whether coping with stress predicts lower subsequent craving, mediated by reduced negative affect, among socioeconomically disadvantaged smokers with mood disorders.

AIMS AND METHODS

This study used ecologically momentary assessment (EMA) data from a randomized controlled trial involving smokers with mood disorders. The final sample included 39 participants.

RESULTS

Traditional mediation path analyses showed that coping with stress predicts lower craving (p = .02) through its impact on negative affect (p < .001) for the contemporaneous model (ie, when craving was measured at the same report as coping). However, coping with stress did not have a prospective effect on craving (ie, when craving was measured at the next report, up to 12 hours later) (p = .11).

CONCLUSIONS

The results suggest that coping with stress reduces craving through negative effect, but only for a limited timeframe. The findings could guide future research on the length of time that the effect of coping lasts and research on interventions to increase coping with stress among smokers with mental illness.

IMPLICATIONS

This is the first study to use EMA to demonstrate that coping with stressful events effectively reduces craving through reducing negative affect among smokers with mood disorders. This finding suggests that individuals heavily burdened with stress and negative affect benefit from coping with stress. We utilized within-subject analyses of EMA data which allowed us to understand these effects within an individual near real time. Our sample is hard to reach and ethnoculturally diverse. Findings could guide intervention research on helping smokers with mental illness cope when experiencing stress.

Association of depression symptom level with smoking urges, cigarette withdrawal, and smoking reinstatement: A preliminary laboratory study

BACKGROUND

Cigarette smoking urges, withdrawal, and smoking reinstatement may be especially relevant to people with elevated depression symptoms who smoke. This laboratory study aimed to assess relations between depression symptom level and smoking urges for reward and relief, cigarette withdrawal, and smoking reinstatement in people who smoke cigarettes daily during acute abstinence and while smoking as usual.

METHODS

Participants with low (n = 51) or elevated (n = 29) baseline depression symptoms underwent two counterbalanced laboratory sessions (i.e., abstinent, non-abstinent). At each session, they completed subjective measures of smoking urges for reward and relief, and withdrawal. They also completed a laboratory smoking reinstatement task measuring whether they would delay smoking and the number of cigarettes smoked.

RESULTS

The elevated depression symptom group reported significantly higher withdrawal (p = .01) and smoked more cigarettes than the low depression symptoms group during the smoking reinstatement task self-administration period at the abstinent session (p = .04). Smoking urges for reward and relief were not significantly different by depression symptom group. There were no significant interactions of depression and abstinence with any outcomes.

CONCLUSIONS

As outcomes were measured at both an abstinent and non-abstinent session, findings identify factors for people with elevated depression symptoms who smoke which may drive smoking behavior and impede smoking cessation efforts. This study provides evidence that people with elevated depression symptoms who smoke may need additional/more pharmacological or behavioral smoking cessation aids targeted at reducing withdrawal and number of cigarettes smoked.

Affect and subjective cognitive functioning by depression symptom levels during naturalistic cigarette smoking in premenopausal females who smoke daily

Objective: High negative affect, low positive affect, and low cognitive functioning are depression-related states that may be particularly relevant to females who smoke cigarettes and may be more prominent following overnight tobacco abstinence. This study aimed to assess relations between depression symptom levels and negative affect, positive affect, and subjective cognitive functioning in premenopausal females who smoke. Methods: Premenopausal females who smoke daily with low (n = 66) or elevated (n = 33) baseline depression symptoms completed subjective ratings of negative affect, positive affect, and cognitive functioning pre-first cigarette (i.e., after overnight tobacco abstinence) and at random prompts throughout the day via ecological momentary assessment (EMA) for 35 days. Results: Participants with elevated depression symptoms reported overall higher negative affect (p = .01). Positive affect was significantly lower prior to the first cigarette of the day (p < .001), but did not significantly differ between depression symptom groups. Subjective cognitive functioning was significantly lower pre-first cigarette of the day (p < .001). There was a significant Depression Symptom × Prompt Type interaction for subjective cognitive functioning (p = .01). Subjective cognitive functioning did not significantly differ by depression symptom group pre-first cigarette of the day but was significantly different at random prompts throughout the day. Conclusions: As participants smoked as usual, findings identify naturalistic factors which may influence smoking behavior among premenopausal females who smoke with elevated depression symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Between- versus within-person emotional and cognitive reactivity in relation to depressive symptoms

BACKGROUND

Theories connecting depression to emotional reactivity (ER) or cognitive reactivity (CR) have not clearly indicated whether ER and CR are between-person or within-person constructs. Most empirical tests of these theories have focused on either between- or within-person operationalizations of these constructs, but not both. Between- and within-person studies address qualitatively different questions and often generate very different results. Consequently, the goals of the current study were to examine the relation of depressive symptoms to both between- and within-person operationalizations of both ER and CR.

METHODS

Participants were 160 undergraduate students who completed daily diary measures (assessing stress, negative emotions, and negative cognitions) and measures of depressive symptoms. Multilevel modeling (MLM) enabled examination of depressive symptoms to the within- and between-person components of ER and CR.

RESULTS

Depressive symptoms were positively related to within-person ER and CR but not to between-person operationalizations of ER and CR.

LIMITATIONS

The sample only included college students and only assessed depressive symptoms, not clinical diagnoses of major depression.

CONCLUSIONS

Important implications emerge for theory, practice, and future research. We recommend distinguishing between-person from within-person dimensions of ER and CR in future research.

Application of Automated Text Analysis to Examine Emotions Expressed in Online Support Groups for Quitting Smoking

Online support groups offer social support and an outlet for expressing emotions when dealing with health-related challenges. This study examines whether automated text analysis of emotional expressions using Linguistic Inquiry and Word Count (LIWC) can identify emotions related to abstinence expressed in online support groups for quitting smoking, suggesting promise for offering targeted mood management to members. The emotional expressions in 1 month of posts by members of 36 online support groups were related to abstinence at month end. Using the available LIWC dictionary, posts were scored for overall positive emotions, overall negative emotions, anxiety, anger, sadness, and an upbeat emotional tone. Greater expressions of negative emotions, and specifically anxiety, related to nonabstinence, while a more upbeat emotional tone related to abstinence. The results indicate that automated text analysis can identify emotions expressed in online support groups for quitting smoking and enable targeted delivery of mood management to group members.

Decídetexto: Feasibility and Acceptability of a Mobile Smoking Cessation Intervention in Puerto Rico

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch >75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p < 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.

Anxiety in social interactions and nicotine dependence in nicotine-dependent men: The role of metacognitions about smoking

Anxiety in social interactions is an important factor in cigarette use and nicotine dependence. Metacognitions about smoking have been found to predict smoking behavior and may help understand the relationship between anxiety in social interactions and nicotine dependence. In the current study, we evaluated the direct effect of anxiety in social interactions on nicotine dependence and its indirect effect through metacognitions (controlling for anhedonia and depression) in nicotine-dependent men (n = 388). Participants completed measures of anxiety in social interactions [the Social Interaction Anxiety Scale (SIAS)], anhedonia [the Snaith HamiltonPleasure Scale (SHAPS)], metacognitions about smoking [e.g., theMetacognitions aboutSmoking Questionnaire (MSQ)] nicotine dependence [the Fagerström Test for Nicotine Dependence (FTND)], and clinical factors related to smoking including depressive symptoms [e.g., the Beck Depression Inventory-II (BDI-II)]. As expected, after controlling for depressive symptoms and anhedonia, anxiety in social interactions indirectly affected nicotine dependence through negative metacognitions about smoking, but not positive metacognitions. These findings are discussed in relation to the metacognitive model of addictive behaviors.

Predictors of Neuropsychiatric Adverse Events with Smoking Cessation Medications in the Randomized Controlled EAGLES Trial

BACKGROUND

Pre-treatment factors that increase smokers' risk of experiencing neuropsychiatric adverse events (NPSAEs) when quitting smoking are unknown.

OBJECTIVE

To identify baseline smoker characteristics beyond the history of mental illness that predict which participants were more likely to experience moderate to severe NPSAEs in EAGLES.

DESIGN

A prospective correlational cohort study in the context of a multinational, multicenter, double-blind, randomized trial.

PARTICIPANTS

Smokers without (N = 3984; NPC)/with (N = 4050; PC) histories of, or current clinically stable, psychiatric disorders including mood (N = 2882; 71%), anxiety (N = 782; 19%), and psychotic (N = 386; 10%) disorders.

INTERVENTIONS

Bupropion, 150 mg twice daily, or varenicline, 1 mg twice daily, versus active control (nicotine patch, 21 mg/day with taper) and placebo for 12 weeks with 12-week non-treatment follow-up.

MAIN MEASURES

Primary safety outcome was the incidence of a composite measure of moderate/severe NPSAEs. Associations among baseline demographic/clinical characteristics and the primary safety endpoint were analyzed post hoc via generalized linear regression.

KEY RESULTS

The incidence of moderate to severe NPSAEs was higher among smokers in the PC (238/4050; 5.9%) than in the NPC (84/3984; 2.1%). Three baseline characteristics predicted increased risk for experiencing clinically significant NPSAEs when quitting regardless of carrying a psychiatric diagnosis: current symptoms of anxiety (for every ~ 4-unit increase in HADS anxiety score, the absolute risk of occurrence of the NPSAE endpoint increased by 1% in both PC and NPC); prior history of suicidal ideation and/or behavior (PC, 4.4% increase; P = 0.001; NPC, 4.1% increase; P = 0.02), and being of White race (versus Black: PC, 2.9% ± 0.9 [SE] increase; P = 0.002; and NPC, 3.4% ± 0.8 [SE] increase; P = 0.001). Among smokers with psychiatric disorders, younger age, female sex, history of substance use disorders, and proxy measures of nicotine dependence or psychiatric illness severity also predicted greater risk. There were no significant interactions between these characteristics and treatment. Smokers with unstable psychiatric disorders or with current, active substance abuse were excluded from the study.

CONCLUSIONS

Irrespective of cessation pharmacotherapy use, smokers attempting to quit were more likely to experience moderate to severe NPSAEs if they reported current anxiety or prior suicidal ideation at baseline and were White. In smokers with a psychiatric history, female sex, younger age, and greater severity of nicotine dependence were also predictive.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01456936.

A randomized controlled trial of distress tolerance treatment for smoking cessation

We previously developed a distress tolerance (DT)-based treatment that showed promising results for smokers with a history of early lapse. In the current study, we conducted a randomized controlled trial of this DT treatment for a general population of smokers not limited to those with a history of early lapse. We randomized 116 participants (41% female) to DT or standard treatment (ST). Both treatments included 1 individual session during Week 1 followed by 7 group sessions during Weeks 2-9 (quit date at Session 4), two 20-min phone sessions, and 8 weeks of transdermal nicotine patch. Results indicated no significant differences between conditions in the primary outcome of biochemically verified 7-day point prevalence smoking abstinence or in time to 1st lapse. Verified abstinence rates in DT were 38.7%, 38.7%, 46.77%, 40.32%, 20.9%, and 17.7% versus 40.7%, 37.0%, 53.7%, 44.4%, 33.3%, and 22.2% in ST at 1, 2, 4, 8, 13, and 26 weeks postquit, respectively. Additionally, we found no significant moderators of treatment efficacy and few differences in treatment process variables. These findings stand somewhat in contrast to those in our previous study and other recent studies of similar acceptance-based treatments. However, differences in methodology, inclusion of nicotine replacement therapy in both treatment conditions, and strict inclusion-exclusion criteria that excluded many smokers with affective vulnerabilities may underlie this discrepancy. Future research should evaluate the utility of DT and other acceptance-based treatments in populations with affective vulnerabilities who might specifically benefit from a DT-based approach. (PsycINFO Database Record