A randomized controlled trial of distress tolerance treatment for smoking cessation.

Abstract

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

Multi-method assessment of distress tolerance and smoking-related factors among adult daily smokers.

“…Framing this intervention as a means of not only reducing nicotine dependence, but building distress tolerance ability, represents a potentially novel approach. Further, practice quit attempts are often an element of multi-component, DI-focused interventions for smoking cessation (e.g., Brown et al, 2018; Farris et al, 2016) and preliminary evidence shows that periods of brief withdrawal exposure prior to a quit attempt can promote smoking abstinence, increase latency to lapse, and prevent progression from first lapse to relapse (Hendricks et al, 2016; McCarthy, Bold, Minami, & Yeh, 2016). Examining the independent contribution of practice quit attempts to both increases in behavioral DT and downstream smoking cessation outcomes is an important direction for future research.…”

Anxiety Sensitivity and Distress Tolerance in Smokers: Relations With Tobacco Dependence, Withdrawal, and Quitting Success†

“…Research should also continue to explore whether interventions designed to improve DT 51,52 can improve quit rates (although cf. 23 where DT vs. standard treatment did not improve quit rates). "Just-in-time" adaptive interventions delivered via mobile phones might help smokers with low DT to cope without lapsing by reminding them of ways to tolerate distress in the moment they need the help.…”

“…17 The ability to draw conclusions about the relations between DT and cessation success is limited in some studies because some of the studies predicting smoking outcomes have used small samples 18 and have been cross-sectional or retrospective rather than prospective. 22 Conversely, a recent randomized controlled trial 23 found that DT treatment in unselected smokers did not improve cessation rates relative to standard treatment, suggesting that perhaps DT is not causally related to cessation (or that the intervention did not increase DT enough to affect outcomes in a general population of smokers).…”

Distress tolerance and cannabis craving: The impact of laboratory-induced distress.

“…Second, as some evidence suggests that cannabis use may actually decrease distress tolerance and tolerance of pain administration (Amerongen et al, 2018;Naef et al, 2003), providing psychoeducation about the acute effects of cannabis on distress tolerance may be helpful for those who use cannabis to cope with negative affective or physical states may be beneficial. Third, given that distress tolerance can increase during treatment (Bornovalova, Gratz, Daughters, Hunt, & Lejuez, 2012;Brown et al, 2008;Brown et al, 2013;Cougle et al, 2011), clinicians may consider teaching patients with CUD skills to increase distress tolerance to improve cannabis-related outcomes.…”