Emotion dysregulation explains relations between sleep disturbance and smoking quit-related cognition and behavior

Abstract

Poor sleep quality and tobacco use are common and co-occurring problems, although the mechanisms underlying the relations between sleep disturbance and smoking are poorly understood. Sleep disturbance lowers odds of smoking cessation success and increases odds of relapse. One reason may be that sleep loss leads to emotion dysregulation, which in turn, leads to reductions in self-efficacy and quit-related problems. To address this gap, the current study examined the explanatory role of emotion dysregulation in the association between sleep disturbance and smoking in terms of (1) self-efficacy for remaining abstinent in relapse situations, (2) the presence of a prior quit attempt greater than 24 hours, and (3) the experience of quit-related problems among 128 adults (Mage=40.2; SD=11.0; 52.3% female) seeking treatment for smoking cessation. Results suggested that increased levels of sleep disturbance are related to emotion dysregulation which, in turn, may lead to lower levels of self-efficacy for remaining abstinent, more quit-related problems, and being less likely to have had a quit attempt of 24 hours or greater. Further, these indirect effects were present above and beyond variance accounted for by theoretically-relevant covariates (e.g., gender and educational attainment), suggesting that they may maintain practical significance. These findings suggest that this malleable emotional risk factor (emotion dysregulation) could serve as a target for intervention among those with poor sleep and tobacco use.

Emotion dysregulation explains the relation between insomnia symptoms and negative reinforcement smoking cognitions among daily smokers

“…Notably, the observed indirect effects were evident after adjusting for the influence of factors known to correlate with the severity of smoking behavior and insomnia, including participant sex, number of cigarettes smoked per day, and psychopathology. The current findings also are in line with past work that found emotion dysregulation mediated the association between insomnia and self-efficacy for remaining abstinent in relapse situations, prior quit-related problems, and presence of a prior quit attempt >24 h among treatment-seeking smokers (Fillo et al, 2016). Yet, in contrast to prediction, insomnia was not associated with somatic symptom expectancies from brief smoking abstinence through the indirect effect of emotion dysregulation.…”

“…Indeed, emotion dysregulation is associated with early smoking lapse (Farris, Zvolensky, & Schmidt, 2016) among treatment-seeking smokers and is a mechanism that links negative emotional states to problematic substance use (e.g., symptoms of dependence; Paulus, Bakhshaie, et al, 2016; Paulus, Jardin, et al, 2016). To our knowledge, there has been only one test of an emotion dysregulation model for insomnia and smoking (Fillo et al, 2016). In this study, emotion dysregulation explained the association between sleep disturbances and less self-efficacy for remaining abstinent in relapse situations, more quit-related problems during past quit attempts, and less quit attempts >24 h among treatment-seeking smokers (Fillo et al, 2016).…”

“…To our knowledge, there has been only one test of an emotion dysregulation model for insomnia and smoking (Fillo et al, 2016). In this study, emotion dysregulation explained the association between sleep disturbances and less self-efficacy for remaining abstinent in relapse situations, more quit-related problems during past quit attempts, and less quit attempts >24 h among treatment-seeking smokers (Fillo et al, 2016). …”

“…Based upon theoretical models of emotion dysregulation and substance use (Leventhal & Zvolensky, 2015) and the findings of Fillo et al (2016), there is a need to broaden our understanding of emotion dysregulation in the context of insomnia and smoking in at least three key ways. First, a central tenet of an emotion dysregulation perspective of insomnia and smoking rests on negative reinforcement processes; specifically, insomnia symptoms may interfere with smokers' capacity to regulate emotional states.…”

“…Finally, since the Fillo et al (2016) study included a sample of treatment-seeking smokers, there is need to test insomnia-emotion dysregulation relations among non-treatment seeking daily smokers in order to understand the generalizability of these findings. For example, treatment-seeking smokers tend to be a more severe population and may therefore be more apt to represent a biased sample when considered in the larger context of the smoking population (i.e., Berkson bias; Berkson, 1946; Rothman, Greenland, & Lash, 2008).…”