The moderating role of experiential avoidance in the relationships between internal distress and smoking behavior during a quit attempt.

Abstract

Recent smoking cessation studies have shown that decreasing experiential avoidance (EA) (i.e., tendency to reduce or avoid internal distress) improves success, but to date none have examined the moderating effect of EA on the role of specific internal distress in smoking cessation. This study examined whether pre-quit general EA (Acceptance & Action Questionnaire) and smoking-specific EA (Avoidance and Inflexibility Scale) moderated the relations between four measures of post-quit internal distress (depressive symptoms, negative affect, physical withdrawal symptoms, craving), and smoking. Participates: 40 adult smokers who participated in a randomized controlled trial of Distress Tolerance treatment for smokers with a history of early lapse. Results: Multilevel models showed that pre-quit smoking-specific EA, but not general EA, significantly moderated the relationship between all measures of internal distress, except craving, and smoking over 13 weeks post-quit. When examined over 26 weeks, these relations remained unchanged for all, but the moderating effect became trend-level for depressive symptoms. Significant associations between post-quit internal distress and smoking were found only in those with high pre-quit smoking-specific EA. Moreover, pre-quit smoking-specific EA did not predict post-quit levels or changes in internal distress, suggesting that decreasing smoking-specific EA pre-quit may not reduce internal distress, but may instead reduce smoking risk in response to such distress during a quit attempt. Conclusions: Results mainly supported hypothesized relations, but only for smoking-specific EA. Smoking cessation interventions focusing on EA reduction may especially benefit those vulnerable to greater post-quit depressive and withdrawal symptoms, and those who smoke to regulate aversive internal states.

Sustained smoking abstinence is associated with reductions in smoking-specific experiential avoidance among treatment-seeking smokers

“…Additionally, these results were observed after accounting for several covarying factors, including participant sex, level of nicotine dependence, presence of emotional disorders, baseline levels of experiential avoidance related to smoking, and study treatment condition. Moreover, while not the central focus of this investigation, consistent with other work (Minami et al, 2014), baseline levels of smoking-specific experiential avoidance were not significantly associated with smoking abstinence status. Thus, pre-quit levels of experiential avoidance do not appear to serve as a risk factor for decreased likelihood of smoking abstinence, although does appear to importantly affect smoking outcomes when considered in the context of internal distress experienced while quitting (interactive effect; Minami et al, 2014).…”

“…Third, it is unknown if the observed effects of abstinence in terms of smoking-specific experiential avoidance would have been observed after shorter or longer periods of abstinence (Minami et al, 2014). Future work may consider exploring more nuanced models of abstinence-timing effects in terms of smoking-specific experiential avoidance.…”

“…Thus, it is unknown whether the course of experiential avoidance (slope) over time would continue to decrease or potentially remain at a lower-stable level as a function of smoking abstinence. Fifth, given divergent findings in terms of how domain-specific versus domain-general experiential avoidance impact the processes of quitting smoking (Minami et al, 2014), it would be important to potentially also consider how the general tendency to experientially avoid is affected by quitting smoking. Last, while pre-cessation (baseline) levels of smoking-specific experiential avoidance were adjusted for in all analyses, it is possible that increases in willingness to experience internal distress related to smoking that occurred prior to the quit attempt could have impacted the cessation likelihood (Farris, Zvolensky, & Schmidt, 2015), and in turn accounted for later reductions in smoking-specific experiential avoidance observed following the cessation attempt.…”

“…Additionally, smoking-specific experiential avoidance is associated with greater negative affect, craving, and nicotine withdrawal at the initiation of smoking cessation treatment (Farris, Zvolensky, & Schmidt, 2015). Further, highly experientially avoidant smokers (relative to low) who also experience higher levels of internal distress while attempting to quit smoking (e.g., negative affect, physical withdrawal symptoms), are at an increased likelihood of smoking lapse following smoking cessation treatment (Minami, Bloom, Reed, Hayes, & Brown, 2014). …”

Relationships Between Social Anxiety and Smoking-Specific Experiential Avoidance

“…Because smoking-specific experiential avoidance is associated with continued smoking and poorer cessation outcomes (J. B. Bricker, Bush, Zbikowski, Mercer, & Heffner, 2014; Gifford et al, 2004; Minami, Bloom, Reed, Hayes, & Brown, 2015; Morissette et al, 2007), further exploring these relationships may provide insight into modifiable mechanisms linking social anxiety to difficulty quitting. Specifically, internal smoking cues can be divided into three categories: physical sensations (e.g., urges, withdrawal symptoms), feelings (e.g., distress, dysphoria), or thoughts (e.g., “I need a cigarette right now”).…”