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Randomized Controlled Trial
. 2013 Dec;15(12):2005-15.
doi: 10.1093/ntr/ntt093. Epub 2013 Jul 24.

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse

Richard A Brown  1 , Kathleen M Palm Reed, Erika Litvin Bloom, Haruka Minami, David R Strong, Carl W Lejuez, Christopher W Kahler, Michael J Zvolensky, Elizabeth V Gifford, Steven C Hayes
Affiliations
Randomized Controlled Trial

Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse

Richard A Brown et al. Nicotine Tob Res. 2013 Dec.

Abstract

Introduction: An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST).

Methods: Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; 9 2-hr group and 6 50-min individual sessions) or ST (N = 22; 6 90-min group and 1 20-min individual session), plus 8 weeks of transdermal nicotine patch.

Results: At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium- to large-effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small- to medium-effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses.

Conclusions: Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.

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Figures

Figure 1.
Figure 1.
CONSORT flow diagram.
Figure 2.
Figure 2.
Abstinence rates (7-day point prevalence) for distress tolerance (DT) and standard treatment (ST) conditions. At week 4 (end of group treatment), the abstinence rate for DT (66.7%) was significantly higher than ST (40.9%), p = .049, d = .71. Verified 7-day point-prevalence abstinence rates at 8, 13, and 26 weeks after quit day did not significantly differ in DT versus ST and were 40.7%, 22.2%, and 14.8%, and 31.8%, 27.3%, and 9.1%, respectively.
Figure 3.
Figure 3.
Weekly negative mood scores for distress tolerance and standard treatment (ST) conditions. POMS = Profile of Mood States. Negative mood was not assessed at week 3 for the ST condition and therefore not included in this figure.
Figure 4.
Figure 4.
Weekly affect withdrawal and craving scores for distress tolerance and standard treatment (ST) conditions. Withdrawal symptoms, including affect and craving, were not assessed at week 3 for the ST condition and therefore not included in this figure.
See this image and copyright information in PMC

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