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. 2020 Jan;12(1):92-100.
doi: 10.1037/tra0000473. Epub 2019 May 23.

The association between cognitive coping strategies and treatment outcomes in smokers with PTSD

Anu Asnaani  1 , Antonia N Kaczkurkin  1 , Hayley E Fitzgerald  1 , Alissa Jerud  1 , Edna B Foa  1
Affiliations

The association between cognitive coping strategies and treatment outcomes in smokers with PTSD

Anu Asnaani et al. Psychol Trauma. 2020 Jan.

Abstract

Objective: Numerous researchers have suggested that certain coping styles (e.g., maladaptive cognitive coping strategies) interfere with recovery from traumatic experiences and contribute to the onset/maintenance of posttraumatic stress disorder (PTSD). Further, given that individuals with PTSD have a high rate of smoking (e.g., Mahaffey et al., 2016) and that maladaptive coping strategies in general are associated with lower smoking quit rates, it is possible that use of maladaptive cognitive coping strategies are particularly problematic for the recovery of smokers with PTSD. The present study examined whether specific cognitive coping strategies are associated with poorer outcome among smokers with PTSD following an integrated treatment for both disorders.

Method: Patients with chronic PTSD and nicotine dependence (N = 142) received up to 12 sessions of smoking cessation counseling combined with varenicline or integrated prolonged exposure therapy and cessation counseling combined with varenicline. We hypothesized that greater maladaptive, and lower adaptive, cognitive coping strategies at baseline would moderate degree of improvement in smoking and PTSD outcomes through to follow-up.

Results: Multilevel modeling revealed that neither maladaptive nor adaptive cognitive coping strategies moderated smoking abstinence outcomes over the course of the study (ps ≥ .271). However, greater use of catastrophizing and lower use of positive reappraisal at baseline were associated with less improvement in the hyperarousal PTSD symptom cluster over the course of the study (ps ≤ .01).

Conclusions: These findings suggest that maladaptive cognitive coping strategies are not necessarily a contraindication for overall outcomes in integrated PTSD and smoking treatment, although they may influence improvement in hyperarousal symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

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Figures

Figure 1.
Figure 1.
Reduction in CERQ subscales over the course of treatment. CERQ Self-blame (1a), Rumination (1b), and Catastrophizing (1c) significantly decreased from baseline to post-treatment, which remained stable at follow-up. CERQ Other-blame (1d) significantly decreased in linear fashion from baseline through follow-up. CERQ = Cognitive Emotion Regulation Questionnaire; tx = treatment.
Figure 2.
Figure 2.
Moderation of PSS-I hyperarousal symptoms. Catastrophizing (2a) moderates PSS-I hyperarousal symptoms, such that higher levels of CERQ Catastrophizing were associated with less improvement in PTSD hyperarousal symptoms, as measured by the PSS-I, compared to lower levels of Catastrophizing. Positive Reappraisal (2b) also moderates PSS-I hyperarousal symptoms, such that lower levels of CERQ Positive Reappraisal were associated with less improvement in PTSD hyperarousal symptoms, as measured by the PSS-I, compared to higher levels of Positive Reappraisal. PSS-I = PTSD Symptom Scale Interview; CERQ = Cognitive Emotion Regulation Questionnaire; tx = treatment.
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