Relapse following smoking cessation: A situational analysis.

Data on the antecedents of relapse crises (actual or near lapses in abstinence) were collected from 183 former smokers who called a relapse-counseling hotline. Most relapse crises were associated with anxiety, anger, and depression. One-third of relapse crises were associated with positive feeling states and were frequently precipitated by other smokers, eating, and alcohol consumption. Withdrawal symptoms played a part in only half of the episodes. Ss' coping responses rather than situational antecedents distinguished relapse crises resulting in smoking from those in which abstinence was maintained. A combination of cognitive and behavioral responses was most successful. Behavioral coping was subject to situational influences; Ss who had been drinking alcohol were less likely to engage in behavioral coping, and depression diminished its effectiveness. Cognitive coping responses, which were less affected by these variables, may be critical components of former smokers' coping repertoires. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An Ecological Momentary Assessment of Relapse Crises in Dieting.

Much of the research on relapse crises in dieting has focused on isolated lapse events and relied heavily on retrospective self-report data. The present study sought to overcome these limitations by using ecological momentary assessment (EMA) techniques to examine situations of dietary temptation and lapse with a sample of obese, formerly sedentary, postmenopausal women (N = 37) during the final week of a weight-loss intervention. Mood was associated with reports of dietary lapse. Abstinence-violation effects were more strongly associated with dietary lapses than temptations. Finally, coping responses distinguished dietary temptations from lapses. Education on the factors associated with relapse crises in dieting may be imperative for weight loss success and maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse crises and coping among dieters.

We examined situational antecedents of dieting relapse crises and dieters' attempts to cope with temptations to overeat. We analyzed postreatment interviews with 57 obese Ss with Type II diabetes, comparing situations in which Ss lapsed with those in which they overcame temptation to overeat. Cluster analysis yielded 3 categories of relapse crises: mealtime, low-arousal, and emotional upset situations. The cluster differed in outcome: Upset situations almost always resulted in overeating; situational factors, especially food-related cues, increased relapse risk; but performance of coping was the strongest correlate of outcome. Cognitive and behavioral coping responses were each equally associated with positive outcomes. When Ss reported combining both types of coping, they were less likely to report overeating. The dynamics of relapse crises among dieters resemble those that govern relapse crises in addictive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

First lapses to smoking: Within-subjects analysis of real-time reports.

Studies of smoking relapse and temptation episodes have relied on retrospective recall and confounded between- and within-subject variability. Real-time data on temptations and lapses to smoke were gathered using palm-top computers. We made within-subject comparisons of the initial lapse, a temptation episode, and base rate data obtained through randomly scheduled assessments. Negative affect discriminated all three situations, with lapses worse than temptations, and temptations worse than random situations. Participants attributed lapses to negative mood and smoking cues, whereas temptations were more often attributed to behavioral transitions. Participants were 12 times more likely to report coping in temptations than in lapses. However, only cognitive ( vs. behavioral ) coping strategies were effective. Lapses (vs. the other situations) were more likely to occur when smoking was permitted, when cigarettes were easily available, and in the presence of other smokers. The results have clinical implications, and the computerized monitoring methods may be applicable to an array of clinical research problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using self-efficacy judgments to predict characteristics of lapses to smoking.

According to relapse prevention theory, abstinence self-efficacy judgments (ASE; confidence in ability to abstain from smoking) about particular affective and environmental contexts should predict behavior in those contexts. Low-ASE contexts should present challenges to abstinence. In this study, the authors used profile correlations to quantify the relationship between context-specific ASE ratings and the characteristics of lapse episodes. To assess the distinctiveness of this relationship, they also correlated the situations surrounding temptation and randomly selected (nontemptation) episodes with context-specific ASE. The ASE-first lapse profile correlation was significantly greater than zero and significantly greater than ASE-temptation and ASE-nontemptation correlations. This pattern of results remained when multiple lapse episodes were considered. Thus, low-ASE contexts tend to be associated with lapses to smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Articulated thoughts and endorsement procedures for cognitive assessment in the prediction of smoking relapse.

Hypothesized advantages of the articulated thoughts during simulated situations (ATSS [G. C. Davison et al; see PA, Vol 70:1572]) paradigm for assessment of cognitions were tested in a prospective study of smoking relapse. Cognitions in high-risk situations were assessed shortly after smoking cessation among 100 Ss. Consistent with G. A. Marlatt's (1985) model, Ss who abstained continuously for 3 mo. had shown higher self-efficacy, more use of cognitive coping tactics, and more negative expectations for the effects of smoking. Cognitions did not predict 12-mo abstinence nor recovery from an initial lapse. ATSS appeared effective in priming stress-related cognitions but did not exceed questionnaire measures in predictive validity. Exploratory analysis suggested that the methods could be combined to yield more useful data. The "metatrait" concept is discussed as a framework for research on combining cognitive assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence violation effect: Validation of an attributional construct with smoking cessation.

The abstinence violation effect (AVE) proposed in Marlatt and Gordon's (1980, 1985) model of smoking relapse was operationalized as a combination of internal, stable, and global causal attributions for smoking a cigarette following the attainment of abstinence from smoking. Causal attributions both for maintaining abstinence and for smoking in hypothetical high-risk situations were obtained prior to quitting from participants in a smoking cessation program. After treatment, subjects who relapsed also provided retrospective causal attributions for initial smoking episodes. Results showed that participants who relapsed following a slip reported significantly higher AVEs (more internal, stable, and global causal attributions) than those who regained abstinence following a slip. Furthermore, the AVE emerged as the strongest predictor of subsequent smoking when included in a discriminant analysis along with other factors associated with the initial smoking episode. Prospective pretreatment attributions for smoking and not smoking in hypothetical high-risk situations were not significantly related to attributions for actual smoking episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic Self-Efficacy and Outcome Expectancies: Prediction of Smoking Lapse and Relapse.

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing smoking relapse, using an individually tailored skills-training technique.

The effectiveness of a relapse prevention program was studied in a population of 744 smokers. Subjects first attended an intensive 4-day series of 2-hr meetings in which they were trained to use more than 40 behavioral and cognitive cessation techniques. At the 1-week follow-up session, those abstinent from smoking (79%, carbon monoxide verified) were randomly assigned to one of three follow-up conditions: (a) a three-session skills-training program in which subjects developed and actively rehearsed individually tailored coping strategies for likely relapse situations, (b) a three-session discussion control condition in which subjects discussed maintenance but did not develop or rehearse coping strategies, or (c) a no-treatment control condition. Survival analysis indicated higher abstinence rates for the skills-training group than for the control groups throughout the following year. After 12 months, the biochemically confirmed continuous abstinence rate was higher in the skills-training group (41.3%) than in the discussion and no-treatment groups (34.1% and 33.3%, respectively). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remember that? A comparison of real-time versus retrospective recall of smoking lapses.

Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking relapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resisting temptations to smoke: Results from within-subjects analyses.

Within-subjects analyses were used to examine differences between resisted temptations to smoke (either a specific close call or the most common temptation) and smoking lapses among 130 participants lapsing within 1 month after a self-initiated quit attempt. Participants were more likely to report coping during resisted temptations than during lapses; those who reported coping in both were more likely to report using multiple strategies and combining cognitive and behavioral strategies during the resisted temptation. Participants were more likely to report that the lapse was precipitated by others smoking, but this difference was not significant when the sample was restricted to those reporting a specific close call. No other statistically significant differences were found. Results support previous findings that the use or nonuse of coping strategies during a temptation to smoke is the variable most strongly associated with its outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing milestones in smoking cessation: Illustration in a nicotine patch trial in adult smokers.

Tests of addiction treatments seldom reveal where treatment exercises its effect (i.e., promoting initial abstinence, preventing lapses, and/or impeding progression from lapse to relapse). The authors illustrate analyses distinguishing effects on these milestones in a randomized trial of high-dose nicotine patch (35 mg; n = 188) versus placebo (n = 136) in adult smokers, who used electronic diaries to monitor smoking in real time during 5 weeks of treatment. High-dose patch promoted initial abstinence (hazard ratio [HR] = 1.3) and decreased the risk of lapsing among those who achieved abstinence (HR = 1.6). The biggest effect of treatment was to prevent progression to relapse among those who had lapsed (HR = 7.1). Analysis of effects by milestones may enhance understanding of cessation treatments and their mechanisms of action. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responses to hypothetical high risk situations: Do they predict weight loss in a behavioral treatment program or the context of dietary lapses?

Before starting a behavioral weight control program and after 6 months of treatment, 93 participants were asked to listen to 4 scenarios describing typical high risk situations for dieters (family celebration, watching TV, tension at work, argument). The number of coping responses generated, latency of responses, and perceived risk of lapsing were assessed; participants also identified which situation would be most difficult for them. Telephone interviews were conducted during the weight loss program to assess situations surrounding actual dietary lapses. Participants who rated the negative affect situations as most difficult were more likely to lapse in situations involving negative affect; 87% of these participants lapsed in association with negative affect. Moreover, participants who generated coping responses to more of the situations subsequently lost more weight. Thus, baseline performance on a hypothetical high risk task predicts subsequent performances in a behavioral weight loss program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of coping with high-risk situations for exercise relapse among healthy women.

29 healthy women's coping responses to situations interfering with planned exercise and subsequent patterns of relapse were evaluated. Participants adopted exercise without formal intervention; their activity was monitored prospectively for 14 wks. Cardiovascular fitness was assessed at baseline, 3 mo, and 9 mo. A 1-wk exercise activity lapse was experienced by 66% of participants, and 41% experienced a 3-wk relapse episode. Relapsers initially reported significantly fewer behavioral and cognitive coping strategies in response to high-risk situations compared with nonrelapsers, controlling for baseline level of self-motivation. Coping responses also predicted short-term fitness. These data demonstrate the importance of coping or problem-solving ability in exercise and suggest that relapse may result from ineffective coping with exercise barriers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How does coping help people resist lapses during smoking cessation?

Objectives: To determine whether types of coping strategies have differential effects on preventing lapses and lowering urge levels and to investigate mechanisms by which coping strategies prevent lapses during smoking cessation. Design: Sixty-one respondents performed ecological momentary assessment using palm-top computers and tape recorders to report their coping strategies and urge levels before and after temptations to smoke. Multilevel linear regression models were used to compare the effects of individual strategy types with the average strategy. Main Outcome Measures: Lapses versus resisted temptations and changes in urge levels. Results: Number of strategies significantly predicted resisting smoking and change in urge levels. Compared with the effect of the average strategy, movement/exercise was marginally worse at preventing lapses, and food/drink was marginally related to higher postcoping urge levels. Conclusion: Although using multiple coping strategies helps people resist the urge to smoke, no particular coping strategy works better than any other. Coping strategies prevent lapses by reducing high urge levels during temptations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does smoking abstinence self-efficacy vary across situations? Identifying context-specificity within the Relapse Situation Efficacy Questionnaire.

According to self-efficacy and relapse theories, abstinence self-efficacy (ASE) ratings should be context-specific; they should vary across situations. This variability may be important, as it could signal high-risk for relapse situations. In this study, confirmatory factor analysis was used to identify situational variability in a novel ASE assessment (Relapse Situation Efficacy Questionnaire, or RSEQ). Results supported a hierarchical structure, where both context-specific and unidimensional measures of ASE exist within the assessment. Context-specific factors included Negative Affect, Positive Affect, Restrictive Situations (to smoking), Idle Time, Social–Food Situations, Low Arousal, and Craving. Multiple context-specific factors and the aggregate factor predicted cessation outcome, even after controlling for concurrent smoking rate. However, the context rated with the least confidence proved to be the best outcome predictor, suggesting the existence of "Achilles' heel" situations. These data indicate the internal and predictive validity of the RSEQ. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of high-dose nicotine patch on the characteristics of lapse episodes.

Objective: Nicotine patch improves treatment outcomes, but lapses are still common. To understand the process of relapse on patch, we investigated differences in the antecedents (withdrawal, setting, triggers) of lapse episodes experienced on high-dose (35 mg) nicotine patches versus placebo. Design: Participants were smokers who lapsed during a randomized, double-blind trial of active patches (n = 100) versus placebo (n = 85). Participants used electronic diaries to monitor their smoking, affect, and activities in real time for 5 weeks during their cessation attempt. Results: We analyzed 490 lapse episodes (active: 266; placebo: 224). Lapses on nicotine patch were characterized by significantly lower positive affect and higher negative affect than placebo lapses. Participants treated with high-dose patch were also significantly more likely to lapse in situations involving little or no craving. Situational antecedents of lapses on patch resembled those on placebo. Conclusion: The results suggest that treatment with patch may set a higher threshold for affective stimuli to provoke lapses, but does not change the proximal cues that trigger lapses. This suggests that behavioral relapse-prevention strategies developed for unmedicated smokers should also apply to those treated with nicotine patch. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consequences of different "lapses" on relapse to heroin seeking in rats.

Although human studies have shown that a lapse, the first violation of abstinence, often induces resumption of drug taking, or relapse, it is not known what aspect of a lapse is critical to relapse or whether this phenomenon can be studied in other species. Rats were trained to self-administer heroin accompanied by a discrete light stimulus. After extinction, different groups experienced different "lapses." Twenty-four hours later, all groups received a test for relapse. It was found that a lapse during which heroin was self-administered, or was presented in close temporal contiguity with lever pressing, induced subsequent heroin seeking. Simple exposure to heroin, or to heroin-related stimuli, during the lapse had little effect on responding in the test for relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)