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Randomized Controlled Trial
, 29 (2), 400-7

The Moderating Role of Experiential Avoidance in the Relationships Between Internal Distress and Smoking Behavior During a Quit Attempt

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Randomized Controlled Trial

The Moderating Role of Experiential Avoidance in the Relationships Between Internal Distress and Smoking Behavior During a Quit Attempt

Haruka Minami et al. Psychol Addict Behav.

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 prequit general EA (Acceptance and Action Questionnaire) and smoking-specific EA (Avoidance and Inflexibility Scale) moderated the relations between 4 measures of postquit internal distress (depressive symptoms, negative affect, physical withdrawal symptoms, craving) and smoking. Forty adult smokers participated in a randomized controlled trial of distress tolerance treatment for smokers with a history of early lapse. Multilevel models showed that prequit smoking-specific EA, but not general EA, significantly moderated the relationship between all measures of internal distress, except craving, and smoking over 13 weeks postquit. When examined over 26 weeks, these relations remained unchanged for all, but the moderating effect became trend-level for depressive symptoms. Significant associations between postquit internal distress and smoking were found only in those with high prequit smoking-specific EA. Moreover, prequit smoking-specific EA did not predict postquit levels or changes in internal distress, suggesting that decreasing smoking-specific EA prequit may not reduce internal distress, but may instead reduce smoking risk in response to such distress during a quit attempt. 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 postquit depressive and withdrawal symptoms, and those who smoke to regulate aversive internal states. (PsycINFO Database Record

Figures

Figure 1
Figure 1
Predicted probability of abstinence over 13 weeks post-quit for smokers with high (3rd quartile: AIS ≥ 50) and low pre-quit smoking-specific experiential avoidance (1st quartile: AIS ≤ 36) for each of the predictors (i.e., depressive symptoms, negative affect, physical symptoms, and craving).
Figure 2
Figure 2
Marginal effects of depressive symptoms, negative affect, physical withdrawal symptoms and craving on abstinence rates over 13 weeks post-quit by pre-quit levels of smoking-specific experiential avoidance. Each plot shows the threshold value of the moderator (i.e., pre-quit smoking-specific experiential avoidance - AIS) where the effects of the predictor on outcome (i.e., smoking risk) become significant. The changes in the coefficient estimate and its 95% confidence intervals as a level of the moderator changes are captured in these marginal effect plots.

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