Mechanisms of change in extended cognitive behavioral treatment for tobacco dependence.
OBJECTIVE
To evaluate potential mediators of an extended cognitive behavioral smoking cessation intervention.


METHODS
Analysis of data from a randomized clinical trial of smoking cessation.


METHODS
The Habit Abatement Clinic, University of California, San Francisco.


METHODS
Participants were older cigarette smokers (>/=50 years old). Those receiving Standard Treatment (N=100) were compared to those receiving extended cognitive behavioral treatment (N=99).


METHODS
Negative affect was measured with the Profile of Mood States (POMS), the Medical Outcome Studies 36-item Short-Form Health Survey (SF-36), and the Perceived Stress Scale (PSS). Abstinence-specific social support was measured with the Partner Interaction Questionnaire (PIQ). Motivation to quit and abstinence self-efficacy were measured on 1-10 scales with the Thoughts about Abstinence Questionnaire. All were measured at the beginning of treatment and week 52.


RESULTS
Analyses revealed that extended CBT increased abstinence self-efficacy over the first 52 weeks postcessation. This effect, in turn, was positively associated with 7-day point prevalence abstinence at week 64 while controlling for treatment condition, and eliminated the independent effect of treatment condition on abstinence. The test of mediation indicated a significant effect, and abstinence self-efficacy accounted for 61% to 83% of the total effect of treatment condition on smoking abstinence. Results failed to support a mediational role of negative affect, abstinence-specific social support, or motivation to quit.


CONCLUSIONS
The results of the present study are consistent with theories of relapse and studies of more time-limited interventions, and underscore the importance of abstinence self-efficacy in achieving long-term abstinence from cigarettes.
Hendricks
Peter S
PS
University of California, San Francisco, 401 Parnassus Ave., TRC Box 0984, San Francisco, CA 94143, United States. phendricks@lppi.ucsf.edu
Delucchi
Kevin L
KL
Hall
Sharon M
SM
D000328:Adult; D000339:Affect; D016642:Bupropion / Q000627:therapeutic use; D002638:Chewing Gum; D015928:Cognitive Behavioral Therapy; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D011594:Psychometrics; D055502:Secondary Prevention; D020377:Self Efficacy; D016540:Smoking Cessation / Q000379:methods*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
D002638:Chewing Gum; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine