title: Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Psychiatry and Human Behavior, Butler Hospital/Alpert Medical School of Brown University, Providence, RI;
authors.forename: Richard A
authors.initials: RA
authors.lastname: Brown
authors.forename: Kathleen M Palm
authors.initials: KM
authors.lastname: Reed
authors.forename: Erika Litvin
authors.initials: EL
authors.lastname: Bloom
authors.forename: Haruka
authors.initials: H
authors.lastname: Minami
authors.forename: David R
authors.initials: DR
authors.lastname: Strong
authors.forename: Carl W
authors.initials: CW
authors.lastname: Lejuez
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Kahler
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zvolensky
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Gifford
authors.forename: Steven C
authors.initials: SC
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D001521:Behavior Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000523:psychology / Q000628:therapy; D013997:Time Factors; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009538:Nicotine