title: Withdrawal exposure with withdrawal regulation training for smoking cessation: a randomized controlled pilot trial.
abstract: Although withdrawal processes form a key motivational basis for cigarette use, smoking cessation treatments appear to exert only modest effects on withdrawal. One treatment option for further reducing withdrawal severity would be to provide smokers with withdrawal regulation training. The objective of this study was to pilot a smoking cessation intervention comprising withdrawal exposure with withdrawal regulation training.
  
  
  
  Adult smokers (N=80) were randomized to one of two conditions: 1) Withdrawal Exposure with Withdrawal Regulation Training (WT), which included the development and application of individualized withdrawal regulation strategies over four separate sessions that spanned the first four hours of abstinence; 2) or Relaxation Control (RC) training, which controlled for the therapeutic contact of WT. All sessions occurred before the quit date, after which differential treatment was discontinued and all participants received brief counseling, nicotine replacement therapy, and self-help literature. Biochemically-confirmed (CO≤3) seven-day point-prevalence abstinence was assessed at Months 2 and 3 after end-of-treatment.
  
  
  
  Treatment completion and ratings of credibility and efficacy were high and equivalent across conditions. 22.2% of participants in the WT condition were abstinent at both time points, whereas 0% and 4.2% of participants in the RC condition were abstinent at Months 2 and 3 (Month 3 OR=6.5 [0.73, 59.19]). In-session withdrawal ratings suggested WT improved regulation of withdrawal symptoms, which were in turn associated with abstinence.
  
  
  
  This small pilot study suggests that WT promotes abstinence by enhancing withdrawal regulation. Results warrant further investigation of this innovative treatment approach.
authors.affiliation: University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294 USA. Electronic address: phendricks@uab.edu.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hendricks
authors.affiliation: University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave., San Francisco, California 94143 USA. Electronic address: sharon.hall@ucsf.edu.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hall
authors.affiliation: University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294 USA. Electronic address: lware200@uab.edu.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Tyus
authors.affiliation: University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294 USA. Electronic address: cbthorne@uab.edu.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Thorne
authors.affiliation: University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294 USA. Electronic address: lappansa@uab.edu.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Lappan
authors.affiliation: University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294 USA. Electronic address: mvmcmurr@uab.edu.
authors.forename: Megan V
authors.initials: MV
authors.lastname: McMurray
authors.affiliation: University of AL at Birmingham, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, 1720 2nd Ave. S., Birmingham, AL 35294 USA. Electronic address: wcbailey@uab.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Bailey
authors.affiliation: University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294 USA. Electronic address: kcropsey@uab.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Cropsey
authors.affiliation: University of Wisconsin, School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St. Suite 200, Madison, Wisconsin 53711 USA. Electronic address: tbb@ctri.wisc.edu.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012064:Relaxation Therapy / Q000379:methods; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000523:psychology / Q000628:therapy*; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cessation; Exposure; Smoking; Tobacco; Treatment; Withdrawal