Mechanisms of change in extended cognitive behavioral treatment for tobacco dependence

Abstract

Aim To evaluate potential mediators of an extended cognitive behavioral smoking cessation intervention. Design Analysis of data from a randomized clinical trial of smoking cessation. Setting The Habit Abatement Clinic, University of California, San Francisco. Participants 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). Measurements 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.