Rôle des croyances rationnelles et irrationnelles concernant la motivation à l’arrêt du tabac

Abstract

Les addictions sont considérées comme une affection psychique chronique mettant en jeu une substance ou un comportement. L’objectif de la présente étude était d’explorer le rôle des croyances rationnelles et irrationnelles dans la motivation à la dépendance tabagique. Pour ce faire, 186 personnes ont complété des échelles concernant la dépendance au tabac, leur motivation à l’arrêt et leurs croyances rationnelles et irrationnelles associées au fait d’être fumeur et leur crainte de prendre du poids en cas d’arrêt. Les résultats montrent que les croyances rationnelles et irrationnelles sur le fait d’être fumeur ont un impact plutôt positif sur la motivation, tandis que les croyances irrationnelles concernant la crainte d’une prise de poids semblent être un frein à la motivation et devraient par conséquent faire l’objet d’une attention particulière de la part du professionnel lors des consultations au sevrage. Addiction is considered as a chronic mental disorder involving a substance or a behavior; subjective experience of addiction includes craving resulting in difficulties linked to stopping substance usage or behavior (Goldman et al., 2005 [1]). Health risks related to smoking addiction are well known, and in 2015 approximately 10 % of deaths will be attributable to smoking (Rosenthal et al., 2011 [3]). Smoking can result in various diseases and health problems (Dolle et al., 2004; Das, 2003; Bartal, 2001 [4], [5], [6]). Nicotine, the active component of smoking, is used to regulate emotions (Benowitz, 2010; Evans et Drobes, 2009; Knott et al., 2009 [7], [8], [9]) and smokers experience concentration problems, dysphoria, anxiety, increased appetite, and irregular heart rhythm when they are suffering nicotine deprivation – (Hughes, 2007; Hughes et Hatsumaki; 1986; Koob et Le Moal, 1997 [10], [11], [12]). Smoking often starts in adolescence (Kandel et al., 2005; Johnston et al., 2007 [13], [14]); the earlier it starts the more serious the long-term dependence (O’Callaghan et al., 2006 [15]). Motivation is another variable that is important to consider in all addiction problems (Curry et al., 1991 [16]). Beliefs and cognitions are often an important factor in helping confront addictions and can also influence motivations. A major belief held by smokers is the concern of weight gain following smoking cessation (Handa et al., 2011; Hagimoto et al., 2009; Hughes, 1992; Williamson et al., 1991; Perskins, 1994 [23], [24], [25], [26], [27]), which is often presented as a motivation against stopping smoking. Ellis’ four basic irrational beliefs (IBs) have been linked to the expression of different forms of psychopathology (depression, anxiety, etc.) and are often used for helping individuals confronting addiction problems (Clark et al., 2006 [28]). The aim of the present study was to explore the impact of rational and IBs on the motivation to quit tobacco dependence. One-hundred eighty-six participants completed scales on tobacco dependence, motivation to quit, and rational and IBs associated with being a smoker including the fear of gaining weight linked to smoking cessation. The questionnaires for motivation and IBs were completed a second time 1 week later. The sample was composed of 123 women (66 %) and 63 men (44 %); the average age was 29 (SD = 8.94) for women and 31 (SD = 10.55) for men. The breakdown of social-professional activities shows that 40 % of the current sample was employed and 28 % were students. Correlations between the scales revealed strong positive correlations between the motivation to quit at T1 and both rational and IBs (r = 0.32 and 0.47; P, 0.05) for both beliefs about smoking itself and the fear of gaining weight. This effect was attenuated at time 2 with lower correlations between both irrational and rational beliefs and motivation to quit (r = 0.21 and 0.29; P < 0.05) although the relationship between motivation and irrational or rational beliefs about weight gain had disappeared as demonstrated by the lack of correlations between these variables. While smokers may have a relatively rational and lucid impression of their smoking problem, IBs, including those regarding weight gain, may have a negative impact on the ability to stop smoking. The effect of beliefs about weight gain appears to decrease over time, but the beliefs about smoking, both rational and irrational, appear to persist. Thus, IBs about the fear of weight gain appear to be an obstacle to stopping smoking in the immediate period, and therefore special attention should be given to this aspect by professionals during consultations for smoking cessation. Future research is warranted towards a better understanding of the role of both rational and IBs in smoking cessation, perhaps within a longitudinal framework to ascertain how beliefs can be modified over time with therapy.