Kathleen A. O'Connell

Coping in real time: using Ecological Momentary Assessment techniques to assess coping with the urge to smoke.

Coping is important for success at smoking cessation, yet little is known about the natural history of coping with urges to smoke during a cessation attempt. In this study, Ecological Momentary Assessment (EMA) methods were used to gather real-time quantitative and qualitative data. For 3 consecutive days during their first 10 days of smoking cessation, 36 participants used tape recorders and palm-top computers to record details of 389 coping episodes, during which they employed 1,047 coping responses. An average of 3.6 coping episodes per day and an average of 2.7 coping responses per episode were reported. Sixty-seven percent of the responses were behavioral and 33% were cognitive. Gender, location of the episode, nicotine dependence, and quitting history were associated with the use of specific strategies. Results indicate that EMA methods and instruments are feasible for measuring coping responses.

How does coping help people resist lapses during smoking cessation

OBJECTIVES To determine whether types of coping strategies have differential effects on preventing lapses and lowering urge levels and to investigate mechanisms by which coping strategies prevent lapses during smoking cessation. DESIGN Sixty-one respondents performed ecological momentary assessment using palm-top computers and tape recorders to report their coping strategies and urge levels before and after temptations to smoke. Multilevel linear regression models were used to compare the effects of individual strategy types with the average strategy. MAIN OUTCOME MEASURES Lapses versus resisted temptations and changes in urge levels. RESULTS Number of strategies significantly predicted resisting smoking and change in urge levels. Compared with the effect of the average strategy, movement/exercise was marginally worse at preventing lapses, and food/drink was marginally related to higher postcoping urge levels. CONCLUSION Although using multiple coping strategies helps people resist the urge to smoke, no particular coping strategy works better than any other. Coping strategies prevent lapses by reducing high urge levels during temptations.

Handbook of health behavior change

Changing health behavior is a major challenge of patient educators. The 24 chapters of this edited volume present a comprehensive view of the issues faced by those who are attempting to alter health behavior. The volume is divided into six sections. The first section reviews numerous theoretical models of behavior change and relapse prevention, and includes a chapter on the measurement of adherence. The second section focuses on interventions in several different populations including persons with hemophilia, pulmonary disease, and coronary heart disease. The third section deals with obstacles to life-style change. Section 4 deals with behavior change in specific populations, including minorities, children, and the elderly. The fifth section includes five chapters on the issue of adherence in clinical trials. And the final section discusses life-style change in the broader contexts of placebo effects, personal responsibility versus public policy and ethical issues. The book contains introductions and commentaries on each section.

Problems with thiocyanate as an index of smoking status: A critical review with suggestions with improving the usefulness of biochemical measures in smoking cessation research.

The purpose of this paper is to present a comprehensive review of the literature on SCN in order to illustrate the methodological issues involved in using biochemical indices of behavior. We discuss issues related to the sensitivity, specificity, predictive value, and reportedly long half-life of SCN. We also briefly discuss how these issues relate to other biochemical indices of smoking. We conclude with suggestions for improving the measurement of smoking status.

Negative affect smoking and smoking relapse

This study examined linkages between negative affect smoking and relapse. A sample of 669 smokers treated in smoking cessation clinics completed the Horn Motives for Smoking Scale at baseline and were followed at 3 and 12 months posttreatment. Negative affect (NA) smoking scores were unrelated to initial cessation or to maintenance at 3 months. Negative affect accounted for 8% of the variance in 12-month outcomes. The findings support the conceptual distinction between cessation and maintenance and suggest the need to distinguish stages within maintenance. The study also examined whether NA was associated with experiencing relapse crises in negative affect situations. Reports of relapse crises (situations leading to smoking or to the verge of smoking) were obtained from 572 subjects at the 3-month follow-up. Negative affect smokers were more likely to report that the crises were precipitated by negative affect. Although weak, this link between baseline smoking patterns and relapse situations suggests the possibility of individually tailored treatments.

Overeating, Reversal Theory, and Weight Cycling:

Americas overweight problem is universally recognized and escalating, despite billions of dollars spent to combat it. For the past century, a unidimensional paradigm was predominantly used to correct the overweight problem by reducing calories through dieting. As a result of the profoundfailure of traditional diet programs, a phenomenon known as weight cycling was born. In this article, a multidimensional paradigm is emphasized to address weight cycling. Reversal theory extends a new theoretical basis that can accountfor unpleasantfeelings, or tension stress, as a trigger of overeating in women who weight cycle. A case example demonstrates how reversal theory explains overeating as a response to high-tension stress. Results of two studies are presented, describing overweight and normal-weight womens reversal theory states during self-reported episodes of overeating and resisting overeating. The multidimensional paradigm calls for emotional overeating behaviors to be addressed in weight management.

Do resisted temptations during smoking cessation deplete or augment self-control resources?

A resource depletion model of self-control posits that for some period following performance of a task requiring self-control, self-control will be reduced and thus less available for use in a subsequent task. Using 2 substantial data sets collected in real time from individuals who were trying to quit smoking (1,660 and 9,516 temptation episodes collected from 61 and 248 individuals, respectively), we evaluated this model by testing the hypotheses that the number and length of resisted temptations and the intensity of the most recently reported urge during the prior 4 hr predict decreased self-control and increased likelihood of lapsing. Survival and multilevel regression modeling showed that contrary to the hypothesis, the number of recently resisted temptations predicted a lower risk of lapsing in both samples. Duration of resisted temptations had no significant effect in either sample. Intensity of most recently reported urge predicted lapsing in 1 data set but not in the other. Overall, there was little support for the resource depletion model. The protective effect of successfully resisting temptations was an unexpected but provocative finding.

Playful and rebellious states vs. negative affect in explaining the occurrence of temptations and lapses during smoking cessation

Reversal theory constructs of playful and rebellious states are compared with negative affect as predictors of temptations and lapses and as predictors of three important correlates of resisting temptations to smoke: Cigarette availability, urge level, and coping during temptations. A total of 61 participants entered data in palmtop computers and tape recorders for the first 14 days of a cessation attempt. Multilevel, random-effects logistic regression analyses showed that fluctuations in playfulness, rebelliousness, negative affect, and cigarette availability all significantly discriminated temptations from nontemptations. Fluctuations in playfulness and rebelliousness, but not negative affect, significantly predicted being in situations where cigarettes were easily available. Fluctuations in playfulness, rebelliousness, and cigarette availability, but not urge levels or negative affect, significantly predicted coping during temptations, whereas coping, rebelliousness, cigarette availability, and urge levels predicted lapsing. Treatment and policy implications of these findings are discussed.

State-outcome consistency in smoking relapse crises : a reversal theory approach

Previous investigations of smoking relapse crises have found limited within-subject consistency. Several investigators have suggested that greater consistency might be observed if situations were described phenomenologically. Reversal theory provides one phenomenological framework. Two relapse crises from each of 49 ex-smokers were compared, using reversal theory constructs. Maintaining abstinence in both crises was consistently associated with being in serious-minded (telic) and conformist states. Smoking in both crises was consistently associated with being in playful (paratelic) or negativistic states. Crises with different outcomes occurred in different state combinations. The findings suggest that coping strategies should be state-tailored for optimal effectiveness.

Self-regulation in individuals with type II diabetes.

A model for self-regulation of diabetes was tested which proposed that individuals monitor their disease status by comparing their current state with their standard of well-being. When a discrepancy is experienced and associated with a change in blood glucose, action is taken to relieve the symptom and thereby regulate blood glucose. Two variables of the self-regulatory process (symptom-associating and action-taking) were tested through semi-structured interviews of 173 subjects who had Type II diabetes. Most (85%) subjects associated their symptoms with a change in blood glucose levels. Of subjects who associated symptoms with elevated blood glucose, 77% took action; of subjects who associated symptoms with lowered blood glucose, 89% took action. Only sex and insulin use were related to symptom associating and action taking. There was no relation between metabolic control measured by glycosylated hemoglobin and symptom association and action taking.