Responding to tobacco cravings using acceptance and/or reappraisal: results from an experimental study employing an online craving induction lab

摘要

Despite recent advances in smoking cessation outcomes, a significant number of people in the UK continue to smoke. Currently available psychological treatments for tobacco addiction include Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT), with research evidence suggesting that both approaches may be effective treatments for tobacco addiction. Nevertheless, relapse rates remain high and there is scope for further improvements in clinical outcomes.udThe present study examined the effectiveness of two psychological strategies (acceptance and reappraisal) primarily with regard to the regulation of tobacco cravings and secondarily with regard to increasing adult smokers’ self-efficacy in abstaining from smoking. Reappraisal is hypothesised to be the mechanism of change within CBT, while acceptance is a key process associated with the ACT literature.udThis research project was designed to include three inter-related components, all of which were carried out online. The principal component consisted of an experimental study of the effectiveness of reappraisal and acceptance in decreasing cravings to smoke and increasing abstinence self-efficacy. This component involved the online recruitment of adult smokers, their random allocation to one of four groups (control group, acceptance, reappraisal, both acceptance and reappraisal), provision of training to the three experimental groups in their respective strategy (or strategies) using videos embedded in an online survey, subjecting participants to an online craving induction lab, and testing the effectiveness of these strategies in relation to the examined variables. Results showed that reappraisal was associated with the greatest gains with regard to cravings and self-efficacy. Acceptance was associated with better outcomes compared to the control group in relation to self-efficacy, but not in relation to craving intensity. Training participants in both groups was not associated with improved outcomes compared to the single-strategy conditions.ud1617, RPV, UofN: 4240578, UofL: 14500289, Thesis Portfolio_Volume _Ι 2udAs part of the same online survey correlational data were collected pertinent to a secondary research aim. This collection of data aimed at providing an insight into how craving intensity and appraisals of cravings were related. Results showed that as craving intensity decreases, appraisals of cravings as intolerable and as threatening to one’s well-being also diminish, while self-efficacy to cope with current cravings increases. These patterns of relationships were shown to be consistent across the acceptance and reappraisal groups. Implications in terms of mechanisms of change associated with reductions in cravings are discussed.udAnother secondary, adjunct component consisted of a short Ecological Momentary Assessment (EMA) study that attempted to collect ‘real-life’ data from participants who had completed the online survey and who wished to put what they had learnt in use and engage in a 24-hour, ‘practice attempt to quit smoking’. Low recruitment and high attrition rates rendered group comparisons impossible. However, useful learning points are discussed which may aid future attempts at conducting EMA designs following online recruitment.ududAim: This online study investigated the effectiveness of acceptance and reappraisal strategies in regulating tobacco cravings and their impact on other smoking-related processes. Method: Following random allocation to one of four conditions (control group, n = 34; acceptance, n = 35; reappraisal, n = 22; both acceptance and reappraisal, n = 19), adult smokers watched condition-specific intervention videos and took part in an online craving induction lab. Levels of cravings, self-efficacy to abstain from smoking and current affective states were assessed at baseline and post-intervention and craving induction. Baseline comparisons on key variables associated with smoking were performed. Results: Reappraisal was associated with greater reductions in cravings and increases in self-efficacy compared to the control group. Reappraisal was also associated with greater craving intensity reductions and self-efficacy increases compared to acceptance in a ‘per protocol’ analysis. In comparison to the control condition, acceptance was associated with greater increases in self-efficacy, but not with reductions in craving intensity. Teaching both strategies was not associated with additional benefits. Conclusions: Reappraisal was shown to be the most effective strategy for reducing cravings and increasing self-efficacy. Acceptance may be associated with better outcomes in relation to self-efficacy compared to habitually employed strategies. Future research recommendations are discussed.