Smoking relapse is most often the end point of a process that unfolds over a period of days or weeks and is characterized by many intermittent lapses. According to Relapse Prevention theory, progression to relapse is driven by the Abstinence Violation Effect (AVE), a set of cognitive and emotional responses to lapsing that predisposes quitters to further lapses in an accelerating downward spiral. However, the dynamic relationship between lapse responses and relapse progression during smoking cessation has not been a focus of research. We used mixed-effect growth modeling and recurrent event survival analyses to investigate the way AVE-related lapse responses evolve over the course of a cessation attempt and prospectively influence subsequent lapse-relapse progression. Participants were 203 smokers who achieved abstinence and subsequently lapsed on one or more separate occasions. Using electronic diaries for Ecological Momentary Assessment, participants recorded their reactions to each lapse in real time. Findings revealed a great deal of variability between participants and from lapse-to-lapse in the severity of AVE responses, indicating that participants differed in the extent that their AVE responses intensified versus improved with each successive lapse. In turn, AVE response was found to explain subsequent lapse progression rates, above and beyond the predictive influence of other traditional explanatory variables. Results indicate that while participants' responses to the first lapse they experienced were unrelated to whether they ultimately relapsed, those who reported higher levels of self-efficacy following their first lapse had a slower rate of progression from each successive lapse to the next (HR=0.93, CI=0.89-0.97). Controlling for responses to their initial lapse, we found that responses to each additional lapse influenced lapse progression rates, such that higher levels of both self-blame (HR=0.99, CI=0.98-0.99) and self-efficacy (HR=0.95, CI=0.92-0.99) were associated with slower progression to a subsequent lapse. Incremental increases in guilt from lapse-to-lapse were associated with slower progression to an additional lapse (HR=0.96, CI=0.92-0.99), while increasingly negative affective valence from lapse-to-lapse was associated with accelerated lapse progression (HR=1.05, CI=1.00-1.09). Results highlight the dynamic nature of lapse responses during smoking cessation, demonstrating the way psychological responses may drive progression from one lapse to the next.
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