Smoking Cessation in a Woman With Breast Cancer, Cardiovascular Problems, and Depressive Symptomatology: Case Study

Smoking is the leading preventable cause of morbidity and mortality and has been linked with diseases such as cancer and cardiovascular diseases. The case of a 50-year-old woman with breast cancer, who suffered a stroke the previous month and is in treatment for depression and wants to quit smoking, is analyzed. She smoked 10 cigarettes a day and had never quit smoking. She received six sessions of a cognitive-behavioral psychological intervention to quit smoking. She stopped smoking and remained abstinent through the 1-year follow-up, showing a clear physical improvement and a significant reduction of depressive symptomatology (from 24 on the Beck Depression Inventory–II [BDI-II] before treatment to 1 at the 12-month follow-up). This indicates that, in many cases, smoking cessation produces an improvement not only in physical health but also in moodThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The present investigation was funded by the Ministry of Economy and Competitiveness of Spain (Project No. PSI2015-66755-R) and the European Fund for Regional Development (FEDER), 2014-2020S

Specific Relapse Predictors: Could Cognitive-Behavioral Treatment for Smoking Cessation Be Improved?

Relapse remains a frequent and complex phenomenon that is not yet well understood. An under-researched area of study that may provide relevant information concerns the assessment of specific post-treatment variables, rather than the composite measures commonly used to predict smoking relapse. The current study sought to examine the effects of post-treatment smoking-related variables, including withdrawal symptomatology, abstinence self-efficacy, and smoking urgency in negative-affect situations and smoking relapse at the 3 month follow-up. The sample comprised 130 participants who achieved abstinence for at least 24 h through a cognitive-behavioral smoking cessation treatment. Regression analysis was conducted for both composite measures and specific subscales and items. Data showed that composite measures of tobacco withdrawal, self-efficacy, and smoking urgency in negative-affect situations were not significant predictors of smoking relapse. However, the analysis including subscales, and specific items showed that lower self-efficacy in negative-affect-related situations (OR = 1.36) and three withdrawal symptoms—irritability/frustration/anger (OR = 2.99), restlessness/impatience (OR = 1.87), and craving (OR = 2.31)—were significant predictors of relapse. These findings offer new insights into the role of different smoking-related post-treatment variables in short-term relapse. Considering and specifically targeting these variables after achieving abstinence may potentially contribute to reducing smoking relapseThis research was supported by the Spanish Ministry of Economy and Competitiveness (Project reference: PSI2015–66755-R) and co-financed by FEDER (European Regional Development Fund; pluri-annual plan 2014–2020)S

Hazardous Alcohol Drinking as Predictor of Smoking Relapse (3-, 6-, and 12-Months Follow-Up) by Gender

Diverse studies have found a relation between alcohol consumption and smoking relapse. Few studies have analyzed the relation of smoking relapse with pretreatment alcohol consumption and gender differences. The main purpose of this study is to analyze the influence of alcohol consumption in smoking relapse over 12 months (3-, 6-, and 12-months follow-up) and to determine possible gender differences. The sample included 374 smokers who quit smoking by participating in a psychological smoking cessation treatment. We assessed hazardous pretreatment alcohol drinking (AUDIT), cigarette consumption (FTND; number of cigarettes) and sociodemographic variables. Higher scores on hazardous pretreatment alcohol drinking predict smoking relapse at 3-, 6-, and 12-months after smoking cessation. In males, higher scores on hazardous pretreatment alcohol drinking predict relapse at 6 and at 12 months. In females, higher scores on hazardous pretreatment alcohol drinking predict tobacco relapse at 3 months. Hazardous pretreatment alcohol drinking predicts relapse at all intervals after smoking cessation (3-, 6-, and 12-months follow-up). However, the influence of hazardous pretreatment alcohol drinking on smoking relapse differs as a function of gender, as it is a short-term predictor in women (3 months) and a long-term predictor in men (6 and 12 months)

Smoking cessation and depressive symptoms at 1-, 3-, 6-, and 12-months follow-up

Background The relationship between tobacco and depressive symptoms has been examined. However, there is little information on the evolution of these symptoms when an individual quits. The aim of this study was to analyze the evolution of depressive symptoms over time (pre-, post-treatment, 1-, 3-, 6-, and 12-months follow-up) in relation to smoking status 12 months after having received a psychological treatment for smoking cessation. Method The sample was made up of 242 adults who received cognitive-behavioral treatment for smoking cessation (64.4% women; mean age=41.71 years). The BDI-II was used to assess depressive symptomatology. Participants were classified into three groups according to smoking status at 12-months follow-up (abstainers, relapsers, and smokers). Results There were no significant differences in depressive symptoms among the three groups at pretreatment. At the end of treatment, abstainers and relapsers presented less depressive symptomatology than smokers. At follow-up, abstainers continued to present less depressive symptomatology than smokers, whereas in relapsers, symptoms began to increase as the relapses occurred. Regarding the evolution of depressive symptomatology, the abstainer and relapser groups showed a significant reduction at the end of treatment. Only in the group of abstainers did the decrease continue during 12 months follow-up. Limitations The decrease of the initial sample size from 562 to 242 participants. Variables such as self-esteem and self-efficacy were not assessed. Conclusions Smoking cessation is associated with a decrease in depressive symptomatology, that is maintained over time. In contrast, relapse is associated with an increase of such symptoms. These findings signify the potential importance of addressing depressive symptomatology in smoking cessation treatment

Does rumination mediate the effect of depressive symptoms on cigarette dependence and craving in seeking treatment smokers?

Despite the advances in understanding the relationship between smoking and depressive symptomatology, scarce research has investigated cognitive variables underlying in such relation. The main aim of this study is to examine the mediating effect of two rumination subtypes (brooding and reflection) in the link between depressive symptoms and both cigarette dependence level and tobacco craving in treatment-seeking smokers. Participants were 275 adult daily smokers seeking treatment to quit smoking (61.5% females; Mage = 45.3 years; SD = 10.9). Multiple mediation analysis was conducted to explore the mediating effects of rumination (brooding and reflection) in the relation between depressive symptoms, cigarette dependence level, and craving. Results showed a significant indirect effect of depressive symptoms through the joint of both rumination subtypes on cigarette dependence (ß = 0.089; 95% BootCI [0.006, 0.168]), and craving (ß = 0.123; 95% BootCI [0.048, 0.205]). The specific analysis of each mediator showed that only brooding subtype had a significant effect on the relation between depressive symptoms and tobacco craving (ß = 0.101; 95% BootCI [0.023, 0.186]). Findings of the present study provide further evidence for the role of rumination in smoking-related variables and for the potential value of introducing rumination-focused interventions into smoking-cessation interventions

Health-related quality of life among smoking relapsers

Background: Previous studies have shown that smoking is associated with health-related quality of life (HRQoL) impairment. In order to evaluate HRQoL in a sample of Spanish relapsers, a cross-sectional study was conducted. Method: The sample was made up of 775 smokers who had relapsed after a period of abstinence. HRQoL was evaluated using the Euro-Qol questionnaire (EQ-5D); through the descriptive profile, the EQ-5D index and the visual analogue scale (EQ-VAS). Results: Higher nicotine dependence was related to worse HRQL. According to the EQ-VAS, higher daily cigarette consumption and more years smoking were related to worse perceived health. In the EQ-5D those who had quit smoking in the previous year perceived worse health. Mobility and anxiety/ depression are the dimensions affected by smoking. Those who are more nicotine dependent (OR = 2.29) and have been smoking for longer (OR = 4.12) are more likely to have mobility problems; and those who are nicotine dependent (OR = 1.85) and relapsed more than a year ago (OR = 0.63), are more likely to experience anxiety/ depression. Conclusions: Nicotine dependence demonstrated a determining effect on HRQOL deterioration in smokers who have relapsed

Smoking relapse situations among a community-recruited sample of Spanish daily smokers

Introduction Relapse is a common factor within the behavior change process. However, there is scarce and limited knowledge of smoking relapse situations in population-based samples. The aim of this study was to identify smoking relapse situations among a sample of Spanish relapsers from the general population. Methods A sample of 775 relapsers was recruited among the general population using a snowball method. Participants completed a survey including sociodemographic, smoking-related and psychopathology variables. Smoking relapse situations were identified through specific questions assessing different aspects related to the last relapse episode. Results The majority of smoking relapse situations were attributed to positive affect (36.6%) and negative affect (34.3%), followed by lack of control (10.1%), smoking habit (6.7%), craving or nicotine withdrawal (6.3%), and social pressure (5.9%). Being unemployed and having a mental disorder in the past increased the likelihood of relapse in situations of negative affect. Being single and having quit smoking to save money were associated with an increased likelihood of relapse in situations of positive affect. Conclusions Affect plays a significant role in smoking relapse among a community sample of unassisted Spanish smokers. Relapse may be much more of an affective and situational process than a habit, physiological or social pressure. Findings from this study may help develop tailored community smoking relapse prevention strategies or programs

Environmental reward and depressive symptoms in the relationship between avoidance and cigarette dependence in treatment-seeking smokers

Background: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. Method: The sample included 275 adult treatment-seeking daily smokers (Mage = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. Results: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. Conclusions: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions

A randomized clinical trial to assess the efficacy of a psychological treatment to quit smoking assisted with an app: study protocol

Abstract: Numerous studies have shown the efficacy of smoking cessation interventions. However, some challenges, such as relapse rates, remain. The availability of information technologies (ICTs) offers promising opportunities to address such challenges. The aim of this paper is to describe the protocol followed to assess the efficacy of a face-to-face cognitive–behavioral intervention for smoking cessation using a smartphone application as a complement, compared with a control group. A single blind, two-arm, randomized controlled trial is proposed (NCT04765813). The participants will be smokers over 18 years old, who smoke at least eight cigarettes per day. Participants will be randomized to one of two conditions, using a 1:1 allocation ratio: (1) cognitive–behavioral smoking cessation treatment along with an App with active therapeutic components (SinHumo App); or (2) cognitive–behavioral treatment along with the use of a control App (without active components). The experimental App will be used during the eight treatment sessions and for 12 months after the end of treatment. The primary outcome measures will be 7-days point-prevalence abstinence at 12-months follow-up. We expect the experimental App to obtain higher abstinence rates at the end of treatment and at one-year post-treatment follow-ups and lower relapse rates, compared to the control AppThis research was supported by the Spanish Ministerio de Ciencia e Innovación (Project PID2019-109400RB-100) and co-financed by FEDER (European Regional Development Fund). The Spanish Ministerio de Ciencia e Innovación had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publicationS

Cognitive-behavioral treatment with behavioral activation for smokers with depressive symptomatology: Study protocol of a randomized controlled trial

Background: Smoking is an important risk factor for mental health-related problems. Numerous studies have supported a bi-directional association between cigarette smoking and depression. Despite the advances in understanding the comorbidity between both problems, the most effective psychological treatment that simultaneously targets smoking and depressive symptomatology remains unclear. The objective of this study is to assess the effectiveness of a cognitive-behavioral intervention for smoking cessation with components of behavioral activation for managing depressed mood. Method: A single blind, three-arm, superiority randomized controlled trial is proposed. Participants will be smokers over 18years old, who smoke at least 8 cigarettes per day. Participants will be randomized to one of three conditions, using a 2:2:1 allocation ratio: 1) standard cognitive-behavioral smoking cessation treatment; 2) standard cognitive-behavioral smoking cessation treatment plus behavioral activation; or 3) a three-month delayed treatment control group. The primary outcome measures will be biochemically verified point-prevalence abstinence (carbon monoxide in expired air) and significant change from baseline in depressive symptoms to the end of treatment, and at the 3-, 6-, and 12-month follow-up. Discussion: This study aims to assess the efficacy of a cognitive-behavioral intervention with behavioral activation components for smoking cessation and depressive symptoms, compared to a standard cognitive-behavioral intervention to quit smoking. As the relation between depressive symptoms, even at subclinical levels, and quitting smoking difficulties is well known, we expect that such intervention will allow obtaining higher abstinence rates, lower relapse rates, and mood improvement. Trial registration:ClinicalTrials.gov: NCT02844595. Retrospectively registered 19th July, 2016. The study started in January 2016, and the recruitment is ongoing