Mechanisms of change in extended cognitive behavioral treatment for tobacco dependence

AimTo evaluate potential mediators of an extended cognitive behavioral smoking cessation intervention.DesignAnalysis of data from a randomized clinical trial of smoking cessation.SettingThe Habit Abatement Clinic, University of California, San Francisco.ParticipantsParticipants were older cigarette smokers (≥50 years old). Those receiving Standard Treatment (N = 100) were compared to those receiving extended cognitive behavioral treatment (N = 99).MeasurementsNegative affect was measured with the Profile of Mood States (POMS), the Medical Outcome Studies 36-item Short-Form Health Survey (SF-36), and the Perceived Stress Scale (PSS). Abstinence-specific social support was measured with the Partner Interaction Questionnaire (PIQ). Motivation to quit and abstinence self-efficacy were measured on 1–10 scales with the Thoughts about Abstinence Questionnaire. All were measured at the beginning of treatment and week 52.ResultsAnalyses revealed that extended CBT increased abstinence self-efficacy over the first 52 weeks postcessation. This effect, in turn, was positively associated with 7-day point prevalence abstinence at week 64 while controlling for treatment condition, and eliminated the independent effect of treatment condition on abstinence. The test of mediation indicated a significant effect, and abstinence self-efficacy accounted for 61% to 83% of the total effect of treatment condition on smoking abstinence. Results failed to support a mediational role of negative affect, abstinence-specific social support, or motivation to quit.ConclusionsThe results of the present study are consistent with theories of relapse and studies of more time-limited interventions, and underscore the importance of abstinence self-efficacy in achieving long-term abstinence from cigarettes.