Thesis

A randomised controlled study of the relative efficacy and mechanisms of action of cognitive-behavioural coping skills training CBST) and acceptance and commitment therapy (ACT) for smoking abstinence

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Awarding institution
  • University of Strathclyde
Date of award
  • 2013
Thesis identifier
  • T13352
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Department, School or Faculty
Abstract
  • Cognitive-behavioural Coping Skills Training (CBST) and Acceptance and Commitment Therapy (ACT) both conceptualise smoking relapse as prototypically motivated by a desire to avoid negative affect and associated cognitions and environments. However, they specify contrasting techniques for increasing smokers' abilities to forgo the powerful negative reinforcement of affect reduction that is available through smoking. Whereas CBST focuses on developing smokers' skills for avoiding and coping with negative affect, ACT aims to reduce smokers' avoidance of cues to negative affect instead foster' their willingness to fully experience these cues. A separate line of research suggests that individual differences in smokers' tendencies to suffer paradoxical effects of experiential avoidance may be an important determinant of CBST's therapeutic impact. This study compared the efficacy of group CBST (n = 37) and ACT (n = 42) for long-term smoking abstinence in motivated-to-quit, nicotine-dependent smokers, and examined mediation of abstinence outcomes by each models' putative mechanisms of action. Moderation of abstinence outcomes by participants' paradoxical behaviour tendencies, as measured on four computer tasks prior to random assignment to CBST or ACT, was also examined. Efficacy analyses showed that CBST and ACT produced high and statistically equivalent rates of past 30-day abstinence at three month follow-up (37% vs. 52%). However at six month follow-up, ACT participants were 3.47 times more likely to report no smoking in the past 30 days, when controlling for other possible explanatory variables (15% vs. 39%). In support of the ACT model, 30-day abstinence outcomes following ACT were mediated by reductions in avoidance of internal smoking cues. In contrast, CBST outcomes were neither mediated by increased use of coping strategies, nor moderated by paradoxical behaviour tendencies. Overall, results suggest that rationalising and training acceptance-based responding to smoking cues may provide an efficient alternative to traditional cognitive-behavioural interventions in the treatment of nicotine dependence.
Resource Type
DOI
Date Created
  • 2013
Former identifier
  • 973109

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