Category: Smoking

Can’t Quit Smoking? It Might Be To Do With How Sad You Are

Depressed man in a cafeBy Emily Reynolds

Emotions have a powerful part to play in both our behavioural choices and our health. Experiencing a range of positive emotions has been associated with lower levels of inflammation, for example, and emotional control has even been linked to higher performance in sportspeople. Negative emotions, too, can have a serious impact on behaviour: research has investigated the emotional triggers of self-harm, for instance.

Now new research from Charles Dorison and colleagues at Harvard University, published in PNAS, has looked at the role of negative emotions in addiction. Though some theories say negative mood in general is associated with problematic substance use, the study suggests that, for tobacco at least, it’s sadness per se that is related to addiction.

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Psychologists explore a new reason why quitting smoking is so difficult

When a cigarette smoker attempts to quit, not only do they crave their usual nicotine hit, they also experience an unpleasant inability to enjoy other pleasures in life – a state known as “anhedonia”.

Jessica Cook and her colleagues studied over a thousand smokers enrolled on a quitting programme in the US. The participants (mostly White, 58.3 per cent were female) were placed on a range of nicotine replacement therapies or they were given placebo. The participants also kept an evening diary from five days before, to ten days after, their quit day. Here they recorded how much pleasure they’d experienced that day across three domains: social, recreation and performance/accomplishment.

The researchers found that stopping smoking was followed by an immediate spike in anhedonia – on the day of quitting, participants in the placebo condition showed a marked reduction in their experience of pleasure from various aspects of life. This quitting-related anhedonia peaked the day after quitting and showed all the hallmarks of being part of the nicotine “withdrawal syndrome”. That is, levels of anhedonia tended to be correlated with other withdrawal symptoms (such as craving and poor concentration); the anhedonia faded over time; and it was eased by the administration of a nicotine therapy, such as a nicotine lozenge or patch.

Perhaps most importantly, the results showed that levels of anhedonia were correlated (negatively) with participants’ subsequent success at abstinence, even after controlling for the predictive value of craving levels and negative mood. In other words, more quitting-related anhedonia was associated with less success at quitting. Greater post-quitting anhedonia also predicted increased risk of an initial lapse transforming into a full return to smoking. It seems likely that quitting-related anhedonia prompts smokers to want to resume smoking so that they can reinstate their usual ability to enjoy other pleasures in life; and once they lapse, the return of the smoker’s usual experience of pleasure acts as a powerful reinforcer.

“The present study is the first, to our knowledge, to demonstrate that post-cessation pleasure in response to daily activities is a significant barrier to quitting smoking,” the researchers said. They added that this could point to important new treatment strategies aimed at helping smokers get through their initial experience of anhedonia (such as “behavioural activation“), especially smokers with other mental health issues, who may use smoking to self-treat their chronic anhedonia.

The study makes a useful contribution to the field, but it does suffer some limitations, as the researchers acknowledged. This includes the reliance on the participants’ rather vague reports of their daily enjoyment of activities, as well as the fact the sample was enrolled on a treatment programme and highly motivated to quit – it remains to be seen how well the findings will generalise.

  ResearchBlogging.orgCook, J., Piper, M., Leventhal, A., Schlam, T., Fiore, M., & Baker, T. (2014). Anhedonia as a Component of the Tobacco Withdrawal Syndrome. Journal of Abnormal Psychology DOI: 10.1037/abn0000016

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Stubbing out thoughts of smoking leads smokers to end up smoking more

Try not to think of a white bear and what happens? You end up thinking of a white bear. This idea that suppressing thoughts makes them rebound stronger is well-established in psychology [pdf]. Now James Erskine and his co-workers have shown that the same or a similar process can lead behaviours to rebound too.

Eighty-five smokers (average age 31), none of whom were currently trying to quit, were divided into three groups for three weeks. One group was instructed to spend the middle week avoiding and suppressing all smoking-related thoughts. The second group were to think about smoking as much as they could during that second week; the third group acted as controls and didn’t suppress or encourage smoking-related thoughts. Participants in all groups kept daily diaries of how much they smoked, their stress levels and how much they’d attempted to suppress smoking-related thoughts.

The main finding was that smokers in the suppression group smoked less than others during the middle week while they were suppressing smoking-related thoughts, but ended up smoking significantly more than the other smokers in the final week. In other words, trying to avoid thinking about smoking had a short term benefit but ultimately led to more smoking later on.

Erskine and his colleagues said this short-term benefit of thought suppression was ‘troublesome’ and could lead smokers to believe mistakenly that the strategy was beneficial.

Another finding to emerge was that smokers from all three groups who suppressed more smoking-related thoughts (as recorded in their evening diaries) tended to have a history of more failed attempts to quit smoking.

‘Thought suppression may be more harmful than previously believed,’ the researchers concluded. ‘Our findings are especially relevant to populations that seek to control behaviours on an ongoing basis (e.g. addicts), but are also relevant to any individuals attempting to control their desires, thoughts, and behaviours.’

This new study comes after an earlier report by James Erskine, in which suppressing thoughts of chocolate led participants to eat more chocolate.

ResearchBlogging.orgErskine JA, Georgiou GJ, & Kvavilashvili L (2010). I Suppress, Therefore I Smoke: Effects of Thought Suppression on Smoking Behavior. Psychological science : a journal of the American Psychological Society / APS PMID: 20660892

Thanks to George Georgiou at the University of Hertfordshire who tipped the Digest off about this new research.

Morbid warnings on cigarette packs could encourage some people to smoke

Every now and again a finding comes along that provides perfect ammunition for psychologists confronted by the tiresome claim that psychology is all ‘common sense’. Researchers have found that death-related health warnings on cigarette packs are likely to encourage some people to smoke. The surprising result is actually consistent with ‘Terror-management Theory’, according to which thoughts of mortality cause us to cling more strongly to our cultural beliefs and to pursue ego-boosting activities.

Jochim Hansen and colleagues first measured how important smoking was to the self-esteem of 39 student smokers. Example questionnaire items included ‘smoking allows me to feel valued by others’. Next, the smokers were divided into two groups: one group looked at two cigarette packs that featured death-related warnings, such as ‘Smokers die earlier’. The other group looked at cigarette packs that featured death-neutral warnings, such as ‘Smoking makes you unattractive.’

Fifteen minutes later all the students reported their attitudes to smoking; the questionnaire included items such as ‘Do you intend to quit smoking?’. Among the students for whom smoking was important to their self-esteem, those who looked at packets with death-related warnings subsequently reported more positive attitudes to smoking compared with those who looked at death-neutral packets. The exact opposite pattern was found for students for whom smoking was not important for their self-esteem.

In other words, for smokers who derive a self-esteem boost from smoking – perhaps they see it as a key part of their identity or they think it makes them look cool – a death-related cigarette packet warning can have the ironic effect of making them want to smoke more, so as to buffer themselves against the depressing reminder of their own mortality. The findings suggest that for these kinds of smokers, packet warnings that target positive beliefs about smoking (e.g. ‘Smoking makes you look unattractive’) could well be more effective.

‘To succeed with anti-smoking messages on cigarette packs one thus has to take into account that considering death may make some people smoke,’ the researchers concluded.

ResearchBlogging.orgHansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal of Experimental Social Psychology, 46 (1), 226-228 DOI: 10.1016/j.jesp.2009.09.007

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Smokers ignore "what might have been"

Thankfully, most of us don’t keep plumping for the same option in life, over and over, regardless of how rewarding it might seem to be. No, we take into account what might have happened if we’d taken a different path, made a different decision. These so-called ‘fictive’ thoughts can lead us to change the way we behave in the future. But now Pearl Chiu and colleagues have shown this ability is lacking in smokers – a finding they say could have implications for treating addiction.

Thirty-one smokers and 31 non-smokers had their brains scanned as they played an investment game. They were given $100 with which to invest in stocks and shares and after each round they were told how much money they’d made, relative to how much money they could have made if they’d invested the maximum amount in their chosen shares.

Discovering how much money they could have made if they’d invested a larger amount affected the subsequent decision-making of the non-smokers but not the smokers. It’s not that the brains of the smokers didn’t register this information – they, like the non-smokers, showed increased activity in a part of the brain called the caudate when shown what they’d missed – it’s just they didn’t act on it. Pearl Chiu and co-workers say this cognitive anomaly helps explain why smokers carry on puffing away without regard for the positive outcomes that could have ensued had they have given up.

Co-author Read Montague told The Digest: “It’s not at all clear from our work yet whether subjects who end up smoking (chronically) start out with a weak coupling between fictive error systems and behavioural control or whether this connection weakens as they become addicted to nicotine. We are gearing up to do a longitudinal study to find this out.”

Chiu, P.H., Lohrenz, T.M., Montague, P.R. (2008). Smokers’ brains compute, but ignore, a fictive error signal in a sequential investment task. Nature Neuroscience DOI: 10.1038/nn2067

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.