Difficulties with Emotion Regulation and Psychopathology Interact to Predict Early Smoking Cessation Lapse

Abstract

There is little knowledge about how emotion regulation difficulties interplay with psychopathology in terms of smoking cessation. Participants (n = 250; 53.2 % female, Mage = 39.5, SD = 13.85) were community-recruited daily smokers (≥8 cigarettes per day) who self-reported motivation to quit smoking; 38.8 % of the sample met criteria for a current (past 12-month) psychological disorder. Emotion regulation deficits were assessed pre-quit using the Difficulties with Emotion Regulation Scale (DERS; Gratz and Roemer in J Psychopathol Behav Assess 26(1):41–54, 2004) and smoking behavior in the 28 days post-quit was assessed using the Timeline Follow-Back (TLFB; Sobell and Sobell in Measuring alcohol consumption: psychosocial and biochemical methods. Humana Press, Totowa, 1992). A Cox proportional-hazard regression analysis was used to model the effects of past-year psychopathology, DERS (total score), and their interaction, in terms of time to lapse post-quit day. After adjusting for the effects of gender, age, pre-quit level of nicotine dependence, and treatment condition, the model revealed a non-significant effect of past-year psychopathology (OR = 1.14, CI95 % = 0.82–1.61) and difficulties with emotion regulation (OR = 1.01, CI95 % = 1.00–1.01) on likelihood of lapse rate. However, the interactive effect of psychopathology status and difficulties with emotion regulation was significant (OR = 0.98, CI95 % = 0.97–0.99). Specifically, there was a significant conditional effect of psychopathology status on lapse rate likelihood at low, but not high, levels of emotion regulation difficulties. Plots of the cumulative survival functions indicated that for smokers without a past-year psychological disorder, those with lower DERS scores relative to elevated DERS scores had significantly lower likelihood of early smoking lapse, whereas for smokers with past-year psychopathology, DERS scores did not differentially impact lapse rate likelihood. Smokers with emotion regulation difficulties may have challenges quitting, and not having such difficulties, especially without psychopathology, decreases the potential likelihood of early lapse.

Emotion Regulation: A Transdiagnostic Perspective on a New RDoC Domain

“…In terms of the variables under study, we encourage researchers to capture various aspects of emotion regulation (reflecting each of the emotion regulation processes discussed above), assess symptoms dimensionally, assess related transdiagnostic factors (e.g., sleep disturbance) to better understand how emotion regulation is influenced by and influences other factors, and consider incorporating a developmental perspective into theories about emotion regulation to help bridge the divide between the adult and child/adolescent bodies of research within emotion regulation research. We also encourage researchers to continue considering the effects of emotion regulation (and mental health more broadly) on physical health (e.g., Farris, Zvolensky, & Schmidt, this issue); such research would be nicely suited to the RDoC framework, given its inclusion of relevant biological constructs. It is of course highly unlikely that any single research study will achieve all of these goals simultaneously, but our hope is that each of these goals may be met as research in this area accumulates.…”

Insomnia symptoms as a risk factor for cessation failure following smoking cessation treatment

“…In addition to these fixed risk factors, other malleable factors have been identified that are associated with smoking cessation failure. These risk factors can theoretically be intervened upon to improve smoking cessation outcomes, and include high anxiety sensitivity, low distress tolerance, anhedonia, and difficulties with emotion regulation (Assayag et al, 2012; Brown et al, 2009; Farris et al, 2015; Leventhal et al, 2015). However, although these risk factors are theoretically malleable, some (e.g., anhedonia, distress tolerance, emotion regulation difficulties) cannot be addressed utilizing brief interventions, making their utility in helping to improve smoking cessation rates less clear.…”

Introduction to the Special Issue: Emotion Regulation as a Transdiagnostic Process

“…In this respect, Farris et al (2015) examined whether the link between emotion regulation difficulties and cigarette smoking relapse would vary as a function of past year psychopathology. Poon et al (2015) tested whether trait emotion regulation difficulties with interact with cortisol reactivity to a social stressor to predict substance abuse and symptoms of MDD and ODD.…”