اثر استراتژی های تنظیم احساسات بر شدت ولع مصرف مصرف سیگار، تعصب توجه و تداوم کار
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34936||2012||8 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 50, Issue 5, May 2012, Pages 333–340
The goal of this study was to investigate the effects of different strategies for regulating emotions associated with smoking on subjective, cognitive, and behavioral correlates of smoking. Emotion regulation was manipulated by instructing participants to reappraise (n = 32), accept (n = 31), or suppress (n = 31) their emotions associated with smoking. The dependent measures included subjective reports of craving, negative affect, and attentional biases, as measured by a modified dot-probe task, and persistence during a task to measure distress tolerance. Individuals who were encouraged to reappraise the consequences of smoking showed diminished craving, lower negative affect, had reduced attentional biases for smoking-related cues, and exhibited greater task persistence than those who were instructed to accept and suppress their urge to smoke. These findings suggest that reappraisal techniques are more effective than acceptance or suppression strategies for targeting smoking-related problems.
Cigarette smoking is a common and serious health problem, with craving being an important reason for the maintenance of this problem. In fact, between 85% and 95% of people resume smoking within 12 months without a formal intervention (Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992). Of those who did receive treatment, more than 75% resume smoking within 6 months (Ferguson, Bauld, Chesterman, & Judge, 2005), possibly due to an inability to tolerate the distress of nicotine withdrawal and associated negative affect and craving (Brown, Lejuez, Kahler, Strong, & Zvolensky, 2005; see also Hajek, Stead, West, Jarvis, & Lancester, 2009, pp. 1–91). At the same time, treatments that specifically target craving are more effective than those that do not (McDonald, Colwell, Husten, & Maule, 2003; Piasecki & Baker, 2001; Shiffman, 1993). Craving is an affective state that reflects the activation of motivational and drug-acquisitive systems that are associated with specific subjective, behavioral, physiological and cognitive correlates (Baker, Morse, & Sherman, 1987; Sayette, Martin, Hull, Wertz, & Perrot, 2003). Craving is likely to arise when substance users are exposed to substance-related cues (Baker et al., 1987; Carter & Tiffany, 1999; Perkins, Epstein, Grobe, & Fonte, 1994). Furthermore, craving and the negative affect associated with nicotine withdrawal have been shown to predict future relapse (DiFranza & Wellman, 2005; Doherty, Kinnunen, Militello, & Garvey, 1995; Orleans, Rimer, Cristinzio, Keintz, & Fleisher, 1991). These motivational and cognitive aspects of drug use are strongly coupled in active smokers, but become uncoupled in individuals who are trying to quit (Tiffany, 1990). Closely associated with craving are attentional biases toward drug cues (Bradley, Field, Mogg, & De Houwer, 2004; Chanon, Sours, & Boettiger, 2010; Ehrman et al., 2002; Field & Cox, 2008; Franken, Kroon, Wiers, & Jansen, 2000; Mogg, Bradley, Field, & De Houwer, 2003). It has been suggested that craving can enhance these attentional biases toward substance-related cues, which may then further increase craving (Field & Cox, 2008) and the likelihood of relapse (Cox and Klinger, 1988 and Cox and Klinger, 2004; Field & Cox, 2008; Franken, 2003; Kavangh, Andrade, & May, 2005). Other studies, however, suggest that attentional biases for substance-related cues are only weakly associated with current substance craving level (Field, Munafo, & Franken, 2009). Reducing craving and cigarette smoking can be effectively approached by employing cognitive regulation strategies, suggesting that cognitive down-regulation of craving involves neural dynamics parallel to those involved in emotion regulation in particular and cognitive control in general (Delgado, Gillis, & Phelps, 2008; Kober, Mende-Siedlecki, Kross, Weber, Mischel, Hart, & Ochsner, 2010). For example, it has been shown that cigarette craving can be significantly reduced when participants were asked to focus on the long-term negative consequences associated with smoking (Kober, Kross, Mischel, Hart, & Ochsner, 2010). When trying to quit, smokers typically experience several nicotine withdrawal symptoms associated with significant physical and psychological discomfort (Hughes, Higgins, & Hatsukami, 1990). This often increases the likelihood of early relapse in an attempt to avoid or escape these distressing symptoms (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004; Brown, Lejuez, Kahler, & Strong, 2002; Brown et al., 2005). Therefore, successful smoking cessation will require distress tolerance and persistence (Brown et al., 2005). This is also evident in smoking-unrelated tasks, because persistence across various behavioral tasks (e.g., mirror tracing, paced auditory serial addition) is related to length of abstinence from cigarette smoking (Brandon et al., 2003; Brown, et al., 2002). For example, a study by Brown et al. (2002) showed that smokers who were abstinent for 3 months were more persistent on these tasks than those who had never quit. There is further evidence to suggest that cognitions can influence the task persistence that is necessary for successful cessation. Consistent with the general emotion regulation literature (e.g., Bargh & Williams, 2007; Gross, 1998 and Gross, 2002; Gross & John, 2003; Gross & Thompson, 2007; Hofmann et al., (inpress) and Hofmann et al., 2010Ochsner & Gross, 2008) and recent literature on emotion regulation in other addictive behaviors (Berking et al., 2011), the experience of craving and negative affect following withdrawal can be down-regulated through cognitive strategies. According to the emotion-generative process model by Gross et al. (Gross, 1998 and Gross, 2002; Gross & John, 2003), emotions can be regulated by either manipulating the input to the system (antecedent-focused emotion regulation) or by manipulating the output of the regulation process (response-focused emotion regulation). Cognitive reappraisal techniques are in line with antecedent-focused strategies and are routinely applied in cognitive-behavioral therapy (CBT), whereas suppression or acceptance strategies may be conceived as response-focused strategies (Hofmann & Asmundson, 2008; Hofmann, Asmundson, & Beck, in press). Acceptance techniques are a feature of Acceptance and Commitment Therapy (ACT; Hayes, Strohsahl, & Wilson, 1999) and involve active acceptance of private events without attempts to change them. Based on this model, maladaptive behaviors associated with substance use disorders are maintained through negative reinforcement by the temporary relief they provide from uncomfortable sensations, thoughts, or emotions (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Consistent with this approach, Bowen and Marlatt (2009) compared the effect of mindfulness-based “urge-surfing” instructions to naturally-used coping techniques on negative affect, smoking-related urges and behavior in undergraduate smokers. No significant differences in smoking urges were found, but results indicated that frequency of smoking cigarettes decreased over a 7-day follow-up period in the mindfulness group compared to the control group (Bowen & Marlatt, 2009). Another study expanded these findings by including a suppression-instructed group (Rogojanski, Vettese, & Antony, 2011). Participants in both the mindfulness-based and suppression conditions reported significant reductions in amount of smoking and increased self-efficacy in coping with smoking urges, but only participants in the mindfulness group reported beneficial effects on nicotine dependence and emotional functioning at the 7-day follow-up. Frequent use of suppression was also found to be associated with longer smoking history and greater attentional bias to smoking cues on an Emotional Stroop Task, compared to frequent use of reappraisal, which was found to be associated with lower expectancies that smoking alleviates unpleasant feelings, greater positive mood, and fewer depressive symptoms (Fucito, Juliano, & Toll, 2010). Several laboratory experiments have compared reappraisal techniques and suppression strategies in regulating negative emotions (Gross, 2002; Gross & John, 2003; Hofmann, Heering, Sawyer, & Asnaani, 2009; Szasz, Szentagotai, & Hofmann, 2011). These studies have shown that suppression is typically associated with greater physiological arousal and negative affective consequences than reappraisal strategies. Several studies have also shown acceptance strategies are more effective at moderating distress in patients with panic attacks (Eifert & Heffner, 2003) and other individuals with clinical anxiety or depression (Campbell-Sills et al., 2006a and Campbell-Sills et al., 2006b) than attempts to suppress emotions. The goal of this study was to examine the comparative effects of reappraisal, acceptance, and suppression strategies for regulating emotions associated with smoking on the subjective, cognitive, and behavioral correlates of smoking. Based on the existing literature, we predicted that suppression will be associated with the most craving, higher levels of negative affect, greater attentional bias to smoking cues in a dot-probe task, and diminished persistence during a mentally challenging task. The cognitive model further predicts that reappraising the consequences of smoking is associated with the least craving, negative affect, attentional biases to smoking cues, and the longest task persistence of a distressing task. In contrast, an acceptance-based model predicts that acceptance is associated with the least craving, negative affect, attentional biases to smoking cues, and longest task persistence.