Relapse Dynamics During Smoking Cessation: Recurrent Abstinence Violation Effects and Lapse-Relapse Progression
Relapse Dynamics During Smoking Cessation: Recurrent Abstinence Violation Effects and Lapse-Relapse Progression
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DOI：
10.1037/a0024451
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Wileyto, E. Paul
中科院分区：
文献类型：
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作者：
Kirchner, Thomas R.;Shiffman, Saul;Wileyto, E. Paul
戒烟是一个随时间展开的过程，其特点是断断续续。我们使用参数化复发事件生存分析来更好地理解一组禁欲违反效应（AVE, Marlatt & Gordon, 1985）对失效和随后的失效-复发进展的反应之间的动态关系。参与者是203名戒烟者，他们在近实时的总共1001次失败事件后，对AVE的三个核心组成部分（内部归因、戒烟自我效能和内疚）进行了评估。参与者第一次吸毒后的自责、自我效能感和内疚感都不能预测复发。控制他们对第一次失误的反应，对每一次失误的反应都能前瞻性地预测失误的进展，因此自我效能的下降与随后失误的加速进展有关（HR = 1.09, CI = 1.02-1.15），而内部归因的增加实际上可以防止失误（HR = 0.98, CI = 0.97-0.99）。尼古丁贴片治疗减缓了复发性失禁的进展（HR = 0.58, CI = 0.48-0.70），但这种效果在多次失禁中消散，并被失禁后内疚评分的升高所缓和（HR = 1.08, CI = 1.01-1.18），这预示着在主动贴片组中加速了失禁的进展，而在安慰剂组中则防止了失禁。结果强调了戒烟过程中过失反应的动态性质，表明自我效能预测了从一个过失到下一个过失的进展，而自责和内疚的归因以意想不到的方式影响了进展。
Smoking cessation is a process that unfolds over time and is characterized by intermittent lapses. We used parametric recurrent event survival analyses to better understand the dynamic relationship between a set of Abstinence Violation Effect (AVE, Marlatt & Gordon, 1985) responses to lapsing and subsequent lapse-relapse progression. Participants were 203 smokers who achieved abstinence and responded to items assessing three core components of the AVE (internal attribution, abstinence self-efficacy and guilt) following a total of 1,001 lapse episodes in near real time. Neither self-blame, self-efficacy, nor guilt following participants' first lapse predicted relapse. Controlling for responses to their first lapse, responses to each additional lapse did prospectively predict lapse progression, such that drops in self-efficacy were associated with accelerated progression to a subsequent lapse (HR = 1.09, CI = 1.02-1.15), while increases in internal attributions of blame actually protected against lapsing (HR = 0.98, CI = 0.97-0.99). Treatment with nicotine patches slowed recurrent lapse progression (HR = 0.58, CI = 0.48-0.70), but this effect dissipated over multiple lapses, and was moderated by elevated ratings of postlapse guilt (HR = 1.08, CI = 1.01-1.18), which predicted accelerated progression within the active patch group, while protecting against lapse in the placebo group. Results highlight the dynamic nature of lapse responses during smoking cessation, indicating that self-efficacy predicts progression from one lapse to the next, while attributions of self-blame and guilt influenced progression in unexpected ways.