Aversive cigarette smoking with an habitual, excessive smoker.

A 39-yr.-old patient was exposed to aversive cigarette smoking consisting of rapid smoking, handling of cigarette litter, and warm smoky air for 6 wk. He reduced from a baseline of 140 cigarettes per day to less than 20 at end of treatment. Follow-ups at 1, 2, 3, 6, and 9 mo. indicated a smoking rate of approximately 25% of baseline.     

The habitual consumer

Consumers sometimes act like creatures of habit, automatically repeating past behavior with little regard to current goals and valued outcomes. To explain this phenomenon, we show that habits are a specific form of automaticity in which responses are directly cued by the contexts (e.g., locations, preceding actions) that consistently covaried with past performance. Habits are prepotent responses that are quick to activate in memory over alternatives and that have a slow-to-modify memory trace. In daily life, the tendency to act on habits is compounded by everyday demands, including time pressures, distraction, and self-control depletion. However, habits are not immune to deliberative processes. Habits are learned largely as people pursue goals in daily life, and habits are broken through the strategic deployment of effortful self-control. Also, habits influence the post hoc inferences that people make about their behavior.     

Children's understanding of habitual behaviour

Research into the development of Theory of Mind (ToM) has shown how children from a very early age infer other people's goals. However, human behaviour is sometimes driven not by plans to achieve goals, but by habits, which are formed over long periods of reinforcement. Habitual and goal‐directed behaviours are often aligned with one another but can diverge when the optimal behavioural policy changes without being directly reinforced (thus specifically hobbling the habitual learning strategy). Unlike the flexibility of goal‐directed behaviour, rigid habits can cause agents to persist in behaviour that is no longer adaptive. In the current study, all children predict agents will tend to behave consistently with their goals, but between the ages of 5 and 10, children showed an increasing understanding of how habits can cause agents to persistently take suboptimal actions. These findings stand out from the typical way the development of social reasoning is examined, which instead focuses on children's increasing appreciation of how others' beliefs or expectations affect how they will act in service of their goals. The current findings show that children also learn that under certain circumstances, people's actions are suboptimal despite potentially ‘knowing better.’     

Experimental evidence for a causal relationship between smoking lapse and relapse

In this study, the authors prospectively evaluated the impact of a smoking lapse on relapse probability. After 4 days of smoking abstinence, 60 smokers were randomly assigned to smoke 5 nicotine-containing or 5 denicotinized cigarettes, or to remain abstinent (no lapse) during a 4-hr time period. Afterward, smoking abstinence was encouraged with monetary incentives, and smoking behavior was tracked for 6 days. Relative to the no-lapse condition, exposure to either of the cigarette types more than doubled the probability of subsequent smoking. Smoking outcomes did not differ between nicotine-containing and denicotinized cigarettes. The data suggest that stimulus factors may play an important role in lapse to relapse processes.     

Age and pre quit-day attrition during smoking cessation treatment

ABSTRACT

The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (M _age = 44.2 years, SD = 11.3 years; age = 22–64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.     

A short duration group treatment of smoking behavior by stimulus saturation

Two saturation procedures of different lengths were administered to Ss who desired to quit smoking. Ss chain-smoked for either 20 hr (group E₁) or 10 hr (E₂). Total abstinence was the main dependent measure. Both groups experienced relatively equal success on a short-term basis. Long-term abstinence was noted for group E₁ only. Sixty per cent of the E₁ Ss were not smoking 4 months after treatment.     

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.     

The temporal structure of goal-directed and habitual operant behavior

Operant behavior can reflect the influence of goal-directed and habitual processes. These can be distinguished by changes to response rate following devaluation of the reinforcing outcome. Whether a response is goal directed or habitual depends on whether devaluation affects response rate. Response rate can be decomposed into frequencies of bouts and pauses by analyzing the distribution of interresponse times. This study sought to characterize goal-directed and habitual behaviors in terms of bout-initiation rate, within-bout response rate, bout length, and bout duration. Data were taken from three published studies that compared sensitivity to devaluation following brief and extended training with variable-interval schedules. Analyses focused on goal-directed and habitual responding, a comparison of a habitual response to a similarly trained response that had been converted back to goal-directed status after a surprising event, and a demonstration of contextual control of habit and goal direction in the same subjects. Across experiments and despite responses being clearly distinguished as goal directed and habitual by total response rate, analyses of bout-initiation rate, within-bout rate, bout length, and bout duration did not reveal a pattern that distinguished goal-directed from habitual responding.     

The sleep-promoting behaviors of habitual short- and longer-sleeping adults

Consistent with the view that habitual longer-sleepers are more concerned with their sleep, this group (n = 25) reported engaging in twice as many sleep-promoting behaviors as a group of short-sleepers (n = 25). The longer sleepers tended to use alcohol and the short sleepers food to promote sleep.     

Implicit associations between smoking and social consequences among smokers in cessation treatment

Explicit expectations of the negative and positive social consequences of smoking are likely to have substantial influence on decisions regarding smoking. However, among smokers trying to quit, success in smoking cessation may be related not only to the content of expectancies about smoking's social effects but also to the ease with which these cognitive contents come to mind when confronted with smoking stimuli. To examine this possibility, we used the implicit association test (IAT) [Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464-1480] to assess implicit cognitive associations between smoking and negative vs. positive social consequences among 67 heavy social drinkers seeking smoking cessation treatment in a randomized clinical trial. Results showed that the relative strength of implicit, negative, social associations with smoking at baseline predicted higher odds of smoking abstinence during treatment over and above the effects of relevant explicit measures. The only variable that significantly correlated with IAT scores was the density of smokers in participants' social environment; those with more smoking in their social environment showed weaker negative social associations with smoking. Results suggest implicit cognition regarding the social consequences of smoking may be a relevant predictor of smoking cessation outcome.     

The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns

Assessed the magnitude of risk that adolescent cigarette smoking carries for adult smoking. Using a longitudinal, prospective design, results indicate that even infrequent experimentation in adolescence significantly raises the risk for adult smoking and that regular (at least monthly) adolescent smoking raises the risk for adult smoking by a factor of 16 compared to nonsmoking adolescents. Relative risk was also increased by an early onset of smoking and by a stable, uninterrupted course from experimentation to regular smoking. Relative risk did not significantly vary by age or sex. The continuity of smoking behavior between adolescence and adulthood supports the importance of primary prevention programs directed at adolescent populations.     

Acquisition of habitual visual attention and transfer to related tasks

Extensive research has shown that statistical learning affects perception, attention, and action control; however, few studies have directly linked statistical learning with the formation of habits. Evidence that learning can induce a search habit has come from location probability learning, in which people prioritize locations frequently attended to in the past. Here, using an alternating training–testing procedure, we demonstrated that the initial attentional bias arises from short-term intertrial priming, whereas probability learning takes longer to emerge, first reaching significance in covert orienting (measured by reaction times) after about 48 training trials, and in overt orienting (measured by eye movements) after about 96 training trials. We further showed that location probability learning is persistent after training is discontinued, by transferring from a letter search task to a scene search task—emulating another characteristic feature of habits. By identifying the onset of probability learning and investigating its task specificity, this study provides evidence that probability cuing can induce habitual spatial attention.     

Program adherence and coping strategies as predictors of success in a smoking treatment program

Ninety-four participants in a 6-week behaviorally oriented smoking cessation program were administered weekly questionnaires assessing their use of the major program recommendations and other quitting strategies throughout treatment. An "affect-regulation" coping inventory was administered at the beginning and end of treatment as well. Adequate adherence was reported for most of the program recommendations. Although a composite measure of adherence did not predict quitting success, adherence and coping assessments were associated with maintenance of treatment gains. Short-term maintenance was associated with an extensive affect-regulation repertoire and use of "stimulus control" strategies during the program, and long-term maintenance was associated with consistent self-monitoring of smoking during treatment. These prospective findings highlight some behavioral characteristics that may be useful targets in future efforts to foster maintenance of smoking behavior change.     

Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.