Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations

In this article, the authors assessed whether continuously scaled symptom parameters derived from growth models (T. M. Piasecki et al., 2003) are linked to smoking at long-term follow-up by using data from a large-scale clinical trial (N = 893). Results revealed that higher withdrawal intercepts, positive linear slopes, and greater volatility were all positively associated with relapse, and cigarette coefficients (indicating smoking-induced withdrawal reduction) were negatively related to relapse. In models keyed around the first lapse to smoking, those destined to lapse reported more severe withdrawal during abstinence, and withdrawal patterns discriminated groups defined according to lapse duration. The findings complement earlier heterogeneity studies in implicating the pattern of changing withdrawal symptoms over time as a factor strongly associated with smoking relapse.     

Smoking withdrawal dynamics in unaided quitters

Considerable research shows that withdrawal severity is inconsistently related to smoking cessation outcomes. This may result from measurement problems or failure to scrutinize important dimensions of the withdrawal experience. Two recent studies demonstrated that withdrawal elevation and variations in the time course of withdrawal were related to relapse in smokers treated with the nicotine patch (T. M. Piasecki, M. C. Fiore, & T. B. Baker, 1998). This article reports a conceptual replication and extension of those findings in unaided quitters. Evidence for temporal heterogeneity was found across different types of withdrawal symptoms. Patterns or slopes of affect and urge reports over time predicted smoking status at follow-up, as did mean elevation in withdrawal symptoms. These results suggest that affect and urge withdrawal symptoms make independent contributions to relapse and that relapse is related to both symptom severity and trajectory.     

Life before and after quitting smoking: an electronic diary study

This article describes a multidimensional, multivariate, and multilevel approach to the assessment of nicotine withdrawal. In this prospective study, 70 adult smokers assigned to an active or placebo nicotine patch condition completed multiple daily assessments using an electronic diary. Average and individual growth curves were estimated for affective and nonaffective withdrawal symptoms. All symptoms but hunger increased significantly on the quit day and remained elevated for three weeks. Variability in symptom experiences across individuals increased from pre- to post-quit. Relations between symptom reports (e.g., negative affect or craving) and episodic events (e.g., stressful events or seeing someone smoke) changed from pre-quit to post-quit. Pre-quit increases in negative affect and quit-day increases in craving were inversely related to abstinence three months after the quit day, suggesting that anticipatory and immediate reactions to quitting influence success.     

Rumination and symptom reports in children and adolescents: Results of a cross-sectional and experimental study

This study explores the relationship between a ruminative response style and symptom reports in children and adolescents of grades 5, 7 and 9 from German secondary schools. Questionnaires were used to assess rumination and symptom reports. A group of children and adolescents (N?=?140) were asked to think first about the items before responding to them (increased attention condition), while a second group (N?=?260) served as control group (standard condition). The assumption was that rumination and also additional attention to the symptoms by instruction would increase the reported frequency of experiencing somatic and psychological symptoms. The results showed significant relations between symptom reports and rumination, which increased with grade. There were sex differences for somatic symptom reports with increased symptom frequencies in girls, which were mediated by rumination. Moreover, instructing participants to think first about the items led to an increase in reported symptoms. It is concluded that an increased attention to symptoms of distress increases symptom reports, which may be induced momentarily by instruction and also more generally by a ruminative response style. Conclusions regarding prevention and concerning instructions in symptom report questionnaires are outlined.     

Dramatic-erratic personality disorder symptoms: I. Continuity from early adolescence into adulthood

This longitudinal study examined dramatic-erratic personality disorder symptoms (histrionic, borderline, and narcissistic symptoms) in a community sample of 407 adolescents to assess whether this diagnostic construct is meaningful in young people. Based on latent variable models and dimensional symptom scales, these so-called Cluster B symptoms were highly stable across an eight-year interval from early adolescence to early adulthood. Furthermore, when compared with internalizing and externalizing symptoms, dramatic-erratic symptoms were more stable over time than these well-established Axis I symptom clusters. Based on high correlations with co-occurring internalizing and externalizing symptoms, Cluster B symptoms clearly reflect emotional distress during adolescence. These analyses reinforce recent efforts to establish personality disorders as a clinically significant and valid diagnostic construct in young people.     

Early cessation success or failure among women attempting to quit smoking: trajectories and volatility of urge and negative mood during the first postcessation week

Aversive symptoms of abstinence from nicotine have been posited to lead to smoking relapse and research on temporal patterns of abstinence symptoms confirms this assumption. However, little is known about the association of symptom trajectories early after quitting with postcessation smoking or about the differential effects of tonic (background) versus phasic (temptation-related) symptom trajectories on smoking status. The current study examined trajectories of urge and negative mood among 300 women using the nicotine patch during the first postcessation week. Ecological momentary assessments collected randomly and during temptation episodes were analyzed using hierarchical linear modeling yielding four individual trajectory parameters: intercept (initial symptom level), linear slope (direction and rate of change), quadratic coefficient (curvature), and volatility (scatter). Early lapsers, who lapsed during the first postcessation week, exhibited more severe tonic urge and phasic negative mood immediately after quitting, and more volatile tonic and phasic urge compared to abstainers. Late lapsers, who were abstinent during the first week but lapsed by 1 month, exhibited more severe tonic urge immediately after quitting compared to abstainers. These results demonstrate the importance of early postcessation urge and negative affect and highlight the value of examining both tonic and phasic effects of abstinence from nicotine.     

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders.

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.     

Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

The Conners' Continuous Performance Test (CPT) is a neuropsychological task that has repeatedly been shown to differentiate ADHD from normal groups. Several variables may be derived from the Conners' CPT including errors of omission and commission, mean hit reaction time(RT), mean hit RT standard error, d', and . What each CPT parameter actually assesses has largely been based upon clinical assumptions and the face validity of each measure (e.g., omission errors measure inattention, commission errors measure impulsivity). This study attempts to examine relations between various CPT variables and phenotypic behaviors so as to better understand the various CPT variables. An epidemiological sample of 817 children was administered the Conners' CPT. Diagnostic interviews were conducted with parents to determine ADHD symptom profiles for all children. Children diagnosed with ADHD had more variable RTs, made more errors of commission and omission, and demonstrated poorer perceptual sensitivity than nondiagnosed children. Regarding specific symptoms, generalized estimating equations (GEE) and ANCOVAs were conducted to determine specific relationships between the 18 DSM-IV ADHD symptoms and 6 CPT parameters. CPT performance measures demonstrated significant relationships to ADHD symptoms but did not demonstrate symptom domain specificity according to a priori assumptions. Overall performance on the two signal detection measures, d' and , was highly related to all ADHD symptoms across symptom domains. Further, increased variability in RTs over time was related to most ADHD symptoms. Finally, it appears that at least 1 CPT variable, mean hit RT, is minimally related to ADHD symptoms as a whole, but does demonstrate some specificity in its link with symptoms of hyperactivity.     

Social learning influences on menstrual symptoms and illness behavior

The contribution of learning to the adult experience of illness was investigated by asking 351 nursing students how their mothers reacted to menstrual symptoms and cold symptoms during their adolescence and how their mothers behaved when they themselves had menstrual symptoms. Mothers of respondents were independently asked the same questions. Nursing students who had been encouraged to adopt a sick role for menses or whose mothers modeled menstrual distress reported significantly more menstrual symptoms, clinic visits, and disability days for these symptoms as adults. Similarly, those encouraged to adopt a sick role for colds or who lived with a chronically ill person reported more clinic visits and disability days for nongynecological symptoms. Specific types of symptom reports and health care appeared to be learned: Encouragement and modeling of the menstrual sick role were more highly correlated with symptom reports, clinic visits, and absenteeism for menstrual than for nongynecological symptoms, and encouragement of the cold sick role was more highly correlated with nongynecological than with menstrual clinic visits and absenteeism.     

The Accuracy of Retrospective Recall of Childhood ADHD: Results from a Longitudinal Study

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset condition that may continue into adulthood. When assessing adult patients, clinicians usually rely on retrospective reports of childhood symptoms to evaluate the age-of-onset criterion. Since inaccurate symptom recall may impede the diagnosis and treatment of ADHD, knowledge about the factors influencing retrospective reports is needed. This longitudinal study investigated (a) the accuracy of retrospective symptom ratings by adult participants with a childhood diagnosis of ADHD (self-ratings) and parents or significant others (proxy ratings), and (b) the influence of current ADHD symptom severity and ADHD-associated impairments on retrospective symptom ratings. Participants (N =?55) were members of the Cologne Adaptive Multimodal Treatment (CAMT) study who had been referred and treated for ADHD in childhood and were reassessed in adulthood (average age 27 years). Participants’ retrospective self-ratings were substantially lower than, and did not correlate with, parents’ ADHD symptom ratings provided at study entry, while retrospective symptom ratings provided by proxy respondents correlated moderately with parents’ childhood ratings. In addition, participants were more likely to underreport childhood symptoms (79%) and more frequently denied the presence of three or more childhood symptoms (17%) compared to proxy respondents (65% underreporting, 10% false-negative recall). Proxy respondents’ symptom recall was best predicted by childhood ADHD, while participants’ symptom recall was best predicted by current ADHD symptom severity. ADHD-associated impairments were not correlated with symptom recall after controlling for childhood ADHD. Together, these findings suggest a recall bias in adult patients and question the validity of retrospective reports, even in clinical samples.

     

Assessing inattention and impulsivity in children during the Go/NoGo task

Behavioural performance in the Go/NoGo task was compared with caregiver and teacher reports of inattention and hyperactivity‐impulsivity in 1,151 children (N=557 boys; N=594 girls) age 9–10 years old. Errors of commission (NoGo errors) were significantly correlated with symptom counts of hyperactivity‐impulsivity, while errors of omission (Go errors) were significantly correlated with symptom counts for inattention in both caregiver and teacher reports. Cross‐correlations were also evident, however, such that errors of commission were related to inattention symptoms, and errors of omission were related to hyperactivity‐impulsivity. Moreover, hyperactivity‐impulsivity and inattention symptoms were highly intercorrelated in both caregiver (r=.52) and teacher reports (r=.70), while errors of commission and omission were virtually uncorrelated in the Go/NoGo task (r=.06). The results highlight the difficulty in disentangling hyperactivity‐impulsivity and inattention in questionnaires, and suggest that these constructs may be more clearly distinguished in laboratory measures such as the Go/NoGo task.     

A multimethod examination of the stability of depressive symptoms in childhood and adolescence

In an 8-wave, 2-cohort longitudinal study, children and adolescents were followed from the fall of 5th grade to the spring of 8th grade. Participants (N = 1,269), their parents, and peers completed reports of depressive symptoms at 6-month intervals. The use of a 2-group latent variable autoregressive model to examine the stability of depressive symptomatology revealed several trends. First, the 6-month stability of depressive symptoms was high for boys and girls. Second, the stability of depressive symptomatology was lower between the spring of 6th grade and the fall of 7th grade than during any other point in the study. Finally, the stability of depressive symptoms did not differ with respect to gender.     

Neuroticism and selective encoding and recall of symptoms: evidence from a combined concurrent-retrospective study.

The association between Neuroticism (N) and elevated symptom reporting has been attributed to differences in the encoding but not in the recall of illness episodes. If high-N persons are selective only at the encoding of illness information, then retrospective reports should be no more exaggerated than concurrent reports. This study uses a concurrent-retrospective design to examine selectivity in concurrent and retrospective reports of symptoms. Concurrent daily reports gathered over 2 months were only moderately correlated with retrospective symptom reports covering the same time period. The direct path from N to recalled symptoms was larger than the indirect path from N through concurrent to recalled symptoms for 3 out of 4 symptoms. Discussion concerns implications of using recollection-based measures, suggestions for reducing selective memory effects, and explanations regarding how and why N relates to selective information processing about the self.     

How benefits of expressive writing vary as a function of writing instructions,ethnicity and ambivalence over emotional expression

Written emotional disclosure has been reported to confer a variety of benefits on physical and psychological well-being. However, variable findings suggest that outcomes may vary systematically as a function of specific parameters of the experimental design. This study aims to investigate the unique and combined effects of disclosure instructions focusing on emotional expression and instructions facilitating cognitive reappraisal and to examine how ambivalence over emotional expression and ethnicity moderate the effects of these writing instructions. Seventy-one Asian and 59 Caucasian undergraduates (N = 130) with at least minimal physical or depressive symptoms were randomly assigned to one of the four writing conditions: emotional disclosure (ED), cognitive reappraisal (COG), the combination of ED and COG, or a control condition. Self-reported physical symptoms, positive affect (PA) and negative affect were assessed at baseline and three follow-ups spanning 4 months. Mixed linear models revealed that COG writing reduced physical symptoms, ED buffered a decrease in PA over time, and the combination of ED and COG (i.e. self-regulation; SR) was most effective. Asians and highly ambivalent participants benefited most from expressive writing. Findings contribute to the development of a SR moderator model and carry implications for designing expressive disclosure studies, particularly for ethnic minorities.     

The symptom perception hypothesis revised: depression and anxiety play different roles in concurrent and retrospective physical symptom reporting

According to the classic symptom perception hypothesis (Costa & McCrae, 1987; Watson & Pennebaker, 1989), the global predisposition to frequently experience a variety of negative emotions-that is, neuroticism (N) or trait negative affectivity (NA)-is associated with inflated physical symptom reporting. We tested a revision of this hypothesis, which posits distinctive roles for depression and anxiety in the physical symptom experience. Three studies tested predictions from the revised symptom perception hypothesis: (a) that depressive affect should be related to inflated retrospective physical symptom reports and (b) that anxious affect should be related to inflated concurrent, or momentary, physical symptom reports. Study 1 assessed the relations among N/NA, depressive affect, and recall of physical symptoms experienced in the previous 3 weeks. Depressive affect was uniquely and positively associated with recalling more symptoms. When entered with depressive affect in multiple regression analyses, neuroticism was not associated with level of symptoms recalled. In Study 2, participants were randomly assigned to anxious, depressed, angry, happy, or neutral mood inductions and then reported about concurrent symptom experience. Participants in the anxious mood condition reported significantly more concurrent physical symptoms than did those in the other 4 conditions. In Study 3, anxious, depressed, or neutral mood was induced, followed by assessment of both concurrent and retrospective physical symptoms. Those assigned to the anxious mood induction reported more concurrent symptoms, while those in the depressed mood condition reported having experienced more symptoms in the past. These findings are consistent with the idea that encoding and retrieval processes, which are differentially associated with anxious versus depressed affect, influence different aspects of physical symptom reporting. The results have implications for self-diagnosis, medical treatment-seeking, and care, and potential insights about other complex social and interpersonal behaviors are discussed.     

Psychiatric Symptom Impairment in Children with Autism Spectrum Disorders

The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6–12 year old children with ASD (N?=?115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents’ and teachers’ ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.     

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.     

Posttraumatic stress disorder's frequency and intensity ratings are associated with factor structure differences in military veterans

We examined possible differences in the factor structure of posttraumatic stress disorder (PTSD) on the basis of whether frequency or intensity symptom response formats were used to assess PTSD. Participants included 669 veterans recruited from an epidemiological study of four Veterans Affairs Medical Centers' primary care clinics in the southeastern United States. Confirmatory factor analysis using measurement invariance testing found that the frequency and intensity symptom formats were significantly different from each other on PTSD's factor structure parameters, including factor loadings, observed variable intercepts, and measurement errors. The only exception was for PTSD's effortful avoidance symptoms, which were associated with equivalent parameter estimates for both the frequency and intensity formats. Implications for the clinical assessment of PTSD and interpretation of the extant literature base on PTSD's factor structure are considered.     

Dynamic effects of self-efficacy on smoking lapse and relapse.

Self-efficacy (SE) is thought to be critical to success in smoking cessation both as an individual difference and as a dynamic process after a quit attempt. In this study, 214 smokers used palm-top computers to record day-to-day variations in SE during 4 weeks after quitting. SE remained at high and stable levels prior to a 1st lapse but decreased and became more variable thereafter. The authors used event history models with time-varying covariates to assess the effect of daily SE on lapse and relapse risk. Daily SE measures predicted an initial lapse on the subsequent day. However, this relationship was accounted for by stable baseline differences in SE (assessed by questionnaire), rather than by day-to-day dynamics in SE. Progression from 1st lapse to relapse was also examined. In this instance, daily SE predicted subsequent relapse risk, even when baseline SE and concurrent smoking were accounted for, suggesting the importance of SE dynamics for this stage of the relapse process.     

LISTENING TO NICOTINE:

Abstract— In recent years, theoretical models of drug motivation and drug dependence have downplayed the role of withdrawal symptoms in the maintenance of addiction. During this same period, strong links between drug use and measures of negative affect have been uncovered in empirical research. In this article we examine these trends in the context of research on smoking. Evidence is presented from two recent studies on smoking relapse that highlight the intimate connection between withdrawal symptomatology and negative affect Specifically, these studies reveal that (a) single-occasion measures of withdrawal symptoms or other markers of physical dependence do not contribute incremental validity in preceding relapse relative to measures of negative affect (b) the trajectory of withdrawal symptoms is highly idiosyncratic, (c) exacerbations cannot be tightly coupled with pharmacological events. (d) the temporal dynamics of withdrawal reflect fluctuations in negative affect, and (e) differences in the trajectory of withdrawal symptoms index relapse vulnerability. We conclude that a broadened view of withdrawal recognizing its probable affective bases will enhance its explanatory power and suggest new treatment strategies.