Heather CrawfordCollaborations 2009

Smith College

Prenatal exposure to nicotinePrenatal exposure to nicotineFamily history

First cigarette @ age 11Addiction developed due toAddiction developed due to

– Social factors– Friend’s mom bought me cigarettesg g

Difficulty quitting• Socioeconomic Identity!• No health coverage of treatment

The model for my quit attempt The model for my quit attempt • Theories of Reasoned Action/Planned Behavior

Attitudes• Fear of extreme or permanent cognitive deficits

Social NormsSocial Norms• Posed problems for me in the past

S lf ffi / P i d B h i l C t lSelf-efficacy/ Perceived Behavioral Control• Failure to quit →

decreased motivation

• Therefore, could it be that When Self-efficacy ↑When Self efficacy ↑ Cognitive Dissonance ↓ ?

Female smokers using active, experiential quit g p qapproach have highest quit rates and motivation to quit (Simmons & Brandon, 2007)

W iti i ki j l ti• Writing in smoking journal- active• Starting quit support group- active

Conditioning and methods focusing on social Conditioning and methods focusing on social norms and self-esteem more effective than drug therapy (Viswesvaran & Schmidt)

S i f i i i i• Some mindfulness techniques = conditioning• Quit support group = social norms• Journal writing can ↑ self-esteem

Exercise decreases symptoms of y pwithdrawal (Daniel, Cropley, Ussher, & West, 2003)

• Self-paced walking and swimming M h l / l k f i h i• May help w/ lack of energy, weight gain

Smoking related to poorer auditory attention performance (Jacobsen, Picciotto, Heath, et al, 2007)al, 2007)

• Cognitive affirmations

I hypothesize that by using experiential yp y g pstrategies, I could reach short and long term goals by reducing the amount of cigarettes I smoke by 1 cigarette every 3 days

• Short Term Goal • Short Term Goal cut down on smoking reduce withdrawal symptoms

• Long Term Goal eventually quit smoking cigarettes completelyy q g g p y

Social supportpp• Asked friends and family to help• Quit support group

S ki j l d IQ b ildSmoking journal and IQ builders• Daily in the AM

Taking itaminsTaking vitamins• Daily in the AM

ExerciseExercise• Every other day

Cognitive affirmations (PRN)Cognitive affirmations (PRN)Mindfulness techniques (PRN)

Three stages, each one weekg• Observation period Research smoking cessation theory/methods Start smoking journal w/out cutting down

• Intervention period• Intervention period Reduced cig’s by 1 every 3 days, starting at the mean

# of cigarettes smoked during observation period

• A post-intervention periodContinue intervention and reflect so far on progress Continue intervention and reflect so far on progress and strategies being used

Mental InterventionsMental Interventions• IQ builders, crossword puzzles, smoking journal,

cognitive affirmations, conditioning, mindfulness cognitive affirmations, conditioning, mindfulness techniques

Physical Interventions• Exercising, breathing exercises, and taking

vitamins

… because nicotine addiction is both iphysical and mental!

Number of Cigarettes Smoked DailyNumber of Cigarettes Smoked Daily

Day Observation Period Intervention Period Post‐Interven. Period

Wednesday 13 6 7

Thursday 11 16 16

F id 15 13 16Friday 15 13 16

Saturday 14 7 13

Sunday 10 13 15

Monday 10 8 19

Tuesday 19 7 13

M (SD) 13 (3) 10 (3 62) 14 (3 48)Mean (SD) 13 (3) 10 (3.62) 14 (3.48)

Median 13 8 15

Success… at least at first!Success… at least at first!• Cut down by 5 cigarettes a day instead of 3

Rebound effect during post-intervention• Smoked more during this period than initially!g p y Possibly due to time confound

V i bilit ↑ ti !Variability ↑ over time!

Ni i Wi hd l R b d Eff !Nicotine Withdrawal Rebound Effect!

Most noticeable symptoms experiencedMost noticeable symptoms experienced• Affective• Cognitive g• Physical

Impossible to know if I was experiencing withdrawal symptoms or reacting normally

Contributions to initial strong effect and then rebound effect

• Timing• Timing

• Pace! Cut down too fast→ more withdrawal symptoms → feeling overwhelmed→ backlash effect→ backlash effect

• Didn’t prepare prior to quit date

Some days easier than othersSome days easier than others• Variability and outliersDeviation from the quit planq pseemed positive at first

Then, led to Confusion Confusion Self-efficacy and personal control ↓Withdrawal symptoms ↑

Hard to come up with specific ways to attack attitudes social norms and self efficacyattitudes, social norms, and self-efficacy

Cognitive Affirmations • Seemed cancelled out by withdrawal symptoms

affecting mood and cognition

Smoking journal • Helped but itself frustrating

Social Norm intervention to just stay away from people who smokep p• Catch 22

Too many interventionsToo many interventions• Confusing, time consuming, overwhelming

Longer Observation Period More accurate Buy all needed supplies beforehand Plan it on usual, busy week Start vitamin/exercise regimes and support group 2 weeks Start vitamin/exercise regimes and support group 2 weeks

prior to quitting

Increase amount of days by which I cut down by y y yone cigarette (slower pace) Every 5 days instead of 3 OR once a week

C t ifi it ti l t f Create specific, situational ways to focus on attitudes and social norms

O ll t l i i ! Overall, a great learning experience!

Daniel, J., Cropley, M., Ussher, M., & West, R. (2003). Acute effects of a short bout of moderate versus light intensity exercise versus inactivity on bout of moderate versus light intensity exercise versus inactivity on tobacco withdrawal symptoms in sedentary smokers. Psychopharmacology, 174 (3), 320-326.

Jacobsen, L.K., Picciotto, M.R., Heath, C.J., et al (2007). Prenatal and adolescent exposure to tobacco smoke modulates the development of adolescent exposure to tobacco smoke modulates the development of white matter microstructure. The Journal of Neuroscience, 27 (39).

Sanderson, C.A. (2004). Health Psychology, 3, 65-69.Simmons, V.N., Brandon, T.H. (2007). Secondary smoking prevention in a

University setting: A randomized comparison of an experiential theoryUniversity setting: A randomized comparison of an experiential, theory-based intervention and a standard didactic intervention for increasing cessation motivation. Health Psychology, 26 (3), 268-277.

Thun, M.J., Day-Lally, C.A., Calle, E.E., Flanders, W.D., & Heath, C.W. (1995). Excess mortality among cigarette smokers: Changes in a 20 year interval Excess mortality among cigarette smokers: Changes in a 20-year interval. American Journal of Public Health, 85, 1223-1230.

Viswesvaran, C., Schmidt, F.L. (1992). A meta-analytic comparison of the effectiveness of smoking cessation methods. Journal of Applied Psychology, 77 (4) 554 56177 (4), 554-561.

Rude Awakening Ashtrayg y