Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse

Introduction: An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt. We conducted a preliminary randomized controlled trial to compare a distress tolerance (DT) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to standard smoking cessation treatment (ST).

Methods: Smokers with a history of early lapse in prior quit attempts received either DT (N = 27; nine 2-hr group and six 50-min individual sessions) or ST (N = 22; six 90-min group and one 20-min individual session), plus 8 weeks of transdermal nicotine patch.

Results: At the end of behavioral treatment, odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST (66.7% vs. 31.8%), equivalent to a medium to large effect size. Odds of abstinence for DT were still 1.73 times greater at 8 weeks, corresponding to a small to medium effect size, although neither this difference nor those at 13 and 26 weeks were statistically significant. Furthermore, of those who lapsed to smoking during the first week postquit, DT participants had over four times greater odds of abstinence than ST participants at the end of treatment. Relative to ST, DT participants also reported a larger decrease in experiential avoidance, a hypothesized DT treatment mediator, prior to quit day. The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses.

Conclusions: Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed.