Anger Management and Stress Control for Smoking Cessation
Anger Management and Stress Control for Smoking Cessation
Purpose: The purpose of this study was to investigate the effects of a cognitive behavioral therapy–oriented anger management and stress control program on smokers' quit rates.
Methods: Of 2348 smokers, 350 were randomly allocated into study and control groups (n = 175 each). An individualized therapy cessation technique was selected for each participant (combination of behavioral counseling, nicotine replacement therapy, and/or pharmacotherapy). The participants in the control group attended a standard quit program, whereas the study group also received an additional 5-session (90 minutes each) cognitive behavioral therapy–oriented program aimed at improving their anger and stress coping skills. At the beginning of the study, both groups were asked to complete the Trait Anger Scale (TAS) of the State and Trait Anger Scale and the Self-Confident (SCS) and Hopeless (HS) subscales of the Stress Coping Styles Inventory; pretest smoking status of both groups and their coping skills were compared with each other as soon as the program ended (post-test results) and after 3 and 6 months (first and second follow-up tests).
Results: Although there was no difference between pretest scores on the TAS (P = .234), SCS (P = .130), and HS (P = .148) subscales, post-test results indicate that the study groups' TAS and HS scores decreased and SCS scores increased (P < .001), whereas there was no change in the control group (P > .05). The study group had a better quit level after 6 months compared with the control group (44% vs 27.4%; P < .001). The anger management and stress control program was found to have a significant effect on cessation (odds ratio, 2.09; 95% confidence interval, 1.14–3.85).
Conclusion: The anger and stress coping skills program may increase the success of quitting smoking.
The importance and effectiveness of primary care interventions in preventing smoking are well known. As part of health promotion activities, one priority has been to increase the success rates of smoking cessation. However, up to 75% of smokers start to smoke again within 6 months, even though they receive behavioral support, nicotine replacement therapy (NRT), or drugs (bupropion or varenicline). Many studies have been performed to understand the interacting physiological and psychological factors involved in relapse. Some sociodemographic risk factors (sex, education level, marital status, living alone, and income) have been identified. Nicotine—a very potent psychological and neurological stimulant that influences behaviors, emotions, and mood—is implicated as the main factor responsible for initiation, maintenance, and relapse in terms of smoking. In recent years a strong relation between anger, stress, and smoking has been noticed. Smokers report that they smoke more when they are stressed, angry, anxious, or sad and that they expect that smoking will alleviate these negative moods. There is strong evidence that nicotine reduces emotions of stress and anger because deprivation causes increases in feelings of anger and stress, despite whether they are amplified by other distressing withdrawal symptoms. Several different interacting models, such as a direct effects mechanism (opioid and reward pathway models) and moderator (restoration of homeostasis model) and mediator effects [situation by trait adaptive response (STAR) model] have been investigated to explain the relation between nicotine, stress, and anger.
Despite all the evidence concerning the relationship between smoking, anger, and stress, the effect of this relationship on relapse is not well documented. Some recent studies noted that individuals with high levels of trait anger and stress are more prone to start smoking again. More recent studies revealed that smokers with insufficient anger management and stress control skills are more vulnerable to relapse. These data reflect the importance of effective anger management and stress control skills in dealing with nicotine abstinence and successful maintenance of quitting smoking. Support for anger and stress is used in many quit-smoking counseling activities. These activities, however, do not address the actual problem. Without improved anger management and stress control skills, smokers who have since quit are at a high risk of relapse in the face of adverse daily life experiences (which may cause high levels of anger and stress) whenever they need the support previously provided by smoking. Anger management and stress control skills are regarded as being in the main domains of emotional intelligence and can be upgraded and promoted with proper cognitive behavioral approaches. It would, therefore, be a logical assumption that improving these skills results in an increase in smokers' quit rates, which may help them to avoid relapse, not only in the short term but also in the mid-term. To test this hypothesis, we designed a 5-session anger management and stress control program to promote these skills in smokers who are willing and ready to quit. This study investigates the effect of a cognitive behavior—oriented anger management and control program designed to be applied in primary care settings dealing with quit-smoking activities to increase quit rates.
Abstract and Introduction
Abstract
Purpose: The purpose of this study was to investigate the effects of a cognitive behavioral therapy–oriented anger management and stress control program on smokers' quit rates.
Methods: Of 2348 smokers, 350 were randomly allocated into study and control groups (n = 175 each). An individualized therapy cessation technique was selected for each participant (combination of behavioral counseling, nicotine replacement therapy, and/or pharmacotherapy). The participants in the control group attended a standard quit program, whereas the study group also received an additional 5-session (90 minutes each) cognitive behavioral therapy–oriented program aimed at improving their anger and stress coping skills. At the beginning of the study, both groups were asked to complete the Trait Anger Scale (TAS) of the State and Trait Anger Scale and the Self-Confident (SCS) and Hopeless (HS) subscales of the Stress Coping Styles Inventory; pretest smoking status of both groups and their coping skills were compared with each other as soon as the program ended (post-test results) and after 3 and 6 months (first and second follow-up tests).
Results: Although there was no difference between pretest scores on the TAS (P = .234), SCS (P = .130), and HS (P = .148) subscales, post-test results indicate that the study groups' TAS and HS scores decreased and SCS scores increased (P < .001), whereas there was no change in the control group (P > .05). The study group had a better quit level after 6 months compared with the control group (44% vs 27.4%; P < .001). The anger management and stress control program was found to have a significant effect on cessation (odds ratio, 2.09; 95% confidence interval, 1.14–3.85).
Conclusion: The anger and stress coping skills program may increase the success of quitting smoking.
Introduction
The importance and effectiveness of primary care interventions in preventing smoking are well known. As part of health promotion activities, one priority has been to increase the success rates of smoking cessation. However, up to 75% of smokers start to smoke again within 6 months, even though they receive behavioral support, nicotine replacement therapy (NRT), or drugs (bupropion or varenicline). Many studies have been performed to understand the interacting physiological and psychological factors involved in relapse. Some sociodemographic risk factors (sex, education level, marital status, living alone, and income) have been identified. Nicotine—a very potent psychological and neurological stimulant that influences behaviors, emotions, and mood—is implicated as the main factor responsible for initiation, maintenance, and relapse in terms of smoking. In recent years a strong relation between anger, stress, and smoking has been noticed. Smokers report that they smoke more when they are stressed, angry, anxious, or sad and that they expect that smoking will alleviate these negative moods. There is strong evidence that nicotine reduces emotions of stress and anger because deprivation causes increases in feelings of anger and stress, despite whether they are amplified by other distressing withdrawal symptoms. Several different interacting models, such as a direct effects mechanism (opioid and reward pathway models) and moderator (restoration of homeostasis model) and mediator effects [situation by trait adaptive response (STAR) model] have been investigated to explain the relation between nicotine, stress, and anger.
Despite all the evidence concerning the relationship between smoking, anger, and stress, the effect of this relationship on relapse is not well documented. Some recent studies noted that individuals with high levels of trait anger and stress are more prone to start smoking again. More recent studies revealed that smokers with insufficient anger management and stress control skills are more vulnerable to relapse. These data reflect the importance of effective anger management and stress control skills in dealing with nicotine abstinence and successful maintenance of quitting smoking. Support for anger and stress is used in many quit-smoking counseling activities. These activities, however, do not address the actual problem. Without improved anger management and stress control skills, smokers who have since quit are at a high risk of relapse in the face of adverse daily life experiences (which may cause high levels of anger and stress) whenever they need the support previously provided by smoking. Anger management and stress control skills are regarded as being in the main domains of emotional intelligence and can be upgraded and promoted with proper cognitive behavioral approaches. It would, therefore, be a logical assumption that improving these skills results in an increase in smokers' quit rates, which may help them to avoid relapse, not only in the short term but also in the mid-term. To test this hypothesis, we designed a 5-session anger management and stress control program to promote these skills in smokers who are willing and ready to quit. This study investigates the effect of a cognitive behavior—oriented anger management and control program designed to be applied in primary care settings dealing with quit-smoking activities to increase quit rates.
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