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Metacognition and cravings during smoking cessation Nosen, Elizabeth

Abstract

Nicotine cravings are important predictors of smoking cessation difficulty and relapse. Metacognitive models suggest that the ways people think about and respond to cravings may affect how severe cravings become. Specifically, appraising cravings to mean something awful about oneself or one’s quit attempt (i.e., as meaning one is weak-willed, destined to fail, or out of control) is predicted to increase distress. Negative affect is then theorized to trigger further craving and motivate unhelpful coping responses such as thought suppression and rumination. The present study examined evidence for this metacognitive model using an experimental paradigm. One hundred and seventy-six adult smokers participated in two lab sessions either during or preceding a cessation attempt; during the first session, participants received metacognitive, control or no psychoeducation. Dependent variables were assessed using ecological momentary assessment and questionnaires four days later. Metacognitive models predict that overly negative beliefs increase cravings and withdrawal-related distress. Consistent with this hypothesis, metacognitive beliefs correlated with increased distress and withdrawal symptoms among both continuing smokers and active quitters. Providing psychoeducation challenging maladaptive beliefs about cravings did not causally impact craving or smoking four days later, but psychoeducation was associated with differential diurnal variation in cravings. Specifically, abstinent smokers experienced lower cravings early and later in the day if they received metacognitive psychoeducation. An alternative directional hypothesis suggests that withdrawal symptoms increase beliefs. Consistent with this, changes in negative affect predicted changes in metacognitive beliefs. Quitting smoking did not causally impact beliefs, but successfully abstinent smokers showed a greater decline in overly negative craving interpretations. Regarding metacognitive responses, cessation increased use of reappraisal, distraction and suppression, but there were no differences in strategies used by successful and unsuccessful abstainers. Only rumination predicted smoking one month later. Overall, results provide partial support for metacognitive models. Causal effects of beliefs on withdrawal symptoms (and vice versa) were not detected but nonexperimental results imply a bidirectional relationship. Future research on rumination and certain types of metacognitive beliefs is warranted. Examination of clinical applications of metacognitive models would also be valuable, particularly among depressed smokers or as an adjunct to behavioural approaches to smoking cessation.

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