The role of negative affect in risk for early lapse among low distress tolerance smokers

“The Center for Epidemiological Studies—Depression Scale (CES-D; Radloff, 1977) is a 20-item measure of depressive symptoms.”

“The PANAS is a 20-item self-report scale that has demonstrated good psychometric properties (Watson et al., 1988).”

“Specifically, we administered the FTQ and scored it as the Fagerström Test for Nicotine Dependence (FTND; see Heatherton et al., 1991) for scoring details.”

“The Fagerström Tolerance Questionnaire (FTQ) was used as a continuous measure of nicotine dependence (Fagerstrom, 1978).”

“…tolerance” to describe the behavioral tendency to pursue a goal despite encountering affective discomfort, which may be in response to perceived physical and/or psychological distress, such as remaining abstinent from smoking in the face of uncomfortable withdrawal symptoms (Brown et al., 2005).”

“Recent evidence also supports the primary role of negative affect factors in nicotine withdrawal as strong determinants of early smoking lapse (Kenford et al., 2002; Piasecki et al., 2000).”

“Nicotine withdrawal symptoms The Nicotine Withdrawal Scale (Piasecki et al., 2000) is a reliable and sensitive scale adapted, in part from the Minnesota Withdrawal Scale (Hughes & Hatsukami, 1986).”

“For example, using ecological momentary assessment approaches to track moment-to-moment changes in smokers' experiences throughout the early course of quit attempts, Shiffman et al. (2004, 2007) found that rapid increases in negative affect often immediately preceded lapse to smoking.”

“For example, Niaura et al. (2001) demonstrated a relationship between symptoms of depression and survival (time to 1st cigarette) in three distinct smoking cessation samples.”

“Across a number of experimental studies (Brandon et al., 2003; Brown et al., 2002; Hajek, Belcher, & Stapleton, 1987), smokers' inability to persist with a physically and/or psychologically distressing task has been associated with a history of early smoking lapse.”

“In one study (McCarthy et al., 2006), escalating negative affect prior to a quit date was associated with poorer smoking outcomes.”

“All rights reserved. on smoking lapse may begin soon after attempts at cessation, as levels of negative affect assessed on quit date have been found to be predictive of smoking lapse (Lerman et al., 2002; McCarthy, Piasecki, Fiore, & Baker, 2006; Westmaas & Langsam, 2005).”

“In addition to their associationwith cigarette smoking, dysphoria and depressive symptoms have consistently been shown to predict smoking cessation failure (Blondal et al., 1999; Burgess et al., 2002; Kinnunen, Doherty, Militello, & Garvey, 1996; Ludman et al., 2000).”

“In addition to their associationwith cigarette smoking, dysphoria and depressive symptoms have consistently been shown to predict smoking cessation failure (Blondal et al., 1999; Burgess et al., 2002; Kinnunen, Doherty, Militello, & Garvey, 1996; Ludman et al., 2000).”

“In addition to their associationwith cigarette smoking, dysphoria and depressive symptoms have consistently been shown to predict smoking cessation failure (Blondal et al., 1999; Burgess et al., 2002; Kinnunen, Doherty, Militello, & Garvey, 1996; Ludman et al., 2000).”

“All rights reserved. on smoking lapse may begin soon after attempts at cessation, as levels of negative affect assessed on quit date have been found to be predictive of smoking lapse (Lerman et al., 2002; McCarthy, Piasecki, Fiore, & Baker, 2006; Westmaas & Langsam, 2005).”

“Distress tolerance has also been conceptualized in terms of emotional vulnerability and found to be related to such constructs as neuroticism, negative affectivity, anxiety sensitivity and emotional dysregulation (Zvolensky & Otto, 2007).”

“An automated apparatus, described in Lejuez et al. (1998), was used for CO2 delivery.”

“…(Brown et al., 2002; Brown et al., 2009) Psychiatric Symptoms (Bonn-Miller et al., 2008) No No evidence Carbon-Dioxide Challenge Smoking Abstinence (Abrantes et al., 2008; Brown et al., 2002; 2009) No No evidence Depressive Sxs (Abrantes et al., 2008) (Abrantes et al., 2008) No evidence Panic Sxs…”

“Much of this work documents that low DT increases risk of very early lapse behavior, including within the first several hours or days of abstinence (e.g., Abrantes et al., 2008; R. A. Brown et al., 2002; Kahler et al., 2013).”

“Such studies have found that smoking and unhealthy eating increase during stressful times (Abrantes et al., 2008; Shi et al., in press; Greeno and Wing, 1994; Magid et al., 2009); alcohol is often used to regulate positive and negative moods (Cooper et al.”

“Previous research has indicated that negative affect, stress, and craving tend to increase on the quit date (e.g., McCarthy, Piasecki, Fiore, & Baker, 2006) and are robust predictors of cessation (e.g., Abrantes et al., 2008; Gwaltney et al., 2005; Kenford et al., 2002; Shiffman et al., 1996).”

“…such as emotional eating, heavy drinking or smoking, while experiencing negative a ff ect might serve as a means of alleviating one ’ s mood state (Abrantes et al., 2008; Bekker, Van De Meerendonk, & Mollerus, 2004; Cooper, Frone, Russell, & Mudar, 1995; Magid, Colder, Stroud, Nichter, &…”

“This finding is consistent with the greater rates of treatment drop-out and relapse in smokers low in distress tolerance (Abrantes et al. 2008; Brown et al. 2009).”

“Therefore, amelioration of the signs of early nicotine withdrawal using medications may prevent relapse to tobacco smoking when the urge to reinitiate nicotine use is the strongest (Abrantes et al., 2008; Brown et al., 2009; Shiffman et al., 2007).”

“Finally, to test whether the regions identified in the conjunction overlapped with those previously reported as commonly activated across self-control types in smokers, we masked the conjunction results with 6-mm spheres centered around these peaks (78): vlPFC (248, 20, 26), dlPFC (244, 24, 30), and dmPFC/presupplemen…”

“We found that NA during either mood induction condition was greater for those lower in distress tolerance as assessed by the self-report DTS ( Figure 2 ), similar to other research ( Abrantes et al., 2008 ).”

“…models of abuse and dependence posit that a propensity for stronger negative affect magnifies risk for progression to alcohol dependence (Abrantes et al. 2008; Tate et al. 2005) and that a stressor provokes additive risk for return to use among adults who recently completed treatment…”

“, 2010), with previous studies consistently finding a significant relation between low distress tolerance and adverse substance use outcomes (Abrantes et al., 2008; Brown et al., 2002; 2009; Daughters et al., 2005a, 2005b), including increased alcohol and marijuana use problems (Buckner et al.”

“The focus on quit day measurements was based on associations between quit day affective symptoms and relapse in prior research [28,35,36].”

“…research suggests that failure to quit smoking may be better explained in terms of a smoker’s (in)ability to manage negative affect produced by nicotine withdrawal, rather than by the intensity or severity of the negative affect (Abrantes et al. 2008; Brown et al. 2005; Gonzalez et al. 2008).”

“The results are also in line with the meta-analysis conducted by Liu, Cheek, and Nestor (2016) regarding the association between life stress”

“While perceived stress is associated with avoidant coping, which in turn is associated with the onset of internalizing symptoms (e.g., Abrantes et al., 2008; Daughters et al., 2013; Eisenbarth, 2012; Hager & Runtz, 2012; Halama & Bakošova, 2009; Sontag & Graber, 2010), we cannot be certain that…”

“2005; Simons and Gaher 2005), and both elevated depressive symptoms (Abrantes et al. 2008; Daughters et al. 2009; Harrington 2006; Schmidt et al. 2006) and major depressive disorder (Ellis et al.”

“In particular, our sample size precluded two interesting analyses: whether the results vary by gender and whether they vary by drug of choice (nicotine versus cocaine versus heroin) [62–64].”

“The study of this construct may be important in the HIV? population because it could potentially amplify affective states and lead to more maladaptive coping behaviors (e.g. substance use; Abrantes et al. 2008; Brown et al. 2005; Bornovalova et al. 2012; Perkins et al. 2010).”

“, breath holding, carbon dioxide inhalation) as compared to individuals who can remain abstinent or complete treatment (Abrantes et al., 2008; Daughters et al., 2005; MacPherson, Stipleman, Duplinsky, Brown, & Lejuez, 2008).”

“Over time, the reliance on these avoidance-based strategies are thought to contribute to the onset or worsening of internalizing and externalizing symptoms (Abrantes et al., 2008; Ellis, Fischer, & Beevers, 2010; Schmidt, Rickey, & Fitzpatrick, 2006).”

“…breath-holding endurance (Abrantes, et al., 2008; Brown, et al., 2009; Hajek, Belcher, & Stapleton, 1987), paced auditory serial addition tasks (Abrantes et al., 2008; Brown et al., 2009), CO2 inhalation (Brown et al., 2009), and the 9-item paper/pencil Persistence scale of the Temperament and…”

“For example, prior literature has found that distress intolerance may only be linked to nicotine withdrawal symptoms severity and risk for smoking lapse when considered in the context of negative affect (Abrantes et al., 2008; Farris, Zvolensky, Otto, & Leyro, 2015).”

“Specifically, a substantial number of investigations have focused solely on the independent relation between negative life events and depressive symptoms, and a growing yet limited line of research has examined the relation between DT and depressive symptoms primarily within adult populations (Abrantes et al., 2008; H…”

“…to provoke distress, such as the Paced Auditory Serial Addition Task (PASAT; Diehr, Heaton, Miller, & Grant, 1998), breath-holding, and carbon-dioxide enriched air inhalation, found that individuals with lower persistence on these tasks were more likely to lapse on quit day (Abrantes et al., 2008).”

“…high distress intolerant smokers, in particular, are more likely to drop out of cessation programs (MacPherson et al., 2008), and are more likely to lapse during a self-guided quit attempt (Abrantes et al., 2008; Brown et al., 2005) and in experimental relapse analogue tasks (Kahler et al., 2013).”

“Indeed, among individuals making an active quit attempt, low DT has been found to be associated with high levels of negative affect, and level of negative affect on quit day was the strongest predictor of smoking lapse among those low in DT (12).”

“In parallel with blunted reactivity, dysfunctional perseverance is also implicated in obesity development (Murphy, Stojek, & MacKillop, 2014) and faster relapse during cigarette and other substance cessation (Abrantes et al., 2008; Steinberg et al., 2012).”

“No studies have evaluated this specific hypothesis, but high DI has been prospectively linked to increased craving and relapse during acute stress in other substance-using populations (Abrantes et al. 2008; Banducci et al. 2016).”

“A wide range of cognitive-affective factors (e.g., emotional states, clinical syndromes, or cognitive styles) have been implicated in tobacco withdrawal (Abrantes et al., 2008; Leventhal, Waters, Boyd, Moolchan, Heishman et al., 2007; Leventhal, & Zvolensky, 2015).”

“Breath-holding has been used in multiple persistence studies (Hajek et al., 1987; Hajek, 1991; Zvolensky et al., 2001; Abrantes et al., 2008; Brown et al., 2009), and the discordance between mirror tracing and breath-holding results is somewhat surprising.”

“DI has been linked to substance use for coping motives (Abrantes et al. 2008; Brown et al. 2005; Buckner et al. 2007; Dennhardt and Murphy 2011; Johnson et al. 2010; Kaiser et al. 2012; Zvolensky et al. 2004), dysfunctional eating (Anestis et al. 2007; Hearon et al. 2014; Kozak and Fought 2011),…”

“, 2009; Leventhal & Zvolensky, 2015), demonstrating that the inability to persist through distress predicts early smoking lapse (Abrantes et al., 2008; Brown et al., 2009) and smoking relapse (Brandon et al.”

“, 2002) and experience greater craving and increased lapse risk during a quit attempt (Abrantes et al., 2008; Brown et al., 2009), compared to those with greater distress tolerance.”

“…cessation outcomes, predicting pre-smoking cessation treatment attrition (MacPherson, Stipelman, 708 Duplinsky, Brown,&Lejuez, 2008), earlier lapse to smoking after initiating a cessation attempt (Brown et al., 2002), and heightened risk for negative affect-induced relapse (Abrantes et al., 2008).”

“The date of an initial lapse after the first treatment was counted as the date of smoking relapse.(25) Questions related to self-efficacy (perceived confidence, importance and difficulties associated with quitting) were measured based on the question: ‘How confident are you, or how important/difficult is it for you, t…”

“Additionally, Abrantes et al. (2008) demonstrated that the relationship between negative affect and early smoking lapse was greater in smokers with low task persistence compared to those with higher task persistence.”

“In this study, quitting is defined as a minimum of 24 hours of abstinence during the observation period, based on studies of smoking relapse (Shiffman et al., 2006; Abrantes et al., 2008).”

“, 2010), but empirical findings on behavioral DT measures and prospective smoking cessation outcomes have been quite inconsistent (Abrantes et al., 2008; Brandon et al., 2003; Brown et al., 2009; Cameron, Reed, & Ninnemann, 2013; Hajek, Belcher, & Stapleton, 1987; Steinberg et al., 2012).”

“T hi s ar tic le is in te nd ed so le ly fo r th e pe rs on al us e of th e in di vi du al us er an d is no t to be di ss em in at ed br oa dl y. crease in negative affect during smoking abstinence, which is also consistent with the literature (Abrantes et al., 2008).”

“Additionally, some studies have highlighted the potential that distress tolerance is a moderating variable in the relationship between negative affect and the development of maladaptive symptoms and behaviors [21–23].”

“, 2018), whereas behavioral measures have been linked with treatment-relevant behaviors in SUD populations (e.g., early lapse, treatment dropout, abstinence duration; Abrantes et al., 2008; Daughters et al., 2005; Reese et al., 2019; Strong et al., 2012) but less consistently with psychopathology/symptom severity (e.”

“Other studies have created a composite measure of respiratory DT, based on both breath-holding and carbon dioxide-enriched air tolerance task duration, to improve measurement properties (Abrantes et al., 2008; Brown et al., 2009).”

“Distress tolerance is considered an important component of emotion regulation, with previous studies consistently finding a significant relation between low distress tolerance and adverse substance use outcomes (Abrantes et al., 2008; Brown et al., 2009; Daughters et al., 2005).”

“Smokers with elevated DI have greater difficulties quitting smoking, which has been documented retrospectively (Brown, Lejuez, Kahler, & Strong, 2002) and prospectively in terms of risk for smoking lapse (Abrantes et al., 2008; Brown et al., 2009) and relapse (Kahler, McHugh, Metrik, Spillane, & Rohsenow, 2013; Rohsen…”

“Moreover, distress intolerant smokers are also more likely to lapse (Abrantes et al., 2008; Brandon et al., 2003; Brown et al., 2009; Kahler, McHugh, Metrik, Spillane, & Rohsenow, 2013).”

“A number of longitudinal studies suggest that DI’s relationship with maladaptive behavior is dependent upon the presence of acute stress (Abrantes et al. 2008; Macatee et al. 2013; Strong et al. 2012; Volz et al. 2014).”

“Different studies have found that many addictive behaviors increased during stressful times, such as smoking and unhealthy eating [34-37] or the use and abuse of alcohol to regulate positive and negative moods [38].”

“Others also have found that negative affect predicts time to relapse among recent ex-smokers [ 10 ].”

“Individuals with higher negative affect had a higher likelihood of lapse [25] and were more likely to lapse earlier during a quit attempt [26].”

“, 2015), and DI predicts a higher risk of early lapse following a quit attempt for individuals reporting greater negative affect (Abrantes et al., 2008).”

“Therefore, amelioration of drug withdrawal with medications may prevent relapse to drug taking during the early withdrawal phase when the urge to reinitiate drug use is the strongest [96, 98–102].”

“…adult populations, distress tolerance has been identified as a risk factor for substance use, with lower levels of distress tolerance being associated with greater substance use reports (Abrantes et al., 2008; Ali et al., 2015; Brown et al., 2009; Bujarski et al., 2012; Orea et al., 2025).”

“For example, higher DI when measured behaviorally (i.e. persistence on several distressing tasks) is associated with increased negative affect on quit day and early lapse, relative to lower DI (Abrantes et al., 2008).”

“Improvements in emotional functioning are thought to be a key mechanism of these effects (Abrantes et al., 2008; Adams et al., 2014; Schuman-Olivier et al., 2014; Vidrine et al., 2009).”