Responding to tobacco craving: Experimental test of acceptance versus suppression.
Open accessAbstract
Acceptance and Commitment Therapy (ACT) provides a theoretical rationale for "acceptance" of thoughts and feelings, and proscribes suppression, a more intuitive and commonly used coping strategy. Suppression is theorized to have negative consequences not applicable to acceptance, including depletion in self-control and ironic postsuppression rebound effects. However, it remains largely unknown whether these strategies differentially affect frequency of drug-related thoughts, craving intensity, drug use behavior, or other relevant outcomes. Adult smokers (N = 162) were randomly assigned to receive a brief laboratory-based coping intervention (acceptance or suppression) or were not given coping instructions (control group) and then were exposed to smoking cues. Results indicated that the suppression group was successful at suppressing thoughts of smoking, as they reported fewer thoughts of smoking than the other two groups. Also, both coping strategies were associated with benefits with respect to craving and affect. However, there were no group differences in depletion, and rebound effects did not occur when coping was discontinued. Following the laboratory session, all participants attempted to quit or at least reduce their smoking for 3 days; the acceptance and suppression groups resumed use of their strategy. At 3-day follow-up, the acceptance and suppression groups reported greater self-efficacy for avoiding smoking when experiencing craving compared to the control group. However, there were no group differences in the number of cigarettes smoked during the 3 days. This study provides support for the value of acceptance-based coping, but it also suggests that more research is needed to differentiate its benefits compared to suppression.
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In three studies, strategy instructions were judged not to be matched with regards to the use of smoking-relevant words.
“In three studies, strategy instructions were judged not to be matched with regards to the use of smoking-relevant words (Litvin et al. 2012; Szasz et al. 2012; Westbrook et al. 2013)”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Of the four studies that used a suppression condition, none reported any difference in craving compared to the PFM strategy conditions.
“Of the four studies that used a suppression condition (Beadman et al. 2015; Litvin et al. 2012; Rogojanski et al. 2011; Szasz et al. 2012), none reported any difference in craving compared to the PFM strategy conditions”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
When mean ESs were examined, there was no significantly superior effect of PFM strategies relative to inactive controls.
“inactive controls (Litvin et al. 2012; Ruscio et al. 2016; k = 2, n = 111; ES = −0.04, 95% CI [−0.52, 0.43], z = 0.18, p = 0.85)”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Standardised manipulation checks were rare.
“standardised manipulation checks were rare (Litvin et al. 2012; Nosen and Woody 2013; Szasz et al. 2012)”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Credibility was assessed in four studies.
“Credibility was assessed in four studies (Beadman et al. 2015; Litvin et al. 2012; Rogojanski et al. 2011; Ussher et al. 2009).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
These effects were generally most evident immediately after strategy use.
“although these effects were generally most evident immediately after strategy use”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
List-wise deletion is a potentially problematic approach given the amount of missing data (~30%).
“a potentially problematic approach given the amount of missing data (~30%; Litvin et al. 2012)”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
One study employed list-wise deletion in the reported analysis.
“One study employed list-wise deletion in the reported analysis, a potentially problematic approach given the amount of missing data (~30%; Litvin et al. 2012).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
The overall mean ES indicated that PFM-based strategies were superior at reducing craving relative to inactive control.
“The overall mean ES from available data (Litvin et al. 2012; May et al. 2011; Ruscio et al. 2016; Ussher et al. 2009; Ussher et al. 2006; Westbrook et al. 2013) indicated that PFM-based strategies were superior at reducing craving relative to inactive control (k = 6, n = 386; ES = −0.24, 95% CI [−0.44, −0.03], z = 2.30, p = 0.02).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
The overall ES for the suppression comparison was not significant.
“and the overall ES was not significant (k = 3, n = 217; ES = −0.08, 95% CI [−0.38, 0.22], z = 0.52, p = 0.61, based on data from Beadman et al. (2015), Litvin et al. (2012) and Rogojanski et al. (2011))”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Six of the seven studies that compared a PFM strategy with an inactive control condition reported significantly larger reductions in cravings in the PFM group.
“Six of the seven studies that compared a PFM strategy with an inactive control condition reported significantly larger reductions in cravings in the PFM group”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Only two of the reviewed studies assessed understanding directly.
“yet only two of the reviewed studies assessed understanding directly (Litvin et al. 2012; Nosen and Woody 2013)”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Litvin and colleagues' study did not find evidence of delayed rebound effects after suppression.
“However, Litvin and colleagues’ study (Litvin et al. 2012) did not find evidence of such delayed effects.”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Of the six studies comparing the effects of a PFM strategy to an inactive control, three reported a larger within-session reduction in negative affect in the PFM group.
“Of the six studies comparing the effects of a PFM strategy to an inactive control (Cropley et al. 2007; Litvin et al. 2012; Ruscio et al. 2016; Ussher et al. 2009; Ussher et al. 2006; Westbrook et al. 2013), three reported a larger within-session reduction in negative affect in the PFM group (Litvin et al. 2012; Ussher et al. 2009; Westbrook et al. 2013).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
Litvin et al. (2012) reported poorer understanding of the PFM strategy compared to control instructions.
“Of these, Litvin et al. (2012) reported poorer understanding of the PFM strategy compared to control instructions.”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
In Litvin et al.'s (2012) study, suppression resulted in an acute reduction in smoking thoughts, which were significantly less frequent than in the PFM strategy group.
“In Litvin et al.’s (2012) study, suppression resulted in an acute reduction in smoking thoughts, which were significantly less frequent than in the PFM strategy group.”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
The overall ES for the inactive-control comparison was significant and favoured the PFM strategy.
“The overall ES for this comparison, based on data from five of the six studies (Litvin et al. 2012; Ruscio et al. 2016; Ussher et al. 2009; Ussher et al. 2006; Westbrook et al. 2013), was significant and favoured the PFM strategy (k = 5, n = 332; ES = −0.42, 95% CI [−0.65, −0.19], z = 3.62, p < 0.01).”
From Mindfulness, Acceptance and Defusion Strategies in Smokers: A Systematic Review of Laboratory Studies (2018) · cites this paper as Litvin et al. 2012
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References 45 · Cited by 23
- Authors
- Litvin, E. B., Kovacs, M. A., Hayes, P. L., & Brandon, T. H.
- Affiliations
- University of South Florida (US)
- ORCID
- Brandon, Thomas H.
- Venue
- Psychology of Addictive Behaviors
- Published
- 2012
- Volume
- 26
- Issue
- 4
- Pages
- 830-837
- ISSN
- 0893-164X (ISSN-L)
- 1939-1501
- PMC
- PMC3990001
- OpenAlex
- W1975398017
- Cited by
- 23
- References
- 45
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2021: 1 · 2020: 4 · 2018: 2 · 2017: 1 · 2016: 1 · 2015: 3 · 2014: 7 · 2013: 1
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychology of Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of South Florida
- Moffitt Cancer Center
- National Cancer Institute (R01 CA137357, R01 CA134347)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- cigarette craving, acceptance and commitment therapy, thought suppression, smoking, smoking cues, ego depletion, self-efficacy, smoking cessation, coping strategies
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Aged, Cues, Female, Humans, Male, Middle Aged, Repression, Psychology, Thinking, Tobacco Use Disorder, Smoking Cessation, Behavior, Addictive, Treatment Outcome, Self Efficacy, Acceptance and Commitment Therapy
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