A pilot randomized controlled trial of distress tolerance treatment for weight concern in smoking cessation among women
Open accessAbstract
INTRODUCTION: The majority of women who smoke cigarettes report that concern about weight gain is a barrier to quitting. We developed an intervention incorporating distress tolerance, appetite awareness, and mindful eating skills to target concerns about post-cessation weight gain and emotional eating (DT-W). In the current study, we conducted a pilot randomized controlled trial of DT-W versus a smoking health education (HE) intervention. METHODS: Participants (N = 69 adult female, weight-concerned smokers) were recruited in cohorts of 4-11. Cohorts were randomized to DT-W or HE. DT-W and HE were matched on format (single individual session followed by eight group sessions), inclusion of cognitive behavioral therapy for smoking cessation (CBT) content, and pharmacotherapy (nicotine patches). Follow-up assessments occurred at 1-, 3-, and 6-months post-treatment. RESULTS: The recruitment goal was met; 61 of the 69 participants attended at least one group session. There were no significant differences between DT-W and HE in the number of group sessions attended (DT-W adjusted M = 5.09, HE adjusted M = 5.03, p = .92), ratings of treatment effectiveness or usefulness of skills, or retention at 6-month follow-up (79% in DT-W vs. 78% in HE) (ps > .05), but comprehension ratings were lower in DT-W than in HE (p = .02). CONCLUSIONS: Overall, these results suggest that the study procedures and interventions were feasible and acceptable, but changes to the DT-W intervention content to improve comprehension should be considered prior to conducting a fully powered trial. IMPLICATIONS: A distress tolerance-based treatment targeting fear of weight gain after smoking cessation and post-cessation emotional eating was feasible and acceptable relative to a smoking HE comparison condition, but changes should be considered before conducting a larger trial. Continued innovation in treatment development for weight-concerned smokers is needed.
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Complete-case analysis for Bloom 2020 did not substantially change the interpretation of the result (RR 0.86, 95% CI 0.26 to 2.86; 54 participants).
“Using complete‐case analysis did not substantially change interpretation of the result (RR 0.86, 95% CI 0.26 to 2.86; 54 participants; Analysis 6.9).”
From Mindfulness for smoking cessation (2022) · cites this paper as Bloom 2020
The Smoking and Weight Outcomes section (page unavailable) reports no significant treatment effect on abstinence, consistent with the stated interpretation. Bloom does not report a complete-case analysis or the cited RR and confidence interval; its Analytic Plan describes mixed models instead. The 54 participants are consistent with the reported six-month follow-up attendance of 26 in DT-W and 28 in HE, but Bloom does not present the cited analysis for them. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBloom 2020 showed no evidence of a benefit of distress tolerance training versus matched-intensity treatment, with the 95% CI spanning benefit and harm (RR 0.87, 95% CI 0.26 to 2.98; 69 participants; low-certainty evidence).
“Bloom 2020 showed no evidence of a benefit of distress tolerance training, with the 95% CI spanning both benefit and harm (RR 0.87, 95% CI 0.26 to 2.98; 69 participants; low‐certainty evidence; Analysis 3.1).”
From Mindfulness for smoking cessation (2022) · cites this paper as Bloom 2020
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Experimental — accuracy not yet measuredBloom 2020 planned to assess depression and negative affect at each follow-up (1 month, 3 months, and 6 months post-treatment), but had not reported these data.
“Bloom 2020 (69 participants) planned to assess depression and negative affect at each follow‐up (1 month, 3 months, and 6 months post‐treatment), but to our knowledge have not reported these data.”
From Mindfulness for smoking cessation (2022) · cites this paper as Bloom 2020
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Interventions for preventing weight gain after smoking cessation
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Reductions in Distress Intolerance via Intervention: A Review
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“…more traditional multi-session psychotherapy interventions, some of which that spanned many weeks, and the majority were group sessions ( n = 11; Bloom et al., 2020; Bornovalova et al., 2012; Brown et al., 2014, 2018 ; Correa, 2020; Kraemer et al., 2016; Lotan et al., 2013; McHugh et al., 2014;…”
InfluentialPost-Cessation Weight Gain among Smokers with Depression Predicts Smoking Relapse
Krotter, A., Diego, G. A., Pérez, Á. G., García–Fernández, G., & Secades‐Villa, R. (2023) · Journal of Dual Diagnosis · doi:10.1080/15504263.2023.2192683 · Cited by 10 · see citing works
“…Prochaska et al., 2008), mindfulness or distress tolerance training for food craving (Kragel et al., 2019) and post-cessation emotional eating (Bloom et al., 2020; Burr et al., 2020), Therefore, it seems that addressing WG concerns, exercise, diet, and disordered eating are key components of…”
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Orea, J. P., Bishop, H. K. D., & Pulvers, K. M. (2025) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2025.100616 · Cited by 1 · see citing works
“…between distress intolerance, coping motives, and CUD symptoms, cognitive theory of addiction (Liese & Beck, 2022) and evidence from interventions (Bloom et al., 2020; Brown et al., 2014) suggest that distress intolerance is a risk factor for CUD and psychological disorders more broadly (Leyro et…”
Tabakabhängigkeit bei Essstörungen und Adipositas
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A Step towards Relapse Prevention
Goni, A. (2022) · Mental Health & Human Resilience International Journal · doi:10.23880/mhrij-16000183 · Cited by 1 · see citing works
LONGITUDINAL CLUSTERING OF HEALTH BEHAVIORS WITHIN THE FRAMINGHAM HEART STUDY
Baumann, N. (2022) · doi:10.23860/diss-baumann-nathan-2022 · Cited by 1 · see citing works
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- Authors
- Bloom, E. L., Ramsey, S. E., Abrantes, A. M., Hunt, L., Wing, R. R., Kahler, C. W., Molino, J., & Brown, R. A.
- Affiliations
- Brown University (US)
- Rhode Island Hospital (US)
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI
- The University of Texas at Austin (US)
- Corresponding author
- Bloom, Erika Litvin
- ORCID
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-01-29
- Volume
- 22
- Issue
- 9
- Pages
- 1578-1586
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- PMC
- PMC7443582
- OpenAlex
- W3003793679
- Cited by
- 13
- References
- 55
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 3
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (K23DA035288)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- distress tolerance, weight concern, smoking cessation, women smokers, post-cessation weight gain, emotional eating, mindful eating, nicotine patch, health education intervention, treatment feasibility and acceptability
- MeSH terms
- Smokers, Body Weight, Female, Humans, Middle Aged, Motivation, Pilot Projects, Smoking, Stress, Psychological, United States, Weight Gain, Health Behavior, Cognitive Behavioral Therapy, Smoking Cessation
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