A prospective examination of distress tolerance and early smoking lapse in adult self-quitters

“E-mail: jbhogan@ uvm.edu predictor of early lapse and sustained relapse during quit attempts (Brown et al., 2002, 2009).”

“…least 3 months compared with those unable to remain abstinent for at least 3 months (Brown et al., 2002), was related to the risk of lapsing in smokers making an unaided quit attempt (Brown et al., 2009), and predicted 7-day point prevalence abstinence at the end of treatment (Hajek et al., 1987).”

“Greater smoking duration is associated with lower perceived general DT (Leyro, Bernstein, Vujanovic, McLeish, & Zvolensky, 2011) but not behavioral task persistence (Brown et al., 2009; Kahler, McHugh, Metrik, Spillane, & Rohsenow, 2012).”

“…the counterintuitive finding here and limited data on this question elsewhere (all of which is limited to intervention studies targeting addictive behaviors; Brandon et al. 2003; Brown et al. 2009; Daughters et al. 2005) suggest a need for greater attention to questions of prospective prediction.”

“These include measures of physical distress tolerance (such as breath-holding) that have been found to offer predictive utility beyond known risk factors for early smoking lapses [14].”

“Several recent investigations have demonstrated feasibility and acceptability as well as preliminary efficacy of DT-focused interventions on smoking cessation outcomes (Bloom et al., 2017, Brown et al., 2009, 2013; Farris et al., 2016), although also see Brown et al., 2018.”

“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).”

“…(e.g., Asmundson et al., 2013; Medina, Jacquart, & Smits, 2015; Smits et al., 2008), mindfulness (e.g., Lotan, Tanay, & Bernstein, 2013; Luberto et al., 2014) self-regulation (e.g., Carpenter & Trull, 2013), and behavioral exposure paired with such techniques (e.g., Brown et al., 2008, 2009).”

“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…”

“Prospective data have further shown that DI consistently predicts poorer smoking cessation outcomes (e.g., Brandon et al., 2003; Brown et al., 2009; Cameron et al., 2013; Hajek et al., 1987).”

“Some studies found BH related to behavior change outcomes [3, 9] while others did not [10, 11].”

“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).”

“In addition, novel behavioral and self-report indices designed to clarify individual differences that affect gaining abstinence during treatment (e.g., emotional vulnerability and stress provocation paradigms; Brown et al., 2009; McKee et al., 2011), may offer additional insights into individual variability in the abi…”

“For instance, DI has been linked to greater risk of relapse/treatment dropout in individuals with substance use disorders (Brown et al. 2009; Daughters et al. 2005; Strong et al. 2012) and greater symptom severity in individuals diagnosed with mood/anxiety conditions (Allan et al.”

“Low DT has been associated with maladaptive avoidance behaviors, such as procrastination behavior (42), substance use (43, 44), stock addiction (45), depression and anxiety (46, 47).”

“repeated tries in a mirror-tracing task, or duration of breath holding, and demonstrated that greater persistence related to less lapses when quitting tobacco smoking (9,11).”

“These measures of distress intolerance have been associated with prior smoking lapse and relapse (Brown, Lejuez, Kahler, & Strong, 2002; Hajek, 1991; Hajek, Belcher, & Stapleton, 1987), future smoking lapse (Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001; Brown et al., 2009), and nicotine dependence (Leyro, Bernstei…”

“…2011), strongly predictive of long-term abstinence (Ashare et al., 2013; Westman, Behm, Simel, & Rose, 1997), and especially rel - evant for smokers with elevated psychological risk factors who are vulnerable to early lapse (Brown, Lejuez, Kahler, Strong, & Zvolensky, 2005 ; Brown et al., 2009).”

“The relationship between DT and substance use disorders is well established (Brown et al., 2002, 2009; Brandon et al., 2003; Daughters et al., 2005a,b; Strong et al., 2012), but the underlying neurocircuitry is poorly understood.”

“…or the perceived ability and behavioral act of tolerating negative psychological and physical states (Leyro, Zvolensky, & Bernstein, 2010; Simons & Gaher, 2005), has been repeatedly linked to adult smoking outcomes (e.g., Brown, Lejuez, Kahler, Strong, & Zvolensky, 2005; Brown et al., 2009).”

“Research has suggested that individuals with low DT are especially prone to engaging in negatively reinforcing avoidance behaviors, such as substance use (Brown et al., 2009), compulsive acquisition (Williams, 2012), or NSSI (Chapman & DixonGordon, 2007).”

“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 substance use are linked to poorer treatment-related outcomes such as earlier drop-out (Daughters, Lejuez, Bornovalova, et al., 2005), elevated craving levels during abstinence (Shorey et al., 2017), and higher relapse rates (Brown et al., 2009; Daughters, Lejuez, Kahler, et al., 2005).”

“The ability to successfully quit smoking has also been linked to a myriad of cognitive and emotional self-regulatory processes, including but not limited to, greater distress tolerance, emotion regulation, and task persistence (Brown et al., 2009; Rogers et al., 2018; Szasz et al., 2012).”

“…validity of persistence in smoking intervention research (Steinberg et al., 2012), results across studies show varying strengths of association between persistence and long-term smoking cessation outcomes (e.g., Brown et al., 2009; Etter, 2010; Kalman, Hoskinson, Sambamoorthi, & Garvey, 2010).”

“BH duration has been frequently used to examine the role of DT in smoking relapse (Brown, Lejuez, Kahler, & Strong, 2002; 2005; Brown et al., 2009; Howell, et al., 2010) and has been found to be a significant factor associated with earlier smoking lapse.”

“It was modified for psychological stress-induction in laboratory-based cardiovascular reactivity research as it reliably increases sympathetic responses, such as increases in blood pressure and heart rate [46–48], skin conductance [49], and negative affect [50, 51].”

“4 propensity, withdrawal severity, and risk of early lapse during a quit attempt (Brown et al., 2009; Mathew et al., 2019; Mathew & Zhou, 2020; Otto et al., 2020; Trujillo et al., 2017).”

“The studies [4,23,24] that analyze this variable indicate that low scores on this variable indicate perseverance in the behavior in spite of frustration and fatigue, impatience, ambition, perfectionism and involvement in the work.”

“…from tobacco (Perkins, Karelitz, Giedgowd, Conklin, & Sayette, 2010), which is in line with previous research that found that lower distress tolerance as measured on behavioral tasks predicts drop-out from smoking cessation treatment and relapse (Abrantes et al., 2008; Brown et al., 2009).”

“…(Leventhal & Zvolensky, 2015) and may be an ideal measurement of DT given that it is easy to administer and lower DT as measured by BH duration was associated with greater risk of poorer smoking cessation outcomes in several studies (Brown et al., 2002; Brown et al., 2009; Hajek et al., 1987).”

“Early smoking lapse, which is strongly associated with a return to regular smoking (Brown et al., 2009), is often precipitated by increases in negative affect (Shiffman, 2005; Shiffman & Waters, 2004) and difficulties in emotion regulation (i.”