How long can you hold your breath? If you are a smoker, the results of
this test would predict the likelihood of being successful at quitting those cigarettes.
This is not because holding your breath is related to your lung capacity.
Rather, it has something to do with distress tolerance.
We probably all know someone who has been unable to discontinue their
cigarette habit, even in spite of numerous attempts to quit. As Richard Brown
and colleagues elaborate in a recent article, smoking is very difficult to
discontinue for three basic reasons: 1) It is a well-rehearsed habit. 2) Nicotine
is physically addictive. 3) Smoking provides and maintains a sense of comfort.
Although there are good treatments for smoking cessation, a sizable percentage
of people attempting to quit never abstain from cigarettes for more than a few
days, even with multiple cessation attempts across years or decades. Brown
hypothesizes that this unfortunate population happens to be particularly
intolerant of the inevitable distress of withdrawal from nicotine. Given that
ACT is designed to promote acceptance and willingness to have these kinds of
experiences, he developed a preliminary treatment program for smoking cessation
with participants who reported being unable to abstain from cigarettes for more
than three days over the past ten years of use. The results of this trial
showed that, although everyone eventually relapsed by the 26-week follow up,
the median number of days that participants abstained from cigarettes was 24, a
whopping increase over their previous efforts and potentially a precursor to
more successful attempts in the future.
Clinical
implications
It is not unusual to encounter clients who present for treatment of
certain psychological difficulties and mention in passing that they also smoke
and cannot seem to quit. And cigarettes are just one drug of choice – most of
us have clients with addictions to alcohol and other drugs (whether we know
about it or not). Part of the trap of addiction is not just the onset of
unpleasant withdrawal symptoms, but also the loss something that is like a
dear, comforting friend. Just as acceptance and mindfulness can teach a client
to relate in a different way to their unwanted thoughts and feelings, so also
can it be used to relate to withdrawal symptoms and urges to return to substance
use.
For more
information:
Here is a more detailed summary of the study:
Though interventions are available that have demonstrated effectiveness
in helping people quit smoking, cigarettes continue to be the leading cause of
preventable deaths in the United States. Data on smoking habits suggest that a substantial
subpopulation of smokers are unable to successfully quit and remain abstinent,
and that these people commonly relapse within just a few days of entering
treatment. Given that smoking becomes a habitual, addictive, and
comfort-inducting activity over time, it is conceivable that this subpopulation
is susceptible to relapse because of an inability to tolerate the distress of
withdrawal and related symptoms. In fact, a simple breath-holding task has been
shown to predict success rates upon entering smoking cessation treatment.
Given that Acceptance and Commitment Therapy builds willingness to have
distressing internal experiences like urges, ACT treatment components were
built in to a smoking cessation treatment involving pharmacotherapy and
traditional exposure. Treatment consisted of six individual sessions, nine
group sessions, and 8 weeks of transdermal nicotine patch usage. Participants
were two cohorts of 8 smokers each, all reporting an inability to abstain from
cigarettes for more than 3 successive days in the past 10 years.
Participants provided self-reports of smoking status at the conclusion
of treatment as well as at 8-, 13-, and 26-week follow ups. Reports of
abstinence were verified by expired carbon monoxide. A relapse was determined
to be 7 consecutive days of smoking after quit day. Results showed that half
the participants relapsed about 45 days after quit day, and that all
participants relapsed by the 26-week follow up. Although relapse was shown to
be inevitable, the amount of time abstaining from cigarettes was markedly
longer on the average than any quit attempt in the past 10 years, and 82% of
participants reported that the skills in the program were very or extremely
useful in helping them quit. The authors point out that this pilot study
represents the only known published attempt to work with early-relapse smokers.
They report that data on a small, randomized controlled trial is forthcoming. For more on the use of ACT with substance abuse, check out:
Brown, R. A, Palm, K. M., Lejuez, C. W., Kahler, C. W., Zvolensky, M.
J., Hayes, S. C., Wilson, K. G., & Gifford, E. V. (2008). Distress
tolerance treatment for early-lapse smokers. Behavior Modification, 32, 302-332.
Have
you ever wondered why ACT experts encourage experiential workshops as part of
the training regimen? There are a few answers to this question, but a new study
out of Germany suggests that mindfulness training can help therapists be generally
better at what they do.
Therapy
is complex. Consider all the possible sources of information available during
any given therapy session that may assist the therapist in their work. During
the session, attention may be directed outward to the client’s statements,
expressions, and posture or inward to the therapist’s own reactions, analyses,
and actions. And all of this, ideally, is done in order to further the work of
assisting the client in his or her life. In addition to informational
complexity, the way the therapist responds emotionally to the client affects
the outcome of therapy. Ludwig Grepmair and colleagues felt that mindfulness
training might be helpful for therapists in managing this complexity and their
own emotional responding in the room with their clients. In a recently
published study, they provided mindfulness training to a group of psychotherapy
trainees and compared outcomes on their clients with outcomes on clients
receiving therapy from trainees who did not receive mindfulness training.
Responses to a variety of symptoms measures showed significantly larger
reductions for clients receiving treatment from therapists who had mindfulness
training.
Clinical implications
While
many of us may engage in a mindfulness practice for personal reasons, this
study suggests that doing so may benefit others in our lives as well, namely
our clients. Perhaps therapy is more than knowing what interventions to conduct
or how to cultivate the therapeutic alliance, but also the capacity and
willingness to hold our experience and the experience of our clients lightly in
the service of being a more effective instrument for them. Adding a regular
mindfulness practice to your routine or utilizing mindfulness and acceptance
with your own behavior may add quality to your professional work as well as
your life more generally.
A blog called Psychotherapy Brown Bag has done a good job of reviewing a recent paper which continues to add to the pile of evidence on the centrality of experiential avoidance in maintaining a variety of psychological disorders. This paper is about the Trichotillomania and is worth a read. Here's what they had to say about it:
In a study just released in Behaviour Research and Therapy, Anna Shusterman, Lauren Feld, Lee Baer, and Nancy Keuthen
(2009) utilized data from a massive online survey to examine the role
that emotions play in prompting and sustaining this disorder. The
description of TTM in the DSM-IV-TR as well as a number of prior
studies have linked TTM behaviors with a sense of relief on the part of
the individual exhibiting the behavior. In other words, many
individuals have reported that pulling out their own hair has resulted
in immediate decreases in negative emotions. Despite this potentially
valuable function, the behavior also includes a variety of less
comfortable correlates, namely subsequent feelings of shame and guilt
and a strong desire to cease the behavior. So, the behavior becomes
rewarding through its ability to quickly reduce certain negative
emotions, but also results in several emotional and social consequences.
For the full description, you can read more about it here.
