Year of Award

2016

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Duncan Campbell

Commitee Members

Kari Harris, Jennifer Robohm, David Schuldberg, Bryan Cochran, Holly Schleicher

Keywords

ACT, Chronic Pain, Depression, Intervention, PTSD, Smoking

Abstract

Smoking and chronic pain are significant public health concerns. Patients with chronic pain smoke at higher rates than the general population (Zvolensky, McMillan, Gonzalez, & Asmundson, 2009), and the pain-smoking relationship appears to be influenced by factors such as pain-related anxiety (Ditre, Zale, Zvolensky, & Kosiba, 2013) and depression (Goesling, Brummett, & Hassett, 2012). To address a gap in the knowledge base, the current study examined the effectiveness and feasibility of a 5-session, telephone-delivered ACT intervention for smoking cessation among 45 participants recruited from two multidisciplinary pain treatment centers. The ACT intervention was compared to an enhanced treatment-as-usual (TAU) control condition. Rates of depression and PTSD were high in our sample: 40% for depression, and 18% for PTSD. Participants in the ACT condition had higher verified smoking 7-day point prevalence abstinence at the end of treatment, with 33% of those who completed the entire ACT treatment reporting abstinence at this time point. However, at the 3-month follow-up assessment, only two participants in the ACT condition and one participant in the TAU condition had quit smoking. There were no significant differences in smoking intensity by condition, but we did observe a reduction in smoking in both conditions at the end of treatment, and at the 3-month follow-up assessments. Regarding psychological symptoms, all study participants demonstrated increases in depression and psychological inflexibility. There were no differences over time or between groups regarding pain intensity, pain interference, or pain-related anxiety. Contrary to our expectations, changes in psychological flexibility or changes in pain-related anxiety were not predictive of smoking outcomes at 3 months. Our findings suggest that chronic pain patients have higher smoking cessation needs compared to the general population, as evidenced by the high rates of depression and PTSD in our sample and the overall low rates of quitting.

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© Copyright 2016 Anayansi Lombardero