Behavior Activation for Smoking Cessation in College Students through Videoconference: Pilot Study
Main Article Content
Abstract
Introduction: tobacco use is a public health problem in the world. In Mexico, prevalence rates are higher in young adults. There are different reasons for smoking or quitting in a college environment, but they all overlap since most include positive affect induction and reduction of negative affect, which accounts for positive and negative reinforcement processes in smoking behavior. Behavioral Activation (BA) was originally proposed in the treatment of depression through the reinforcement of incompatible behaviors. Promising results have been reported recently in the use of substances and modification of affective states.
Objective: to evaluate the effectiveness of a Behavioral Activation intervention to Smoking cessation (BA-S) in the consumption pattern.
Method: BA-S was applied by videoconference to 15 college students, with a single-case design with replication; the effect size was calculated using the non-overlap of all pairs (NAP). Results: The BA-S was effective for smoking cessation and reducing consumption patterns. The effect size ranged between 91.10% and 100%; nine students quit smoking and six reduced their consumption.
Discussion and conclusions: BA-S decreased the pattern of tobacco consumption and modified the affective states; these results should be taken with caution due to the limited number of participants. It is suggested to continue with the application of the intervention through videoconference since it is a viable alternative in this population.
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References
American Psychological Association [APA]. (2013). Guidelines for the Practice of Telepsychology. https://www.apa.org/practice/guidelines/telepsychology
Audrain-McGovern, J., Rodriguez, D., Rodgers, K., & Cuevas, J. (2010). Declining alternative reinforcers link depression to young adult smoking. Addiction, 106(1), 178-187. https://doi.org/10.1111/j.1360-0443.2010.03113.x
Baeza-Torres, E. S., Cruz-Morales, S. E., & Lira-Mandujano, J. (2021). Evaluación de activación conductual en universitarios que consumen mariguana: estudio piloto. Revista Internacional De Investigación En Adicciones, 7(2), 13-22. https://doi.org/10.28931/riiad.2021.2.02
Baker, T. B., Brandon, T. H., & Chassin, L. (2004) Motivational influences on cigarette smoking. Annual Review of Psychology, 55(1), 463-491. https://doi.org/10.1146/annurev.psych.55.090902.142054
Becoña, E., Míguez, M. C., Fernández del Río, E., & López, A. (2010). El tratamiento psicológico de los fumadores. En E. Becoña (Ed.). Dependencia del tabaco. Manual de casos clínicos (pp. 43-60). Sociedad Española de Psicología Clínica, Legal y Forense.
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Patrick, C., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How We Design Feasibility Studies. American Journal of Preventive Medicine, 36(5), 452-457. https://doi.org/10.1016/j.amepre.2009.02.002
Brown, R. A., Lejuez, C. W., Kahler, C. W., Strong, D. R., & Zvolensky, M. J. (2005). Distress tolerance and early smoking lapse. Clinical Psychology Review, 25(6), 713-733. https://doi.org/10.1016/j.cpr.2005.05.003
Byaruhanga, J., Paul, C. L., Wiggers, J., Byrnes, E, Mitchell, A., Lecathelinais, C., & Tzelepis, F. (2020). Connectivity of Real-Time Video Counselling Versus Telephone Counselling for Smoking Cessation in Rural and Remote Areas: An Exploratory Study. International Journal Environmental Research Public Health, 17(8), 2891. https://doi.org/10.3390/ijerph17082891
Carmody, T. P., Vieten, C., & Astin, J. A. (2007). Negative affect, emotional acceptance, and smoking cessation. Journal of Psychoactive Drugs, 39(4), 499-508. https://doi.org/10.1080/02791072.2007.10399889
Currell, R., Urquhart, C., Wainwright, P., & Lewis, R. (2000). Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (2). https://doi.org/10.1002/14651858.CD002098
Daughters, S. B., Magidson, J. F., Anand, D., Seitz-Brown, C. J., Chen, Y., & Baker, S. (2017). The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial. Addiction, 113(3), 535-544. https://doi.org/10.1111/add.14049
Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The Origins and Current Status of Behavioral Activation Treatments for Depression. Annual Review of Clinical Psychology, 7(1), 1-38. https://doi.org/10.1146/annurev-clinpsy-032210-104535
Eissenberg, T. (2004). Measuring the emergence of tobacco dependence: the contribution of negative reinforcement models. Addiction, 99(1), 5-29. https://doi.org/10.1111/j.1360-0443.2004.00735.x
Ferster, C. B. (1973). A functional analysis of depression. AmericanPsychologist, 28(10), 850-870. https://doi.org/10.1037/h0035605
Gavino Díaz, G. E., López Rivadeneira, E. J., Guaraca Parreño, V. H., & Romero Urrea, H. E. (2019). Factores que inciden en el consumo de tabaco en los estudiantes de ingeniería: Estudio piloto. Ciencia Digital, 3(4), 55-70. https://doi.org/10.33262/cienciadigital.v3i4.910
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168. https://doi.org/10.1037/0022-006X.64.6.1152
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: a revision of the Fagerströom Tolerance Questionnaire. British Journal of Addiction, 86(9), 1119-1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
Heffner, J. L., Mull, K. E., McClure, J. B., & Bricker, J. B. (2017). Positive Affect as a Predictor of Smoking Cessation and Relapse: Does It Offer Unique Predictive Value among Depressive Symptom Domains? Substance Use & Misuse, 53(6), 980-988. https://doi.org/10.1080/10826084.2017.1387569
Hogarth, L., Mathew, A. R., & Hitsman, B. (2017). Current major depression is associated with greater sensitivity to the motivational effect of both negative mood induction and abstinence on tobacco-seeking behavior. Drug and Alcohol Dependence, 176, 1-6. https://doi.org/10.1016/j.drugalcdep.2017.02.009
Humeniuk, R., Henry-Edwards, S., Ali, R., Poznyak, V., & Monteiro, M. G. (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for use in primary care. World Health Organization. https://doi.org/10665/44320
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12-19. https://doi.org/10.1037/0022-006X.59.1.12
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255-270. https://doi.org/10.1093/clipsy.8.3.255
Kahler, C. W., Surace, A., Gordon, R. E. F., Cioe, P. A., Spillane, N. S., Parks, A., Bock, B. C., & Brown, R. A. (2018). Positive psychotherapy for smoking cessation enhanced with text messaging: Protocol for a randomized controlled trial. Contemporary Clinical Trials, 71, 146-153. https://doi.org/10.1016/j.cct.2018.06.013
Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation?: A review of the empirical literature. Clinical Psychology Review, 30(6), 608-620. https://doi.org/10.1016/j.cpr.2010.04.001
Kazdin, A. E. (1978). Methodological and interpretive problems of single-case experimental designs. Journal of Consulting and Clinical Psychology, 46(4), 629-642. https://doi.org/10.1037/0022-006X.46.4.629
Kerlinger, F., & Howard, B. (2002). Investigación del comportamiento (4a Ed.). McGraw-Hill.
Klemperer, E. M., Hughes, J. R., Peasley-Miklus, C. E., Callas, P. W., Cook, J. W., Streck, J. M., & Morley, N. E. (2020). Possible New Symptoms of Tobacco Withdrawal III: Reduced Positive Affect—A Review and Meta-analysis. Nicotine & Tobacco Research, 23(2), 259-266. https://doi.org/10.1093/ntr/ntaa044
Kopetz, C., MacPherson, L., Mitchell, A. D., Houston-Ludlam, A. N., & Wiers, R. (2017). A novel training approach to activate alternative behaviors for smoking in depressed smokers. Experimental and Clinical Psychopharmacology, 25(1), 50-60. https://doi.org/10.1037/pha0000108
Lang, A. E., & Yakhkind, A. (2020). Coronavirus Disease 2019 and Smoking: How and Why We Implemented a Tobacco Treatment Campaign. Chest, 158(4), 1770-1776. doi:10.1016/j.chest.2020.06.013
Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression. Treatment manual. Behavior modification, 25(2), 255-286. https://doi.org/10.1177/0145445501252005
Leventhal, A. M., & Zvolensky, M. J. (2015). Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychological Bulletin, 141(1), 176-212. https://doi.org/10.1037/bul0000003
Leventhal, A. M., Greenberg, J. B., Trujillo, M. A., Ameringer, K. J., Lisha, N. E., Pang, R. D., & Monterosso, J. (2013). Positive and negative affect as predictors of urge to smoke: Temporal factors and mediational pathways. Psychology of Addictive Behaviors, 27(1), 262-267. https://doi.org/10.1037/a0031579
Leventhal, A., Ramsey, S., Brown, R., LaChance, H., & Kahler, C. (2008). Dimensions of Depressive Symptoms and Smoking Cessation. Nicotine & Tobacco Research, 10(3), 507-517. https://doi.org/10.1080/14622200801901971
Liebmann, E. P., Preacher, K. J., Richter, K. P., Cupertino, A. P., & Catley, D. (2019). Identifying pathways to quitting smoking via telemedicine-delivered care. Health Psychology, 38(7), 638-647. https://doi.org/10.1037/hea0000740
Lira-Mandujano, J. (2002). Desarrollo y evaluación de un programa de tratamiento para la adicción a la nicotina [Tesis de Maestría]. Universidad Nacional Autónoma de México. https://repositorio.unam.mx/contenidos/216620
Lira-Mandujano, J. (2009). Programa de intervención breve motivacional para fumadores y terapias de sustitución con nicotina: Resultados de un ensayo clínico aleatorio controlado [Tesis doctoral]. Universidad Nacional Autónoma de México. https://repositorio.unam.mx/contenidos/90502
Lira-Mandujano, J., González-Betanzos, F., Carrascoza-Venegas, C. A., Ayala-Velázquez, H. E., & Cruz-Morales, S. E. (2009). Evaluación de un programa de intervención breve motivacional para fumadores: resultados de un estudio piloto. Salud Mental, 32(1), 35-41. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000100005&lng=es&tlng=es
Lira-Mandujano, J., Valdez-Piña, E., Núñez-Lauriano, M., Pech-Puebla, D., Morales-Chainé, S., & Cruz-Morales, S. E. (2018). Ansiedad, depresión, afecto negativo y positivo asociados con el consumo de tabaco en universitarias. Revista Internacional de Investigación en Adicciones, 4(1), 4-12. https://doi.org/10.28931/riiad.2018.1.02
Lira-Mandujano, J., Valdez-Piña, E., Pérez-González, M. Á., Pech-Puebla, D., & Arriaga-Ramírez, J. C. P. (2020). Asociación entre consumo de tabaco, factores emocionales y motivos para fumar en universitarios. Enseñanza e Investigación en Psicología, 2(1), 47-59.
MacPherson, L., Collado, A., Ninnemann, A., & Hoffman, E. (2016). Development of a Behavioral Activation–Based Intervention for Cigarette-Smoking Young Adults. Cognitive and Behavioral Practice, 24(1), 101-114. https://doi.org/10.1016/j.cbpra.2016.03.004
MacPherson, L., Tull, M. T., Matusiewicz, A. K., Rodman, S., Strong, D. R., Kahler, C. W., Hopko, D. R., Zvolensky, M. J., Brown, R. A., & Lejuez, C. W. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Journal of Consulting and Clinical Psychology, 78(1), 55-61. https://doi.org/10.1037/a0017939
Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: strategies for guided action. New York: W. W. Norton, & Company, Inc.
Martínez-Vispo, C., Martínez, Ú., López-Durán, A., Fernandez del Rio, E., & Becoña, E. (2018). Effects of behavioural activation on substance use and depression: a systematic review. Substance Abuse Treatment, Prevention, and Policy, 13(1). https://doi.org/10.1186/s13011-018-0173-2
Martínez-Vispo, C., Rodríguez-Cano, R., López-Durán, A., Senra, C., Fernández Del Río, E. F., & Becoña, E. (2019). Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial. PLOS ONE, 14(4), e0214252. https://doi.org/10.1371/journal.pone.0214252
McCarthy, D. E., Piasecki, T. M., Lawrence, D. L., Jorenby, D. E., Shiffman, S., & Baker, T. B. (2008). Psychological mediators of bupropion sustained-release treatment for smoking cessation. Addiction, 103(9), 1521-1533. https://doi.org/10.1111/j.1360-0443.2008.02275.x
McCord, C., Bernhard, P., Walsh, M., Rosner, C., & Console, K. (2020). A consolidated model for telepsychology practice. Journal of Clinical Psychology, 76(6), 1060-1082. https://doi.org/10.1002/jclp.22954
McKay, J. R. (2016). Making the hard work of recovery more attractive for those with substance use disorders. Addiction, 112(5), 751-757. https://doi.org/10.1111/add.13502
National Institute for Health and Care Excellence [NICE]. (2018). Stop smoking interventions and services. https://www.nice.org.uk/guidance/ng92/resources/stop-smoking-interventions-and-services-pdf-1837751801029
National Institute on Drug Abuse [NIDA]. (2020). ¿En qué consisten los tratamientos para la dependencia del tabaco? https://www.drugabuse.gov/es/publicaciones/serie-de-reportes/adiccion-al-tabaco/hay-tratamientos-eficaces-para-la-adiccion-al-tabaco
Nussbaum, R., & Dietz, A. (2021). Smoking Cessation Interventions in College Students: A Systematic Review. Williams Honors College, Honors Research Projects. https://ideaexchange.uakron.edu/honors_research_projects/1293
Organización Mundial de la Salud [OMS]. (2017). Tabaco. http://www.who.int/mediacentre/factsheets/fs339/es/
Ortega-Ceballos, P. A., Terrazas-Meraz, M. A., Arizmendi-Jaime, E. R., & Tapia-Domínguez, M. (2018). Conocimientos, actitudes y factores asociados al consumo de tabaco en estudiantes universitarios de enfermería. Enfermería Universitaria, 15(2), 159-171. https://doi.org/10.22201/eneo.23958421e.2018.2.65173
Pang, R. D., Zvolensky, M. J., Schmidt, N. B., & Leventhal, A. M. (2015). Gender Differences in Negative Reinforcement Smoking Expectancies. Nicotine & Tobacco Research, 17(6), 750-754. https://doi.org/10.1093/ntr/ntu226
Parker, R. I., & Vannest, K. (2009). An improved effect size for single-case research: NonOverlap of all pairs. Behavior Therapy, 40(4), 357-367. https://doi.org/10.1016/j.beth.2008.10.006
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect Size in Single-Case Research: A Review of Nine Nonoverlap Techniques. Behavior Modification, 35(4), 303-322. https://doi.org/10.1177/0145445511399147
Piper, M. E., Bullen, C., Krishnan-Sarin, S., Rigotti, N. A., Steinberg, M. L., Streck, J. M., & Joseph, A. M. (2019). Defining and Measuring Abstinence in Clinical Trials of Smoking Cessation Interventions: An Updated Review. Nicotine & Tobacco Research, 22(7), 1098-1106. https://doi.org/10.1093/ntr/ntz110
Pott, S. L., Delgadillo, J., & Kellett, S. (2021). Is behavioral activation an effective and acceptable treatment for co-occurring depression and substance use disorders? A meta-analysis of randomized controlled trials. Journal of Substance Abuse Treatment, 132, 108478. https://doi.org/10.1016/j.jsat.2021.108478
Reynales-Shigematsu, L. M., Zavala A. L., Paz B. W. C., Gutiérrez, T. D. S., García, B. J. C., Rodríguez, A. M. A., Gutiérrez, R. J., & Mendoza, A. L. (2017). Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016-2017: Reporte de Tabaco. Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Instituto Nacional de Salud Pública, Comisión Nacional Contra las Adicciones y Secretaría de Salud.
Robles, R., & Páez., F. (2003). Estudio sobre la traducción al español y las propiedades psicométricas de las escalas de afecto positivo y negativo [PANAS]. Salud Mental, 26(1), 69-75. http://www.redalyc.org/pdf/582/58212608.pdf
Roussos, A. J., (2007). El diseño de caso único en investigación en psicología clínica. Un vínculo entre la investigación y la práctica clínica. Revista Argentina de Clínica Psicológica, XVI (3), 261-270. http://www.redalyc.org/articulo.oa?id=281921790006
Sánchez-Angulo, J., Barraca-Mairal, J., Pérez-Padilla, J. R., Thirion, I. I., Mora-Ríos, J., Cruz-Morales, S. E., & García-Gómez, L. (2021). A preliminary study on the application of Behavioral Activation in the treatment of smoking in women. Psychology, Society, & Education, 13(2), 35-47. https://ojs.ual.es/ojs/index.php/psye/article/view/3511
Sánchez-Angulo, J., Mora-Rios, J., Barraca-Mairal, J., & Reyes, M. (2020). Propuesta de un programa de tratamiento para dejar de fumar basado en la Activación Conductual. Análisis y Modificación de Conducta, 46, 173-174. https://doi.org/10.33776/amc.v46i173-4.4675
Sanz, J., & García-Vera, M. P. (2015). Técnicas para el análisis de diseños de caso único en la práctica clínica: ejemplos de aplicación en el tratamiento de víctimas de atentados terroristas. Clínica y Salud, 26(3), 167-180. https://doi.org/10.1016/j.clysa.2015.09.004
Sanz, J., Perdigón, A. L., & Vázquez, C. (2003). Adaptación española del Inventario para la Depresión de Beck-II (BDI-II): 2. Propiedades psicométricas en población general. Clínica y Salud, 14(3), 249-280. https://www.redalyc.org/pdf/1806/180617972001.pdf
Sharareh, P., Leili, T., Abbas, M., Jalal, P., & Ali, G. (2020). Determining correlates of the average number of cigarette smoking among college students using count regression models. Scientific Reports, 10, 8874. https://doi.org/10.1038/s41598-020-65813-4
Shiffman, S., Balabanis, M. H., Paty, J. A., Engberg, J., Gwaltney, C. J., Liu, K. S., Gnys, M., Hickcox, M., & Paton, S. M. (2000). Dynamic effects of self-efficacy on smoking lapse and relapse. Health Psychology, 19(4), 315-323. https://doi.org/10.1037//0278-6133.19.4.315
Sobell, L. C., & Sobell, M. B. (1992). Timeline Follow-Back. In: R. Z. Litten & J. P. Allen (Eds.). Measuring Alcohol Consumption. Humana Press. https://doi.org/10.1007/978-1-4612-0357-5_3
Tiburcio-Sainz, M., Rosete-Mohedano, M., Natera-Rey, G., Martínez-Vélez, N., Carreño-García, S., & Pérez-Cisneros, D. (2016). Validez y confiabilidad de la prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) en estudiantes universitarios. Adicciones, 28(1), 19-27. https://doi.org/10.20882/adicciones.786
Turner, J., & Leach, D. (2012). Behavioural Activation Therapy: Philosophy, Concepts, and Techniques. Behaviour Change, 29(2), 77-96. https://doi.org/10.1017/bec.2012.3
Tzelepis, F., Paul, C. L., Williams, C. M., Gilligan, C., Regan, T., Daly, J., Hodder, R. K., Byrnes, E., Byaruhanga, J., McFadyen, T., & Wiggers, J. (2019). Real-time video counselling for smoking cessation. Cochrane Database System Review, (10), CD012659. https://doi.org/10.1002/14651858.CD012659.pub2
Vinci, C., Li, L., Wu, C., Lam, C. Y., Guo, L., Correa-Fernández, V., Spears, C. A., Hoover, D. S., Etcheverry, P. E., & Wetter, D. W. (2017). The association of positive emotion and first smoking lapse: An ecological momentary assessment study. Health Psychology, 36(11), 1038-1046. https://doi.org/10.1037/hea0000535
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063-1070. https://doi.org/10.1037/0022-3514.54.6.1063
Zvolensky, M. J., Stewart, S. H., Vujanovic, A. A., Gavric, D., & Steeves, D. (2009). Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine & Tobacco Research, 11(3), 323-331. https://doi.org/10.1093/ntr/ntn037