Cognitive and Behavioral Prognostic Factors of Smoking Cessation XVth European Meeting of Société Française de Cardiologie January, 22nd 2005
Yvonnick NOEl, PhD. University of Rennes 2 (France) Department of Psychology Email:
[email protected]
Note: These slides are available online from the author's website http://yvonnick.noel.free.fr/papiers/Cardio22012005.pdf
A practical question ●
From epidemiological studies, we know that smoking rates tend to remain constant where no prevention programs exist.
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From psychological studies, we know that too much pressure put on heavy smokers tend to produce reactance (« entrenched smoking »).
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Question: Between nothing and too much, what should we do in the clinical setting ?
Aims of this talk ●
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Provide a brief summary of some important results in the description of behavior change in smoking cessation (Prochaska, DiClemente & Norcross, 1992): –
Stages of change,
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Processes of change,
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And their interactions.
Provide a continuous version of the discrete stages-of-change model (Noel, 1999).
Stages of change in smoking cessation ●
DiClemente & Prochaska (1985) proposed to distinguish between 5 stages of change : –
Precontemplation: Smokers not considering quitting.
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Contemplation: Smokers seriously considering quitting in the next 6 months, but having done nothing up to now.
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Preparation: Smokers seriously considering quitting in the next 30 days, and having done at least one attempt during the last 12 months.
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Action: Smokers having quit during the last 6 months (recent quitters).
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Maintenance: Smokers having quit since more than 6 months.
Transitions Velicer et al. (1999) have followed a cohort of 308 Ss for 36 months, and assess stage of change every 6 month. ● The figure on the right give some of the highest transition probabilities from one stage to another (6 months later). ● These probabilities do not change significantly at each followup point (a markovian structure). ●
1. 2. 3. 4. 5. Pre Contem Prepa Action Mainte contempl. plation ration nance
0.27
0.61 0.14
0.16
0.60
0.27
0.11
0.53 0.18
0.46
0.25 0.07
0.85
10 basic processes of change (Prochaska et al., 1988) COGNITIVE PROCESSES
BEHAVIORAL PROCESSES
Perception of nonsmokers' social roles
Self-reinforcement (rewarding oneself for not smoking)
Information taking (hazards, quitting methods...)
Helping relationship (relying on someone)
Perception of the consequences on environment
Counterconditioning (substitute smoking by another behavior, sport...)
Negative emotional feelings about smoking
Stimulus Control
Self-reevaluation (smoking as a personal challenge)
Self-liberation (selfconfidence, will...)
Interaction between stages and processes
The other way around: From processes to stages ●
A problem with the discrete stage concept is that most smokers seen in the clinical setting belong to stage 2 or 3. What you really get is a 2-stage model !
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We look for a continuous model of change, where each smoker would be located by a score on a cognitive-behavioral continuum.
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Method: Though we don't know where a given smoker is on that continuum, we are able to measure how close two smokers are to each other, just by looking at their processes of change scores.
Two sample items
Comparison between the discrete and the continuous models
Distributions of scores by stage
Practical consequences ●
From contemplation (stage 2) to action (stage 4), use of cognitive processes (« motivation ») decrease, while behavioral processes increase.
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So a natural intervention is not to enhance motivation (already at its top level) but behavioral commitment (reinforcement management, counterconditioning etc.).
References ●
Noël, Y. (1999). Recovering Latent Unimodal Patterns of Change by Unfolding Analysis : Application to Smoking Cessation. Psychological Methods, 4(2), 173191.
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Noël, Y. (1999). An Ordination Approach to the Quantification of Smokers' Readiness to Change. Swiss Journal of Psychology, 58(2), 123-133.
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Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In Search of How People Change: Applications to addictive behaviors. American Psychologist, 47 (9), 1102-1114.
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Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Homewood. Illinois, Dorsey Press.
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Prochaska, J.O., Velicer, W.F., DiClemente, C.C., & Fava, J. (1988). Measuring Processes of Change: Applications to the Cessation of Smoking, Journal of Consulting and Clinical Psychology, 56, 520-528.
