How do coping and depressive symptoms affect the relapse process after smoking cessation

Inadequate coping and depression and are established predictors of lapses and relapses during a smoking cessation attempt. However, it is not yet clear to what extent and through which mechanisms coping and depressive symptoms affect the relapse process and whether some coping strategies are more helpful than others.

The presented study analysed ecological momentary assessment (EMA) data of 242 self-quitters reporting 7,112 observations during the first two weeks of a smoking cessation attempt. We collected real-time data on negative affect, physical withdrawal symptoms, the urge to smoke, abstinence-related self-efficacy and lapses after a smoking cessation attempt. Online questionnaires were employed to assess distinct coping styles, depressive symptoms and nicotine dependence at baseline and frequency of smoking at the one- and three month follow-up. 

Using multilevel modelling, we firstly analysed how distinct stress- and temptation-coping strategies were associated with the level of the urge to smoke and the occurrence of lapses. We identified helpful, ineffective and detrimental coping strategies. Secondly, we explored to what extent and through which mechanisms negative affect, physical withdrawal symptom, urge to smoke, and abstinence-related self-efficacy affected the lapse risk and how depressive symptoms influenced proximal antecedents of lapses in men and women.