Within-day temporal patterns of smoking, withdrawal symptoms, and craving

University of Pittsburgh, Pittsburgh, PA, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 02/2011; 117(2-3):118-25. DOI: 10.1016/j.drugalcdep.2010.12.027
Source: PubMed


We examined the temporal relationships between smoking frequency and craving and withdrawal. 351 heavy smokers (≥15 cigarettes per day) used ecological momentary assessment and electronic diaries to track smoking, craving, negative affect, arousal, restlessness, and attention disturbance in real time over 16 days. The waking day was divided into 8 2-h "bins" during which cigarette counts and mean levels of craving and withdrawal were computed. Cross-sectional analyses showed no association between restlessness and smoking, and arousal and smoking, but craving (b=0.65, p<0.01) was positively associated, and negative affect (b=-0.20, p<0.01), and attention disturbance (b=-0.24, p<0.01) were inversely associated with smoking. In prospective lagged analyses, higher craving predicted more subsequent smoking and higher smoking predicted lower craving (p's<0.01). Higher restlessness also predicted more subsequent smoking and higher smoking predicted lower restlessness (p's<0.01). Higher negative affect did not predict later smoking, but more smoking preceded lower negative affect (p<0.01). Neither attention disturbance nor arousal predicted, or were predicted by variations in smoking. In short, smoking exhibits time-lagged, reciprocal relationships with craving and restlessness, and a one-way predictive relationship with negative affect. Temporal patterns of craving and restlessness may aid in the design of smoking cessation interventions.

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    • "Moreover, they avoid relying on individuals' autobiographical memory (which is the case in retrospective self-reports), which is prone to random error but also fraught with systematic bias[25]. Evidence from other clinical studies, such as smoking cessation, indicates that ambulatory monitoring of subjective states provides greater temporal resolution than can be achieved by laboratory assessments[26,27]. This setting provides rich and detailed information on both the background level of mood and well-being (tonic levels), as well as the frequency and magnitude of acute fluctuations (phasic variation), and identifies specific periods when these occur (for example, early morning). "
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    ABSTRACT: Deviation from the physiological glucocorticoid dynamics (circadian and underlying ultradian rhythmicity) is a common characteristic of various neuropsychiatric and endocrine disorders as well as glucocorticoid-based therapeutics. These states may be accompanied by neuropsychiatric symptomatology, suggesting continuous dynamic glucocorticoid equilibrium is essential for brain homeostasis. The study consists of two parts. The preliminary stage of the study aims to validate (technically and pharmacologically) and optimise three different patterns of systemic cortisol administration in man. These patterns are based on the combinatory administration of metyrapone, to suppress endogenous cortisol production, and concurrent hydrocortisone replacement. The second, subsequent, core part of the study is a randomised, double-blinded, placebo-controlled, crossover study, where participants (healthy male individuals aged 18–60 years) will undergo all three hydrocortisone replacement schemes. During these infusion regimes, we plan a number of neurobehavioural tests and imaging of the brain to assess neural processing, emotional reactivity and perception, mood and self-perceived well-being. The psychological tests include: ecological momentary assessment, P1vital Oxford Emotional Test Battery and Emotional Potentiated Startle Test, Leeds Sleep Evaluation Questionnaire and the visual working memory task (n-back). The neuroimaging protocol combines magnetic resonance sequences that capture data related to the functional and perfusion status of the brain. Results of this clinical trial are designed to evaluate the impact (with possible mechanistic insights) of different patterns of daily glucocorticoid dynamics on neural processing and reactivity related to emotional perception and mood. This evidence should contribute to the optimisation of the clinical application of glucocorticoid-based therapeutics. Trial registration UK Clinical Research Network, IRAS Ref: 106181, UKCRN-ID-15236 (23 October 2013)
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    • "Those refinements are possible with ecological momentary assessment (EMA), a method in which participants use a handheld computer or smartphone to report on their activities and moods in real time as they go about their daily lives (Preston and Epstein 2011; Shiffman 2005). Recent EMA studies from our clinic and others have shown increases in negative affect, 1 craving, and restlessness preceding lapse to or continued use of cocaine or cigarettes (Chandra et al. 2011; Preston and Epstein 2011; Shiffman 2005). We have also shown with EMA that negative affect and craving increase as stress increases, but, crucially, we have been unable to show a statistically significant relationship between stress and actual drug use (Preston and Epstein 2011). "

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    • "Also, the co-variations between pulmonary functions tested by a spirometer and positive/negative affect in patients with asthma were reported [17]. In addition, some studies demonstrated that addictive behaviors such as smoking [18,19] and alcohol consumption [20,21] are related to the fluctuations in psychological states, e.g., positive/ negative affect and craving. Furthermore, the associations of momentary psychological states with self-reported physical activity were demonstrated [22,23]. "
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    ABSTRACT: Computerized ecological momentary assessment (EMA) is widely accepted as a "gold standard" method for capturing momentary symptoms repeatedly experienced in daily life. Although many studies have addressed the within-individual temporal variations in momentary symptoms compared with simultaneously measured external criteria, their concurrent associations, specifically with continuous physiological measures, have not been rigorously examined. Therefore, in the present study, we first examined the variations in momentary symptoms by validating the associations among self-reported symptoms measured simultaneously (depressive mood, anxious mood, and fatigue) and then investigated covariant properties between the symptoms (especially, depressive mood) and local statistics of locomotor activity as the external objective criteria obtained continuously. Healthy subjects (N = 85) from three different populations (adolescents, undergraduates, and office workers) wore a watch-type computer device equipped with EMA software for recording the momentary symptoms experienced by the subjects. Locomotor activity data were also continuously obtained by using an actigraph built into the device. Multilevel modeling analysis confirmed convergent associations by showing positive correlations among momentary symptoms. The increased intermittency of locomotor activity, characterized by a combination of reduced activity with occasional bursts, appeared concurrently with the worsening of depressive mood. Further, this association remained statistically unchanged across groups regardless of group differences in age, lifestyle, and occupation. These results indicate that the temporal variations in the momentary symptoms are not random but reflect the underlying changes in psychophysiological variables in daily life. In addition, our findings on the concurrent changes in depressive mood and locomotor activity may contribute to the continuous estimation of changes in depressive mood and early detection of depressive disorders.
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