Heffner Jaimee L, Watson Noreen L, McClure Jennifer B, Anthenelli Robert M, Hohl Sarah, Bricker Jonathan B
a Division of Public Health Sciences , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.
b Kaiser Permanente Washington Health Research Institute (Formerly Group Health Research Institute) , Seattle , Washington , USA.
J Dual Diagn. 2018 Jan-Mar;14(1):32-39. doi: 10.1080/15504263.2017.1390278. Epub 2018 Jan 19.
Smokers with bipolar disorder (BD) have low rates of successful quitting, yet no prior studies have evaluated the process of quitting among these smokers in the context of a current quit attempt. To facilitate development of more effective interventions, we conducted a qualitative exploration of challenges and facilitators of quitting in an intervention study for smokers with BD.
Participants were adult daily smokers with BD (n = 10) who completed a 10-week smoking cessation intervention consisting of Acceptance and Commitment Therapy (ACT) and nicotine patch. We administered semistructured interviews focused on the quitting process at the end of treatment and used inductive content analysis to extract themes.
Emergent themes representing challenges of quitting included social impediments, lack of awareness, avoidance, maladaptive beliefs, ambivalence, benefits of smoking, and difficulties with nicotine replacement. Themes representing change facilitators included positive treatment effects (ACT-specific, nonspecific, and nicotine patch-related), coping behaviors, reasons to quit, changes in self-perception, and social benefits.
Results suggest a need for assistance with obtaining social support and handling social impediments, interrupting the automaticity of smoking, expanding the behavioral repertoire to handle aversive internal states that tend to be avoided by smoking, preventing maladaptive beliefs from interfering with quitting, taking meaningful action toward change while experiencing ambivalence, either replacing the benefits of smoking or accepting their loss, and troubleshooting difficulties with nicotine replacement. Findings regarding facilitators of quitting supported previous quantitative findings that the ACT intervention impacted theory-based targets and highlighted the importance of the counseling relationship.
双相情感障碍（BD）吸烟者成功戒烟率较低，但此前尚无研究在当前戒烟尝试的背景下评估这些吸烟者的戒烟过程。为了促进开发更有效的干预措施，我们在一项针对BD吸烟者的干预研究中，对戒烟的挑战和促进因素进行了定性探索。
参与者为患有BD的成年每日吸烟者（n = 10），他们完成了一项为期10周的戒烟干预，该干预包括接受与承诺疗法（ACT）和尼古丁贴片。我们在治疗结束时进行了以戒烟过程为重点的半结构化访谈，并使用归纳性内容分析法提取主题。
代表戒烟挑战的新出现主题包括社会障碍、缺乏意识、回避、适应不良信念、矛盾心理、吸烟的益处以及尼古丁替代的困难。代表改变促进因素的主题包括积极的治疗效果（ACT特异性、非特异性以及与尼古丁贴片相关的）、应对行为、戒烟理由、自我认知的变化以及社会益处。
结果表明，需要在获得社会支持和应对社会障碍、中断吸烟的自动性、扩展行为模式以应对往往通过吸烟来回避的厌恶内心状态、防止适应不良信念干扰戒烟、在经历矛盾心理时朝着改变采取有意义的行动、要么替代吸烟的益处要么接受其损失以及解决尼古丁替代的困难等方面提供帮助。关于戒烟促进因素的研究结果支持了之前的定量研究结果，即ACT干预影响了基于理论的目标，并突出了咨询关系的重要性。
