The association between cognitive coping strategies and treatment outcomes in smokers with PTSD.
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY(2020)
摘要
Objective: Numerous researchers have suggested that certain coping styles (e.g., maladaptive cognitive coping strategies) interfere with recovery from traumatic experiences and contribute to the onset/maintenance of posttraumatic stress disorder (PTSD). Further, given that individuals with PTSD have a high rate of smoking (e.g., Mahaffey et al., 2016) and that maladaptive coping strategies in general are associated with lower smoking quit rates, it is possible that use of maladaptive cognitive coping strategies are particularly problematic for the recovery of smokers with PTSD. The present study examined whether specific cognitive coping strategies are associated with poorer outcome among smokers with PTSD following an integrated treatment for both disorders. Method: Patients with chronic PTSD and nicotine dependence (N = 142) received up to 12 sessions of smoking cessation counseling combined with varenicline or integrated prolonged exposure therapy and cessation counseling combined with varenicline. We hypothesized that greater maladaptive, and lower adaptive, cognitive coping strategies at baseline would moderate degree of improvement in smoking and PTSD outcomes through to follow-up. Results: Multilevel modeling revealed that neither maladaptive nor adaptive cognitive coping strategies moderated smoking abstinence outcomes over the course of the study (ps >= .271). However, greater use of catastrophizing and lower use of positive reappraisal at baseline were associated with less improvement in the hyperarousal PTSD symptom cluster over the course of the study (ps <= .01). Conclusions: These findings suggest that maladaptive cognitive coping strategies are not necessarily a contraindication for overall outcomes in integrated PTSD and smoking treatment, although they may influence improvement in hyperarousal symptoms. Clinical Impact Statement Maladaptive cognitive coping strategies (e.g., catastrophizing) contribute to the maintenance of both posttraumatic stress disorder (PTSD) and smoking. In the current study, a combination of prolonged exposure (PE) and smoking cessation and smoking cessation alone led to significant reductions in maladaptive cognitive coping. However, participants with greater catastrophizing and less positive reappraisal at baseline showed significantly less improvement in PTSD hyperarousal symptoms across the sample. Thus, while PE and smoking cessation each generally target maladaptive coping strategies, clinicians should pay particular attention to the role of catastrophizing and positive reappraisal to bolster treatment outcomes in this comorbid population.
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关键词
cognitive coping,PTSD,smoking cessation,treatment outcome,moderators
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