Negative Affect & Relapse

• Mission Statement by Jessica Broitman, 11/9/96
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    • Why can't they cope? by Jessica Broitman, 1/16/97
      
      

In this one session intervention with the post MI patients, we try to use Prochaska & DiClemente's Change Process Model by adapting the intervention to the stage of readiness to change. Many people have used this same approach, but essentially it involves the following (presented in the most global way):

Precontemplation: The focus here is on raising awareness and helping the patient perceive smoking as a health problem. I rely on Miller's work on motivational enhancement therapy where you try to roll with resistance and elicit motivational statements from patients.

Contemplation: Since this is a stage characterized by ambivelence the therapists task is to help elicit the pros of quitting and tip the balance toward quitting.

Preparation: In this stage it seems useful to lay out the next steps, for my work this means the plan of action when the patient leaves the hospital. I use Prochaska's Self-Efficacy scale to get a sense of the most likely triggers for relapse and try to use some problem solving strategies.

All of the above works quite nicely, HOWEVER, about one third or more patients that I interview in the hospital tell me that they successfully quit before (often for months and years at a time). Inevitably they always describe some severe negative affect that precipitated the return to smoking. Wearing a non-researcher hat, it usually seems to be depression, anger, grief and/or shame related to some event in their lives which taxed their coping ability to the limit. Although the literature is not conclusive, there is lots of evidence that negative affect does in fact precipitate relapse from smoking.

So this is what I've been thinking about lately. I'm wondering whether when you identify patients who have successfully quit before for a long period of time, it might be useful to try to actively guide the patient in exploring the feelings that seemed to precipitate the relapse. Remember that I only have one face to face session, the patients have just been through a traumatic medical event and most of this work is based on cognitive-behavioral approaches rather than grounded in psychodynamic theory.

No time to write more now, but hopefully we can continue the discussion

By definition, I only work with patients at these first three stages in the hospital, although once they leave a majority of patients move into the Action and Maintenance stages. Again, phone follow-up is geared to the particular stage. The goal is alway to help the patient advance one stage, not to propell them into quitting if they aren't ready for that.

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