New reason why quitting smoking is so difficult

When a cigarette smoker attempts to quit, not only do they crave their usual nicotine hit, they also experience an unpleasant inability to enjoy other pleasures in life - a state known as "anhedonia".

Jessica Cook and her colleagues studied over a thousand smokers enrolled on a quitting programme in the US. The participants (mostly White, 58.3 per cent were female) were placed on a range of nicotine replacement therapies or they were given placebo. The participants also kept an evening diary from five days before, to ten days after, their quit day. Here they recorded how much pleasure they'd experienced that day across three domains: social, recreation and performance/accomplishment.

The researchers found that stopping smoking was followed by an immediate spike in anhedonia - on the day of quitting, participants in the placebo condition showed a marked reduction in their experience of pleasure from various aspects of life. This quitting-related anhedonia peaked the day after quitting and showed all the hallmarks of being part of the nicotine "withdrawal syndrome". That is, levels of anhedonia tended to be correlated with other withdrawal symptoms (such as craving and poor concentration); the anhedonia faded over time; and it was eased by the administration of a nicotine therapy, such as a nicotine lozenge or patch.

Perhaps most importantly, the results showed that levels of anhedonia were correlated (negatively) with participants' subsequent success at abstinence, even after controlling for the predictive value of craving levels and negative mood. In other words, more quitting-related anhedonia was associated with less success at quitting. Greater post-quitting anhedonia also predicted increased risk of an initial lapse transforming into a full return to smoking. It seems likely that quitting-related anhedonia prompts smokers to want to resume smoking so that they can reinstate their usual ability to enjoy other pleasures in life; and once they lapse, the return of the smoker's usual experience of pleasure acts as a powerful reinforcer.

"The present study is the first, to our knowledge, to demonstrate that post-cessation pleasure in response to daily activities is a significant barrier to quitting smoking," the researchers said. They added that this could point to important new treatment strategies aimed at helping smokers get through their initial experience of anhedonia (such as "behavioural activation"), especially smokers with other mental health issues, who may use smoking to self-treat their chronic anhedonia.

The study makes a useful contribution to the field, but it does suffer some limitations, as the researchers acknowledged. This includes the reliance on the participants' rather vague reports of their daily enjoyment of activities, as well as the fact the sample was enrolled on a treatment programme and highly motivated to quit - it remains to be seen how well the findings will generalise.
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  Cook, J., Piper, M., Leventhal, A., Schlam, T., Fiore, M., & Baker, T. (2014). Anhedonia as a Component of the Tobacco Withdrawal Syndrome. Journal of Abnormal Psychology DOI: 10.1037/abn0000016

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.