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relapse was likely to occur.
Shiffman (1982) demonstrated the importance of cognitive coping responses and showed
that these were less likely to be affected by situational determinants than were behavioural coping strategies. In a study of 183 ex-smokers who called a telephone service for help in staying off cigarette smoking when they felt they were about to relapse or had just started to relapse, interviewers obtained information about the relapse situation, the possible precipitants and the coping behaviours the caller had used in the attempt to refrain. While experience of withdrawal symptoms since quitting and immediately prior to the critical situation which initiated the call were examined, no attempt was made to assess severity of dependence. The findings suggest that situational determinants were important antecedents of relapse crises but did not determine the outcome. Rather it was the use of coping responses that determined the outcome. Situational determinants, specifically drinking alcohol, affected the application of behavioural coping and depression reduced the effectiveness of behavioural coping. With these exceptions, there was no difference overall between the effectiveness of behavioural or cognitive coping responses; participants who used both types were more likely to survive the situation than those who used only one type or who used none at all. In an extension of the study conducted two years later (Shiffman 1984), the relationship between behavioural and cognitive coping was examined for the entire sample of 264 ex-smokers; a relationship of unequal interdependence was found between the two groups of responses. Behavioural coping behaviours were accompanied by cognitive coping behaviours 79% of the time, while cognitive coping was accompanied by behavioural coping 63% of the time. The number of coping responses used was not predictive of the outcome. As mentioned with reference to the earlier study, no attempt was made to assess dependence, but when age, number of cigarettes smoked or number of years smoking were examined, no relationship with coping was found. Formal treatment was shown to affect the nature of coping responses with people undergoing such treatment being more likely to use behavioural responses than untreated people, more likely to combine behavioural with cognitive responses and less likely to use cognitive coping alone. Both groups were equally likely to report using cognitive coping. Overall the study found that the combination of behavioural and cognitive coping responses was significantly more effective in maintaining abstinence than using either type of response alone, or than using no coping. No one behavioural coping response was superior in its effectiveness to any other; in the cognitive coping category however, while will power was found to be significantly different to no coping, it was also found to be significantly less effective in its association with outcome. Self-punitive cognitions are associated with significantly more relapses than other cognitive coping
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