Re: "Are functional beliefs about smoking a proxy for nicotine withdrawal symptom reduction?" by Gillian S Gould, Alan Clough, and Andy McEwen

Omid Fotuhi, Department of Psychology,

Other Contributors:

August 27, 2012

Omid Fotuhi,1 Geoffrey T Fong,1,2 Mark P Zanna,1 Ron Borland,3 Hua- Hie Yong,3 K Michael Cummings4

1. Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada 2. Ontario Institute for Cancer Research, Toronto, Ontario, Canada 3. The Cancer Council Victoria, Melbourne, Victoria, Australia 4. Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA

Email for lead author, Omid Fotuhi: ofotuhi@uwaterloo.ca

NOT PEER REVIEWED Response to letter:

In our recent study--using a large set of nationally representative samples of smokers from Canada, the US, the UK, and Australia--we reported on the longitudinal patterns of smoking-related beliefs and how these beliefs vary with changes in smoking status. We found a consistent pattern of attitude-behaviour congruence: smokers highly endorsed risk-minimizing beliefs (e.g., "I have the genetic make-up that allows me to smoke without any health problems") and functional beliefs (e.g., "Smoking helps me concentrate"). But the most interesting finding was the longitudinal pattern of how these justifications for smoking changed over time as their smoking status changed: smokers endorsed these beliefs the least when they had quit; and again endorsed these beliefs to their pre-quit levels if they relapsed back to smoking, whereas the levels of endorsement of these beliefs stayed low among those smokers who had quit smoking and were able to stay quit in the long-term. We proposed that the waxing and waning of these smoking-related beliefs as a function of smoking status were driven by motivations to reduce cognitive dissonance (Festinger, 1957)--a fundamental human motivation to maintain consistency between one's attitudes and one's behaviours.

In response to these findings, Gould, Clough, and McEwen have offered a thoughtful commentary. In addition to writing about the importance for public health measures to target smokers' erroneous beliefs that smoking reduces stress, they agreed with our view that smokers are driven to modify their risk-minimizing beliefs because of their motivation to reduce dissonance.

However, Gould et al. suggest that an alternate mechanism is responsible for the longitudinal pattern of functional beliefs that we report in our study. Rather than being driven by dissonance-reducing motivations, they suggest that higher endorsements of functional beliefs among smokers are "representations of smokers' genuine experiences of nicotine withdrawal 'in between' cigarettes or on quitting."

We, on the other hand, do not see a contradiction between their interpretation and ours. Rather, we suggest that the physiological reactions to withdrawal and dependence are the starting point for the cognitive dissonance process. This is a view that has long been shared by dissonance researchers (e.g., Zanna, Cooper, & Taves, 1978; Croyle & Cooper, 1983).

So the Gould et al. account does not, at the core, differ from our account. They are pointing out the nature of the reasons for the justifications, which is the whole point of our argument: the fact that smokers are addicted and that they suffer withdrawal symptoms leads to the search for justifications for their smoking (rather than saying that "I am addicted"). The physiological symptoms of dependence and withdrawal can, therefore, lead to effects far outside the realm of the physiology of the smoker.

Thus, their account is not an alternative explanation--it may well be the starting point for what then become biases in cognitions to justify smoking.

In addition, when looking at the data from our study, we note that non-quitters endorsed both risk-minimising and functional beliefs more, compared to successful and failed quitters, at all three waves--even at times when all three groups were smoking (wave 1). Because it is unlikely that the pattern of risk-minimizing beliefs (e.g., "You've got to die someday, so why not enjoy yourself and smoke") is driven primarily by withdrawal symptoms--and given the strikingly similar pattern for both functional and risk-minimizing beliefs--we suggest that, at least in part, similar dissonance-reducing processes may also be responsible for the shifting of functional beliefs as smokers vacillate between smoking and having quit.

Furthermore, let us be clear that we do not claim that all smokers' smoking-related beliefs are distortions that serve only to reduce dissonance. We fully acknowledge that there may, in fact, be unique and genuine physiological experiences of nicotine consumption and withdrawal. We propose, however, that these experiences can more effectively be captured by specific measures that tap into the visceral aspects of nicotine addiction. For instance, the Hughes (1992) article cited by Gould and colleagues nicely captures these physiological experiences among quitters at various time points (e.g., increased irritability, hunger, restlessness, and cravings to smoke). These items are more directly representative of physiological responses to nicotine consumption and withdrawal than some of our functional beliefs measure (e.g., "Smoking is an important part of your life" or "Smoking makes it easier to socialize").

In fact, we would even argue that in comparison to risk-minimizing beliefs, functional beliefs are more readily employed in the service of dissonance reduction because they are less likely to be countered by reality constraints (Kunda, 1990). Specifically, we think that the functional beliefs in our study [(1) "You enjoy smoking too much to give it up"; (2) "Smoking calms you down when you are stressed or upset"; (3) "Smoking helps you concentrate better"; (4) "Smoking is an important part of your life"; and (5) "Smoking makes it easier for you to socialize"] are exactly the kind of malleable beliefs that smokers commonly employ--more so than the risk-minimizing beliefs which may be countered by rational thought (e.g., "The medical evidence that smoking is harmful is exaggerated")--to rationalize a behaviour that they know is harmful to their health.

Nonetheless, we appreciated the comments by Gould et al. because they encouraged us to take a closer look at our data and, consequently, to further think about our original interpretation of the findings.

We hope that further research continues to explore the role of attitudes in the domain of health behaviour, and specifically addictive behaviours, such as smoking. Experimental studies that more clearly determine causality and studies that examine the taxonomy of rationalizations commonly used by smokers would be especially useful for the advancement of this research topic. These findings would also have the important potential of informing policies to more effectively help save lives.

References

Croyle, R. T., & Cooper, J. Dissonance arousal: Physiological evidence. J Pers Soc Psychol. 1983;45:782-791.

Festinger L. A Theory of Cognitive Dissonance. Evanston, IL: Row, Peterson, 1957.

Hughes JR. Tobacco withdrawal in self-quitters. J Consult Clin Psychol. 1992;60(5):689-97.

Kunda Z. The case for motivated reasoning. Psychol Bull. 1990;108:480e98.

Zanna, M. P., & Cooper, J. Dissonance and the pill: An attribution approach to studying the arousal properties of dissonance. J Pers Soc Psychol 1974;29:703-709.

Conflict of Interest:

None declared

Conflict of Interest

None declared