It may not be that feeling sad directly leads to failed quit attempts, but rather a pervasive inability to experience pleasure surrounding life activities that one normally enjoys, according to a paper recently published in the Journal of Consulting Clinical Psychology. The paper, based on UW-CTRI data from the Wisconsin Smokers’ Health Study (WSHS), revealed that clinical attention to anhedonia, or the diminished interest or pleasure in normally enjoyable activities, may be a key to helping groups of smokers who struggle so much to quit tobacco use.

Anhedonia and depressed mood (i.e., elevated sadness) constitute the two hallmark features of Major Depressive Disorder (American Psychiatric Association, 1994). Either anhedonia or depressed mood is required (in addition to at least four other symptoms) to qualify for a Major Depression diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV). Although they are both key symptoms of the same syndrome (i.e., Major Depressive Disorder), anhedonia and depressed mood are empirically distinct. Assistant Professor of Medicine 
Dr. Jessica Cook has made anhedonia a key focus of her UW-CTRI work. 

WSHS results show that, while lifetime depressive disorder didn’t predict inability to quit tobacco use, anhedonia did. This could be important because anhedonia-related features are present in several psychopathologies (e.g., posttraumatic stress disorder, schizophrenia). Hence, anhedonia may account for high rates of cessation failure in other psychiatric populations; that is, it may constitute a core common mechanism linking multiple manifestations of psychological disturbance with difficulty quitting smoking. As smoking rates drop below 20% across the nation, about half of the cigarettes are smoked by those who suffer from mental illness and/or substance abuse issues. 

“Recent research has shown that the smoking rate has not fallen for smokers with mental health issues,” said co-author 
Dr. Megan Piper. “They are more likely to smoke, smoke more heavily and suffer greater physical health consequences. This makes this population an especially important one to understand and target with appropriate treatment.”

The results of this research illustrated that incorporating smoking cessation treatments that boost interest in—and pleasure from—enjoyable activities may be helpful for mitigating relapse risk in smokers with mood disturbance, and perhaps for smokers in general.

The lead author of this paper was Adam Leventhal from the Departments of Preventive Medicine and Psychology, USC Keck School of Medicine. In addition to Jess and Megan, UW-CTRI Research Director 
Dr. Tim Baker contributed to the paper. Former UW-CTRI grad student Sandra Japuntich also contributed; she now works at the National Center for PTSD, Veterans Affairs Boston Healthcare System.

Leventhal AM, Piper ME, Japuntich SJ, Baker TB, Cook JW. Anhedonia, Depressed Mood, and Smoking Cessation Outcome. Journal of Consulting Clinical Psychology. Epub: November 2013.