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A PSYCHOPHYSICAL TASK TO QUAXTIFY ShIOKING CESSATIOS-INDUCED IRRITABILITY: THE REACTIVE IRRITABILITY SCALE (RIS) JANE B. ACRI and NEIL E. GRUNBERG Department

ofhledical

Psychology.

Uniformed

Services University

ofthe

Health

Sciences.

Bethesda.

.L1D

Abstract - A ps!chophysical rating scale using magnitude estimation was de\clopcd as a tool to quantif) irritabilit) as one index of drug withdrawal. The scale measures reacti\e irritabilit) by using environmental sounds as probes. Three studies are described in which target and reierence stimuli are selected. tested for reliabilit). and presented to cigarette smokers abstaining from smoking. cigarette smokers who are not abstaining. and nonsmokers. This reactive irritabilit! scale (RISI uas found to have test/re-test reliability and content validit?. The RIS signiticantl) differentiated abstaining smokers from nonsmokers and from smokers allowed to smoke. N hereas the commonly used self-report measures of irritability failed to distinguish the two groups of smokers. By measuring irritability as a type of reactivity rather than as a static attribute. a different type of irritability is measured than that which is assessed b> self-report questionnaires. The RIS should be used in the stud\ of withdrwal from nicotine and other drugs ofabuse.

ISTRODUCTIOS Ir is well established that cigarette smokers who abstain from nicotine experience a number of symptoms. collectively known as a withdra\val syndrome (Shiffman. 1979: U.S. Department of Health and Human Services. 1985). Commonly reported symptoms include irritability. craving. frustration, ansiety. difficulty concentrating. drowsiness, restlessness, insomnia, and changes in caloric intake (.i\merican Ps\.chiatric .4ssociation (APA). 1987: U.S. Depanment of Health and Human Services. 1988. 1989: Hatsukami. Dahlgren. Zimmerman. e( Hughes. 1988: Hughes. Higgins. & Hatsukami. 1990: Hughes & Hatsukami. 1986: Hughes, Hatsukami. Pickens. & Svikis, 198-l). The most consistent of these changes across attempts to quit smoking include irritability, insomnia. change in caloric intake. drowsiness. and changes in heart rate (Hughes et al.. 1984; U.S. Department of Health and Human Services. 1988). Man! of these symptoms are believed to contribute to relapse to tobacco use after abstinence (Shiffman et al.. 1986). In addition to nicotine LvithdraLval. irritability is commonly associated tvith withdrawal from several other drugs. including alcohol. amphetamine. cocaine. and anxiolytics (APA. 1987). Irritability also is a component ofthe DSM-IIIR diagnostic criteria for manic episodes. post-traumatic stress disorder. and anxiety disorders in adults. as well as depressive episodes and dysthymia in children and adolescents (.4PA. 1987). The most commonly used measures of irritability in nicotine Lvithdrawal are selfreport instruments that also assess craving. anxiety. dificulty concentrating, and dro\vsiness (Hughes & Hatsukami. 1986: Shiffman & Jarvik. 1976). Additional measures of irritability are available in the Irritability. Depression. and Anxiety Scale (Snaith. ConThis research was supported by USUHS protocol CO 7727. The opinions and assertions expressed herein are the private ones of the authors and are not to be construed as official or representing those ofthc Department of Defense or the Uniformed Services University of the Health Sciences. Reprint requests should be sent to Dr. Seil E. Grunberg. Department of hledical Psychology. Cniformed Serx ices University of the Health Sciences. 4301 Jones Bridge Road. Bethesda. MD 208 II. 587

585

JANE B. .ACRI and SEIL E. GRUNBERG

stantopoulos, Jardine. & McGuffin. 1978). in the Buss-Durkee Hostility-Guilt Inventory (Buss & Durkee. 1957). and in a single question in the Beck Depression Inv.entory (Beck, 1975). Unfortunately. all ofthese questionnaire and self-report instruments offer a limited range ofquantification and are subject to several biases. One bias that may affect self-reports of states of irritability is related to the state-trait issue. That is, individuals responding to the question. “Are you irritable?” may answer in terms of the recent past or as a general life history question. rather than as an indicant ofthe present experience. Another problem inherent in a self-report ofirritability is that a person is likely to be unaware of the extent of irritability until an irritating stimulus triggers a response. This situation is analogous to cardiovascular reactivity in a stress test as opposed to one baseline reading of heart rate and blood pressure. hieasures of reactivity to a precipitating stimulus versus measures of a nonperturbed state are different. A third problem of self-report measures of irritability is that individuals are less likely to perceive or to report negative characteristics that are socially undesirable (Edwards. 1957). Irritability may be subject to this bias. Therefore. it would be advantageous to use a measurement tool for irritability in which individuals respond to a stimulus. thus enabling individuals to place irritability outside, rather than inside the self. Ideally. this measurement tool also would have a wide range ofpotential responses that do not artificially constrict the ratings. The tirst indication ofthe value of measuring irritable reactivity in cigarette smoking research appeared in an experiment by Perlick ( 1977). This study esamined annoyance ratings of smokers and nonsmokers to simulated aircraft over-flights while watching a television show. Pack-or-more-a-day smokers who abstained from smoking or who smoked low-nicotine cigarettes during the experiment were considerably more annoyed by the unwanted sound than were pack-a-day smokers who smoked freely during the experiment and nonsmokers. Although this experiment reported clear differences in irritability that provided insight regarding the role of nicotine in cigarette smoking. the procedures required an elaborate and expensive custom-designed laboratory. The protocol could not be used outside that type of laboratory and certainly could not be used in clinical settings. One of the assets of Perlick’s (1977) approach was the use of magnitude estimation to quantify annoyance reactivity rather than to simply ask subjects, “Are you annoyed?” Magnitude estimation is a psychophysical scaling technique that has been used to quantify subjective experience of various events. This type of scaling offers a reliable way to quantify a wide range of psychological responses. It has been used to assess subjective ratings of effects such as intensity of sensory stimuli (Stevens. 1955), social readjustment to life events (Masuda & Holmes, 1967) occupational prestige (Orth & Wegener, 1983). and health states (Sintonen. 1981). Psychological magnitude of sensory stimuli, or prothetic continua. often approximate a power function of stimulus magnitude. meaning that the stimulus change required to produce an apparent magnitude change of 2 to 1 is a constant percentage of the stimulus intensity (Stevens, 1957). However. in cases where there is no 0bjectiv.e measure of stimulus magnitude, as in qualitative or metathetic continua like irritability, the relationship is more difficult to measure and may not occur (Stevens. 1966). If two types of ratings of the same event are made. as in rating by a category scale and a magnitude scale by the same or different observers. then similar relationships exist. In the case of seriousness of offenses (Sellin Lp:Wolfgang. 1964) or occupational prestige (Orth & Wegener, 1983). category or interval ratings of events also relate to magnitude estimations by a generalized power function. with either linear or logarithmic coordinates. Additionally. diRerent raters with

The reactive irritabilit! scale

589

different levels of experience are remarkably consistent in such psychological judgments as ratings of conditions such as seriousness of offenses (Sellin 8: Wolfgang. 1964) and health states (Sintonen. I98 I ). Magnitude estimation data have other stable, consistent characteristics such as the relationship between mean and variance. Following Ekman’s Law. variability measured in psychological units is linearly related to psychological magnitude measured in the same psychological units (Stevens. 1966). Consequently. best measures of central tendenc!, are geometric means or medians and no normalizing is needed prior to averaging (Stevens, 1966). When these values are plotted against category or interval ratings in linear or log coordinates, the value of the exponent or slope yields information about the relationship between the two ratings. Accordingly, slopes of functions derived from individuals or groups can be compared. This analytic approach offers advantages over Liken-format questionnaire techniques that limit subjects to narrow ranges and may not be sensitive to smaller differences or changes. In addition. the state-trait problem discussed above is minimized in a reactive task. particularly when magnitude estimation is used. The purpose of the present research was to develop a psychophysical task for measuring irritability that could be used easily in various laboratory field. and clinical settings. Three studies were conducted to select sounds. to test the reliability of subjects’ reactions to these sounds. and to determine whether smokers smoking, smokers not smoking. and nonsmokers responded differently to this test of reactivity. In the first study. the stimulus sounds were rated on a 0- 100 scale in order to select test sounds. In the second study the stimulus sounds were presented twice each to the same subjects who rated them using magnitude estimation. In the third study, the scale was used to quantify differences in reactive irritability among subjects abstaining from cigarettes compared with smokers allowed to smoke and nonsmokers. STUDY

I

The purpose of this experiment was to select the test sounds. Sixteen subjects rated a total of 90 environmental sounds, and test stimuli were selected based upon these ratings.

Subjccrs. Sixteen subjects (8 men. 8 women) ranging in age from 22 to 40 years (.\I = 28.1 years. SD = 5.0 years) were screened for normal hearing, good health, no medications. and no history of drug or alcohol abuse. All subjects vvere recruited from graduate programs at the Uniformed Services University and had a mean of 17.3 years of education (SD = 1.9). Fifteen subjects were nonsmokers and, of these, 10 had never smoked. The 5 nonsmoking subjects who had previously smoked reported smoking a mean of 10 years (SD = 2.5) and had quit a mean of 5 years ago (SD = 3.3). One of the 16 subjects still smoked and had been smoking for 5 years, and one of the nonsmoking subjects had quit approximately 4 weeks prior to participation. The 8 men and 8 women agreed to abstain from exercise and caffeine use for 1 hour prior to the laboratory session. The smoker was not asked to abstain from cigarettes. Proc~dnvc. Subjects listened to 90 environmental sounds from commercially available cassette recordings (DLM. Allen. TX and Auditec of St. Louis. St. Louis. MO) of

J-\SE

590

6. .ACRI and NEIL

E. GRUNBERG

everyday sounds. Familiar environmental sounds were used in order that the test would mimic “real world” reactive irritability that is likely to occur in daily life and therefore would establish content validity (Shelley & Cohen, 1986). Subjects rated 90 sounds from these two tapes on a 0- 100 scale ranging from “not at all irritating” to “extremely irritating.” Stimuli were presented in the order recorded on the tapes via Sony WM-D3 Walkman-type tape players with open air earphones (MCR-W20) at a predetermined comfortable level of volume at vvhich the mean stimulus intensity was 55-75 dB SPL (re: 0.0002 dynes/cm’).

Mean. median. and variance of ratings were determined for each stimulus sound across the 16 subjects. There were no order effects or trends for sounds to be rated as more or less irritating as the task progressed. Twelve sounds were selected from the original 90 on the basis of central tendency ratings across the loo-point range and comparable variances. Stimulus sounds with standard deviations ranging from 20-28 were selected to insure that there would be enough variability in how subjects reacted to stimuli to detect reliable differences between groups when they exist. but not so much variability that reliable differences in irritability would be obscured. Sounds with central tendencv ratings that represented the entire rating range vvere selected to have a broad set of irritating stimuli included. Medians were the most appropriate measure ofcentral tendency to use in this technique to reduce the influence of extreme scores. Tvvo additional sounds were selected for practice items. Table I lists these 14 environmental sounds. S[I~YY~ ancc!j~~ Presentation levels and acoustic spectral analyses through the Walkman system uere verified using a Bruel and Kjaer high resolution signal analyzer Type 2033, a Type 2606 measuring amplifier for 2-200.000 Hz, and a KEMAR mannikin to approximate the earphone coupled to the average human ear. Each stimulus consisted of several bursts of sound, so the first two peaks for each stimulus were analyzed. Peak intensity levels (re: 0.0002 dynes/cm’) ranged from 60-78 dB for the first peak. and from 57-80 dB for the second peak. Average intensity levels across the duration of each stimulus ranged from 55-75 dB. Median irritability rating for each of the

Table

I.

Fourteen

environmental

Stimulus

Stimulus *

Diving Telephone Roller coaster Trotting

SI SZ s3 s4 S5 S6

Bude Cuckoo clock Barking TrafficShooting Siren Fire engine Bowling Gong Motorcycle

:; s9 SIO

Sll Reference Practice Practice

sounds used in the RIS Mean 21 34 43 -? 2 __ 2: 7.5 78 86 88 56 34 68

Median

SD

15

22

30

21 24 22 25 28 ‘2 21 ‘4 20 24 23 30 26

35 43 50 53 72 75 85 95 98 58 20 15

The reactive irritability scale

591

12 stimuli was not significantly correlated with average signal intensity for each stimulus (r( 10) = 0.50) or with peak frequency or intensity for the first (r( 10) = 0.26.0.48) and second (r (10) = 0.06.0.57) temporal peaks in the spectral analysis.

From the resultsofthisstudy. 14 stimuli (1 1 test stimuli. I reference sound, 2 practice stimuli) were selected for use in the reactive irritability scale. The 1 I test stimuli were distributed across the 0- 100 scale such that several sounds were not at all irritating and several were extremely irritating for the normal listeners. A reference sound (bowling) was selected with mean and median values close to the middle of the loo-point range and with a variance comparable to those of the test stimuli. STUDY

2

The selected stimulus sounds were then tested in Study 2 using a different psychophysical scaling technique. Magnitude estimation, rather than O-100 rating. was selected for use for several reasons. First, in order to more accurately measure the degree of differences in ratings. magnitude estimation imposes no upper or lower limits on the ratings that individuals may make. This technique allows a greater range in the ratings that individuals may make on both the high and the low end. Secondly. data generated by magnitude estimation have stable mathematical properties that allow specific transformations and comparisons (Stevens, 196 1. 1975). specihcally. slope comparisons. This study used the subjects from Study 1 four months later to determine whether reactive irritability differed over time in a normal sample and to determine vvhether responses to the same stimuli. but using different scaling techniques, would be significantly correlated. Additionally. each stimulus was presented twice in block randomized order to determine whether ratings vvould be consistent over a brief time interval and whether order effects would occur. Further, irritability ratings by magnitude estimation and O-100 rating were compared to insure that the same psychophysical and mathematical relationships existed as occur for other qualitative and perceptual continua for which there is no objective scale.

S&jcc3ts. The same 16 subjects who participated in Study 1 were called back 4 months later and were asked to rate some ofthe sounds again. These ratings were made using the magnitude estimation technique. Procetirrre. Using magnitude estimation, subjects were asked to compare each of the sound. The reference sound (bowling) had a prior median rating of 58. It vvas assigned a value of 500 for magnitude estimation comparisons. Two practice items and the 11 target sounds were each compared to the reference sound and assigned a number that indicated how much more or less irritating each subject found the target sounds as compared to the reference sound. The reference sound was repeated for each of the comparisons. Two randomized lists were presented for a total of 24 ratings, including two ratings of the reference sound itself. All instructions were on the tape that was professionally recorded on low noise. high density recording tape. I 1 target sounds to a reference

592

JASE B. ;\CRI and NEIL E. GRUSBERG

The magnitude estimation technique prov.ed to be easy for subjects to understand. and magnitude estimates were highly correlated with 0- 100 ratings made 4 months earlier (f( IO) = .86. p < .Oj) for the I2 sounds (including the reference sound itself). Men and women did not differ in their ratings. Ratings were extremely stable across the two presentations of each stimulus. as indicated by significant correlations of means for the two stimulus presentations (r( IO) = 0.98, p -C .05). Medians for the two stimulus presentations similarly were highly correlated (r( IO) = 0.96, p < .Oj). Because stimuli were listed on the response sheet by number rather than by a descriptive name. it is unlikely that subjects were able to compare their two separate ratings ofthe same sound by checking back on the answer sheet. Irritability ratings by O-100 (ordinal) rating and magnitude estimation. like other metathetic continua measured by two types of ratings, also were related. Whether using linear or logarithmic coordinates, a strong linear relationship was found to exist. Vatiability and means of magnitude estimation also were linearly related (r (9) = 0.98, p < .O1) in accordance with Ekman’s Law (Stevens, 1966).

The results of this study indicate that irritability reactions to auditory stimuli can be quantified and are stable over time and type of rating scale in a normal sample of the population. The ratings also followed standard mathematical relationships for magnitude estimation data. In addition. the magnitude estimates were stable within a giv,en testing session and were not influenced by order effects. Subjects had no difficulty understanding the instructions or performing the task. Therefore. the reactive irritability scale developed in this study had test/re-test reliability and content validity because of the use of environmental sounds that consistently generated different levels of irritable reactions. STUDY

3

Study 3 was designed to test the utility of the reactive irritability scale (RIS) and to quantify differences in irritability between smoking and nonsmoking subjects. Although cigarette smokers in withdrawal typically report irritability on questionnaires, the RIS assesses a dynamic, real time reaction to a stimulus rather than a static state and. therefore. may be more sensitive to differences as well as yield more specific information about those differences. This study analyzed irritability ratings of nonsmokers, smokers vvho were asked to abstain from smoking for 12 hours prior to the experiment, and smokers who were not asked to abstain from smoking.

.S’rlbj,jcc,ts. Subjects in good health and ranging in age from 18-45 were recruited from newspaper advertisements in which they were asked to participate in a study of reactions to environmental sounds. Forty-one subjects including 20 men and 7 1 women (mean age 33.6 years. SD = 9.8) were used in the analysis. including 13 nonsmokers. 14 smokers. and 14 smokers who had been asked to abstain from nicotine products for 12 hours prior to the experimental session. Abstaining smokers were asked to abstain from cigarettes and nicotine-containing products on the basis of its influence of the measures to be taken. Smoking subjects assigned to the “smokers smoking” and

The rexti\e

irritability

scale

593

“smokers not smoking” groups did not differ in number of cigarettes smoked per day (mean number of cigarettes per day = 13.8. SD = 13.9). Groups were comparable for age and education level and were comprised of approximately 50% men and 50% women. All subjects believed that the study was about the annoyance ofenvironmental sounds and did not know that smoking-related differences in irritability were the focus of the experiment. Hewing. Hearing was screened in 42 potential subjects using a Maico MA27 audiometer calibrated to ANSI 1969 standards in a quiet room (ambient noise = 50 dBA i- 3 dB) prior to presentation of the taped task. One subject who did not respond to screening lev.eIs at octave frequencies 0.5-4.0 kHz was excluded from the study. E.ypired cnrbon mono.~-idc hleasurement of expired carbon monoxide was used to validate abstinence using an Ecolyzer CO analyzer. (National Draeger Instruments Division. Pittsburgh. PA) which was calibrated weekly. Subjects provided a breath sample by exhaling into a vinyl sampling bag following two deep breaths. Rmctiw irritnbilitj, scditzg task. The RIS was presented to each subject via Sony WM-D3 W’alkman-type tape player with open air phones (MCR-W20) in a quiet room. The volume level was predetermined such that mean stimulus intensity was 55-75 dB, with peaks from 59-79 dB, and spoken taped instructions were delivered at a comfortable listening level of 60-70 dB. An AC adaptor was used with the tape player to eliminate fluctuations in power from batteries. All instructions were presented on the tape itselfto minimize any possible variation between subjects that might result from experimenter dil??rences in explanations. Additionally, printed instructions which followed the taped instruction were on the response form in front ofthe subject during the entire tape. Subjects were told not to touch the tape recorder or reposition the headphones during the tape. I yi.ulu/rolalog smlc~: rqfhwxv sowd. The first item on the RIS consisted of a visual analog scale in which subjects rated the irritability of the reference sound by placing an “X” on a line. One end of the line was labeled “not at all irritating” and the other end was labeled “estremely irritating.” Subjects rated the irritability of the reference sound prior to the magnitude estimation task. This measure was included to control for the possibility that subjects’ magnitude estimation ratings might be affected by different perceptions of the reference sound itself. Qrlc~.stic,~j,lili~cs. In addition to the taped task, subjects completed several questionnaires. These included a general health and background questionnaire. the Profile of Mood States (McNair, Lorr. & Droppleman. 1971). the Beck Depression Inventory (Beck.197S). the Shiffman-Jarvik Withdrawal Scale (Shiffman & Jarvik. 1976), the Signs and Symptoms of Tobacco Withdrawal (Hughes & Hatsukami, 1986). and the Irritability. Depression and Anxiety Scale (Snaith. Constantopoulos. Jardine. & McGuffin. 1978). Plocmrrrr. Subjects were told that the purpose of the study was to explore differences in how irritating different environmental sounds are to different people. After entering the laboratop. all subjects were given an overview of the procedures and subjects in the smokers smoking condition were casually told that it was okay to smoke during the

594

Jr\NE B. .ACRI and NEIL E. GRUNBERG

experiment. An ashtray was on the table for the smokers smoking condition. and the experimenter had cigarettes available (but not in view) in the event that a subject in the smokers smoking condition expressed a desire to smoke but did not have cigarettes. After consenting to participate. all subjects filled out a general health and background questionnaire. Hearing was screened and expired carbon monoxide was measured. Subjects then listened to the irritability tape, that lasted 25 minutes. followed by the remaining questionnaires. Finally, subjects were debriefed. paid, and thanked. The session lasted 75 minutes. Subjects began experimental sessions at a time of day of their ovvn choice between the hours of 10 a.m. and 6 p.m. There were no significant time ofday differences among groups.

Hc~rir~g. All subjects used in the analysis met hearing criteria for the study. One subject from the smoking group was not able to hear two of the test frequencies at the screening level in one ear, and therefore, data from this subject were excluded from analyses. .-lbstinence. Although some of the subjects who had agreed not to smoke for 12 hours prior to the session did not completely abstain, none of the subjects in this group reported that they smoked normally during the 12 hour period prior to the session, and they were at least partially deprived of nicotine prior to the session. Mean expired carbon monoxide levels were used to verify group condition and were as follows: 4.5 (SD = 1.4, range = 3-8) ppm for the nonsmokers, 13.3 (SD = 8.2, range = 5-32) ppm for the smokers not smoking, and 2 1.9 (SD = 13.4. range = j-50) ppm for the smokers smoking. An ANOVA found significant differences between groups (F (2,40) = 12.1, p < .OOO1) and Fisher PLSD post hoc analyses found that all groups differed significantly from each other (Fisher PLSD = 7.2, 7.2, 7.1. p < .Oj). Further, when asked in the health and background questionnaire how many hours it had been since the last cigarette, the smokers not smoking reported a mean of 10.3 (SD = 4.9, range = 0.5-18) hours and the smokers smoking reported a mean of 1A (SD = 3.8, range = 0- 12) hours. Smokers smoking and smokers not smoking differed significantly from one another (t (26) = 5.17, p < .OOOl) in terms of hours since last cigarette. Of the 14 subjects in the smokers smoking condition, 6 subjects smoked their own cigarettes during the session. Two subjects smoked one cigarette each, two subjects smoked two cigarettes each, and two subjects smoked three cigarettes each. I i’.s~n/CUIN/O,Y. Ratings of the irritability of the reference sound by visual analog were computed by measuring the point at which the “X” was placed divided by the total line length. A subject who found the sound extremely irritating and placed the “X” at the far right would have a rating of 1.O, whereas an “X” placed exactly in the middle. or at the moderately irritating point. would have a rating ofO.5. The groups did not differ in their initial irritability ratings of the reference sound. and reference scale ratings were not correlated with any ofthe other measures including the slope ofthe magnitude estimation function. .I/qtzitdc cwinrruiotzs. Figure I presents the median magnitude estimate values for the stimuli for each of the treatment groups. Ratings on the irritability scale kvere ana-

The reactive irritabilit)

scale

3ooo’

NONSMOKERS SMOKERS SMOKING SMOKERS NOT SMOKING 2Qoil-

/

lOOO-

O~~‘,‘,‘~‘~‘,‘,.,‘,‘,.,, Sl

S2

53

S4

S5

S6

57

58

S9

SlO

Sll

STIMULI Fig. I. Median magnitude estimates of each stimulus sound by smohing condition.

lyzed using the Wilcoxon signed rank test for related samples and the Mann-Whitney test. Results of the Wilcoxon analysis indicated that smokers not smoking found the 1 I auditory stimuli to be significantly more irritating than did the nonsmokers (Z = -2.3 1, p < .05) and the smokers smoking (Z = -2.49, p < .Oj). The smokers smoking and nonsmokers did not differ, and men and women did not differ from one another. Subsequent Mann-Whitney U tests to determine which stimuli contributed most to the differences between smokers not smoking and nonsmokers revealed that three stimuli-sounds of horses trotting. sirens, and fire engine noise-differed significantly at Z = - 1.95. p < .051, Z = 2.0, p < .05. and Z = -2.63, p < .Ol. respectively. Data derived from magnitude estimation also can be analyzed by plotting either raw data or data in log-log coordinates and observing the slope of the linear function of relationship. In this case. because there are no completely objective units of irritability, the scaled 0- 100 ratings provided by the listeners from Studies 1 and 2 were used as “objective units.” and these median ratings were plotted on the abscissa. Median magnitude estimates for each stimulus sound for each group were derived. and these values were plotted on the ordinate (See Figure 2). It is evident that the slope ofthe irritability function is steeper for the smokers not smoking (see Figure 5d). Signs and Svmptoms OJ Tobacco Withdrawal (SSTUi). Several questionnaire subscales differentiated the treatment groups (see Figure 3). The SSTW (Hughes & Hatsukami, 1986) significantly differentiated the groups for questions of craving for tobacco, restlessness, impatience, desire to eat, and drowsiness. For craving, groups differed significantly (F(2.40) = 16.7, p < .OOOl), with nonsmokers reporting the least craving and smokers not smoking reporting the most. All groups differed significantly from each other in post hoc analyses of craving (Fisher PLSD = 0.90, 0.90, 0.89.

396

J.I\SE B. .ACRI and NEIL E. GRUNBERG

l NONSMOKERS a SMOKERS SMOKING A SMOKERS NOT SMOKING

MEDIAN (O-100 SCALE)

Fig. 3. Median magnitude estimates plotted against median ratings from O-100 scale. Slopes of linear functionsare: nonsmokers = 7.97. smokers not smoking = 2 I .22.and smokers smoking = 7.97.

p -=c.Oj). For restlessness, groups also differed (F(2.40) = 6.05, p < .005). with nonsmokers reporting the least restlessness and smokers not smoking reporting the most. In post hoc analyses of restlessness, smokers not smoking differed significantly from nonsmokers and smokers smoking (Fisher PLSD = 0.97,0.95, p < .05). The groups also differed in degree of impatience (F(2,40) = 4.7. p < .O1). with nonsmokers reporting the least impatience and smokers not smoking reporting the most. In post hoc analyses of impatience, smokers not smoking differed significantly from nonsmokers (Fisher PLSD = 0.92, p < .05). Smokers not smoking also reported the greatest desire to eat and smokers smoking reported the least, with an overall group difference (F&40) = 4.8, p < .Ol). Post hoc analyses of desire to eat found that smokers not smoking differed significantly from nonsmokers and smokers smoking (Fisher PLSD = 0.92. 0.90. p < .05). Groups differed significantly in degree of drowsiness (F(2,40) = 3.6, p -==z .04). with nonsmokers reporting the least drowsiness and smokers not smoking reporting the most. Smokers not smoking differed significantly from nonsmokers and smokers smoking (Fisher PLS'D= 0.97.0.95, p < .05) in post hoc analyses of drowsiness. These results indicated that the smokers not smoking were indeed experiencing some degree of nicotine withdrawal.

The reactive

irritability

597

sc;1Ie

n NONSMOKERS

a

SMOKERS SMOKING

cl SMOKERS NOT SMOKING

CRAVING

RESTLESSNESS

IMPATIENCE

DESIRE

TO EAT

DROWSY

ITEM Fig. 3. Results ofquestionnaire

items from the SSTW

scale.

Proble of Mood States (P0.U.T). Two scales of the POMS differentiated the groups, and these data are presented graphically in Figure 4. The Composed-Anxious scale differentiated the groups (F(2,40) = 3.3, p< .Oj) with nonsmokers reporting the greatest degree of composure. Nonsmokers differed significantly from smokers not smoking and smokers smoking (Fisher PLSD = 5.7,5.6. p < .05) in post hoc analyses ofcomposure. The Agreeable-Hostile scale also differentiated the groups (F(2,40) = 4.1. p

A psychophysical task to quantify smoking cessation-induced irritability: the reactive irritability scale (RIS).

A psychophysical rating scale using magnitude estimation was developed as a tool to quantify irritability as one index of drug withdrawal. The scale m...
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