Research in Nursing zyxwvutsrqpon & Health, 1995, zyxwvutsr 10, 217-224 zyxwvutsr Reversal Theory Constructs and Cigarette Availability Predict Lapse Early in Smoking Cessation Mary R. Cook, Mary M. Gerkovich, Kathleen A. O’Connell, and Miriam Potocky The purpose of this study was to investigate the contribution of reversal theory constructs (i.e., metamotivationalstates) to understanding the outcome of tempting situations that occur in the first 6 weeks of smoking cessation. Cessation program participants (N = 68) were interviewed about tempting situations in which they either smoked or maintainedabstinence. Both indepen- dent groups and repeated measures analyses indicated that metamotivational state (serious and goal-directedvs. playful and spontaneous) and cigarette availability significantly predicted outcome. Reversal theory constructs correctly predicted outcome of the tempting episode for zy 70% of the subjects, while cigarette availability was an accurate predictor for 74%. Metamotiva- tional state and cigarette availability together predicted the outcome for 89% of the subjects. zy 0 1995 John Wiley & Sons, Inc. zyxwvutsrq Despite numerous methods for altering the smoking habit, relapse rates are consistently high (70% to 89% within 3 months of a cessation at- tempt) (Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992; Hughes et al., 1992; Hunt, Bar- nett, & Branch, 1971; Marlatt & Gordon, 1980; O’Connell, 1985). Moreover, smoking a single cigarette during a cessation attempt has been shown to be associated with a 90% chance of returning to regular smoking (Brandon, Tiffany, & Baker, 1986; O’Connell, 1985). Therefore, in- vestigators have focused on describing the situa- tions in which lapses are likely to occur and how these situations differ from those in which ex- smokers resist strong temptations to smoke (e.g., Baer & Lichtenstein, 1988; O’Connell & Martin, 1987; Shiffman, 1982, 1986). Concepts central to the theory of psychological reversals, a compre- hensive psychological theory concerned with mo- tivation, emotion, and behavior (Apter, 1982, 1989), have been useful in discriminating be- tween highly tempting situations in which ex- smokers lapse and those in which they maintain abstinence (O’Connell, Cook, Gerkovich, Pot- ocky, & Swan, 1990; Potocky, Gerkovich, O’Connell, & Cook, 1991). However, these stud- ies involved highly tempting situations experi- enced by exsmokers who had remained absti- Mary R. Cook, PhD, is Head, BiobehavioralSciences Section, and Mary M. Gerkovich, MA, is a senior biostatistician, Life Sciences Department, Midwest Research Institute. Kathleen A. O’Connell, PhD, RN, is a professor of nursing, University of Kansas, School of Nursing. Miriam Potocky, PhD, is an assistant professor, Florida International University. This research was partially funded by the National Center for Nursing Research, NIH (NR 01675). Dr. OConnell’s contributions were supported by a Research Service Award from the National Center for Nursing Research. The authors thank Michael J. Apter for comments and suggestions, Renee Flippin for help with interviewing and coding, and Charles Graham and Michael Gibertini for reviewing an earlier draft. This article was received on February 4, 1994, revised, and accepted for publication on October 17, 1994. Requests for reprintscan be addressed to Dr. Mary R. Cook, Midwest Research Institute, 425 Volker Boulevard, Kansas City, MO 641 10. zyxwvu 0 1995 John Wiley & Sons, Inc. CCC 0160-6891/95/030217-08 217