The effects were not mediated or moderated by use of help (medication), so we have no evidence for the second mechanism that motivation is being used as a substitute for more effective strategies. Imatinib mechanism It is possible that the measures of motivation we used are unrelated to the capacity of the individual to generate competing thoughts at times when cravings to smoke threaten relapse, that is, that general motivation has no additional benefit beyond some threshold level (which might be indexed by enough to try). Postquitting, it may be the strength of the motivational force at the moment when a craving occurs that is critical, something consistent with West��s PRIME model. If so, it suggests that we need to be developing new measures of motivation that are specific to relapse prevention rather than assuming the adequacy of general measures that can be assessed independently of the behavioral state.

Such measures will need to be referenced to, or take into account, the actual experiences of being quit and how these might change and/or might be amenable to interventions (including pharmacotherapies and skills development). They might be like Kahler et al. (2007) measure of commitment to quit or of determination to quit (Segan et al., 2002). However, these kinds of measures can really only be assessed once the individual has made a commitment to quit or has actually stopped. Third, the possibility that those with high motivation are, on average, a group predisposed to relapse due to factors such as higher nicotine dependence and lower self-efficacy was only partially supported.

We tested this by controlling for past quitting history, behavioral dependence, and self-efficacy but found that these factors, particularly dependence, had little effect on the associations with the motivation variables. Herd, Borland, and Hyland (2009) found that frequency of strong urges to smoke postquitting was a predictor of relapse after controlling for time quit and prequit measures of dependence (which were not predictive), so some elements of dependence, other than the conventional behavioral measures used here, may be important. Even if dependence did fully account for the reversal of effects, it is hard to see it masking a true positive association between the motivational variables we measured and maintenance.

However, high motivation to cease a behavior that one is nonetheless continuing to engage in can be seen as evidence of high internal conflict. The only motivational measure to remain a significant negative predictor of maintenance after controlling for all other variables, frequency of butting out, may be a good measure of such internal conflict. GSK-3 Those who frequently stub out a cigarette before finishing it may be highly conflicted by the competing desire to quit and to smoke, which would make it more difficult to remain quit once an attempt is made.