Diminished Positive Affect as an Understudied Feature of Nicotine Withdrawal: Development and Validation of a Short Withdrawal Symptom Scale (SWiSS).

Abstract

Given the burgeoning evidence that low positive affect (PA) and anhedonia are important smoking withdrawal symptoms, we added the PA/Friendly items of the Profile of Mood States (POMS) alongside established withdrawal items from the Shiffman-Jarvik Withdrawal Questionnaire (SJWQ) to identify the best subsets of items for predicting smoking relapse. The Short Withdrawal Symptom Scale (SWiSS) was generated from these selected items. Secondary data analysis was conducted with four randomized clinical trials of cessation-seeking smokers (N = 333) who maintained abstinence for 31-67 days. SWiSS items were selected from the POMS and the SJWQ using a procedure encompassing longitudinal trajectory preservation, multilevel factor analysis, psychometric evaluation, and predictive validation. Logistic and survival models were used to predict smoking outcomes from growth parameters of withdrawal symptoms across days 3-31 post-quit. The original 91-item pool was reduced to 28 items, forming five within-person factors: positive affect/friendliness, negative affect, fatigue/arousal, depression, and craving, plus one appetite item. These SWiSS factors demonstrated strong reliability and clean factor structure. Predictive validation results matched or exceeded original scales. Higher early post-quit PA/friendliness was protective, whereas early craving and fatigue predicted greater relapse risk. Notably, PA was the only domain for which both early level and rate of recovery independently predicted cessation outcomes. The SWiSS is a relatively brief, psychometrically robust measure that preserves relapse-predicting information about withdrawal dynamics. Its development highlights low PA as a significant and understudied predictor of relapse risk, and supports the inclusion of PA items in smoking withdrawal measures.