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Anxiety sensitivity and difficulties with smoking cessation
... Nearly all participants chose to receive NRT (98.5%). The NRT doseNicotine replacement gum (2 mg or 4 mg) or nicotine replacement skin patch dose (7 mg, 14 mg, or 21 mg)-was determined by the respondent's level of measured nicotine dependence and was delivered over the course of treatment in line with evidence-based standards to complement the cognitive-behavioral smoking cessation intervention (Mullane et al., 2008). ...
... The manualized treatment included standardized evidence-based behavioral and cognitive strategies and NRT assessment and treatment. In addition, the program included education on coping strategies to address withdrawal symptoms, cravings and triggers, relapse prevention and maintenance, and healthy lifestyle practices (see Mullane et al. (2008) for a more detailed description of the intervention). ...
... Thus, elevated levels of maintained AS were related to an increased risk of relapse during a 4-week cognitive-behavioral group Tobacco Intervention Program. This work adds to the empirical literature suggesting AS may be a risk factor for poor smoking cessation outcome ( Brown et al., 2001;Mullane et al., 2008; and suggests that degree of change in this cognitive factor is an important explanatory process for smoking cessation outcome. ...
This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.
... Many different ratios, ranging from 29.1% to 45.5%, were reported from other smoking cessation clinics in Turkey [10,11]. Therewithal, another study [18] found a smoking cessation rate of 44.2% for the first year and 48% for the first six months. The reason of these high rates may be related with the calculation methods, as some of the calculations were done based on the patients who continued to follow-up instead of including all patients referred to the clinic. ...
... A prospective study on 119 patients indicated that increased anxiety and AS caused an increase in nicotine withdrawal symptoms during the first week of cessation. The same study also claimed that smoking cessation levels had decreased for the first month following an increase in the AS levels [18]. The barriers to motivation of smoking cessation were studied and the possible barriers were defined as panic attack history, daily smoking amount, and high levels of AS. Johnson and his colleagues conducted a study with 123 participants and had two outcomes. ...
... Many different ratios, ranging from 29.1% to 45.5%, were reported from other smoking cessation clinics in Turkey [10,11]. Therewithal, another study [18] found a smoking cessation rate of 44.2% for the first year and 48% for the first six months. The reason of these high rates may be related with the calculation methods, as some of the calculations were done based on the patients who continued to follow-up instead of including all patients referred to the clinic. ...
... A prospective study on 119 patients indicated that increased anxiety and AS caused an increase in nicotine withdrawal symptoms during the first week of cessation. The same study also claimed that smoking cessation levels had decreased for the first month following an increase in the AS levels [18]. The barriers to motivation of smoking cessation were studied and the possible barriers were defined as panic attack history, daily smoking amount, and high levels of AS. Johnson and his colleagues conducted a study with 123 participants and had two outcomes. ...
Aim: In this study, we aimed to investigate the relationship between the anxiety sensitivity levels and nicotine dependence and smoking cessation outcomes in patients referred to the Smoking Cessation Policlinics.Methods: This retrospective study included 286 patients referred to a smoking cessation policlinic between January 2017 and July 2017. Socio-demographic characteristics, Fagerström Test for Nicotine Dependence (FTDN) scores, depression scores measured by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Anxiety Sensitivity Index-3 (ASI) scale scores were retrospectively retrieved from patient medical files. All patients were contacted and the instant smoking status of the patients was recorded.Results: Of the participants, 19.5% (n=56) (including those who did not come to follow-up) had quit smoking and were abstinent at least six months after the quitting date. The mean scores of anxiety sensitivity were significantly higher in moderate/high nicotine dependent patients than in mild nicotine dependent patients (p=0.001 and p<0.001, respectively). The mean scores of anxiety sensitivity and all its subscales were significantly higher in current smokers than ex-smokers (p<0.001 for each).Conclusion: It has been determined that anxiety sensitivity may be a severe barrier to smoking cessation success. Therewithal, anxiety sensitivity is significantly associated with high nicotine dependence. It is essential to evaluate the anxiety sensitivity, anxiety, and depression levels from the first days of patients who are planning to stop smoking. High anxiety sensitivity smokers should be carefully monitored, and treatments should be applied to reduce their anxiety sensitivities to increase quit rates
... For instance, AS (or pre-quit change in AS) has been found to predict post-quit withdrawal, 8 greater reductions in stress-induced negative affect following smoking, 9 and lapse or relapse early in a quit attempt. [10][11][12] Also, a recent study offers some evidence that AS may be altered by "AS reduction treatment" 13 ; however, there was no evidence of a direct effect of AS reduction treatment on cessation success. Overall, knowledge of the role of AS in tobacco motivation and cessation remains limited. ...
... This finding is congruent with other studies suggesting AS does not robustly predict cessation outcome 12 (cf. 11 ). This may be because AS is focused on fear of a single type of affect (anxiety) and quitting does not solely involve tolerating anxiety. ...
Introduction:
This study examined relations of two affective vulnerabilities, high anxiety sensitivity (AS) and low distress tolerance (DT), with tobacco dependence, withdrawal, smoking cessation, and pharmacotherapy response.
Methods:
Smokers interested in quitting (N = 1067; 52.2% female, 28.1% African-American) were randomized to 12 weeks of nicotine patch, nicotine patch + nicotine lozenge, or varenicline. Baseline questionnaires assessed AS, DT, negative affect, anxiety, and dependence. Withdrawal was assessed the first week post-quit via ecological momentary assessment.
Results:
DT, but not AS, predicted biochemically-confirmed point-prevalence abstinence at multiple endpoints: Weeks 4, 12, 26, and 52 post-quit (p's < .05); relations remained after controlling for pharmacotherapy treatment, AS, baseline negative affect, anxiety, and anxiety disorder history (p's < .05). Additional exploratory analyses examining Week 4 abstinence showed DT predicted abstinence (p = .004) even after controlling for baseline dependence, post-quit withdrawal (craving and negative affect), and treatment. DT moderated treatment effects on abstinence in exploratory analyses (interaction p = .025); those with high DT were especially likely to be abstinent at Week 4 with patch + lozenge versus patch alone.
Conclusions:
Distress tolerance (DT), but not anxiety sensitivity, predicted abstinence over 1 year post-quit (higher DT was associated with higher quit rates), with little overlap with other affective measures. DT also predicted early abstinence independent of dependence and withdrawal symptoms. Results suggest low DT may play a meaningful role in motivation to use tobacco and constitute an additional affective risk factor for tobacco cessation failure beyond negative affect or clinical affective disorders.
Implications:
People in a stop-smoking study who reported a greater ability to tolerate distress were more likely to quit smoking and remain smoke-free 1 year later. Smokers with high distress tolerance were more likely to be smoke-free 4 weeks after their target quit day if they received nicotine patch plus nicotine lozenge rather than nicotine patch alone.
Trial registration:
ClinicalTrials.gov Identifier: NCT01553084.
... AS also relates to stronger beliefs of smoking leads to health consequences (e.g., , which is in line with theoretical models of AS (i.e., expectancy of negative consequences). The overall weight of scientific evidence is consistent with the perspective that expectations of (and motivation to obtain) smoking's acute affectmodulatory effects are paramount and outweigh heightened perceptions of smoking's potential negative consequences in high-AS individuals Consistent with evidence linking AS to expectancies that abstinence provokes negative affect, AS also is related to the actual experience of more severe nicotine withdrawal symptoms among those initiating an abstinence attempt in the early phases of abstinence (i.e., one week post quit; Johnson, Stewart, Rosenfield, Steeves, & Zvolensky, 2012;Marshall, Johnson, Bergman, Gibson, & Zvolensky, 2009), but less so in later phases of abstinence (Mullane, Stewart, Rhyno, Steeves, Watt, & Eisner, 2008). Importantly, ASrelated amplification of withdrawal during abstinence is more robust for withdrawal symptoms that are affective and anxiety-related in nature (i.e., frustration, restlessness, depression, anxiety, irritability) than non-affective withdrawal symptoms (i.e., cigarette craving, concentration problems). ...
... One study found AS was associated with an increased likelihood of smoking lapse (any smoking behavior) during the first week of a quit attempt among depressed smokers receiving combination psychosocial and nicotine replacement therapy (Brown, Kahler et al., 2001). A separate prospective investigation found AS was related to increased relapse likelihood among adult daily smokers by one-month following cessation (Mullane et al., 2008). In a more recent of smokers receiving cessation counseling and NRT, found that pre-quit AS was significantly associated with an increased risk of early smoking lapse (i.e., any smoking behavior) at days 1, 7, and 14 following the quit day, but not full relapse (i.e., seven consecutive days of smoking). ...
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
... attempts (Mullane et al., 2008;Zvolensky et al., 2007;Zvolensky, Bonn-Miller, Bernstein, & Marshall, 2006), one study did not find this relationship . Some research has suggested that alcohol-dependent individuals have higher levels of anxiety sensitivity compared with a nonclinical population (McNally, 1996). ...
... Step 2 common nicotine withdrawal symptom, it is not surprising to observe a significant relationship between nicotine withdrawal symptoms and measures of anxiety at both prequit and early postquit timepoints. These results support previous research that showed a relationship between severity of nicotine withdrawal and anxiety sensitivity (Johnson et al., 2012;Marshall, Johnson, Bergman, Gibson, & Zvolensky, 2009), and the results are consistent with other literature showing that individuals with higher levels of anxiety sensitivity have difficulty tolerating bodily sensations related to nicotine withdrawal or emotional states (Mullane et al., 2008;Zvolensky, Baker et al., 2004). ...
Introduction:
Anxiety-related characteristics, including anxiety sensitivity and trait anxiety, are elevated in individuals with alcohol and nicotine dependence and associated with greater difficulties with quitting smoking. However, little is known about how anxiety-related characteristics are related to smoking cessation outcomes in alcohol-dependent smokers. The present study, part of a larger smoking cessation clinical trial, examined associations between anxiety sensitivity, trait anxiety, nicotine withdrawal symptoms, smoking urges, and smoking cessation outcomes in a sample of 83 alcohol-dependent smokers.
Methods:
Participants were enrolled in concurrent alcohol and tobacco treatment as part of a substance-abuse intensive outpatient program. Smoking cessation treatment was administered in a 3-week cognitive-behavioral format that included 8 weeks of open-label nicotine patch treatment. Information on nicotine withdrawal, smoking urges, and CO-confirmed smoking consumption rates was collected at baseline, quit date, end of behavioral treatment, and at a 1-month follow-up.
Results:
Higher levels of anxiety sensitivity were associated with more smoking urges due to anticipation of negative affect relief at quit date. Higher levels of trait anxiety were associated with more smoking urges due to positive reinforcement and anticipation of relief of negative affect at quit date, as well as more severe nicotine withdrawal symptoms at the end of treatment. Levels of anxiety sensitivity and trait anxiety were not associated with Cox regression survival times to relapse.
Conclusion:
These results indicate that for alcohol-dependent smokers, levels of anxiety sensitivity and trait anxiety are important to consider in the assessment and treatment of nicotine dependence.
... Note that the percentage of individuals who met criteria for a panic attack in this study is similar to that found in past work (Zvolensky, Leen-Feldner, et al., 2004). The mean ASI for the current sample (M = 21) may have been slightly lower than has been found in similar samples (M = 25; Mullane et al., 2008). The covariate of daily smoking rate was not significantly related to quit-day withdrawal (r = .10, ...
... In terms of main effects, as hypothesized, higher levels of anxiety sensitivity were related to greater severity of acute nicotine withdrawal symptoms; the size of this effect was large in magnitude (Cohen, 1988). This finding is consistent with previous empirical work demonstrating that smokers high in anxiety sensitivity appear to be hypersensitive to interoceptive sensations, specifically those related to nicotine withdrawal or related aversive emotional states during the early phases of quitting (e.g., Mullane et al., 2008; Zvolensky, Baker et al., 2005). It is possible that individuals high in anxiety sensitivity lapse to smoking more quickly following a quit attempt (e.g., R. A.), in part, because of their perceptions of nicotine withdrawal symptoms as being more aversive and harmful. ...
The current investigation explored the main and interactive effects of panic attacks in response to laboratory-induced bodily sensations and anxiety sensitivity in predicting acute nicotine withdrawal symptoms among daily smokers making a self-guided quit attempt. Participants were 99 daily smokers (58% women; M(age) = 28.4 years, SD = 11.7) who completed a battery of questionnaires, a voluntary hyperventilation challenge, and a measure of nicotine withdrawal symptoms 12 hr after making a self-guided quit attempt. Results indicated that the interaction of anxiety sensitivity and panic responsivity to the challenge predicted quit-day nicotine withdrawal symptom severity above and beyond the main effects (p < .05). The form of the interaction indicated that the relationship between postchallenge panic attack status and acute nicotine withdrawal was more robust among individuals who were low in anxiety sensitivity. Individuals who did not experience a panic attack posthyperventilation who were also low in anxiety sensitivity reported the lowest levels of nicotine withdrawal. Results suggest that anxiety sensitivity may be less relevant with regard to acute nicotine withdrawal severity among individuals with panic-related problems.
... Further, the authors note important associations between higher anxiety sensitivity and greater (i.e. amplified) pain severity (Ocañez et al. 2010), a higher rate of cigarette use and tobacco dependence (Bakhshaie et al. 2016), as well as higher risk of smoking lapse and relapse (Brown et al. 2001;Mullane et al. 2008;). Consistent with fearavoidance models, these constructs (i.e., pain-related fear, pain-related anxiety, and anxiety sensitivity) serve to amplify escape and avoidance behavior, contributing to greater chronic pain and functional impairment. ...
This commentary synthesizes research examining cognitive mechanisms underlying the links between anxiety, health behaviors, and illness outcomes. We provide a brief summary of contributions to this special issue and review common themes and methodological limitations. Notably, a number of related constructs emerged as amplification factors, increasing vulnerability to psychopathology and maladaptive health behaviors. These include anxiety sensitivity, distress and discomfort intolerance, emotion regulation, health literacy, and repetitive negative thinking. Finally, we discuss clinical implications, and conclude with suggestions for further research in this area.
... In addition, cross-sectional studies that asked daily male and female smokers to report the longest period they were able to abstain from smoking observed medium to large effects of anxiety sensitivity on the likelihood of reporting an early relapse to smoking . Prospective research corroborates the notion that anxiety sensitivity can predict risk of smoking lapse and relapse (Brown et al. 2001;Mullane et al. 2008;). Moreover, among daily smokers participating in an "anxiety sensitivity reduction-smoking cessation" intervention trial, those with elevated anxiety sensitivity at baseline evinced the lowest degree of pre-quit reduction in anxiety sensitivity and went on to experience the highest levels of quit-day cigarette craving (Bakhshaie et al. 2016). ...
Despite the notable prevalence and comorbidity of tobacco cigarette dependence and chronic pain, relatively little is known about potential mechanisms of action. Research has emphasized the utility of identifying core underlying dimensions that reflect shared etiological processes, and it has been posited that anxiety-relevant transdiagnostic factors may be particularly important to understanding pain-smoking comorbidity. This review examined the empirical literature linking pain-related fear (fear of pain and activities that elicit pain), pain-related anxiety (anxious responses to pain), and anxiety sensitivity (degree to which the experience of anxiety is expected to have deleterious consequences) to both chronic pain and tobacco cigarette smoking. We then integrated this literature to inform a conceptual model explicating the function of anxiety-relevant transdiagnostic factors in pain-tobacco smoking comorbidity. Finally, we drew upon this conceptual model to highlight novel clinical implications and inform future research.
... Higher levels of anxiety sensitivity also are associated with greater rates of smoking, perceived barriers for cessation, beliefs about the affect-regulation properties of smoking, and negative affect reduction smoking motives (Johnson, Farris, Schmidt, & Zvolensky, 2012;Zvolensky, Farris, Schmidt, & Smits, 2014). Higher anxiety sensitivity is additionally associated with increased withdrawal symptoms and craving during a quit attempt and periods of smoking abstinence generally (Johnson et al., 2012;Zvolensky, Farris, Guillot, & Leventhal, 2014), as well as less sucess in quitting (Assayag et al., 2012;Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001;Mullane et al., 2008;Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009). that anxiety sensitivity also maintains a latent class structure, such that individuals differ from one another categorically between latent discontinuous forms of anxiety sensitivity. ...
... That is, data suggest that AS is linked to several indices of smoking behavior, including smoking frequency (e.g. number of cigarettes a day; Dedert et al. 2012;Fu et al. 2007), nicotine dependence (Zvolensky et al. 2014b), severity of smoking urges during abstinence (Zvolensky et al. 2014b), and duration of abstinence after attempting to quit (Assayag et al. 2012;Brown et al. 2001;Mullane et al. 2008;Zvolensky et al. 2009). In addition, AS has been posited as a possible central mechanism for explaining the association between emotional disorders and smoking (Zvolensky et al. 2014c). ...
Objectives:
Anxiety sensitivity (AS) is related to the development and maintenance of posttraumatic stress disorder (PTSD) among cigarette smokers, and is also implicated in the amplification of acute nicotine withdrawal symptoms. The present study sought to examine the role of nicotine withdrawal in moderating the association between AS and PTSD symptom severity among a sample of treatment-seeking smokers with PTSD.
Method:
Participants (n = 117) were enrolled in a randomized controlled trial for the treatment of PTSD and nicotine dependence. Cross-sectional data were randomly sampled from three different study time points. A series of multiple regression models were tested.
Results:
Results revealed main effects of both AS and withdrawal severity on PTSD severity after controlling for gender, assessment time-point, negative affectivity, and biochemically verified smoking (expired carbon monoxide). The interaction of AS and withdrawal was also significant, and appeared to be specific to PTSD avoidance and hyperarousal symptoms. However, contrary to expectations, the association between AS and PTSD symptoms was only significant at relatively lower levels of nicotine withdrawal.
Conclusions:
These findings highlight the complex interplay between AS, nicotine withdrawal, and their synergistic effect in terms of the exacerbation of PTSD symptomology.
... From a cessation perspective, smokers higher relative to lower in anxiety sensitivity perceive quitting as more difficult (Zvolensky, Vujanovic, et al., 2007). Other work has identified that anxiety sensitivity may be related to more intense nicotine withdrawal during early phases in quitting (i.e., 1 week post-quit; Johnson, Stewart, Rosenfield, Steeves, & Zvolensky, 2012;Langdon et al., 2013;Marshall, Johnson, Bergman, Gibson, & Zvolensky, 2009;, but not necessarily withdrawal in later phases of quitting (Mullane et al., 2008). Higher levels of anxiety sensitivity are also related to greater odds of early lapse (Brown et al., 2001) and relapse during quit attempts (Assayag, Bernstein, Zvolensky, Steeves, & Stewart, 2012;Zvolensky et al., 2006;Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009). ...
The present study evaluated a Spanish-language version of an Anxiety Sensitivity Reduction Program for Smoking Cessation among a sample of daily adult smokers from Argentina (n = 6; M-age = 49.4, SD = 15.43) in an open trial methodological design. To be eligible, each participant expressed a current desire to quit smoking and previous difficulties with anxiety/mood symptoms during past quit attempts (e.g., anxiety, stress, depression, irritability). Participants completed a baseline assessment and received eight 90-minute weekly group sessions. The study involved one doctoral-level and two graduate-level therapists. Follow-up visits were scheduled at 1, 2, 4, 8, and 12 weeks post-quit day. Smoking status was confirmed biochemically and via self-report at quit day and each follow-up assessment. The treatment yielded positive results in terms of attendance, positive smoking cessation outcome (5 out of 6 were abstinent at 12-week follow-up), and significant reductions in anxiety sensitivity. The results suggest potential clinical utility among Spanish-speaking smokers for an anxiety-sensitivity smoking cessation program in regard to cessation outcome.
... From a cessation perspective, smokers higher relative to lower in anxiety sensitivity perceive quitting as more difficult (Johnson et al., 2013) and may experience more intense nicotine withdrawal during early phases in quitting (i.e., one week post quit; Johnson, Stewart, Rosenfield, Steeves, & Zvolensky, 2012), but not necessarily withdrawal in later phases of quitting (Mullane, Stewart, Rhyno, Steeves, Watt, & Eisner, 2008). Higher levels of anxiety sensitivity are also related to greater odds of early lapse (Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001) and relapse during quit attempts (Assayag, Bernstein, Zvolensky, Steeves, & Stewart, 2012). ...
Recent scholarly attention has focused on explicating the nature of tobacco use among anxiety-vulnerable smokers. Anxiety sensitivity (fear of aversive internal anxiety states) is a cognitive-affective individual difference factor related to the development and maintenance of anxiety symptoms and disorders and various smoking processes. The present study examined the cross-sectional associations between anxiety sensitivity and a range of cognitive and behavioral smoking processes, and the mediating role of the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (i.e., avoidance and inflexibility to smoking [AIS]) in such relations. Participants (n = 466) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco cessation study. Baseline (pretreatment) data were utilized. Self-report measures were used to assess anxiety sensitivity, AIS, and 4 criterion variables: barriers to smoking cessation, quit attempt history, severity of problematic symptoms reported in past quit attempts, and mood-management smoking expectancies. Results indicated that anxiety sensitivity was indirectly related to greater barriers to cessation, greater number of prior quit attempts and greater mood-management smoking expectancies through the tendency to respond inflexibly/avoid to the presence of distressing smoking-related thoughts, feelings, and internal sensations; but not severity of problems experienced while quitting. The present findings suggest AIS may be an explanatory mechanism between anxiety sensitivity and certain smoking processes. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
... These data, in conjunction with extant literature supporting a robust relationship between panic and smoking and/or alcohol-related problems (see Zvolensky, Schmidt, et al., 2003;, for review), hold important implications for the efficacious treatment of panic and related conditions. Augmenting smoking cessation or alcohol use treatments with panic or anxiety reduction strategies may be an effective way to increase abstinence rates, because panic-related variables such as anxiety sensitivity are associated with an increased rate of early smoking lapse and relapse following a quit attempt (Brown et al., 2001; Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001; Mullane et al., 2008; Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009), and comorbid panic is associated with higher rates of relapse after alcohol use treatment (Tomasson & Vaglum, 1996). Thus, development of targeted treatments for individuals with panic disorder, as well as substance use problems, is an important direction of future research. ...
Individuals with anxiety often report greater smoking and drinking behaviors relative to those without a history of anxiety. In particular, smoking and alcohol use have been directly implicated among individuals experiencing panic attacks, diagnosed with panic disorder, or high on panic-relevant risk factors such as anxiety sensitivity. Less is known, however, about specific features of panic that may differentiate among those who do or do not use cigarettes or alcohol. The purpose of the current study was to replicate previous research findings of an association between panic symptomatology, cigarette smoking, and alcohol consumption, as well as extend findings by examining whether specific symptoms of panic attacks differentiated among those who do or do not use cigarettes or alcohol. Participants (n = 489) completed the Panic Attack Questionnaire-IV, a highly detailed assessment of panic attacks and symptoms, as well as self-report measures of smoking history and alcohol use. Consistent with previous research, participants who reported a history of panic attacks (n = 107) were significantly more likely to report current daily or lifetime daily cigarette smoking, and significantly greater hazardous or harmful alcohol use than participants with no panic history (n = 382). Although smoking and hazardous alcohol use were highly associated regardless of panic status, participants with panic attacks showed elevated hazardous alcohol use after controlling for daily or lifetime smoking. Surprisingly, although participants who reported having had at least one panic attack were more likely to smoke, panic attack symptoms, intensity, or frequency did not differentiate panickers who did or did not smoke. Furthermore, panic-related variables were not shown to differentially relate to problematic drinking among panickers. Implications for understanding the complex relationship between panic attacks and smoking and drinking behaviors are discussed.
... Other studies have found that AS is related to negative affect reduction expectancies for smoking (beliefs that smoking will reduce negative affect [40,41] ). Additionally, smokers high in AS perceive the prospect of quitting as both a more difficult and personally threatening experience [42] , possibly due to a hypersensitivity to aversive internal sensations such as nicotine withdrawal symptoms [43] or elevated state anxiety444546. High AS smokers compared to those low in AS also experience greater increases in positive affect from pre-to post-cigarette consumption and report greater smoking satisfaction [47]. ...
Objectives:
High anxiety sensitivity predicts poor smoking cessation outcomes. Aerobic exercise reduces anxiety sensitivity and aspects of the risk conferred by anxiety sensitivity. In the current study, we examined whether exercise can aid smoking cessation in adults with high anxiety sensitivity.
Methods:
Participants were sedentary and low-activity adult daily smokers (n = 136) with elevated prescreen anxiety sensitivity. Participants received 15 weeks of standard smoking cessation treatment (ST; cognitive behavioral therapy plus nicotine replacement therapy). In addition, participants were simultaneously randomized to 15 weeks of either an exercise intervention (ST + EX; n = 72) or a wellness education control condition (ST + CTRL; n = 64). Self-reported smoking abstinence was assessed weekly during the intervention, at the end of treatment (10 weeks after the target quit date), and at 4 and 6 months after the target quit date. Abstinence was verified by expired carbon monoxide readings and saliva cotinine.
Results:
Results indicated that point prevalence abstinence (PPA) and prolonged abstinence (PA) rates were significantly higher for ST + EX than for ST + CTRL at each of the major end points among persons with high anxiety sensitivity (PPA: b = -0.91, standard error [SE] = 0.393, t(1171) = -2.33, p = .020; PA: b = -0.98, SE = 0.346, t(132) = -2.84, p = .005), but not among those with low anxiety sensitivity (PPA: b = -0.23, SE = 0.218, t(1171) = -1.06, p = .29; PA: b = -0.31, SE = 0.306, t(132) = -1.01, p = .32).
Conclusions:
The present results suggest that exercise facilitates the odds of quit success for smokers with high levels of anxiety sensitivity and therefore may be a useful therapeutic tactic for this high-risk segment of the smoking population.
Trial registration:
ClinicalTrials.gov, NCT01065506.
... For example, smokers with PD retrospectively report greater withdrawal symptom severity during past quit attempts compared to individuals without such a history (Marshall et al., 2009;Zvolensky et al., 2004b). There also is a limited body of work that suggests anxiety sensitivity (AS), a core cognitive component of panic psychopathology, may be related to the severity of nicotine withdrawal symptoms across laboratory and clinical studies (Johnson, Stewart, Rosenfield, Steeves, & Zvolensky, 2012;Marshall et al., 2009;Mullane et al., 2008;Vujanovic & Zvolensky, 2009). Overall, empirical work suggests acute nicotine withdrawal may be related to increased risk of panic responding, yet direct empirical evidence is lacking for PD. ...
The current investigation evaluated nicotine withdrawal symptoms elicited by 12 hours of smoking deprivation on anxious and fearful responding to bodily sensations among daily smokers with and without panic disorder (PD). It was hypothesized that smokers with PD who were experiencing greater levels of nicotine withdrawal would experience the greatest levels of fearful responding to, and delayed recovery from, a 10% carbon dioxide-enriched air (CO2) biological challenge procedure. Participants were 58 adults who reported smoking 19.72 cigarettes daily (SD = 7.99). Results indicated that nicotine withdrawal and PD status interacted to predict greater postchallenge panic attack symptoms. Also, individuals with PD initially evidenced a quicker decrease in subjective anxiety following the challenge, but their rate of recovery decelerated over time as compared to those without PD. There was, however, no significant interaction for change in subjective anxiety pre- to postchallenge. Results are discussed in relation to the role of nicotine withdrawal in anxious and fearful responding for smokers with PD. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
... Other studies have found that AS is related to the belief that smoking will reduce negative affect (i.e., negative reinforcement/negative affect reduction expectancies ; Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001 ;Gregor, Zvolensky, McLeish, Bernstein, & Morissette, 2008 ). Additionally, smokers high in AS perceive the prospect of quitting as both a more diffi cult and personally threatening experience , possibly due to a hypersensitivity to aversive internal sensations such as nicotine withdrawal symptoms ( Zvolensky et al., 2004 ) or elevated state anxiety ( Mullane et al., 2008 ;. Perhaps most notably, AS is signifi cantly associated with less success during smoking cessation attempts ( Zvolensky & Bernstein, 2005 ). ...
Introduction:
Empirical research has found that panic attacks are related to increased risk of more severe nicotine withdrawal and poor cessation outcome. Anxiety sensitivity (AS; fear of anxiety and related sensations) has similarly been found to be related to an increased risk of acute nicotine withdrawal and poorer cessation outcome. However, research has yet to examine the relative contributions of panic attacks and AS in terms of cognitive-based smoking processes (e.g., negative reinforcement smoking expectancies, addictive and negative affect-based reduction smoking motives, barriers to cessation, problem symptoms experienced while quitting).
Method:
Participants (n = 242; 57.4% male; M (age) = 38.1) were daily smokers recruited as a part of a larger randomized control trial for smoking cessation. It was hypothesized that both panic attacks and AS would uniquely and independently predict the studied cognitive-based smoking processes.
Results:
As hypothesized, AS was uniquely and positively associated with all smoking processes after controlling for average number of cigarettes smoked per day, current Axis I diagnosis, and participant sex. However, panic attack history was only significantly related to problem symptoms experienced while quitting smoking.
Conclusions:
Although past research has demonstrated significant associations between panic attacks and certain aspects of cigarette smoking (e.g., severity of nicotine withdrawal; lower abstinence rates, and negative affect reduction motives), the present findings suggest that AS may be more relevant to understanding beliefs about and motives for smoking behavior as well as perceptions of cessation-related difficulties.
... Other studies have found that AS is related to smoking outcome expectancies for negative affect reduction (beliefs smoking will reduce negative affect; Brown et al., 2001;Gregor, Zvolensky, McLeish, Bernstein, & Morissette, 2008;Zvolensky et al., 2005). In addition, smokers high in AS report perceiving the prospect of quitting as both a more difficult and personally threatening experience , possibly because of a hypersensitivity to aversive internal sensations such as nicotine withdrawal symptoms (Zvolensky, Baker, et al., 2004) or elevated state anxiety (Mullane et al., 2008); both aversive states routinely occur upon abstinence from smoking (Hughes, Higgins, & Hatsukami, 1990). ...
The present investigation examined the moderating role of anxiety sensitivity (AS) in regard to the relation between acute nicotine withdrawal and anxious and fearful responding to a 10% carbon dioxide-enriched air (CO2) procedure. Ninety daily smokers (35 women; M(age) = 28.87, SD = 12.12) were assigned randomly to one of two groups (12-hr nicotine deprivation or smoking "as usual") and subsequently underwent a 10% CO2 provocation challenge. Partially consistent with prediction, results indicated that the AS by nicotine withdrawal (group status) interaction was significantly predictive of peri-challenge anxiety ratings (anxiety during the challenge), but not skin conductance reactivity. Findings are discussed in the context of the role of AS in amplifying smoking-based fear responses to bodily sensations.
Background and objectives:
PTSD and cigarette smoking frequently co-occur for reasons that are not well understood. The current behavioral and pharmacological treatments and emerging new treatment targets for smoking cessation are discussed.
Methods:
Here we describe recent research on PTSD and smoking with an emphasis on 1) the clinical characteristics of smokers with PTSD, 2) smoking treatment trials that specifically targeted smokers with PTSD, 3) recent research on stress-response and affect regulation pathways that might link the two disorders and 4) potential ways to leverage new findings on stress response systems and affect regulation mechanisms to improve treatment outcomes for smokers with PTSD.
Results:
Smokers with PTSD have higher rates of smoking compared to the general population and have greater difficulty quitting compared to smokers without PTSD. There have been several studies of adjunctive and integrated smoking cessation interventions for smokers with PTSD, but fewer tailored interventions that intensively target stress-response pathways or affect regulation related to both tobacco use and PTSD. Stress-response pathways and affect regulation appear to be important mechanisms involved in the development and maintenance of smoking in individuals with PTSD.
Conclusions and scientific significance:
Additional research that focuses on smokers with PTSD is warranted given that successful tobacco treatment response is low and the negative health effects of each disorder can be greatly amplified. (Am J Addict 2015;XX:1-10).
Despite the increased rates of smoking and poor cessation outcomes among individuals with asthma relative to those without, little scholarly attention has examined mechanisms linking asthma to smoking cessation processes. The current study sought to examine the indirect effect of anxiety sensitivity in terms of asthma and smoking cessation processes (i.e., duration of longest quit attempt, motivation to quit smoking, smoking dependence motives).
Participants were 90 regular daily smokers: 43 with asthma (51.2% male, Mage=38.0years, SD=12.5) and 47 without asthma (46.8% male, Mage=35.4years, SD=11.2) who were participating in a larger smoking cessation study. Data from the baseline (pre-quit attempt) assessment session were used.
After accounting for the effects of gender, race, daily smoking rate, and negative affectivity, asthma status was indirectly related to motives for smoking related to nicotine dependence and motivation to quit smoking through anxiety sensitivity. There was no significant indirect effect for duration of longest quit attempt.
These findings suggest that smokers with asthma may be particularly fearful of physiological arousal, which in turn, may account for greater motivation to quit smoking, but also stronger dependence motives for smoking.
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Objective:
The aim of the present investigation was to explore the main and interactive effects of anhedonic depressive symptoms and anxiety sensitivity in terms of the individual components of nicotine withdrawal symptoms experienced on quit day as well as throughout the initial 14 days of cessation.
Method:
Participants included 65 daily cigarette smokers (38 women; Mage = 46.08 years, SD = 9.12) undergoing psychosocial-pharmacological cessation treatment.
Results:
Results indicated that, after controlling for the effects of participant sex and nicotine dependence, anhedonic depression symptoms, but not anxiety sensitivity, significantly predicted quit day levels of mood-based nicotine withdrawal symptoms. Conversely, anxiety sensitivity, but not anhedonic depression symptoms, was significantly related to the change in most nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between anxiety sensitivity and anhedonic depression symptoms related to the slope of certain withdrawal symptoms over time. Specifically, among participants with higher levels of anxiety sensitivity, greater levels of anhedonic depression symptoms were related to greater increases in withdrawal symptoms over time for two of the nine anxiety-relevant components of nicotine withdrawal (restlessness and frustration).
Conclusions:
Among high anxiety-sensitivity persons, compared with those low in anxiety sensitivity, anhedonic depression symptoms may be more relevant to the experience of some withdrawal symptoms being more intense and persistent during the early phases of quitting.
The present investigation applied Item Response Theory (IRT) methodology to the 16-item Anxiety Sensitivity Index (ASI) [Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8] for a sample of 475 daily adult smokers (52% women; Mage = 26.9, S.D. = 11.1, range = 18–65). Using non-parametric item response analysis, all 16 ASI items were evaluated. Evaluation of the option characteristic curves for each item revealed 4 poorly discriminating ASI items (1: “It is important not to appear nervous;” 5: “It is important to me to stay in control of my emotions;” 7: “It embarrasses me when my stomach growls;” 9: “When I notice my heart beating rapidly, I worry that I might be having a heart attack”), which were dropped from analysis. Upon repeat analysis, the remaining items appeared to make adequate separations within levels of anxiety sensitivity in this sample. Graded response modeling data indicated important differences in ASI items’ capacity to discriminate between, and provide information about, latent levels of anxiety sensitivity. Specifically, three items best discriminated and provided the most information regarding latent levels of AS—items 3, 15, and 16. Items 1, 5, 7, and 9 were omitted due to their limited capacity to discriminate between latent levels of anxiety sensitivity; items 8, 12, and 13 also performed poorly. Overall, current findings suggest that evaluation of anxiety sensitivity among adult smokers using the 16-item ASI may usefully choose to focus on items that performed well in these IRT analyses (items: 2, 3, 4, 6, 10, 11, 14, 15, and 16).
The current investigation explored the main and interactive effects of anxiety sensitivity (AS) and state anxiety in predicting acute nicotine withdrawal symptoms experienced during the initial 14 days of smoking cessation. Participants included 123 adult daily smokers (84 women; Mage = 45.93 years, SD = 10.34) undergoing psychosocial-pharmacological cessation treatment. Results indicated that after controlling for the effects of participant sex and nicotine dependence, state anxiety but not AS significantly predicted initial levels of nicotine withdrawal symptoms. Results also demonstrated that both state anxiety and AS were significantly related to the change in nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between AS and state anxiety. Specifically, higher levels of AS were associated with a stronger relation between state anxiety and nicotine withdrawal symptoms experienced during the cessation attempt. Results suggest that among high AS persons, state anxiety may be more relevant, compared to those low in AS, in regard to experiencing withdrawal symptoms as more intense during the early phases of quitting.
The present investigation examined whether anxiety sensitivity, relative to anxiety and depressive symptoms, was related to duration to early smoking lapse and relapse (during first 2 weeks postquit) among daily smokers receiving smoking cessation treatment.
Participants included 123 daily cigarette smokers (84 women; M(age) = 45.93 years, SD = 10.34) living in the Halifax Regional Municipality in Nova Scotia, Canada.
Anxiety sensitivity was significantly associated with an increased risk of early smoking lapse (i.e., any smoking behavior) at days 1, 7, and 14 following the quit day. Such effects were evident above and beyond the variance accounted for by gender, nicotine dependence, and nicotine withdrawal symptoms, as well as the shared variance with prequit (baseline) anxiety and depressive symptoms. In contrast to expectation, anxiety sensitivity was not related to smoking relapse (i.e., seven consecutive days of smoking) during the first 2 weeks of quitting.
Results are discussed in terms of better understanding the role of anxiety sensitivity, along with other affective vulnerability processes, in early problems encountered during a quit attempt.
Prior research has shown that anxiety sensitivity (AS) is associated with smoking to reduce negative affect (e.g., [Comeau, N., Stewart, S.H., & Loba, P., (2001). The relations of trait anxiety, anxiety sensitivity and sensation seeking to adolescents' motivations for alcohol, cigarette, and marijuana use. Addictive Behaviors, 26, 803-825.]). However, given limitations in the measurement of smoking motives in previous AS studies, it has yet to be definitively established that AS is specifically related to negative reinforcement smoking motives. Moreover, the overall AS construct is comprised of three lower-order components: physical, psychological, and social concerns (e.g., [Stewart, S.H., Taylor, S., & Baker, J.M., (1997). Gender differences in dimensions of anxiety sensitivity. Journal of Anxiety Disorders, 11, 179-200.]). Previous investigations generally have not examined the relative contributions of each of these three AS components to smoking for negative reinforcement motives. The present study attempted to address each of these gaps in the literature. A sample of 119 smokers attending a tobacco intervention program (see [Mullane, J.C., Stewart, S.H., Rhyno, E., Steeves, D., Watt, M., & Eisner, A., (2008). Anxiety sensitivity and difficulties with smoking cessation. In A.M. Columbus (Ed.), Advances in Psychological Research (vol. 54A, pp. 141-155). Hauppauge, NY: Nova Science Publishers.]) completed the Anxiety Sensitivity Index (ASI; [Peterson, R.A., & Reiss, S., (1992). The Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Services.]) and the Reasons For Smoking scale (RFS; [Ikard, F.F., Green, D.E., & Horn, D., (1969). A scale to differentiate between types of smoking as related to the management of affect. International Journal of the Addictions, 4, 649-659.]) at pre-treatment. In a principal components analysis (PCA) of the RFS items, stringent parallel analysis supported a two-factor solution (negative and positive reinforcement smoking motives) as opposed to the intended six factors ([Ikard, F.F., Green, D.E., & Horn, D., (1969). A scale to differentiate between types of smoking as related to the management of affect. International Journal of the Addictions, 4, 649-659.]). ASI total scores were significantly positively correlated with both RFS factors in bivariate correlational analyses. In partial correlations, the relation between the ASI and the RFS negative reinforcement factor remained significant when controlling for RFS positive reinforcement smoking motives, but the correlation of ASI with RFS positive reinforcement motives was not significant after controlling for RFS negative reinforcement motives. At the level of AS components, AS psychological concerns were related to both negative and positive reinforcement motives, while AS physical concerns were more strongly related to negative reinforcement motives. Implications for designing targeted tobacco interventions for high AS smokers are discussed.
The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; M(age)=24.97 years, SD=9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking.
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