Anxiety sensitivity mediates relations between emotional disorders and smoking.

Abstract

Objectives Research has documented consistent and robust relations between emotional disorders (i.e., depressive and anxiety disorders) and smoking. Yet, it is presently unclear whether anxiety sensitivity, the fear of aversive internal anxiety states, may account for the relations between emotional disorders and various smoking processes, including nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms while quitting during past cessation attempts. Method Participants (n = 465) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco cessation study. Baseline (pre-treatment) data were utilized. Emotional disorders were assessed via clinical diagnostic interview; self-report measures were used to assess anxiety sensitivity and three criterion variables: nicotine dependence, barriers to smoking cessation, and severity of problematic symptoms while quitting in past attempts. Results Emotional disorders were predictive of higher levels of nicotine dependence, greater perceived barriers to cessation, and greater severity of problematic symptoms while quitting in past attempts; each of these relations were accounted for by the indirect effect of anxiety sensitivity. Discussion The present findings suggest that anxiety sensitivity may be an important transdiagnostic construct in explicating the nature of the relations between emotional disorders and various smoking processes.

The Efficacy of Vigorous-Intensity Exercise as an Aid to Smoking Cessation in Adults With High Anxiety Sensitivity

“…In the first model, we tested whether individuals presenting with high anxiety sensitivity assigned to the ST+EX condition reported lower anxiety sensitivity during the targeted quit week relative to their counterparts assigned to the ST+CTRL condition. This hypothesis is consistent with our previous work guiding the current study showing that exercise effectively reduces anxiety sensitivity (3, 14–16) and lower anxiety sensitivity is associated with greater odds of quit success (11–13). Accordingly, we modeled the growth curve of ASI scores from week 0 through quit week using multilevel modeling (MLM) with Time (in weeks), Treatment Condition, and Time × Treatment Condition as predictors.…”

“…This analysis showed that, in the ST+CTRL condition, participants with higher ASI had lower abstinence rates ( b =−.07, SE= .025, t (1171)=2.95, p =.003 for PPA; and b =−.08, SE= .016, t (993)=5.35, p <.001 for PA). These effects replicate earlier findings that smokers with high anxiety sensitivity are less likely to successfully quit smoking than those with low anxiety sensitivity (11–13). On the other hand, in the ST+EX condition ASI scores were not significantly related to abstinence as measured by PPA ( b =−.02, SE= .023, t (1171)=−0.76, p =.447), and was only weakly related to prolonged abstinence ( b =−.03, SE= .014, t (993)=−1.97, p =.049).…”

“…Moreover, smokers higher in anxiety sensitivity, relative to those with lower anxiety sensitivity, perceive quitting as more difficult (9) and experience more intense nicotine withdrawal during early phases in quitting (10). Furthermore, anxiety sensitivity explains the relation between emotional disorders and nicotine dependence, barriers to cessation, and severity of problematic symptoms while quitting (11). Importantly, high anxiety sensitivity is related to greater odds of early smoking lapse (12) and relapse during quit attempts (13).…”

Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion–smoking comorbidity.

“…Thus, AS may prevent regular smokers from making a cessation attempt. Consistent with this perspective, Zvolensky, Farris, Schmidt, and Smits (in press) recently found in treatment-seeking daily smokers that AS was indirectly related (i.e., statistical mediation) to greater perceived barriers to cessation, greater number of prior quit attempts, and greater mood-management smoking expectancies through the the tendency to escape and avoid aversive smoking-related thoughts, feelings and internal sensations. Because high-AS individuals may be more apt to excessively worry about the stress of quitting because they inflexibly rely on smoking to cope with anxiety, they may be at risk for treatment drop out.…”

“…Results are mixed on this issue, with a wide range of effect sizes for relations of AS to cig/day and nicotine dependence severity in daily smokers ( r s = .03 to .44; Johnson et al, 2012; Zvolensky, Farris, Schmidt, & Smits, in press; Zvolensky, Kotov, et al, 2003). Given the methodological caveats with these studies (e.g., cross-sectional, do not assess progression from non-daily to daily smoking), prospective work is warranted to clarify if AS accelerates progression from irregular to regular smoking.…”