Smoking-induced affect modulation in nonwithdrawn smokers with posttraumatic stress disorder, depression, and in those with no psychiatric disorder.

Abstract

This research sought to determine whether smoking influences affect by means other than withdrawal reduction. Little previous evidence suggests such an effect. We surmised that such an effect would be especially apparent in posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), two disorders that are frequently comorbid with smoking and that involve dysregulated affect. Participants were US veterans who were regular smokers (N=159): 52 with PTSD (58% with comorbid MDD); 51 with MDD, and 56 controls with no psychiatric disorder. During three positive and three negative mood induction trials (scheduled over two sessions), non-withdrawn participants smoked either a nicotine-containing cigarette (NIC+), a nicotine-free cigarette (NIC−), or held a pen. Positive and negative affect were each measured before and after mood induction. Results showed a significant 2-way interaction of smoking condition x time on negative affect during the negative mood induction [F(6, 576)=2.41, p=.03] in those with PTSD and controls. In these groups, both NIC+ and NIC−, relative to pen, produced lower negative affect ratings following the negative mood induction. There was also a 2-way interaction of smoking condition x time on positive affect response to the positive mood induction amongst those with PTSD and controls F(6, 564)=3.17, p= .005] and amongst MDD and controls [F(6, 564)=2.27, p= .036]. Amongst all smokers, NIC+ enhanced the magnitude and duration of positive affect more than did NIC−. Results revealed affect modulation outside the context of withdrawal relief; such effects may motivate smoking among those with psychiatric diagnoses, and among smokers in general.

Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis

“…Of those studies, ten found that individuals with PTSD do not smoke a higher number of cigarettes than those without this condition, and one study reported that a diagnosis of PTSD was not associated with cigarettes smoked per day. Again, when exploring the comparison groups we found that most were vulnerable populations including individuals who are homeless (Baggett et al, 2016), individuals exposed to a traumatic event (Baschnagel et al, 2008;Beaudoin, 2011;Farris, 2015;Ritter et al, 2011), and individuals with current or prior diagnosis of a psychiatric disorder (Cook et al, 2017;Marshall et al, 2008;Marshall et al, 2009;Mitchell et al, 2012;Wilson et al, 2014). Finally, one study found mixed results wherein individuals with PTSD smoked more heavily than those without this condition (Zvolensky et al, 2008), but not more than individuals with another anxiety disorder.…”

“…Four studies found no difference in levels of dependence between individuals with PTSD and those with other conditions, such as anxiety or depression (Marshall et al, 2008;Marshall et al, 2009;Young-Wolff et al, 2014;. Finally, one study found higher levels of nicotine dependence among individuals with PTSD compared to those with no psychiatric condition, but there no differences compared to individuals with major depressive disorder (Cook, Baker, Beckham, & McFall, 2017).…”

“…Eleven studies found PTSD was not associated with heavier use of tobacco products (Baggett et al, 2016;Baschnagel et al, 2008;Beaudoin, 2011;Beckham et al, 2007;Cook et al, 2017;Farris, 2015;Marshall et al, 2008;Marshall et al, 2009;Mitchell et al, 2012;Ritter, McCauley, Amstadter, et al, 2011;Wilson et al, 2014). Of those studies, ten found that individuals with PTSD do not smoke a higher number of cigarettes than those without this condition, and one study reported that a diagnosis of PTSD was not associated with cigarettes smoked per day.…”

Examining the relationship between negative affect and posttraumatic stress disorder symptoms among smokers using ecological momentary assessment

“…Cigarette smoking is highly prevalent in individuals with PTSD (Beckham, 1999), and smokers with PTSD report higher levels of anxiety and depression (Beckham et al, 1995). Past research has shown that smoking can temper negative affect following a negative mood induction task (Cook et al, 2017), and smoking is associated with decreased cravings, PTSD symptoms, and negative affect in the presence of trauma-related imagery (Beckham et al, 2007). The use of a sample of smokers could limit generalizability to other clinical populations.…”

“…Higher cravings, negative affect, and PTSD symptoms are associated with trauma-related imagery in groups with and without PTSD, and smoking is associated with decreased cravings, PTSD symptoms, and negative affect in the presence of trauma-related imagery (Beckham et al, 2007). Research has also shown that motivation to smoke can underlie relationships between negative affect and PTSD, in that individuals might be motivated to smoke to regulate negative emotionality experienced due to PTSD (Mahaffey et al, 2016) or acute stressors (Cook et al, 2017). As PTSD and negative affect are reportedly high in cigarette smokers, examining the moment-to-moment relationship between these variables merits examination in this sample.…”