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Kunas SL, Hilbert K, Yang Y, Richter J, Hamm A, Wittmann A, Ströhle A, Pfleiderer B, Herrmann MJ, Lang T, Lotze M, Deckert J, Arolt V, Wittchen HU, Straube B, Kircher T, Gerlach AL, Lueken U. The modulating impact of cigarette smoking on brain structure in panic disorder: a voxel-based morphometry study. Soc Cogn Affect Neurosci 2021; 15:849-859. [PMID: 32734299 PMCID: PMC7543937 DOI: 10.1093/scan/nsaa103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/17/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
Cigarette smoking increases the likelihood of developing anxiety disorders, among them panic disorder (PD). While brain structures altered by smoking partly overlap with morphological changes identified in PD, the modulating impact of smoking as a potential confounder on structural alterations in PD has not yet been addressed. In total, 143 PD patients (71 smokers) and 178 healthy controls (62 smokers) participated in a multicenter magnetic resonance imaging (MRI) study. T1-weighted images were used to examine brain structural alterations using voxel-based morphometry in a priori defined regions of the defensive system network. PD was associated with gray matter volume reductions in the amygdala and hippocampus. This difference was driven by non-smokers and absent in smoking subjects. Bilateral amygdala volumes were reduced with increasing health burden (neither PD nor smoking > either PD or smoking > both PD and smoking). As smoking can narrow or diminish commonly observed structural abnormalities in PD, the effect of smoking should be considered in MRI studies focusing on patients with pathological forms of fear and anxiety. Future studies are needed to determine if smoking may increase the risk for subsequent psychopathology via brain functional or structural alterations.
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Affiliation(s)
- Stefanie L Kunas
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - Alfons Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald 17489, Germany
| | - André Wittmann
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, University of Münster, Münster 48149, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Thomas Lang
- Christoph-Dornier-Foundation for Clinical Psychology, Bremen 28359, Germany.,Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg 20146, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald 17489, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg 97080, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster 48149, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden 01069, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Alexander L Gerlach
- Department of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior (CMBB), Philipps-University Marburg, Marburg 35037, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany
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Mayorga NA, Smit T, Shepherd JM, Orr MF, Garey L, Zvolensky MJ. Worry and e-cigarette cognition: The moderating role of sex. Addict Behav 2021; 112:106621. [PMID: 32920456 DOI: 10.1016/j.addbeh.2020.106621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 12/30/2022]
Abstract
As electronic cigarette (e-cigarette) use continues to rise, it is important to identify individual characteristics that may influence e-cigarette use behavior and potential group-level moderators of effects, such as sex. Initial evidence has suggested that worry, defined as excessive, unrealistic thoughts focused on the possibility of future negative events, may contribute to e-cigarette use behavior. Yet, how these established relations differ across groups, such as male and female e-cigarette users, has not been explored. The present study evaluated the effect of worry on perceived barriers for quitting e-cigarettes, perceptions of benefits for e-cigarette use, and perceived negative consequences of e-cigarette use across sex. The sample included 584 current e-cigarette users (52.2% female, Mage = 35.15 years, SD = 10.27). Analyses indicated a significant interaction between sex and worry on each criterion variable (perceived benefits: b = 0.02, SE = 0.01, t = -2.73, p = .01; perceived barriers for quitting e-cigarettes: b = -0.45, SE = 0.08, t = -5.70, p ≤ 0.001; negative consequences to use: b = -0.033, SE = 0.01, t = -4.50, p < .001), such that worry was more strongly related to each outcome among males than females. These findings suggest that sex plays a role in e-cigarette use behaviors and that males may constitute a group that is especially vulnerable to the effects of worry on both positive and negative e-cigarette use perceptions and perceived barriers for quitting e-cigarettes.
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Mykletun A, Overland S, Aarø LE, Liabø HM, Stewart R. Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study. Eur Psychiatry 2020; 23:77-84. [DOI: 10.1016/j.eurpsy.2007.10.005] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 09/18/2007] [Accepted: 10/11/2007] [Indexed: 11/26/2022] Open
Abstract
AbstractSmoking is reported to be associated with depression and anxiety. The present study (a) examines these associations taking comorbidity into account, (b) investigates possible confounders, (c) examines how former smokers compared to current and never-smokers in terms of anxiety and depression, and if anxiety and depression decline by time since cessation. Participants (66%) aged 20–89 years in a population-based health survey (N = 60,814) were screened employing the HADS. (a) The association with smoking was strongest in comorbid anxiety depression, followed by anxiety, and only marginal in depression. Associations were stronger in females and younger participants. (b) Variables partly accounting for the association comprised somatic symptoms, socio-demographics, alcohol problems, and low physical activity. (c) Anxiety and depression were most common in current smokers, followed by quitters, and then never-smokers. No decline in anxiety or depression was found with time since cessation. Previous studies of associations between depression and smoking might have overestimated the association when ignoring comorbid anxiety.
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Yang MJ, Zvolensky MJ, Leyro TM. The indirect effect of panic disorder on smoking cognitions via difficulties in emotion regulation. Addict Behav 2017; 72:126-132. [PMID: 28395248 PMCID: PMC6532648 DOI: 10.1016/j.addbeh.2017.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/25/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
Abstract
Panic disorder (PD) and cigarette smoking are highly comorbid and associated with worse panic and smoking outcomes. Smoking may become an overlearned automatized response to relieve panic-like withdrawal distress, leading to corresponding smoking cognitions, which contribute to its reinforcing properties and difficultly abstaining. Difficulties in emotion regulation (ER) may underlie this relation such that in the absence of adaptive emotion regulatory strategies, smokers with PD may more readily rely upon smoking to manage affective distress. In the current study, the indirect relation between PD status and smoking cognitions through ER difficulties was examined among daily smokers (N=74). We found evidence for an indirect relation between PD status and negative affect, addictive and habitual smoking motives, and anticipating smoking will result in negative reinforcement and personal harm, through self-reported difficulties with ER. Our findings are aligned with theoretical models on anxiety and smoking, and suggest that reports of greater smoking cognitions may be due to ER difficulties.
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Affiliation(s)
- Min-Jeong Yang
- Rutgers, The State University of New Jersey, Department of Psychology, Tillett Hall, 53 Avenue E., Piscataway, NJ 08854, USA
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Suite 104, Houston, TX 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, USA
| | - Teresa M Leyro
- Rutgers, The State University of New Jersey, Department of Psychology, Tillett Hall, 53 Avenue E., Piscataway, NJ 08854, USA.
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Kauffman BY, Garey L, Jardin C, Otto MW, Raines AM, Schmidt NB, Zvolensky MJ. Body Mass Index and functional impairment: the explanatory role of anxiety sensitivity among treatment-seeking smokers. PSYCHOL HEALTH MED 2017. [PMID: 28651434 DOI: 10.1080/13548506.2017.1344357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Obesity and smoking are highly prevalent public health concerns in the United States. Data indicate that elevated Body Mass Index (BMI) is related to functional impairment. However, there is limited understanding of mechanisms that may explain their comorbidity among smokers. The current study sought to test whether anxiety sensitivity explained the relation between BMI and functional impairment among 420 (46.9% females; Mage = 38 years, SD = 13.42) treatment-seeking, adult smokers. Results indicated that BMI yielded a significant indirect effect through anxiety sensitivity for functional impairment, b = 0.01, SE = .01, 95% CI = [.002, .021]. These findings remained significant after controlling for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions (i.e. hypertension, heart problems, respiratory disease, asthma). Such data provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.
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Affiliation(s)
- Brooke Y Kauffman
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Lorra Garey
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Charles Jardin
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Michael W Otto
- b Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | - Amanda M Raines
- c Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Norman B Schmidt
- c Department of Psychology , Florida State University , Tallahassee , FL , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,d Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , Texas , USA
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Family Smoking, Exposure to Secondhand Smoke at Home and Family Unhappiness in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14557-70. [PMID: 26580642 PMCID: PMC4661667 DOI: 10.3390/ijerph121114557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 12/05/2022]
Abstract
Tobacco use adversely affects many aspects of well-being and is disliked by non-smokers. However, its association with family happiness is unknown. We investigated the associations of family unhappiness with smoking in family members and secondhand smoke (SHS) exposure at home in Hong Kong children. In a school-based survey in 2012–2013, 1238 primary school students (mean age 8.5 years, standard deviation 0.9; 42.6% boys) reported family smoking, SHS exposure at home and whether their families had any unpleasant experience caused by smoking or SHS in the past 30 days (tobacco-related unpleasant experience), and rated the overall level of happiness in their families (family unhappiness). Multivariable logistic regression was used to study the associations of tobacco-related unpleasant experience and family unhappiness with family smoking and SHS exposure at home. Tobacco-related unpleasant experience and family unhappiness were reported by 27.5% and 16.5% of students. Unpleasant experience was more strongly associated with family smoking than SHS exposure at home. Family unhappiness was associated with both family smoking (odds ratio 2.37; 95% confidence interval 1.51–3.71) and SHS exposure at home (1.82; 1.39–2.40). These results suggest a previously neglected possible impact of tobacco use on family happiness.
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Blumenthal H. A laboratory-based test of the relation between adolescent alcohol use and panic-relevant responding. Exp Clin Psychopharmacol 2015; 23:303-13. [PMID: 26053320 PMCID: PMC4578981 DOI: 10.1037/pha0000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A burgeoning literature supports a link between alcohol use and panic-spectrum problems (e.g., panic attacks, disorder) among adolescents, but the direction of influence has yet to be properly examined. From a theoretical perspective, panic-spectrum problems may increase risk for problematic drinking via affect regulation efforts (e.g., self-medication), and problematic consumption also may increase or initiate panic-relevant responding (e.g., learning or kindling models). The objective of the current investigation was to examine the role of prior alcohol use in predicting panic-relevant responding, as well as panic symptom history in predicting the desire to consume alcohol, in the context of either a voluntary hyperventilation or a low-arousal task. Participants were community-recruited adolescents aged 12-17 years (n = 92, Mage = 15.42, SD = 1.51; 39.1% girls). Results indicated that prior alcohol use predicted panic-relevant responding among those undergoing the hyperventilation task (but not the low-arousal task), and that this finding was robust to the inclusion of theoretically relevant covariates (i.e., age, sex, negative affectivity). However, panic symptom history did not predict the desire to consume alcohol as a function of either the hyperventilation or low-arousal condition. This work sheds further light on the nature of the relation between panic-spectrum problems and problematic alcohol use in adolescence. Specifically, the current findings suggest that frequent alcohol use may increase panic vulnerability among adolescents, whereas acute panic symptoms may not elicit the immediate (self-reported) desire to drink.
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Sawchuk CN, Roy-Byrne P, Noonan C, Bogart A, Goldberg J, Manson SM, Buchwald D. The Association of Panic Disorder, Posttraumatic Stress Disorder, and Major Depression With Smoking in American Indians. Nicotine Tob Res 2015; 18:259-66. [PMID: 25847288 DOI: 10.1093/ntr/ntv071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 03/12/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Rates of cigarette smoking are disproportionately high among American Indian populations, although regional differences exist in smoking prevalence. Previous research has noted that anxiety and depression are associated with higher rates of cigarette use. We asked whether lifetime panic disorder, posttraumatic stress disorder, and major depression were related to lifetime cigarette smoking in two geographically distinct American Indian tribes. METHODS Data were collected in 1997-1999 from 1506 Northern Plains and 1268 Southwest tribal members; data were analyzed in 2009. Regression analyses examined the association between lifetime anxiety and depressive disorders and odds of lifetime smoking status after controlling for sociodemographic variables and alcohol use disorders. Institutional and tribal approvals were obtained for all study procedures, and all participants provided informed consent. RESULTS Odds of smoking were two times higher in Southwest participants with panic disorder and major depression, and 1.7 times higher in those with posttraumatic stress disorder, after controlling for sociodemographic variables. After accounting for alcohol use disorders, only major depression remained significantly associated with smoking. In the Northern Plains, psychiatric disorders were not associated with smoking. Increasing psychiatric comorbidity was significantly linked to increased smoking odds in both tribes, especially in the Southwest. CONCLUSIONS This study is the first to examine the association between psychiatric conditions and lifetime smoking in two large, geographically diverse community samples of American Indians. While the direction of the relationship between nicotine use and psychiatric disorders cannot be determined, understanding unique social, environmental, and cultural differences that contribute to the tobacco-psychiatric disorder relationship may help guide tribe-specific commercial tobacco control strategies.
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Affiliation(s)
- Craig N Sawchuk
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN;
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Carolyn Noonan
- Department of Medicine, University of Washington, Seattle, WA
| | - Andy Bogart
- Group Health Cooperative, Center for Health Studies, Seattle, WA
| | - Jack Goldberg
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Spero M Manson
- American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Aurora, CO
| | - Dedra Buchwald
- Department of Medicine, University of Washington, Seattle, WA
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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10
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Zvolensky MJ, Farris SG, Guillot CR, Leventhal AM. Anxiety sensitivity as an amplifier of subjective and behavioral tobacco abstinence effects. Drug Alcohol Depend 2014; 142:224-30. [PMID: 25015688 PMCID: PMC4127105 DOI: 10.1016/j.drugalcdep.2014.06.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/01/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anxiety sensitivity, a transdiagnostic cognitive vulnerability factor described as an amplifier of negative emotional states, is implicated in the maintenance of cigarette smoking and cessation difficulties. The current study aimed to examine the role of anxiety sensitivity in predicting abstinence-induced changes in nicotine withdrawal, smoking urges and smoking behavior during an experimental relapse analogue task (RAT). METHOD Participants were 258 non-treatment seeking smokers (M [SD] age=44.0 [10.73]; 69.8% male). Participants attended two counterbalanced experimental sessions including smoking deprivation (16 h of smoking abstinence) and smoking as usual. The Minnesota Nicotine Withdrawal Scale (MNWS) and Brief Questionnaire of Smoking Urges (QSU) were completed at each session in addition to the RAT. Hierarchical regressions were conducted to examine the predictive impact of anxiety sensitivity on withdrawal and urges during smoking deprivation. Follow-up mediational analyses were conducted to examine whether abstinence-induced withdrawal and urges mediated responding during the RAT. RESULTS Anxiety sensitivity amplified the effects of experimentally manipulated acute abstinence on subjective nicotine withdrawal symptoms and smoking urges. Additionally, higher levels of anxiety sensitivity indirectly predicted shorter latency to smoking initiation after deprivation during the RAT through the effects of greater abstinence-induced nicotine withdrawal and smoking urges. Anxiety sensitivity was unrelated to increased smoking during the RAT, although this may be partially attributed to the type of laboratory assessment employed. CONCLUSIONS Elevated anxiety sensitivity appears to impact initiation of smoking after nicotine deprivation through the effects of abstinence-induced withdrawal and smoking urges.
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Affiliation(s)
- Michael J Zvolensky
- University of Houston, Department of Psychology, Fred J. Heyne Building, Suite 104, Houston, TX 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, USA.
| | - Samantha G Farris
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler Street, Houston, TX 77030, USA
| | - Casey R Guillot
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, 2250 Alcazar, St, CSC 240, Los Angeles, CA 90033, USA
| | - Adam M Leventhal
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, 2250 Alcazar, St, CSC 240, Los Angeles, CA 90033, USA; University of Southern California, Department of Psychology, 2250 Alcazar, St, CSC 240, Los Angeles, CA 90033, USA
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11
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Attwood AS, Ataya AF, Bailey JE, Lightman SL, Munafò MR. Effects of 7.5% carbon dioxide inhalation on anxiety and mood in cigarette smokers. J Psychopharmacol 2014; 28:763-72. [PMID: 24763184 PMCID: PMC4986884 DOI: 10.1177/0269881114529378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cigarette smoking is associated with elevated risk of anxiety and mood disorder. Using the 7.5% carbon dioxide (CO2) inhalation model of anxiety induction, we examined the effects of smoking status and abstinence from smoking on anxiety responses. Physiological and subjective responses to CO2 and medical air were compared in smokers and non-smokers (Experiment One) and in overnight abstinent and non-abstinent smokers (Experiment Two). CO2 induced greater increases in blood pressure in non-smokers compared with smokers (ps < 0.043), and greater increases in anxiety (p = 0.005) and negative affect (p = 0.054) in non-abstinent compared with abstinent smokers. CO2 increased physiological and subjective indices of anxiety. There were differences across smoking groups indicating that the CO2 inhalation model is a useful tool for examining the relationship between smoking and anxiety. The findings suggested that both acute smoking and acute abstinence may protect against anxious responding. Further investigation is needed in long-term heavy smokers.
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Affiliation(s)
- Angela S. Attwood
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom,UK Centre for Tobacco and Alcohol Studies, United Kingdom,School of Experimental Psychology, University of Bristol, United Kingdom
| | - Alia F. Ataya
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom,UK Centre for Tobacco and Alcohol Studies, United Kingdom,School of Experimental Psychology, University of Bristol, United Kingdom
| | - Jayne E. Bailey
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | | | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom,UK Centre for Tobacco and Alcohol Studies, United Kingdom,School of Experimental Psychology, University of Bristol, United Kingdom
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12
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Bakhshaie J, Zvolensky MJ, Brandt CP, Vujanovic AA, Goodwin R, Schmidt NB. The Role of Anxiety Sensitivity in the Relationship Between Emotional Non-Acceptance and Panic, Social Anxiety, and Depressive Symptoms Among Treatment-Seeking Daily Smokers. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.2.175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Moylan S, Gustavson K, Karevold E, Øverland S, Jacka FN, Pasco JA, Berk M. The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms: the TOPP Study. PLoS One 2013; 8:e63252. [PMID: 23696803 PMCID: PMC3655993 DOI: 10.1371/journal.pone.0063252] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/30/2013] [Indexed: 11/18/2022] Open
Abstract
Cigarette smoking is increased in people with trait anxiety and anxiety disorders, however no longitudinal data exist illuminating whether smoking in adolescence can influence the developmental trajectory of anxiety symptoms from early vulnerability in infancy to adult anxiety expression. Using The Tracing Opportunities and Problems in Childhood and Adolescence (TOPP) Study, a community-based cohort of children and adolescents from Norway who were observed from the age of 18 months to age 18-19 years, we explored the relationship between adolescent smoking, early vulnerability for anxiety in infancy (e.g. shyness, internalizing behaviors, emotional temperaments) and reported early adult anxiety. Structural equation modeling demonstrated that adolescent active smoking was positively associated with increased early adulthood anxiety (β = 0.17, p<0.05), after controlling for maternal education (proxy for socioeconomic status). Adolescent anxiety did not predict early adult smoking. Adolescent active smoking was a significant effect modifier in the relationship between some infant vulnerability factors and later anxiety; smoking during adolescence moderated the relationship between infant internalizing behaviors (total sample: active smokers: β = 0.85, p<0.01, non-active smokers: ns) and highly emotional temperament (total sample: active smokers: β = 0.55, p<0.01,non-active smokers: ns), but not shyness, and anxiety in early adulthood. The results support a model where smoking acts as an exogenous risk factor in the development of anxiety, and smoking may alter the developmental trajectory of anxiety from infant vulnerability to early adult anxiety symptom expression. Although alternative non-mutually exclusive models may explain these findings, the results suggest that adolescent smoking may be a risk factor for adult anxiety, potentially by influencing anxiety developmental trajectories. Given the known adverse health effects of cigarette smoking and significant health burden imposed by anxiety disorders, this study supports the importance of smoking prevention and cessation programs targeting children and adolescence.
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Affiliation(s)
- Steven Moylan
- School of Medicine, Deakin University, Geelong, Victoria, Australia.
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Moylan S, Jacka FN, Pasco JA, Berk M. How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav 2013; 3:302-26. [PMID: 23785661 PMCID: PMC3683289 DOI: 10.1002/brb3.137] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 12/24/2022] Open
Abstract
Multiple studies have demonstrated an association between cigarette smoking and increased anxiety symptoms or disorders, with early life exposures potentially predisposing to enhanced anxiety responses in later life. Explanatory models support a potential role for neurotransmitter systems, inflammation, oxidative and nitrosative stress, mitochondrial dysfunction, neurotrophins and neurogenesis, and epigenetic effects, in anxiety pathogenesis. All of these pathways are affected by exposure to cigarette smoke components, including nicotine and free radicals. This review critically examines and summarizes the literature exploring the role of these systems in increased anxiety and how exposure to cigarette smoke may contribute to this pathology at a biological level. Further, this review explores the effects of cigarette smoke on normal neurodevelopment and anxiety control, suggesting how exposure in early life (prenatal, infancy, and adolescence) may predispose to higher anxiety in later life. A large heterogenous literature was reviewed that detailed the association between cigarette smoking and anxiety symptoms and disorders with structural brain changes, inflammation, and cell-mediated immune markers, markers of oxidative and nitrosative stress, mitochondrial function, neurotransmitter systems, neurotrophins and neurogenesis. Some preliminary data were found for potential epigenetic effects. The literature provides some support for a potential interaction between cigarette smoking, anxiety symptoms and disorders, and the above pathways; however, limitations exist particularly in delineating causative effects. The literature also provides insight into potential effects of cigarette smoke, in particular nicotine, on neurodevelopment. The potential treatment implications of these findings are discussed in regards to future therapeutic targets for anxiety. The aforementioned pathways may help mediate increased anxiety seen in people who smoke. Further research into the specific actions of nicotine and other cigarette components on these pathways, and how these pathways interact, may provide insights that lead to new treatment for anxiety and a greater understanding of anxiety pathogenesis.
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Affiliation(s)
- Steven Moylan
- Deakin University School of Medicine Barwon Health, Geelong, Victoria, Australia
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Brady KT, Haynes LF, Hartwell KJ, Killeen TK. Substance use disorders and anxiety: a treatment challenge for social workers. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:407-423. [PMID: 23731428 PMCID: PMC3775646 DOI: 10.1080/19371918.2013.774675] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Converging evidence from epidemiologic and treatment studies indicate that anxiety disorders and substance use disorders commonly co-occur, and the interaction is multifaceted and variable. Epidemiological studies and investigations within clinical substance abuse populations have found an association between anxiety disorders and substance use disorders. Specific anxiety disorders including generalized anxiety disorder, panic disorder, and post traumatic stress disorder have all been associated with substance use. The association with obsessive-compulsive disorder is less robust, and some research has found a negative association. The risk of nicotine dependence is significantly higher among individuals with an anxiety disorder, and conversely, smoking has been found to be associated with trait anxiety and anxiety disorders. A review of the current literature and the relationship between specific anxiety disorders and alcohol and substance use disorders is discussed in detail. This article, written for social workers in a variety of practice settings, reviews the prevalence, diagnostic, and treatment issues at the interface of substance use disorders and anxiety disorders.
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Affiliation(s)
- Kathleen T Brady
- Department of Psychiatry, Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC 29425, USA.
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16
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Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder. Drug Alcohol Depend 2012; 126:138-46. [PMID: 22633368 DOI: 10.1016/j.drugalcdep.2012.05.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has indicated a strong association of smoking with depression and anxiety disorders, but the direction of the relationship is uncertain. Most research has been done in general population samples. We investigated the effect of smoking and nicotine dependence on the severity and course of depressive and anxiety symptoms in psychiatric patients. METHODS Data came from the Netherlands Study of Depression and Anxiety (NESDA) including participants with a current diagnosis of depression and/or an anxiety disorder (N=1725). The course of smoking status and symptoms of depression, general anxiety, social anxiety, and agoraphobia were measured at baseline and after one and two years. Age, gender, education, alcohol use, physical activity, and negative life events were treated as covariates. RESULTS At baseline, the symptoms of depression, general anxiety, and agoraphobia were more severe in nicotine-dependent smokers than in never-smokers, former smokers, and non-dependent smokers. These differences remained after adjusting for covariates. Smaller differences were observed for severity of social anxiety which were no longer significant after controlling for covariates. Over a two-year follow-up, the improvement of depressive and anxiety symptoms was slower in nicotine-dependent smokers than in the other groups even after controlling for covariates. There were no differences between the groups in the course of symptoms of social anxiety and agoraphobia over time. CONCLUSIONS In psychiatric patients, smoking is associated with higher severity of depressive and anxiety symptoms, and with slower recovery, but only when smokers are nicotine-dependent.
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Moylan S, Jacka FN, Pasco JA, Berk M. Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies. BMC Med 2012; 10:123. [PMID: 23083451 PMCID: PMC3523047 DOI: 10.1186/1741-7015-10-123] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/19/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized. METHODS We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders. RESULTS In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified. CONCLUSIONS Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.
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Affiliation(s)
- Steven Moylan
- Deakin University School of Medicine, Barwon Health, Geelong, Victoria, Australia.
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Leyro TM, Zvolensky MJ. The interaction of nicotine withdrawal and panic disorder in the prediction of panic-relevant responding to a biological challenge. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 27:90-101. [PMID: 22867297 DOI: 10.1037/a0029423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Teresa M Leyro
- Department of Psychiatry, University of California-San Francisco
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19
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Jamal M, Does AJWVD, Penninx BWJH, Cuijpers P. Age at Smoking Onset and the Onset of Depression and Anxiety Disorders. Nicotine Tob Res 2011; 13:809-19. [DOI: 10.1093/ntr/ntr077] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Graef S, Schönknecht P, Sabri O, Hegerl U. Cholinergic receptor subtypes and their role in cognition, emotion, and vigilance control: an overview of preclinical and clinical findings. Psychopharmacology (Berl) 2011; 215:205-29. [PMID: 21212938 DOI: 10.1007/s00213-010-2153-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 12/15/2010] [Indexed: 01/10/2023]
Abstract
RATIONALE The cholinergic system has long been linked to cognitive processes. Two main classes of acetylcholine (ACh) receptors exist in the human brain, namely muscarinic and nicotinic receptors, of which several subtypes occur. OBJECTIVES This review seeks to provide an overview of previous findings on the influence of cholinergic receptor manipulations on cognition in animals and humans, with particular emphasis on the role of selected cholinergic receptor subtypes. Furthermore, the involvement of these receptor subtypes in the regulation of emotion and brain electrical activity as measured by electroencephalography (EEG) shall be addressed since these domains are considered to be important modulators of cognitive functioning. RESULTS In regard to cognition, the muscarinic receptor subtypes have been implicated mainly in memory functions, but have also been linked to attentional processes. The nicotinic α7 receptor subtype is involved in working memory, whereas the α4β2* subtype has been linked to tests of attention. Both muscarinic and nicotinic cholinergic mechanisms play a role in modulating brain electrical activity. Nicotinic receptors have been strongly associated with the modulation of depression and anxiety. CONCLUSIONS Cholinergic receptor manipulations have an effect on cognition, emotion, and brain electrical activity as measured by EEG. Changes in cognition can result from direct cholinergic receptor manipulation or from cholinergically induced changes in vigilance or affective state.
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Affiliation(s)
- Susanne Graef
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany.
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21
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Abstract
Anxiety disorders are the most common mental health condition and frequently co-occur with a variety of health risk factors, such as physical inactivity, cigarette smoking, and alcohol consumption. As such, untreated anxiety and increased risk for engagement in these health risk habits can further increase risk for later-onset chronic disease and complications in disease management. Contemporary studies have identified unique temporal relationships between the onset of specific anxiety disorders with smoking and alcohol use disorders. Incorporating exercise with evidence-based treatments for anxiety is emerging and promising in enhancing treatments for anxiety-related conditions. Likewise, substance use treatment programs may benefit from the detection and management of anxiety. Collaborative care models for anxiety may provide the needed systems-based approach for treating anxiety more effectively in primary and specialty care medical settings. Based on a qualitative review of the literature, this article summarizes the current research on the associations between anxiety, health risk factors, and the risk for chronic diseases. The authors also offer suggestions for future research that would help in better understanding the complex relationships between the role anxiety plays in the vulnerability for and management of physical inactivity and substance use.
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Affiliation(s)
- Craig N. Sawchuk
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington (CNS)
- Department of Psychology, Vanderbilt University, Nashville, Tennessee (BOO)
| | - Bunmi O. Olatunji
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington (CNS)
- Department of Psychology, Vanderbilt University, Nashville, Tennessee (BOO)
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Vujanovic AA, Marshall EC, Gibson LE, Zvolensky MJ. Cognitive-affective characteristics of smokers with and without posttraumatic stress disorder and panic psychopathology. Addict Behav 2010; 35:419-25. [PMID: 20060228 DOI: 10.1016/j.addbeh.2009.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 10/06/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
Abstract
The present study evaluated differences among daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), panic attacks (PA), and no axis I psychopathology (past 6 months) in terms of several cognitive-affective variables implicated in both the onset and maintenance of anxiety psychopathology and cigarette smoking. The sample consisted of 123 daily smokers (62% women: M(age)=29.7, SD=11.9). Compared to the PA and no psychopathology groups, the PTSD group reported significantly higher levels of anxiety sensitivity, discomfort intolerance, negative affectivity, anxious arousal, and anhedonic depression; and, the PTSD group reported significantly lower levels of perceived control over anxiety-related events than the PA group. The PD group, compared to those in the PA and no psychopathology groups, reported significantly higher levels of anxiety sensitivity, negative affectivity, and anxious arousal; and significantly lower levels of perceived control over anxiety-related events. No significant differences were evident between the PTSD and PD groups. Theoretical and clinical implications of the present findings are discussed in terms of smoking and emotional vulnerability.
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Cougle JR, Zvolensky MJ, Fitch KE, Sachs-Ericsson N. The role of comorbidity in explaining the associations between anxiety disorders and smoking. Nicotine Tob Res 2010; 12:355-64. [PMID: 20156885 DOI: 10.1093/ntr/ntq006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Research has generally found strong associations between smoking and anxiety disorders. The present study sought to examine the role of comorbidity in explaining these relationships. METHODS Participants from the National Comorbidity Survey-Replication (N = 5,692) were included in the present study. Axis I disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview. In addition, smoking and mental health treatment history were assessed. RESULTS Multivariate analyses covarying for demographic variables and psychiatric and substance use comorbidity found that posttraumatic stress disorder was uniquely associated with every smoking outcome of interest, including 12-month and lifetime daily and heavy smoking, nicotine dependence, and cessation failure. Generalized anxiety disorder and social anxiety disorder were associated with fewer smoking-related outcomes, and contrary to predictions, panic disorder was only independently associated with 12-month daily smoking. Panic attack history, however, was uniquely associated with 12-month daily and heavy smoking, nicotine dependence, and lifetime cessation failure. In addition, analyses indicated that greater number of anxiety disorders was associated with greater prevalence of each smoking outcome, and the presence of even one anxiety disorder was associated with elevated smoking prevalence. DISCUSSION Several specific anxiety disorders were found to be uniquely associated with smoking behavior. Findings suggest that comorbidity may only explain the associations with smoking difficulties for some anxiety disorders.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA.
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Marshall EC, Johnson K, Bergman J, Gibson LE, Zvolensky MJ. Anxiety sensitivity and panic reactivity to bodily sensations: relation to quit-day (acute) nicotine withdrawal symptom severity among daily smokers making a self-guided quit attempt. Exp Clin Psychopharmacol 2009; 17:356-364. [PMID: 19803635 PMCID: PMC2913276 DOI: 10.1037/a0016883] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Johnson KA, Stewart SH, Zvolensky MJ, Steeves D. Evaluating the mediating role of coping-based smoking motives among treatment-seeking adult smokers. Nicotine Tob Res 2009; 11:1296-303. [PMID: 19703943 DOI: 10.1093/ntr/ntp134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Empirical work has demonstrated a linkage between smoking rate and anxious arousal symptoms. However, there is little understanding of the mechanisms underlying this association. METHOD The present investigation examined the role of coping-based smoking motives in terms of mediating the relations between smoking rate and anxious arousal symptoms and anxious arousal symptoms and smoking rate among a sample of treatment-seeking adult smokers (N = 123; 84 women; M(age) = 45.93, SD = 10.34). RESULTS Results indicated that coping motives mediated the relations between smoking rate and anxious arousal symptoms and anxious arousal symptoms and smoking rate. DISCUSSION These results suggest that coping motives play a key role in terms of better understanding the association between smoking rate and anxious arousal symptoms.
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Affiliation(s)
- Kirsten A Johnson
- Department of Psychology, The University of Vermont, Burlington, VT, USA
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26
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Zvolensky M, Bonn-Miller M, Bernstein A, Marshall E. Anxiety sensitivity and abstinence duration to smoking. J Ment Health 2009. [DOI: 10.1080/09638230600998888] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rodríguez-Esquivel D, Cooper TV, Blow J, Resor MR. Characteristics associated with smoking in a Hispanic sample. Addict Behav 2009; 34:593-8. [PMID: 19394148 PMCID: PMC2720853 DOI: 10.1016/j.addbeh.2009.03.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 02/06/2009] [Accepted: 03/25/2009] [Indexed: 01/11/2023]
Abstract
Although general smoking prevalence has declined, similar declines have not been observed in some underserved populations. For example, groups such as ethnic minorities, individuals with psychiatric diagnoses, those with a history of substance use, and weight concerned smokers have not shown comparable reductions. The goal of this study is to create a profile of Hispanic smokers in the El Paso/Juárez area and identify predictors of smoking. In this cross-sectional study, these variables were assessed in 160 English-speaking Hispanic volunteers. Participants completed measures of tobacco use, nicotine dependence, weekly alcohol consumption, acculturation, depressive symptomatology, weight concern, and drug use. Expired carbon monoxide and body composition were also assessed. Participants were light smokers with low levels of nicotine dependence and expired carbon monoxide, a significant number of past quit attempts, and limited use of cessation aids. Significant characteristics associated with smoking included male gender, use of mental health services, increasing number of drinks per week, and lifetime use of illicit drugs. These findings suggest substance use and psychiatric comorbidity are associated with smoking in this population and may be barriers to quitting. These factors should be considered in developing culturally-sensitive tobacco cessation interventions for Hispanic smokers, particularly those residing on the U.S./México border.
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Affiliation(s)
| | - Theodore V. Cooper
- The University of Texas at El Paso, Department of Psychology, 500 W. University Ave., El Paso, TX 79968 USA, ,
| | - Julie Blow
- The University of Texas at El Paso, Department of Psychology, 500 W. University Ave., El Paso, TX 79968 USA, ,
| | - Michelle R. Resor
- The University of North Carolina at Charlotte, Department of Psychology, 9201 University City Blvd., Charlotte, NC 28027 USA,
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Negative affectivity as a moderator of the association between smoking status and anxiety sensitivity, anxiety symptoms, and perceived health among young adults. J Nerv Ment Dis 2009; 197:111-6. [PMID: 19214046 PMCID: PMC6561469 DOI: 10.1097/nmd.0b013e3181961683] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present investigation evaluated the moderational role of negative affectivity in the relation between smoking status and panic-relevant symptoms in a young adult sample (n = 222; 123 females; mean age = 22.45 years, SD = 8.08). Consistent with the prediction, negative affectivity moderated the association of smoking status with anxious arousal symptoms, anxiety sensitivity, and perceived health. Specifically, greater negative affectivity was associated with higher levels of anxious arousal and anxiety sensitivity and lower levels of perceived health among smokers compared to nonsmokers. The effects were evident after controlling for the variance accounted for by alcohol use problems and gender. Findings are discussed with regard to the role of negative affectivity in the relation between smoking and panic-related processes.
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Morissette SB, Gulliver SB, Kamholz BW, Duade J, Farchione T, Devine E, Brown TA, Barlow DH, Ciraulo D. Differences between daily smokers, chippers, and nonsmokers with co-occurring anxiety and alcohol-use disorders. Addict Behav 2008; 33:1425-1431. [PMID: 18656314 PMCID: PMC2579260 DOI: 10.1016/j.addbeh.2008.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 06/04/2008] [Accepted: 06/06/2008] [Indexed: 11/23/2022]
Abstract
Tobacco use is disproportionately represented among both alcohol-use disorders (AUDs) and anxiety disorders (ANX) compared to the general population [Kalman, D. A., Morissette, S. B., & George, T. P. (2005). Co-morbidity of nicotine and tobacco use in psychiatric and substance use disorders. The American Journal on Addictions, 14, 1-18]. Despite this common overlap, little is known about how smokers with co-occurring AUD-ANX differ from their nonsmoking counterparts. Seventy-two patients participated in a larger clinical trial evaluating the efficacy of venlafaxine and cognitive-behavioral therapy for AUD-ANX. Differences between daily smokers (n=23), chippers (n=12) and nonsmokers (n=37) with AUD-ANX were examined with respect to intensity and frequency of alcohol use, anxiety symptoms, depressed mood, and stress. Point prevalence of current daily smoking was 31.9%, which is considerably lower than traditionally reported in AUD studies. Consistent with predictions, daily smokers reported higher levels of alcohol dependence, average drinks per drinking occasion, and peak blood concentration levels in a day than nonsmokers during the 90 days prior to assessment. Chippers were nonsignificantly different from either smokers or nonsmokers. Smokers and nonsmokers did not differ with respect to percent heavy drinking days or emotional symptoms.
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Affiliation(s)
- Sandra B Morissette
- VA Boston Healthcare System, USA; Boston University School of Medicine, USA; Boston University Department of Psychology, USA.
| | - Suzy B Gulliver
- Central Texas Veterans Healthcare System, USA; Texas A&M, USA
| | - Barbara W Kamholz
- VA Boston Healthcare System, USA; Boston University School of Medicine, USA; Boston University Department of Psychology, USA
| | - James Duade
- Boston University Department of Psychology, USA
| | | | | | | | - David H Barlow
- Boston University Department of Psychology, USA; Boston University School of Medicine, USA
| | - Domenic Ciraulo
- Boston University School of Medicine, USA; VA Boston Healthcare System, USA
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Marshall EC, Zvolensky MJ, Vujanovic AA, Gibson LE, Gregor K, Bernstein A. Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology. J Anxiety Disord 2008; 22:1214-26. [PMID: 18282685 PMCID: PMC2600664 DOI: 10.1016/j.janxdis.2008.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 12/30/2007] [Accepted: 01/04/2008] [Indexed: 11/16/2022]
Abstract
The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.
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Feldner MT, Zvolensky MJ, Babson K, Leen-Feldner EW, Schmidt NB. An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy. J Anxiety Disord 2008; 22:1227-43. [PMID: 18281190 PMCID: PMC2666044 DOI: 10.1016/j.janxdis.2008.01.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 12/31/2007] [Accepted: 01/04/2008] [Indexed: 11/17/2022]
Abstract
Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.
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Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, Manderscheid R, Kroenke K. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry 2008; 30:127-37. [PMID: 18291294 DOI: 10.1016/j.genhosppsych.2007.12.008] [Citation(s) in RCA: 361] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to examine the extent to which depression and anxiety are associated with smoking, obesity, physical inactivity and alcohol consumption in the US population using the Patient Health Questionnaire 8 (PHQ-8) and two questions on lifetime diagnosis of anxiety and depression. METHODS Data were analyzed in 38 states, the District of Columbia and two territories using the 2006 Behavioral Risk Factor Surveillance System (n=217,379), a large state-based telephone survey. RESULTS Overall, adults with current depression or a lifetime diagnosis of depression or anxiety were significantly more likely than those without each diagnosis to smoke, to be obese, to be physically inactive, to binge drink and drink heavily. There was a dose-response relationship between depression severity and the prevalence of smoking, obesity and physical inactivity and between history of depression (never depressed, previously depressed, currently depressed) and the prevalence of smoking, obesity, physical inactivity, binge drinking and heavy drinking. Lifetime diagnosis of depression and anxiety had an additive association with smoking prevalence. CONCLUSION The associations between depression, anxiety, obesity and unhealthy behaviors among US adults suggest the need for a multidimensional and integrative approach to health care.
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Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Zvolensky MJ, Kotov R, Bonn-Miller MO, Schmidt NB, Antipova AV. Anxiety sensitivity as a moderator of association between smoking status and panic-related processes in a representative sample of adults. J Psychiatr Res 2008; 42:69-77. [PMID: 17098257 PMCID: PMC2219200 DOI: 10.1016/j.jpsychires.2006.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 09/25/2006] [Accepted: 09/29/2006] [Indexed: 11/23/2022]
Abstract
The present investigation evaluated a moderational role of anxiety sensitivity (fear of anxiety and anxiety-related states; [McNally RJ. Anxiety sensitivity and panic disorder. Biological Psychiatry 2002; 52:938-946.]) in the relation between smoking status and anxiety/depressive symptoms in a Russian epidemiological sample (n = 390; 197 females, Mean age = 43.55). Consistent with prediction, anxiety sensitivity moderated the association of smoking status with indices of anxiety and depressive symptoms; the effects were evident after controlling for the variance accounted for by alcohol use problems, environmental stress (past month), and gender. These findings are discussed with regard to the role of anxiety sensitivity in etiologic connection between smoking and panic-related processes.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, The University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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Lekka NP, Lee KH, Argyriou AA, Beratis S, Parks RW. Association of cigarette smoking and depressive symptoms in a forensic population. Depress Anxiety 2007; 24:325-30. [PMID: 17041915 DOI: 10.1002/da.20235] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The link between mental health issues and smoking has been an important area of investigation. However, little is known about this association in a general adult, male forensic population. The aim of this study was to identify demographic and clinical (depression and anxiety) variables that predict smoking in a forensic population. A large cohort of 353 inmates in a high-security prison underwent a psychiatric interview, including administration of the Montgomery-Asberg Rating Scale for Depression (MADRS) and Hamilton's Rating Scale for Anxiety (HAM-A). Multiple regression analysis suggested that younger age and higher depression scores might predict the amount of daily smoking in this population. In contrast, anxiety symptoms were not an independent predictor for smoking in our study. These findings support the need for additional research to focus on those factors associated with smoking in forensic populations. Psychiatric screening for younger male individuals in forensic settings and targeted cognitive-behavioral interventions to treat depressed smokers may ameliorate the smoking abstinence rate in prisons.
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Affiliation(s)
- Nicoletta P Lekka
- Academic Clinical Psychiatry, University of Sheffield School of Medicine, The Longley Centre, Sheffield, United Kingdom.
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35
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Booker TK, Butt CM, Wehner JM, Heinemann SF, Collins AC. Decreased anxiety-like behavior in beta3 nicotinic receptor subunit knockout mice. Pharmacol Biochem Behav 2007; 87:146-57. [PMID: 17509676 DOI: 10.1016/j.pbb.2007.04.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 04/04/2007] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
Nicotine, via a family of nicotinic acetylcholine receptors, elicits many physiological responses, including alterations in anxiety. Studies suggest that the effects of nicotine on anxiety may support smoking behaviors. We reported previously that mice lacking the beta3 nicotinic receptor subunit demonstrate increased activity in the open field arena. Open field activity has been shown to be a composite of anxiety and locomotor activity, behaviors that are both altered by nicotine. We therefore sought to differentiate the role(s) of beta3-containing receptors in anxiety and locomotor activity. Anxiety behaviors were examined in the elevated plus maze, the black/white box and the mirrored chamber. Beta3 null mutant mice demonstrated decreased anxiety with more time spent on the open arm of the elevated plus maze than their wildtype littermates. No significant differences were observed with the black/white box or the mirrored chamber. Levels of the stress hormone, corticosterone, were significantly higher in the beta3 null mutant mice at baseline and following exposure to stress. Increased locomotor activity in the Y-maze was also observed for the beta3 null mutant mice, but only following exposure to stress. These findings strongly suggest that beta3-containing nicotinic receptors influence anxiety and may be critical for the continuation of smoking behaviors.
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Affiliation(s)
- T K Booker
- Salk Institute for Biological Studies, La Jolla, CA 92037 USA.
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36
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Morissette SB, Brown TA, Kamholz BW, Gulliver SB. Differences between smokers and nonsmokers with anxiety disorders. J Anxiety Disord 2006; 20:597-613. [PMID: 16202562 DOI: 10.1016/j.janxdis.2005.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 07/08/2005] [Accepted: 08/18/2005] [Indexed: 11/17/2022]
Abstract
Epidemiological data suggest that early smoking increases the risk for emergence of certain anxiety disorders (e.g., panic disorder, generalized anxiety disorder (GAD)), and that presence of certain anxiety disorders (e.g., social anxiety) increases the risk for later development of nicotine dependence. Although some studies report a high prevalence of smoking among anxiety disorders, the extent to which smokers with anxiety disorders differ from their nonsmoking counterparts remains uncertain. Differences between smokers and nonsmokers with anxiety disorders (N=527) were examined with respect to multiple measures of theoretical and clinical interest. Compared to nonsmokers, smokers with anxiety disorders reported greater anxiety sensitivity, anxiety symptoms, agoraphobic avoidance, depressed mood, negative affect, stress and life interference; however, these differences were largely accounted for by panic disorder. No differences were found between smokers and nonsmokers regarding social anxiety, worry, obsessive-compulsive symptoms or positive affect. Differential patterns were observed when evaluating constructs within anxiety disorder diagnoses.
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Affiliation(s)
- Sandra Baker Morissette
- VA Boston Healthcare System, Psychology Service, 116B, 150 South Huntington Avenue, Boston, MA 02130, USA.
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37
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Sheahan SL, Rayens MK, An K, Riegel B, McKinley S, Doering L, Garvin BJ, Moser DK. Comparison of Anxiety Between Smokers and Nonsmokers With Acute Myocardial Infarction. Am J Crit Care 2006. [DOI: 10.4037/ajcc2006.15.6.617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Increased anxiety correlates with increased complications after acute myocardial infarction. Anxiety levels and use of anxiolytic agents have not been compared between smokers and nonsmokers hospitalized because of acute myocardial infarction.
• Objectives To compare anxiety level, sociodemographic factors, and clinical variables between smokers and nonsmokers hospitalized with acute myocardial infarction and to examine predictors of use of β-blockers and anxiolytic agents among smokers and nonsmokers.
• Methods Secondary data analysis of a prospective multisite study on anxiety in 181 smokers and 351 nonsmokers with acute myocardial infarction. Anxiety was measured by using the State Trait Anxiety Inventory and the anxiety subscale of the Basic Symptom Inventory within 72 hours of admission.
• Results Smokers reported higher anxiety levels than nonsmokers reported on both anxiety scales. Female smokers reported the highest anxiety and peak pain levels of all, yet women were the least likely to receive anxiolytic agents. Smoking status was not a predictor for anxiety level when sex, peak pain, use of β-blockers in the hospital, and age were controlled for. However, smokers were twice as likely as nonsmokers to receive an anxiolytic agent and 60% more likely to receive a β-blocker in the emergency department, and smokers were 80% more likely than nonsmokers to receive an anxiolytic agent during hospitalization when these variables were controlled.
• Conclusions Older female smokers are at risk for complications because they are older than their male counterparts and less likely to receive β-blockers and antianxiety medications in the emergency department.
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Affiliation(s)
- Sharon L. Sheahan
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Mary K. Rayens
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Kyungeh An
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Barbara Riegel
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Sharon McKinley
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Lynn Doering
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Bonnie J. Garvin
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
| | - Debra K. Moser
- The University of Kentucky College of Nursing, Lexington, Ky (sls, mkr, dkm), Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Korea (ka), University of Pennsylvania, Philadelphia, Pa (br), University of Technology, Sydney and Royal North Shore Hospital, Sydney, Australia (sm), University of California, Los Angeles, Los Angeles, Calif (ld), and The Ohio State University, Columbus, Ohio (bjg)
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Lifetime associations between cannabis, use, abuse, and dependence and panic attacks in a representative sample. J Psychiatr Res 2006; 40:477-86. [PMID: 16271364 DOI: 10.1016/j.jpsychires.2005.09.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 09/26/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND The present investigation evaluated lifetime associations between cannabis use, abuse, and dependence and panic attacks after controlling for alcohol abuse, polysubstance use, and demographic variables. METHODS Data for this study were obtained as part of a large statewide survey, the Colorado Social Health Survey (CSHS). Participants were contacted using randomly sampled household addresses (72% response rate) and interviews took place in participants' homes. Participants consisted of a representative sample from the Colorado general adult population (n=4745; 52% female). The Diagnostic Interview Schedule was administered to obtain diagnoses. RESULTS After controlling for polysubstance use, alcohol abuse, and demographic variables, lifetime history of cannabis dependence, but not use or abuse, was significantly related to an increased risk of panic attacks. Additionally, among participants reporting a lifetime history of both panic attacks and cannabis use, the age of onset of panic attacks (M=19.0 years of age) was significantly earlier than for individuals with a lifetime panic attack history but no cannabis use (M=27.6 years of age). CONCLUSIONS Structured interview data suggest lifetime cannabis dependence is significantly associated with an increased risk of panic attacks.
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Zvolensky MJ, Bernstein A, Marshall EC, Feldner MT. Panic attacks, panic disorder, and agoraphobia: associations with substance use, abuse, and dependence. Curr Psychiatry Rep 2006; 8:279-85. [PMID: 16879791 DOI: 10.1007/s11920-006-0063-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anxiety and substance use disorders frequently co-occur. Despite the clinical importance of this co-occurrence, theory and research addressing the relations between anxiety-substance use disorder comorbidity remain limited. The present commentary is intended to briefly review and summarize key aspects of this literature, with a specific focus on panic-spectrum psychopathology (panic attacks, panic disorder, and agoraphobia) and its associations with tobacco, alcohol, and marijuana use, abuse, and dependence. A heuristic theoretical model for better understanding the panic-substance use relations also is offered. Extant data suggest clinically meaningful bidirectional associations are evident between panic problems and premorbid risk factors for such problems and various forms of tobacco, alcohol, and marijuana use. Key clinical implications and future directions are outlined based upon the review.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
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40
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Zvolensky MJ, Bonn-Miller MO, Bernstein A, McLeish AC, Feldner MT, Leen-Feldner EW. Anxiety sensitivity interacts with marijuana use in the prediction of anxiety symptoms and panic-related catastrophic thinking among daily tobacco users. Behav Res Ther 2006; 44:907-24. [PMID: 16122698 DOI: 10.1016/j.brat.2005.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 06/26/2005] [Accepted: 06/26/2005] [Indexed: 11/18/2022]
Abstract
The present investigation evaluated whether anxiety sensitivity interacted with marijuana use in relation to the prediction of panic-relevant variables among young adult tobacco smokers (n=265). Approximately 73% of the sample was composed of current marijuana smokers, with 78.5% of this sub-sample using marijuana more than once per week. As expected, after covarying cigarettes per day, alcohol use, and negative affectivity, the interaction between marijuana use and anxiety sensitivity predicted anxiety symptoms and agoraphobic cognitions. Partially consistent with prediction, the interaction between frequency of marijuana use and anxiety sensitivity predicted only anxiety symptoms. These results are discussed in relation to better understanding the potential role of regular marijuana use and anxiety sensitivity for panic-relevant emotional vulnerability among regular tobacco smokers.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Room 202, Burlington, 05405 0134, USA.
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41
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Zvolensky MJ, Sachs-Ericsson N, Feldner MT, Schmidt NB, Bowman CJ. Neuroticism moderates the effect of maximum smoking level on lifetime panic disorder: a test using an epidemiologically defined national sample of smokers. Psychiatry Res 2006; 141:321-32. [PMID: 16499972 DOI: 10.1016/j.psychres.2005.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 04/03/2005] [Accepted: 07/28/2005] [Indexed: 11/26/2022]
Abstract
The present study evaluated a moderational model of neuroticism on the relation between smoking level and panic disorder using data from the National Comorbidity Survey. Participants (n=924) included current regular smokers, as defined by a report of smoking regularly during the past month. Findings indicated that a generalized tendency to experience negative affect (neuroticism) moderated the effects of maximum smoking frequency (i.e., number of cigarettes smoked per day during the period when smoking the most) on lifetime history of panic disorder even after controlling for drug dependence, alcohol dependence, major depression, dysthymia, and gender. These effects were specific to panic disorder, as no such moderational effects were apparent for other anxiety disorders. Results are discussed in relation to refining recent panic-smoking conceptual models and elucidating different pathways to panic-related problems.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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42
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Zvolensky MJ, Bonn-Miller MO, Feldner MT, Leen-Feldner E, McLeish AC, Gregor K. Anxiety sensitivity: Concurrent associations with negative affect smoking motives and abstinence self-confidence among young adult smokers. Addict Behav 2006; 31:429-39. [PMID: 15964151 DOI: 10.1016/j.addbeh.2005.05.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 05/17/2005] [Indexed: 11/24/2022]
Abstract
The present study evaluated the association between the lower-order facets of Anxiety Sensitivity construct (Physical, Mental Incapacitation and Social Concerns) and theoretically relevant cognitive-based smoking processes. Participants were 151 young adult daily smokers (63 females); mean number of cigarettes/day = 12.3 [S.D. = 5.6]). Both AS Physical and Mental Incapacitation Concerns were significantly associated with greater negative affect reduction smoking motives and lower levels of self-confidence in remaining abstinent from smoking when emotionally distressed. The observed effects were over and above the variance accounted for by nicotine dependence, smoking rate, and gender. Results are discussed in relation to better understanding cognitive-based smoking processes among individuals at heightened risk for panic psychopathology.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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43
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Zvolensky MJ, Feldner MT, Leen-Feldner EW, McLeish AC. Smoking and panic attacks, panic disorder, and agoraphobia: a review of the empirical literature. Clin Psychol Rev 2005; 25:761-89. [PMID: 15975699 DOI: 10.1016/j.cpr.2005.05.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The empirical literature regarding panic-spectrum problems (i.e., panic attacks, panic disorder, and agoraphobia) and cigarette smoking is reviewed. In the first section of the paper, empirical studies that document the prevalence of smoking and panic-related problems are presented and discussed. In the second section of the paper, studies pertaining to the role cigarette smoking may play in the onset and maintenance of panic-related problems are critically reviewed. In the third section of the paper, studies related to the association between panic vulnerability factors and the nature of smoking behavior are presented. In the fourth section of the paper, specific areas not otherwise covered in the review are presented to stimulate further development in these areas (e.g., specialized treatment development).
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, The University of Vermont, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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44
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Goodwin RD, Lewinsohn PM, Seeley JR. Cigarette smoking and panic attacks among young adults in the community: the role of parental smoking and anxiety disorders. Biol Psychiatry 2005; 58:686-93. [PMID: 16018987 DOI: 10.1016/j.biopsych.2005.04.042] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 04/18/2005] [Accepted: 04/20/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND The goal of the current study is to examine the association between cigarette smoking and panic attacks and panic disorder among youth and to investigate parental anxiety disorders and parental cigarette smoking in these links. METHODS Data were drawn from the Oregon Adolescent Depression Project (OADP) (n = 1709). Cigarette smoking and panic attacks and panic disorder were assessed at three time points from adolescence to young adulthood. RESULTS Daily cigarette smoking at Time 1 was associated with a significantly increased risk of panic attacks (odds ratio [OR] = 2.6 [1.3, 5.3]) and panic disorder (OR = 4.2 [2.0, 8.9]) at Time 3. After adjusting for parental anxiety disorder and parental smoking, the association between cigarette smoking and panic attack was no longer statistically significant (OR = 2.0 [.9, 4.5]), though the association between cigarette smoking and panic disorder remained (OR = 3.7 [1.6, 8.9]). The association between smoking and panic was not evident between smoking and other anxiety disorders. CONCLUSIONS These findings replicate previous results showing cigarette smoking in adolescence is associated with an increased risk of panic attacks and panic disorder in early adulthood and provide initial evidence that parental anxiety and parental smoking may play a role.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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45
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Zvolensky MJ, Schmidt NB, Antony MM, McCabe RE, Forsyth JP, Feldner MT, Leen-Feldner E, Karekla M, Kahler CW. Evaluating the role of panic disorder in emotional sensitivity processes involved with smoking. J Anxiety Disord 2005; 19:673-86. [PMID: 15927780 DOI: 10.1016/j.janxdis.2004.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Revised: 06/22/2004] [Accepted: 07/22/2004] [Indexed: 11/17/2022]
Abstract
The present study investigated the relationship between panic disorder and emotional sensitivity processes related to smoking. Participants were 170 young adult (mean age = 25.2 [8.4]) regular smokers (mean cigarettes per day = 15.6 [2.4]) with (n = 69) and without (n = 101) a primary diagnosis of panic disorder. Consistent with prediction, smokers with panic disorder showed greater motivation to smoke in order to reduce negative affect (but not other reasons for smoking), reported anxiety symptoms but not non-anxiety symptoms as problematic obstacles to quitting during past (lifetime) quit attempts, and reported lower levels of confidence in remaining abstinent when emotionally distressed. Results are discussed in relation to panic-relevant emotional sensitivity processes involved with smoking.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, John Dewey Hall, Burlington, VT 05405-0134, USA.
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46
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Zvolensky MJ, Baker K, Yartz AR, Gregor K, Leen-Feldner EW, Feldner MT. Mental health professionals with a specialty in anxiety disorders: Knowledge, training, and perceived competence in smoking cessation practices. COGNITIVE AND BEHAVIORAL PRACTICE 2005. [DOI: 10.1016/s1077-7229(05)80053-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Zvolensky MJ, Leen-Feldner EW, Feldner MT, Bonn-Miller MO, Lejuez CW, Kahler CW, Stuart G. Emotional responding to biological challenge as a function of panic disorder and smoking. J Anxiety Disord 2004; 18:19-32. [PMID: 14725866 DOI: 10.1016/j.janxdis.2003.07.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present investigation evaluated anxious and fearful responding to bodily sensations as a function of panic disorder (PD) and smoking status. Participants completed a voluntary hyperventilation procedure that elicits panic-relevant bodily sensations. Psychophysiological data were collected throughout the study procedures. Assessments of anxiety and bodily distress were conducted pre-challenge baseline, post-hyperventilation, and during a recovery period following the challenge. Results indicated that smokers with PD reported greater levels of anxiety and bodily distress than smokers without PD and than nonsmokers with PD at the post-challenge assessment and recovery period. No differences in autonomic responding were evident during the challenge or in the recovery phase. In terms of rate of recovery, the linear decrease in anxiety, but not bodily distress, was significantly more steep for nonsmokers with PD than for smokers with PD. These findings are discussed in relation to better understanding the potential role that smoking may play in terms of anxious and fearful responding to bodily sensations.
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Affiliation(s)
- Michael J Zvolensky
- The University of Vermont, Department of Psychology, 2 Colchester Avenue, John Dewey Hall, Burlington, VT 05405-0134, USA.
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48
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Abstract
The purpose of this study was to test the theory put forth by Zvolensky et al. [Clin. Psychol. Sci. Pract. 10 (2003) 29] that smoking is specifically associated with panic disorder (PD) and not more generally associated with other anxiety disorders. Smoking behaviors were examined across three anxiety disorders: panic disorder with or without agoraphobia, social phobia (SP), and obsessive-compulsive disorder (OCD). A greater proportion of the PD group (40.4%) reported smoking compared to the SP (20%) and OCD (22.4%) groups. Those in the PD group were also more likely than those in the other groups to report being a heavy smoker (greater than 10 cigarettes daily). No significant interaction between diagnosis and smoking status was found for any of the symptom measures. However, participants who smoked had significantly higher scores than nonsmokers on a number of scales, including measures of depression, general anxiety, and distress. Differences in anxiety sensitivity between smokers and nonsmokers approached significance. These findings provide support for Zvolensky et al.'s [Clin. Psychol. Sci. Pract. 10 (2003) 29] theoretical conceptualization and suggest a specific link between smoking and panic disorder. Further investigation is warranted to determine the causal direction of this association.
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Affiliation(s)
- Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Anxiety Treatment and Research Centre, St Joseph's Healthcare, 50 Charlton Ave. East, Ont, Hamilton, Canada L8N 4A6.
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49
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Zvolensky MJ, Lejuez C, Kahler CW, Brown RA. Integrating an interoceptive exposure-based smoking cessation program into the cognitive-behavioral treatment of panic disorder: Theoretical relevance and case demonstration. COGNITIVE AND BEHAVIORAL PRACTICE 2003. [DOI: 10.1016/s1077-7229(03)80052-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Zvolensky MJ, Eifert GH, Feldner MT, Leen-Feldner E. Heart-focused anxiety and chest pain in postangiography medical patients. J Behav Med 2003; 26:197-209. [PMID: 12845934 DOI: 10.1023/a:1023456419736] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The present cross-sectional study sought to examine the extent to which heart-focused anxiety is associated with the co-occurrence of coronary artery disease (CAD) and a history of regular smoking in a sample of 148 postangiography patients from a cardiology unit. Individuals with CAD who regularly smoked demonstrated significantly greater heart-focused attention, but no greater degree of avoidance and fear of heart-focused sensations, than did nonsmoking persons with CAD and smokers without CAD. We also found evidence that heart-focused attention and fear incrementally predicted (above and beyond demographic variables and body mass index) intensity of average chest pain. Overall, this study provides some of the first empirical evidence that the occurrence of regular smoking and CAD is associated with specific dimensions of health anxiety. We discuss these findings in relation to models of panic pathology and anxious responding to bodily sensations.
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Affiliation(s)
- Michael J Zvolensky
- Anxiety and Health Research Laboratory and Clinic, Department of Psychology, University of Vermont, John Dewey Hall, Burlington, Vermont 05405-0134, USA.
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