1
|
Rodríguez-Espinosa S, Coloma-Carmona A, Pérez-Carbonell A, Román-Quiles JF, Carballo JL. Clinical and psychological factors associated with interdose opioid withdrawal in chronic pain population. J Subst Abuse Treat 2021; 129:108386. [PMID: 34080554 DOI: 10.1016/j.jsat.2021.108386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). METHODS This cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference. RESULTS Forty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05). CONCLUSION Psychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions.
Collapse
Affiliation(s)
- Sara Rodríguez-Espinosa
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain
| | - Ainhoa Coloma-Carmona
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain
| | - Ana Pérez-Carbonell
- University General Hospital of Elche, Camino de la Almazara, 11, 03203 Elche, Spain
| | - José F Román-Quiles
- University General Hospital of Elche, Camino de la Almazara, 11, 03203 Elche, Spain
| | - José L Carballo
- Center for Applied Psychology, Miguel Hernández University, Avenida Universidad, s/n, 03202 Elche, Spain.
| |
Collapse
|
2
|
BinShabaib M, ALHarthi SS, Akram Z, Khan J, Rahman I, Romanos GE, Javed F. Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers. Arch Oral Biol 2019; 102:212-217. [DOI: 10.1016/j.archoralbio.2019.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 02/09/2023]
|
3
|
Svicher A, Zvolensky MJ, Cosci F. Study of the relationship between anxiety sensitivity, smoking abstinence expectancies, nicotine withdrawal, and cigarette dependence among daily smokers. J Addict Dis 2018; 37:55-63. [DOI: 10.1080/10550887.2018.1542239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Svicher
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Health Institute, University of Houston, Houston, Texas, USA
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
4
|
Rogers AH, Bakhshaie J, Garey L, Piasecki TM, Gallagher MW, Schmidt NB, Zvolensky MJ. Individual differences in emotion dysregulation and trajectory of withdrawal symptoms during a quit attempt among treatment-seeking smokers. Behav Res Ther 2018; 115:4-11. [PMID: 30384961 DOI: 10.1016/j.brat.2018.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Cigarette smoking remains the leading preventable cause of death in the United States, and withdrawal symptoms are central to the maintenance of tobacco use. Previous research suggests that individual differences in the propensity to experience negative affect may be related to more severe withdrawal symptoms. However, little research has examined how individual differences in the ability to regulate affect (emotion dysregulation) may impact withdrawal symptoms over time. METHOD Therefore, the current study examined the effects of emotion dysregulation on change in tobacco withdrawal symptoms over 12 weeks following a cigarette quit attempt among 188 (Mage = 38.52, SD = 14.00, 46.8% male) treatment seeking smokers. RESULTS Results from the study indicated greater emotion dysregulation was associated with greater quit day withdrawal symptoms as well as with as slower decline in withdrawal symptoms over the 12-week period (B = -0.001, SE = 0.001, p = .046). CONCLUSION The current study offers novel evidence into the role of emotion dysregulation in relation to withdrawal symptoms during a quit attempt. Assessing and reducing heightened emotion dysregulation prior to a quit attempt may be a potentially important therapeutic tactic for helping smokers achieve greater success in managing tobacco withdrawal. PUBLIC HEALTH SIGNIFICANCE STATEMENT This study emphasizes the ways in which emotional dysregulation may affect tobacco withdrawal symptoms. This study can be utilized to further target smoking cessation programs for those attempting to quit smoking.
Collapse
Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Thomas M Piasecki
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
5
|
Zvolensky MJ, Garey L, Allan NP, Farris SG, Raines AM, Smits JAJ, Kauffman BY, Manning K, Schmidt NB. Effects of anxiety sensitivity reduction on smoking abstinence: An analysis from a panic prevention program. J Consult Clin Psychol 2018; 86:474-485. [PMID: 29683703 PMCID: PMC6022361 DOI: 10.1037/ccp0000288] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Scientific evidence implicates anxiety sensitivity (AS) as a risk factor for poor smoking cessation outcomes. Integrated smoking cessation programs that target AS may lead to improved smoking cessation outcomes, potentially through AS reduction. Yet, little work has evaluated the efficacy of integrated smoking cessation treatment on smoking abstinence. The present study prospectively examined treatment effects of a novel AS reduction-smoking cessation intervention relative to a standard smoking cessation intervention on smoking abstinence. METHOD Participants (N = 529; 45.9% male; Mage = 38.23, SD = 13.56) included treatment-seeking smokers who received either a 4-session integrated anxiety-reduction and smoking cessation intervention (Smoking Treatment and Anxiety Management Program; [STAMP]) or a 4-session standard smoking cessation program (SCP). The primary aims focused on examining the effects of STAMP on (a) AS reduction during treatment, (b) early and late smoking point prevalence abstinence, and (c) the mechanistic function of AS reduction on treatment effects across early and late smoking abstinence. RESULTS Results indicated a significantly greater decline in AS in STAMP relative to SCP (B = -.72, p < .001). Treatment condition did not significantly directly predict early or late abstinence. However, the effect of STAMP on early abstinence was significantly mediated by reductions in AS (indirect = .16, 95% CI [.02, .40]). CONCLUSIONS Findings provide evidence for the efficacy of a novel, integrated anxiety and smoking cessation treatment to reduce AS. Moreover, the meditation pathway from STAMP to early abstinence through reductions in AS suggest that AS is a clinically important mechanism of change for smoking cessation treatment and research. (PsycINFO Database Record
Collapse
Affiliation(s)
| | | | | | - Samantha G Farris
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | | | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | | | | | | |
Collapse
|
6
|
Offer and Use of Smoking-Cessation Support by Depression/Anxiety Status: A Cross-Sectional Survey. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Higher levels of anxiety and depression have been found to be associated with greater difficulty in stopping smoking. This raises the question as to whether mood disturbance may be associated with exposure to, and use of, quitting support.Aims: This study examined whether General Practitioner (GP) advice and/or offer of support, or stop-smoking service use differed between smokers reporting or not reporting depression/anxiety.Methods: Data came from the Smoking Toolkit Study. Participants were 1,162 English adults who reported currently smoking or having stopped within the past 12 months, aged 40+ years, surveyed between April and September 2012. Anxiety/depression was assessed by the mood disturbance item of the EuroQol five dimensions questionnaire (EQ-5D). This was compared to recall of GP quit advice and/or support, and stop-smoking aid use adjusting for age, gender, and social grade.Results/Findings: Smokers reporting depression/anxiety were more likely to recall being offered advice and support to stop smoking by their GP (OR = 1.50, 95% C.I. = 1.05–2.13). However, there were no significant differences in use of stop-smoking aids during the past year.Conclusions: Smokers reporting depression/anxiety are more likely to be offered stop-smoking support by their GPs, but this does not appear to translate into stop-smoking aid use, despite high motivation to quit. Given higher nicotine dependence in this group, mental health specific support may need to be offered, and more needs to be done to make this offer of aid attractive.
Collapse
|
7
|
Bakhshaie J, Zvolensky MJ, Langdon KJ, Leventhal AM, Schmidt NB. Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: an examination among successful quitters. Cogn Behav Ther 2017; 47:301-314. [DOI: 10.1080/16506073.2017.1395907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center MD Anderson Cancer Center, Houston, TX, USA
| | - Kirsten J. Langdon
- National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Adam M. Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, CA, USA
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
8
|
Abrams K, Krimmel S, Johnson S, Cieslowski K, Strnad H, Melum A, Kryder C. Nicotine deprivation attenuates panic reactivity in smokers: Findings from a placebo-controlled nicotine patch study. Depress Anxiety 2017; 34:996-1005. [PMID: 28489321 DOI: 10.1002/da.22652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective studies consistently find that smoking is a risk factor for the development of panic disorder (PD). A possible explanation is that nicotine deprivation promotes heightened sensitivity to bodily sensations and/or arterial carbon dioxide (CO2 ). Abrams et al. (2011) previously found that, in response to a CO2 rebreathing challenge, smokers experiencing more (vs. less) intense nicotine withdrawal had more severe panic symptoms and a stronger urge to escape. However, participants were aware of the last time they smoked, leaving unclear the extent to which fear reactivity was influenced by the pharmacologic effects of nicotine deprivation versus beliefs regarding when nicotine was most recently used. The present study aimed to ascertain whether nicotine deprivation, independent of beliefs regarding recent nicotine use, promotes fear reactivity among smokers. METHODS Moderate to heavy smokers without PD (N = 25) participated in a placebo-controlled, double-blind study consisting of two sessions spaced 1 week apart. Participants abstained from nicotine for 2 hr prior to sessions. During one session participants were given a 21 mg nicotine replacement patch and, during the other, a placebo patch, with the order counterbalanced. For both sessions, after a 3-hr absorption period, participants underwent a 10-min CO2 rebreathing challenge. RESULTS Wearing a nicotine (vs. placebo) patch increased self-reported panic reactivity among participants, but did not significantly affect physiological and behavioral measures of reactivity. CONCLUSIONS In smokers without a history of PD, nicotine deprivation attenuates subjective panic reactivity. Possible explanations for the contrast between theory and laboratory findings as well as clinical implications are discussed.
Collapse
Affiliation(s)
- Kenneth Abrams
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Sam Krimmel
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Stacey Johnson
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Kate Cieslowski
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Helen Strnad
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Arielle Melum
- Department of Psychology, Carleton College, Northfield, MN, USA
| | - Caroline Kryder
- Department of Psychology, Carleton College, Northfield, MN, USA
| |
Collapse
|
9
|
Farris SG, Brown LA, Goodwin RD, Zvolensky MJ. Panic attack history and smoking topography. Drug Alcohol Depend 2017; 171:84-90. [PMID: 28033542 PMCID: PMC5263108 DOI: 10.1016/j.drugalcdep.2016.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about panic attacks and puffing topography, a behavioral index of the value of smoking reinforcement. This study examined smoking style during the course of smoking of a single cigarette among adult daily smokers with and without a history of panic attacks. METHOD Participants (n=124, Mage=43.9, SD=9.7; 44.4% female) were non-treatment seeking daily smokers. Lifetime panic attack history was assessed via diagnostic assessment; 28.2% (n=35) of the sample had a panic attack history. Participants smoked one cigarette during an ad libitum smoking trial. Puff volume, duration, and inter-puff interval were measured using the Clinical Research Support System (CReSS) pocket device. RESULTS Regression analyses revealed that panic attack status was not associated with significant differences in average puff volume, duration, or inter-puff interval. Multi-level modeling was used to examine puffing trajectories. Puff-level data revealed that there was a significant quadratic time x panic effect for puff volume and duration. Those with a panic attack history demonstrated relatively sustained levels of both puff volume and duration over time, whereas those without a history of panic attacks demonstrated an increase followed by a decrease in volume and duration over time. These effects were not accounted for by the presence of general psychopathology. DISCUSSION Smokers with a panic attack history demonstrate more persistent efforts to self-regulate the delivery of nicotine, and thus may be at risk for continued smoking and dependence. Tailored treatment may be needed to address unique vulnerabilities among this group.
Collapse
Affiliation(s)
- Samantha G. Farris
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906 USA,The Miriam Hospital, Centers for Behavioral and Preventative Medicine, 164 Summit St., Providence, RI 02906 USA,Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 USA,Corresponding author: Samantha G. Farris, Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior; 345 Blackstone Blvd, Butler Hospital, Providence, RI 02906. ; Phone: 401-455-6219; Fax: 401-455-6685
| | - Lily A. Brown
- University of Pennsylvania Perlman School of Medicine, Department of Psychiatry, 3535 Market St., Philadelphia, PA 19103
| | - Renee D. Goodwin
- Queens College, Department of Psychology and The Graduate Center, City University of New York (CUNY), 6530 Kissena Blvd., Queens, NY 11367 USA,Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 W 168th St, New York, NY 10032 USA
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Houston, TX 77204 USA,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler St., Houston, TX 77230 USA
| |
Collapse
|
10
|
Piper ME, Vasilenko SA, Cook JW, Lanza ST. What a difference a day makes: differences in initial abstinence response during a smoking cessation attempt. Addiction 2017; 112:330-339. [PMID: 27633341 PMCID: PMC5233552 DOI: 10.1111/add.13613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/04/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
AIMS To (1) identify distinct classes of smokers based on quit day withdrawal symptoms and (2) explore the relations between withdrawal classes and demographics, tobacco dependence, treatment and smoking outcomes. DESIGN Secondary data analysis of participants (n = 1504) in a randomized double-blind placebo-controlled multi-site smoking cessation trial who provided ecological momentary assessments of withdrawal symptoms on their quit day. Participants received smoking cessation counseling and were randomized to receive placebo or one of five active pharmacotherapies. SETTING Research offices in Madison and Milwaukee, Wisconsin, USA. PARTICIPANTS Adult smokers (n = 1236; 58% female, 86% white), recruited from the community via advertisements, who abstained on their quit day. MEASUREMENTS Demographics and tobacco dependence were assessed at baseline and participants carried palmtop computers to record withdrawal symptoms (craving, negative affect, difficulty concentrating, hunger and anhedonia) on their quit day. Point-prevalence abstinence and latency to relapse were assessed at 8 weeks and 6 months post-quit. FINDINGS Latent class analysis identified four withdrawal classes [Akaike information criterion (AIC) = 70.09]: Moderate withdrawal (64% of sample), high craving-anhedonia (8% of sample), affective withdrawal (13% of sample) and hunger (15% of sample). The high craving-anhedonia class reported significantly higher dependence (P < 0.01), were less likely to have received combination nicotine replacement, reported lower week 8 abstinence rates and relapsed sooner than those in the moderate withdrawal class (P < 0.05). The affective withdrawal class reported higher levels of baseline negative affect and life-time psychopathology (P < 0.05) and relapsed more quickly than the moderate withdrawal class (P < 0.01). CONCLUSIONS While the majority of smokers report typical levels of withdrawal symptoms on their quit day, more than one-third report extreme craving or extreme negative affective or extreme hunger responses to initial abstinence. These distinct quit-day withdrawal symptom patterns are related to baseline characteristics, treatment and cessation success.
Collapse
Affiliation(s)
- Megan E. Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison,Department of Medicine, University of Wisconsin, Madison
| | | | - Jessica W. Cook
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison,Department of Medicine, University of Wisconsin, Madison,William S. Middleton Memorial Veterans Hospital
| | - Stephanie T. Lanza
- The Methodology Center, The Pennsylvania State University,Department of Biobehavioral Health and Human Development, The Pennsylvania State University
| |
Collapse
|
11
|
Anxiety sensitivity in relation to quit day dropout among adult daily smokers recruited to participate in a self-guided cessation attempt. Addict Behav 2016; 58:12-5. [PMID: 26896560 DOI: 10.1016/j.addbeh.2016.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 11/20/2022]
Abstract
Anxiety sensitivity (AS; fear of anxiety and internal sensations) has been implicated in a variety of aspects of smoking, including difficulties achieving and maintaining abstinence during tobacco cessation. However, research has yet to evaluate whether AS impacts premature termination of initiating a quit attempt. Therefore, the aim of the present investigation was to explore the extent to which AS was associated with tobacco cessation dropout, as indexed by attendance on the scheduled quit day visit. Participants included 84 adult daily cigarette smokers (61.7% male; Mage=34.6years, SD=13.9), who were recruited to participate in a self-guided quit attempt (an attempt to quit smoking without professional or pharmacological aid). Results indicated that after controlling for the effects of participant sex, race, current (past month) psychological disorder, cigarettes smoked per day, number of years as a regular smoker, and pre-quit levels of motivation to quit, AS significantly predicted increased odds of study dropout prior to attending the scheduled quit day. These findings suggest that AS may be a mechanism involved with challenges in the initiation of quitting.
Collapse
|
12
|
Farris SG, Zvolensky MJ. An experimental test of the effect of acute anxious arousal and anxiety sensitivity on negative reinforcement smoking. J Psychopharmacol 2016; 30:641-53. [PMID: 27097735 DOI: 10.1177/0269881116642880] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Although anxiety sensitivity has been reliably associated with smoking-anxiety comorbidity, there has not been a test of whether this construct moderates the effect of acute anxious arousal on actual smoking behavior. The present study utilized an experimental design to test the moderating role of anxiety sensitivity on laboratory-induced anxious arousal in terms of smoking urges and topography (puff style). METHOD Participants were adult daily smokers (n=90; Mage=43.6 SD =9.7); average 15.8 cigarettes per day). A between-subjects design was used; participants were randomly assigned to complete a biological challenge procedure consisting of either a single vital capacity inhalation of 35% carbon dioxide (CO2)-enriched air mixture or compressed room air. Smoking urges and smoking topography (puff behavior) were assessed before and after the challenge. RESULTS Results revealed a significant interaction between anxiety sensitivity and experimental condition (b=-9.96, p=0.014), such that high anxiety sensitive smokers exposed to 35% CO2-enriched air reported significantly lower levels of smoking urges, relative to low anxiety sensitive smokers; the conditional effect of anxiety sensitivity was not observed for the room air condition. There were no significant interaction effects of experimental manipulation by anxiety sensitivity for any of the smoking topography outcomes. DISCUSSION The present results suggest for smokers with higher levels of anxiety sensitivity, the acute experience of anxious arousal is related to decreased subjective smoking urges. These data invite future research to explore the reasons for dampened smoking urges, including cardiorespiratory symptom severity.
Collapse
Affiliation(s)
- Samantha G Farris
- Department of Psychology, University of Houston, Houston, TX, USA Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael J Zvolensky
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
13
|
Guillot CR, Leventhal AM, Raines AM, Zvolensky MJ, Schmidt NB. Anxiety sensitivity facets in relation to tobacco use, abstinence-related problems, and cognitions in treatment-seeking smokers. Addict Behav 2016; 56:30-5. [PMID: 26802790 DOI: 10.1016/j.addbeh.2016.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 01/15/2023]
Abstract
Anxiety sensitivity (AS)--fear of anxiety-related experiences--has been implicated in smoking motivation and maintenance. In a cross-sectional design, we examined AS facets (physical, cognitive, and social concerns) in relation to tobacco use, abstinence-related problems, and cognitions in 473 treatment-seeking smokers. After controlling for sex, race, age, educational attainment, hypertension status, and neuroticism, linear regression models indicated that AS physical and cognitive concerns were associated with tobacco dependence severity (β=.13-.14, p<.01), particularly the severity of persistent smoking regardless of context or time of day (β=.14-.17, p<.01). All three AS facets were related to more severe problems during past quit attempts (β=.23-.27, p<.001). AS cognitive and social concerns were related to negative affect reduction smoking motives (β=.14, p<.01), but only the social concerns aspect of AS was related to pleasurable relaxation smoking motives and positive and negative reinforcement-related smoking outcome expectancies (β=.14-.17, p<.01). These data suggest that AS physical and cognitive concerns are associated with negative reinforcement-related smoking variables (e.g., abstinence-related problems), whereas the social concerns aspect of AS is associated with positive and negative reinforcement-related smoking variables. Together with past findings, current findings can usefully guide AS-oriented smoking cessation treatment development and refinement.
Collapse
|
14
|
Abstract
The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic stress disorder. It also summarizes experimental studies aimed at identifying biopsychosocial mechanisms that underlie the high smoking rates seen in people with these disorders. Research indicates that smokers with chronic mental illness can quit with standard cessation approaches with minimal effects on psychiatric symptoms. Although some studies have noted high relapse rates, longer maintenance on pharmacotherapy reduces rates of relapse without untoward effects on psychiatric symptoms. Similar biopsychosocial mechanisms are thought to be involved in the initiation and persistence of smoking in patients with different disorders. An appreciation of these common factors may aid the development of novel tobacco treatments for people with chronic mental illness. Novel nicotine and tobacco products such as electronic cigarettes and very low nicotine content cigarettes may also be used to improve smoking cessation rates in people with chronic mental illness.
Collapse
Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| |
Collapse
|
15
|
Gaalema DE, Miller ME, Tidey JW. Predicted Impact of Nicotine Reduction on Smokers with Affective Disorders. TOB REGUL SCI 2015; 1:154-165. [PMID: 26236765 PMCID: PMC4517852 DOI: 10.18001/trs.1.2.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In 2009 the FDA acquired the authority to reduce the nicotine content in cigarettes if appropriate for public health, prompting research to evaluate the implications of this policy scientifically. Studies in non-psychiatric populations show that reducing the nicotine content of cigarettes to non-addictive levels reduces smoking rates and nicotine dependence. However, few studies have examined this hypothesis in vulnerable populations. METHODS In this narrative review we examined the extant literature on the effects of nicotine reduction or cessation on symptoms of withdrawal, as well as psychiatric symptoms, among those with affective disorders. RESULTS Following initial withdrawal from nicotine, smokers with affective disorders experience more severe mood disruption than smokers without these disorders. Use of very low nicotine content (VLNC) cigarettes during abstinence may help mitigate the mood-disrupting effects of initial abstinence. Once the initial effects of nicotine withdrawal on mood have passed, longer-term abstinence is associated with psychiatric improvement rather than worsening. CONCLUSIONS These findings suggest that if a national nicotine reduction policy were to be implemented, smokers with affective disorders would need additional support to overcome initial withdrawal but that long-term outcomes would likely be positive.
Collapse
Affiliation(s)
- Diann E Gaalema
- Vermont Center of Behavior and Health, University of Vermont, Burlington VT
| | - Mollie E Miller
- Center for Alcohol and Addictions Studies, Brown University, Providence RI
| | - Jennifer W Tidey
- Center for Alcohol and Addictions Studies, Brown University, Providence RI
| |
Collapse
|
16
|
Brandt CP, Bakhshaie J, Garey L, Schmidt NB, Leventhal AM, Zvolensky MJ. The Moderating Role of Smoking Amount Per Day on the Relations Between Anxiety Sensitivity, Smoking Dependence, and Cognitive-Affective Aspects of Smoking Among Treatment Seeking Smokers. Addict Behav Rep 2015; 1:26-33. [PMID: 26114159 PMCID: PMC4476409 DOI: 10.1016/j.abrep.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/30/2022] Open
Abstract
The current study examined the moderating effects of smoking amount per day on the relation between anxiety sensitivity and nicotine dependence, cigarette smoking outcome expectancies, and reasons for quitting smoking among 465 adult, treatment-seeking smokers (48% female; Mage = 36.6, SD = 13.5). Smoking amount per day moderated the relation between anxiety sensitivity and nicotine dependence, smoking expectancies for negative consequences and appetite control as well as intrinsic reasons for quitting. However, no moderating effect was evident for negative reinforcement expectancies. The form of the significant interactions indicated across dependent variables lower levels of smoking amount per day suppressed the relation between anxiety sensitivity and smoking related dependent variable, such that the positive relation of anxiety sensitivity to smoking dependence and cognitive-affective aspects of smoking is weaker in heavier smokers and more robust in lighter smokers.
Collapse
Affiliation(s)
- Charles P. Brandt
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, United States
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, United States
| | - Lorra Garey
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, United States
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, 1107 West Call St, Tallahassee, FL 32306, United States
| | - Adam M. Leventhal
- Department of Psychology and Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 9033, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX 77204, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
17
|
Asnaani A, Farris SG, Carpenter JK, Zandberg LJ, Foa EB. The Relationship between Anxiety Sensitivity and Posttraumatic Stress Disorder: What is the Impact of Nicotine Withdrawal? COGNITIVE THERAPY AND RESEARCH 2015; 39:697-708. [PMID: 26560135 DOI: 10.1007/s10608-015-9685-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anxiety sensitivity (AS) is related to the development and maintenance of posttraumatic stress disorder (PTSD) among cigarette smokers, and is also implicated in the amplification of acute nicotine withdrawal symptoms. The present study sought to examine the role of nicotine withdrawal in moderating the association between AS and PTSD symptom severity among a sample of treatment-seeking smokers with PTSD. METHOD Participants (n = 117) were enrolled in a randomized controlled trial for the treatment of PTSD and nicotine dependence. Cross-sectional data were randomly sampled from three different study time points. A series of multiple regression models were tested. RESULTS Results revealed main effects of both AS and withdrawal severity on PTSD severity after controlling for gender, assessment time-point, negative affectivity, and biochemically verified smoking (expired carbon monoxide). The interaction of AS and withdrawal was also significant, and appeared to be specific to PTSD avoidance and hyperarousal symptoms. However, contrary to expectations, the association between AS and PTSD symptoms was only significant at relatively lower levels of nicotine withdrawal. CONCLUSIONS These findings highlight the complex interplay between AS, nicotine withdrawal, and their synergistic effect in terms of the exacerbation of PTSD symptomology.
Collapse
Affiliation(s)
- Anu Asnaani
- University of Pennsylvania, Philadelphia, PA
| | | | - Joseph K Carpenter
- University of Pennsylvania, Philadelphia, PA ; Boston University, Boston, MA
| | | | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
18
|
Piper ME. Withdrawal: Expanding a Key Addiction Construct. Nicotine Tob Res 2015; 17:1405-15. [PMID: 25744958 DOI: 10.1093/ntr/ntv048] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets.
Collapse
Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
19
|
Foster DW, Langdon KJ, Schmidt NB, Zvolensky M. Smoking processes, panic, and depressive symptoms among treatment-seeking smokers. Subst Use Misuse 2015; 50:394-402. [PMID: 25496170 PMCID: PMC4418538 DOI: 10.3109/10826084.2014.984849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The present study evaluated the relative contribution of panic and depressive symptoms in relation to past cessation difficulties and smoking motives among treatment-seeking daily smokers. METHODS The sample included 392 treatment-seeking daily smokers (47.07% female; Mage = 35.48; SD = 13.56), who reported smoking an average of 10 or more cigarettes daily for at least one year. RESULTS Findings indicated that panic and depressive symptoms were significantly associated with quit problems as well as addictive and negative affect motives for smoking. However, depressive symptoms were not associated with habitual smoking motives. CONCLUSIONS Differential patterns of associations with smoking-based processes imply that although panic and depression are related, there are important distinctions. Such data highlight the need for additional research to examine the putative role of panic and depressive symptoms in relation to smoking behaviors to further elucidate the mechanisms through which panic, depression, and smoking impact one another.
Collapse
Affiliation(s)
- Dawn W Foster
- 1Department of Psychiatry, Yale University School of Medicine , New Haven, Connecticut , USA
| | | | | | | |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
| | | |
Collapse
|
21
|
Farris SG, Langdon KJ, DiBello AM, Zvolensky MJ. Why Do Anxiety Sensitive Smokers Perceive Quitting as Difficult? The Role of Expecting “Interoceptive Threat” During Acute Abstinence. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9644-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Zvolensky MJ, Farris SG, Leventhal A, Schmidt NB. Anxiety sensitivity mediates relations between emotional disorders and smoking. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:912-920. [PMID: 25222178 PMCID: PMC4244904 DOI: 10.1037/a0037450] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has documented consistent and robust relations between emotional disorders (i.e., depressive and anxiety disorders) and smoking. Yet, it is presently unclear whether anxiety sensitivity--the fear of aversive internal anxiety states--accounts for the relations between emotional disorders and various smoking processes, including nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms during past cessation attempts. Participants (N = 465) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco-cessation study. Baseline (pretreatment) data were utilized. Emotional disorders were assessed via clinical diagnostic interview; self-report measures were used to assess anxiety sensitivity and 3 criterion variables: nicotine dependence, barriers to smoking cessation, and severity of problematic symptoms while quitting in past attempts. Emotional disorders were predictive of higher levels of nicotine dependence, greater perceived barriers to cessation, and greater severity of problematic symptoms while attempting to quit in the past; each of these relations were accounted for by the indirect effect of anxiety sensitivity. The present findings suggest that anxiety sensitivity may be an important transdiagnostic construct in explicating the nature of the relations between emotional disorders and various smoking processes.
Collapse
Affiliation(s)
- Michael J. Zvolensky
- University of Houston, Department of Psychology
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science
| | | | - Adam Leventhal
- Department of Psychology, University of Southern California
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | | |
Collapse
|
24
|
An Anxiety Sensitivity Reduction Smoking-Cessation Program for Spanish-Speaking Smokers (Argentina). COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.10.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
25
|
Farris SG, Zvolensky MJ, Blalock JA, Schmidt NB. Negative affect and smoking motives sequentially mediate the effect of panic attacks on tobacco-relevant processes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:230-9. [PMID: 24720260 DOI: 10.3109/00952990.2014.891038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Empirical work has documented a robust and consistent relation between panic attacks and smoking behavior. Theoretical models posit smokers with panic attacks may rely on smoking to help them manage chronically elevated negative affect due to uncomfortable bodily states, which may explain higher levels of nicotine dependence and quit problems. METHODS The current study examined the effects of panic attack history on nicotine dependence, perceived barriers for quitting, smoking inflexibility when emotionally distressed, and expired carbon monoxide among 461 treatment-seeking smokers. A multiple mediator path model was evaluated to examine the indirect effects of negative affect and negative affect reduction motives as mediators of the panic attack-smoking relations. RESULTS Panic attack history was indirectly related to greater levels of nicotine dependence (b = 0.039, CI95% = 0.008, 0.097), perceived barriers to smoking cessation (b = 0.195, CI95% = 0.043, 0.479), smoking inflexibility/avoidance when emotionally distressed (b = 0.188, CI95% = 0.041, 0.445), and higher levels of expired carbon monoxide (b = 0.071, CI95% = 0.010, 0.230) through the sequential effects of negative affect and negative affect smoking motives. CONCLUSIONS The present results provide empirical support for the sequential mediating role of negative affect and smoking motives for negative affect reduction in the relation between panic attacks and a variety of smoking variables in treatment-seeking smokers. These mediating variables are likely important processes to address in smoking cessation treatment, especially in panic-vulnerable smokers.
Collapse
|
26
|
Cosci F, Bertoli G, Abrams K. Effects of nicotine withdrawal on panic-like response to breath holding: a placebo-controlled, double-blind, crossover patch study. Depress Anxiety 2013; 30:1217-21. [PMID: 23554155 DOI: 10.1002/da.22113] [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] [Received: 02/20/2013] [Revised: 03/11/2013] [Accepted: 03/12/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cigarette smoking may increase the likelihood of developing panic disorder. Periods of nicotine withdrawal, in particular, may promote panic in individuals high in anxiety sensitivity. We examined the importance of nicotine withdrawal in the occurrence of smoking and panic. METHODS We utilized a placebo-controlled, double-blind, randomized, crossover design. Fifty smokers underwent a breath-holding (BH) challenge after the transdermal administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline as well as directly before and after the challenges. RESULTS Nicotine abstinence induced a decrease in heart rate and systolic blood pressure (BP) before the BH procedure (heart rate: 78.80 ± 11.43 under nicotine, 70.88 ± 10.83 under placebo; systolic BP: 124.90 ± 11.34 under nicotine, 121.18 ± 13.44 under placebo) and shorter BH duration relative to the nicotine patch condition. Nicotine abstinence did not, though, increase fear reactivity to the challenge. CONCLUSIONS The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic.
Collapse
Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | |
Collapse
|
27
|
Langdon KJ, Leventhal AM, Stewart S, Rosenfield D, Steeves D, Zvolensky MJ. Anhedonia and anxiety sensitivity: prospective relationships to nicotine withdrawal symptoms during smoking cessation. J Stud Alcohol Drugs 2013; 74:469-78. [PMID: 23490577 DOI: 10.15288/jsad.2013.74.469] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of the present investigation was to explore the main and interactive effects of anhedonic depressive symptoms and anxiety sensitivity in terms of the individual components of nicotine withdrawal symptoms experienced on quit day as well as throughout the initial 14 days of cessation. METHOD Participants included 65 daily cigarette smokers (38 women; Mage = 46.08 years, SD = 9.12) undergoing psychosocial-pharmacological cessation treatment. RESULTS Results indicated that, after controlling for the effects of participant sex and nicotine dependence, anhedonic depression symptoms, but not anxiety sensitivity, significantly predicted quit day levels of mood-based nicotine withdrawal symptoms. Conversely, anxiety sensitivity, but not anhedonic depression symptoms, was significantly related to the change in most nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between anxiety sensitivity and anhedonic depression symptoms related to the slope of certain withdrawal symptoms over time. Specifically, among participants with higher levels of anxiety sensitivity, greater levels of anhedonic depression symptoms were related to greater increases in withdrawal symptoms over time for two of the nine anxiety-relevant components of nicotine withdrawal (restlessness and frustration). CONCLUSIONS Among high anxiety-sensitivity persons, compared with those low in anxiety sensitivity, anhedonic depression symptoms may be more relevant to the experience of some withdrawal symptoms being more intense and persistent during the early phases of quitting.
Collapse
|
28
|
Kelly MM, Grant C, Cooper S, Cooney JL. Anxiety and smoking cessation outcomes in alcohol-dependent smokers. Nicotine Tob Res 2012; 15:364-75. [DOI: 10.1093/ntr/nts132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
29
|
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.
Collapse
Affiliation(s)
- Teresa M Leyro
- Department of Psychiatry, University of California-San Francisco
| | | |
Collapse
|
30
|
Assayag Y, Bernstein A, Zvolensky MJ, Steeves D, Stewart SS. Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment. Cogn Behav Ther 2012; 41:51-62. [PMID: 22375732 DOI: 10.1080/16506073.2011.632437] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.
Collapse
|
31
|
Johnson KA, Stewart S, Rosenfield D, Steeves D, Zvolensky MJ. Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:289-297. [PMID: 21644805 PMCID: PMC3457797 DOI: 10.1037/a0024133] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current investigation explored the main and interactive effects of anxiety sensitivity (AS) and state anxiety in predicting acute nicotine withdrawal symptoms experienced during the initial 14 days of smoking cessation. Participants included 123 adult daily smokers (84 women; Mage = 45.93 years, SD = 10.34) undergoing psychosocial-pharmacological cessation treatment. Results indicated that after controlling for the effects of participant sex and nicotine dependence, state anxiety but not AS significantly predicted initial levels of nicotine withdrawal symptoms. Results also demonstrated that both state anxiety and AS were significantly related to the change in nicotine withdrawal symptoms over time. Finally, our results revealed a significant interaction between AS and state anxiety. Specifically, higher levels of AS were associated with a stronger relation between state anxiety and nicotine withdrawal symptoms experienced during the cessation attempt. Results suggest that among high AS persons, state anxiety may be more relevant, compared to those low in AS, in regard to experiencing withdrawal symptoms as more intense during the early phases of quitting.
Collapse
Affiliation(s)
| | | | | | - Dan Steeves
- Nova Scotia Department of Health Promotion and Protection, Capital District Health Authority
| | | |
Collapse
|
32
|
Johnson KA, Farris SG, Schmidt NB, Smits JAJ, Zvolensky MJ. Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers. Nicotine Tob Res 2012; 15:1-10. [PMID: 22544839 DOI: 10.1093/ntr/ntr332] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Empirical research has found that panic attacks are related to increased risk of more severe nicotine withdrawal and poor cessation outcome. Anxiety sensitivity (AS; fear of anxiety and related sensations) has similarly been found to be related to an increased risk of acute nicotine withdrawal and poorer cessation outcome. However, research has yet to examine the relative contributions of panic attacks and AS in terms of cognitive-based smoking processes (e.g., negative reinforcement smoking expectancies, addictive and negative affect-based reduction smoking motives, barriers to cessation, problem symptoms experienced while quitting). METHOD Participants (n = 242; 57.4% male; M (age) = 38.1) were daily smokers recruited as a part of a larger randomized control trial for smoking cessation. It was hypothesized that both panic attacks and AS would uniquely and independently predict the studied cognitive-based smoking processes. RESULTS As hypothesized, AS was uniquely and positively associated with all smoking processes after controlling for average number of cigarettes smoked per day, current Axis I diagnosis, and participant sex. However, panic attack history was only significantly related to problem symptoms experienced while quitting smoking. CONCLUSIONS Although past research has demonstrated significant associations between panic attacks and certain aspects of cigarette smoking (e.g., severity of nicotine withdrawal; lower abstinence rates, and negative affect reduction motives), the present findings suggest that AS may be more relevant to understanding beliefs about and motives for smoking behavior as well as perceptions of cessation-related difficulties.
Collapse
Affiliation(s)
- Kirsten A Johnson
- Department of Psychology, University of Vermont, Burlington, VT, USA
| | | | | | | | | |
Collapse
|
33
|
McLeish AC, Cougle JR, Zvolensky MJ. Asthma and cigarette smoking in a representative sample of adults. J Health Psychol 2011; 16:643-52. [PMID: 21346012 DOI: 10.1177/1359105310386263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The current study examined the association between asthma and both smoking and nicotine dependence in the National Comorbidity Survey-Replication (NCS-R) as well as the temporal patterning between smoking and asthma onset (N = 5692; 53% female; M (age) = 45.01, SD = 17.9). Results indicated lifetime history of daily smoking and nicotine dependence were both significantly associated with asthma diagnosis and half of individuals with asthma reported that their asthma diagnosis preceded smoking onset. These data suggest that nicotine dependence may maintain a stronger relation with asthma than smoking and that there may be distinct developmental trajectories for asthma-smoking relations.
Collapse
Affiliation(s)
- Alison C McLeish
- Department of Psychology, University of Cincinnati, PO Box 210376, Cincinnati, OH 45221-0376, USA.
| | | | | |
Collapse
|
34
|
Perkins KA, Karelitz JL, Giedgowd GE, Conklin CA, Sayette MA. Differences in negative mood-induced smoking reinforcement due to distress tolerance, anxiety sensitivity, and depression history. Psychopharmacology (Berl) 2010; 210:25-34. [PMID: 20217051 PMCID: PMC2882096 DOI: 10.1007/s00213-010-1811-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE Negative mood increases smoking reinforcement and may do so to a greater degree in smokers vulnerable to negative mood dysregulation. METHODS Adult smokers (N = 71) without current depression were randomly assigned to one of two smoking conditions (nicotine or denic cigarettes, presented blind) maintained across all sessions. Subjects completed one neutral mood session and four negative mood induction sessions. Negative mood inductions included one each of the following: 1) overnight smoking abstinence, 2) challenging computer task, 3) public speech preparation, 4) watching negative mood slides. In each session, subjects took 4 puffs on their assigned cigarette, rated it for "liking" (reward), and then smoked those cigarettes ad libitum (reinforcement) during continued mood induction. Affect was assessed intermittently before and after smoking. Differences in responses were examined as functions of self-reported history of major depression and levels of distress tolerance and anxiety sensitivity. RESULTS Smoking reinforcement, but not reward or negative affect relief, was greater in all sessions in those with a history of depression and greater after overnight abstinence in those with lower distress tolerance. Reward and affect relief, but not reinforcement, were greater during speech preparation among those high in anxiety sensitivity. CONCLUSIONS Low distress tolerance may enhance acute smoking reinforcement due to abstinence, while depression history may broadly increase acute smoking reinforcement regardless of mood. Neither smoking reward nor affect help explain these individual differences in smoking reinforcement.
Collapse
Affiliation(s)
- Kenneth A. Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Joshua L. Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Grace E. Giedgowd
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Cynthia A. Conklin
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213, USA
| | - Michael A. Sayette
- Department of Psychology, University of Pittsburgh, 3137 Sennott Square, Pittsburgh, PA 15261, USA
| |
Collapse
|