Community-Based Smoking Cessation Treatment for Adults with High Anxiety Sensitivity: A Randomized Clinical Trial.

Abstract

BACKGROUND AND AIMS\nPeople with anxiety disorders are more likely to smoke and less likely to succeed when they try to quit. Anxiety sensitivity may underlie both phenomena, such that people with high anxiety sensitivity react to interoceptive distress by avoidance. This study aimed to test the efficacy of an exercise program that induced interoceptive distress and thereby created tolerance to this distress in a safe environment.\n\n\nDESIGN\nRandomized clinical trial.\n\n\nSETTING\nFour YMCA branches in Austin, Texas, United States.\n\n\nPARTICIPANTS\nParticipants (N=150; 130[86.7%] white; 101[67.3%] female; mage =38.6, SDage =10.4) were adult, daily smokers with high anxiety sensitivity motivated to quit smoking, who reported no regular moderate-intensity exercise.\n\n\nINTERVENTIONS\nParticipants were assigned a YMCA personal trainer who guided them through a 15-week intervention aerobic exercise program. Participants assigned to the personalized intervention trained at 60-85% of their heart rate reserve (HRR) whereas participants assigned to the control intervention trained at 20-40% of their HRR. Participants in both groups received standard behavioral support and nicotine replacement therapy.\n\n\nMEASUREMENTS\nThe primary outcome was biologically-verified 7-day point prevalence abstinence (PPA) at 6-month follow-up.\n\n\nFINDINGS\nSixty-one percent of participants were available at the 6-month follow-up. PPA at 6 months was higher in the personalized intervention than the control intervention, (27.6% vs. 14.8%; OR=2.20,95% CI:[1.28,3.80],P=.005), assuming missing at random. Anxiety sensitivity declined in both groups with no evidence that this differed between groups.\n\n\nCONCLUSIONS\nAn exercise program of high intensity increased abstinence from smoking in people with high anxiety sensitivity but may not have done so by reducing anxiety sensitivity.