Samantha G. Farris

Panic attack history and anxiety sensitivity in relation to cognitive-based smoking processes among treatment-seeking daily smokers.

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.

Evaluation of the Anxiety Sensitivity Index-3 among Treatment-Seeking Smokers

The Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) is a self-report assessment of anxiety sensitivity, reflecting an individuals tendency to misinterpret the meaning of anxiety-relevant sensations. Despite this construct being related to a wide array of clinically significant smoking maintenance and relapse processes, the psychometric properties of scores on the ASI-3 have not yet been investigated for use among smokers. Therefore, the current study aimed to test the psychometric properties of the scores on the ASI-3 in a sample of cigarette smokers. Participants were treatment-seeking daily smokers who completed the ASI-3 at a precessation visit (Time 1, N = 464) and 3 months postcessation attempt (Time 2, n = 137). Confirmatory factor analyses results of the scores on ASI-3 at Time 1 and Time 2 revealed the hypothesized 3-factor model, including physical, social, and cognitive concerns. In addition, the ASI-3 factor scores evidenced factor stability, test-retest reliability, internal consistency, and convergent, and discriminant, and predictive validity. The present study provides evidence in support of the validity and reliability of scores on the ASI-3 as a measure of anxiety sensitivity among treatment-seeking cigarette smokers.

The role of smoking inflexibility/avoidance in the relation between anxiety sensitivity and tobacco use and beliefs among treatment-seeking smokers

Recent scholarly attention has focused on explicating the nature of tobacco use among anxiety-vulnerable smokers. Anxiety sensitivity (fear of aversive internal anxiety states) is a cognitive-affective individual difference factor related to the development and maintenance of anxiety symptoms and disorders and various smoking processes. The present study examined the cross-sectional associations between anxiety sensitivity and a range of cognitive and behavioral smoking processes, and the mediating role of the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (i.e., avoidance and inflexibility to smoking [AIS]) in such relations. Participants (n = 466) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco cessation study. Baseline (pretreatment) data were utilized. Self-report measures were used to assess anxiety sensitivity, AIS, and 4 criterion variables: barriers to smoking cessation, quit attempt history, severity of problematic symptoms reported in past quit attempts, and mood-management smoking expectancies. Results indicated that anxiety sensitivity was indirectly related to greater barriers to cessation, greater number of prior quit attempts and greater mood-management smoking expectancies through the tendency to respond inflexibly/avoid to the presence of distressing smoking-related thoughts, feelings, and internal sensations; but not severity of problems experienced while quitting. The present findings suggest AIS may be an explanatory mechanism between anxiety sensitivity and certain smoking processes.

Anxiety sensitivity mediates relations between emotional disorders and smoking.

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.

Anxiety Sensitivity and Cognitive-Based Smoking Processes: Testing the Mediating Role of Emotion Dysregulation Among Treatment-Seeking Daily Smokers

The current study investigated whether emotion dysregulation (difficulties in the self-regulation of affective states) mediated relationships between anxiety sensitivity (fear of anxiety and related sensations) and cognitive-based smoking processes. Participants (n = 197; 57.5% male; mean age = 38.0 years) were daily smokers recruited as part of a randomized control trial for smoking cessation. Anxiety sensitivity was uniquely associated with all smoking processes. Moreover, emotion dysregulation significantly mediated relationships between anxiety sensitivity and the smoking processes. Findings suggest that emotion dysregulation is an important construct to consider in relationships between anxiety sensitivity and cognitive-based smoking processes among adult treatment-seeking smokers.

Anxiety sensitivity as an amplifier of subjective and behavioral tobacco abstinence effects

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.

Social anxiety and coping motives for cannabis use: The impact of experiential avoidance.

Social anxiety is robustly associated with cannabis-related problems. This relation appears to be largely explained by coping-oriented motives for cannabis use. Yet, factors associated with coping motives among socially anxious individuals have yet to be identified. The current study tested whether experiential avoidance (i.e., unwillingness to experience distressing internal states) and its subfacets mediated the relation between social anxiety and coping motives for cannabis use. The sample consisted of current (past-month) cannabis-using adults (n = 103). Results indicated that social anxiety was robustly related to experiential avoidance, which was robustly related to coping motives. Follow-up analyses indicated that behavioral avoidance was the only experiential avoidance subtype to be related to both social anxiety and coping motives after controlling for theoretically relevant variables. Experiential avoidance (globally) and behavioral avoidance (specifically) mediated the relation between social anxiety and coping motives. Together, the results suggest experiential avoidance (especially behavioral avoidance) may play an important role in cannabis use behaviors, particularly among socially anxious users.

Smoking-specific experiential avoidance cognition: explanatory relevance to pre- and post-cessation nicotine withdrawal, craving, and negative affect.

BACKGROUND Negative-reinforcement based cognitive processes have been implicated in the maintenance of cigarette smoking. Given the expectation that smoking will attenuate aversive internal experiences, smokers may be particularly unwilling to experience or remain in contact with smoking-related distress (i.e., experiential avoidance). Yet, there is little known about a cognitive-based process termed smoking-specific experiential avoidance with regard to withdrawal, craving, or negative affect during a quit attempt. METHOD Data were collected from adult daily smokers (n = 259) participating in a larger smoking cessation trial. Pre- and post-quit experiences of nicotine withdrawal, craving, and negative affect were examined in terms of cognitive-based smoking-specific experimental avoidance, measured by the Avoidance and Inflexibility Scale (AIS). RESULTS Results indicated that baseline smoking-specific experiential avoidance was associated with greater overall levels of withdrawal, craving, and negative affect at treatment initiation (pre-cessation). Reductions in smoking-specific experiential avoidance from baseline to quit day were associated with increased likelihood of quit day abstinence. Such reductions were also predictive of lower levels of nicotine withdrawal, craving, and negative affect on quit day. Also, less reduction in experiential avoidance was associated with experiencing greater withdrawal in the early phase of quitting. DISCUSSION The impact of cognitive-based experiential avoidance pertaining to smoking impacts both pre- and post-cessation experiences in terms of negative affect, withdrawal, and smoking cravings and may represent an important treatment target.

Dysphoria and smoking among treatment seeking smokers: the role of smoking-related inflexibility/avoidance

Abstract Background: Emerging data suggest that dysphoria is one facet of depression that is especially related to various aspects of cigarette smoking. However, it is presently unknown what emotional processes may account for these relations. Objectives: In the current cross-sectional study, the impact of avoidance and inflexibility to smoking (AIS), a smoking-specific form of experiential avoidance, was tested on the relationship of dysphoria to four specific smoking processes that are key factors in cessation: perceived barriers to cessation, severity of problems during prior quit attempts, negative reinforcement smoking expectancies, and motivation to quit smoking. Methods: Participants (n = 465) were treatment-seeking adult daily smokers. Relative indirect effects were subjected to bootstrap analyses to test direct and indirect effects of dysphoria on smoking processes. Results: After controlling for gender, nicotine dependence severity, drinking problems, cannabis use, negative affectivity, tobacco-related medical problems, and AIS, dysphoria remained directly, positively related to perceived barriers and cessation problems. Additionally, dysphoria was indirectly, positively related to perceived barriers, cessation problems, negative reinforcement smoking expectancies, and motivation to quit indirectly through higher levels of AIS. Conclusion: In the context of dysphoria, AIS may explain a wide range of clinically-relevant smoking processes.

Main and Interactive Effects of Anxiety Sensitivity and Physical Distress Intolerance with Regard to PTSD Symptoms Among Trauma-Exposed Smokers

The present study examined the roles of anxiety sensitivity (AS; the tendency to misinterpret physical internal sensations of harmful) and distress tolerance (the capacity to tolerate aversive stimuli) in terms of the expression of posttraumatic stress disorder (PTSD) symptoms among a sample of trauma-exposed, treatment-seeking tobacco smokers (n = 137; Mage = 37.7 years, 48.2% female). It was hypothesized that higher AS and lower physical distress tolerance would interact to predict greater PTSD avoidance and hyperarousal symptoms. Results were partially consistent with this prediction. Specifically, there was a significant interactive effect of AS by physical distress tolerance in terms of PTSD hyperarousal symptom cluster severity. The form of the interaction was in the expected direction, with the highest levels of PTSD hyperarousal symptoms reported among smokers with higher levels of AS and a lower capacity to tolerate physical distress. Findings underscore the importance of considering AS and physical distress tolerance in terms of better understanding mechanisms underlying the expression of PTSD symptoms among trauma-exposed smokers.