یک تحقیق تجربی از رابطه بین عملکرد هراس اجتماعی و مصرف سیگار

Introduction Individuals with social phobia (SP) represent a large group with elevated rates of cigarette smoking and cessation rates lower than that of individuals without psychopathology. For individuals with SP, cigarette smoking may be used to reduce social anxiety in anticipation of and during social situations. However, no study to date has experimentally examined this association. The aim of the current study was to experimentally examine the relationship between cigarette smoking and SP as a function of induced social stress. Method We recruited daily smokers ages 18–21 who scored in either a clinical or normative range on the Social Interaction Anxiety Scale (SIAS). Participants included 54 smokers (42.6% female, 77.8% White, age M(SD) = 19.65(1.18), CPSD M(SD) = 7.67(4.36), 46.30% high SP) who attended two sessions: one social stress session and one neutral session. Results Results indicated that high SP smokers experienced significant decreases in negative affect (NA) following smoking a cigarette when experiencing social stress. This effect was specific to high SP smokers under social stress and was not observed among individuals' average in SP or when examining changes in positive affect. Conclusions For individuals with SP, cigarette smoking may be maintained due to changes in NA associated with smoking specifically in the context of social stress. These results speak to the importance of targeted cessation interventions that address the nature of smoking for individuals with SP.

Individuals with psychological disorders are overrepresented among U.S. smokers, experience a disproportionate amount of the smoking-related public health burden, and, as such, are an important target for prevention and intervention efforts (Schroeder & Morris, 2010). Psychological comorbidities for which cigarette smoking may be used to cope with or manage psychological symptoms may be the most problematic for smoking outcomes (Gehricke et al., 2007). A growing body of research suggests that Social Phobia (SP), a highly prevalent disorder for which 12.1% of the population meets diagnostic criteria (Ruscio et al., 2008), exhibits this relationship with tobacco use such that SP symptoms predict the initiation of cigarette smoking (Johnson et al., 2000), nicotine dependence (Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000), and poor cessation outcomes (Lasser et al., 2000 and Ruscio et al., 2008). Moreover, there are significantly greater rates of smoking among individuals with SP than among individuals without psychological comorbidities; specifically, 54.0% of individuals with SP are lifetime smokers and 35.9% of individuals with SP are current smokers (Lasser et al., 2000 and Ruscio et al., 2008). In teasing apart potential mechanisms underlying the relationship between cigarette smoking and SP, a negative reinforcement model is relevant. From a negative reinforcement framework, individuals with SP would smoke cigarettes in order to reduce or avoid feelings of distress in relation to social situations or in anticipation of social situations. There has been some support for this negative reinforcement link between SP and cigarette smoking in early adolescence prior to the onset of regular smoking such that adolescents high in SP report greater urge to smoke during peer interactions than adolescents without elevated SP symptoms (Henry, Jamner, & Whalen, 2012), suggesting that tobacco use may develop and escalate as a method to regulate social anxiety. Strong theory and etiological data suggest the temporal ordering of SP, cigarette smoking onset, and nicotine dependence (e.g., Sonntag et al., 2000). However, there are only a few studies that have examined the functional utility of cigarette smoking for individuals with SP symptomatology. The studies that have examined smoking and SP suggest that SP symptoms are positively related to self-reported smoking to cope behaviors during social situations as well as to cigarette craving when deprived of nicotine (Watson, VanderVeen, Cohen, DeMarree, & Morrell, 2012). Furthermore, the relationship between SP symptoms and nicotine dependence is mediated by affiliative attachment motives, suggesting that among individuals with elevated SP symptomatology, cigarette smoking may help to cope with the feelings of loneliness or social rejection associated with SP (Buckner & Vinci, 2013). Other studies have not specifically assessed SP symptomatology, but have utilized experimental manipulations to induce social stress among samples of smokers and have found that in response to social stress, the urge to smoke is positively associated with self-reported and observer-reported anxiety (Niaura, Shadel, Britt, & Abrams, 2002) and that, in turn, smoking a cigarette is related to lower levels of self-reported anxiety (Gilbert & Spielberger, 1987). Taken together, these studies further support a unique negative reinforcement relationship between SP and tobacco use. There are several remaining gaps in the literature on SP and cigarette smoking. Although self-report data from Watson et al. (2012) suggests that SP is related to smoking to cope with social situations, this relationship has yet to be experimentally examined and it remains unclear whether cigarette smoking modulates negative affect (NA) associated with social stress for socially phobic smokers. Additionally, no studies to date have assessed smoking behavior (i.e., via smoking topography) among socially phobic smokers in response to social stress. Thus, it remains unknown whether self-reported smoking to cope translates to differential smoking in response to a social stressor as compared to in response to a neutral mood.