بررسی نقش اختلال پانیک در فرایندهای حساسیت عاطفی درگیر با استعمال سیگار

The present study investigated the relationship between panic disorder and emotional sensitivity processes related to smoking. Participants were 170 young adult (mean age = 25.2 [8.4]) regular smokers (mean cigarettes per day = 15.6 [2.4]) with (n = 69) and without (n = 101) a primary diagnosis of panic disorder. Consistent with prediction, smokers with panic disorder showed greater motivation to smoke in order to reduce negative affect (but not other reasons for smoking), reported anxiety symptoms but not non-anxiety symptoms as problematic obstacles to quitting during past (lifetime) quit attempts, and reported lower levels of confidence in remaining abstinent when emotionally distressed. Results are discussed in relation to panic-relevant emotional sensitivity processes involved with smoking.

A positive association between cigarette smoking and a history of panic attacks and panic disorder is well-established (Amering et al., 1999; Hughes, Hatsukami, Mitchell, & Dalgren, 1986; Pohl, Yeragani, Balon, Lycaki, & McBride, 1992). Epidemiological studies, for instance, report that approximately 42–48% of individuals with panic disorder are current smokers and approximately 60–65% have a lifetime history of smoking (Breslau, Kilbey, & Andreski, 1991; Lasser et al., 2000). These rates are greater than those reported for both individuals with no psychiatric illness and individuals with certain types of anxiety disorders (e.g., specific phobia, social phobia, obsessive–compulsive disorder; Bejerot, & Humble, 1999; Lasser et al., 2000 and McCabe et al., 2004). Although cigarette smoking is associated with an increased risk of panic-related problems (Breslau & Klein, 1999; Goodwin & Hamilton, 2002; Isensee, Wittchen, Stein, Hofler, & Lied, 2003; Johnson et al., 2000; Zvolensky, Kotov, Antipova, & Schmidt, 2003; Zvolensky, Schmidt, & McCreary, 2003), there has been little scientific attention directed at better understanding the extent to which panic vulnerability factors may relate to emotional sensitivity processes involved with smoking. Zvolensky, Schmidt, and Stewart (2003) proposed a model of smoking and panic disorder to help understand the high co-occurrence and interplay between such problems. This model suggests that panic disorder may be related to a number of theoretically and clinically relevant emotional sensitivity processes associated with smoking. This conceptualization is based, in part, on the large empirical literature that documents persons with panic disorder are fearful of anxiety-related symptoms and bodily sensations (Taylor, Koch, & McNally, 1992), react with anxiety and fear when confronted with personally relevant interoceptive cues (Barlow, 2002, pp. 139–179), and cope with anxiety-related states by trying to escape or avoid them (Feldner, Zvolensky, & Leen-Feldner, 2004). These affective characteristics may undergrid an association with emotional sensitivity processes involved with smoking, including (1) specific types of motivation to smoke and (2) biases to report affective problems when abstaining from smoking (e.g., reporting more negative emotional symptoms as obstacles to quitting, reporting less confidence in remaining abstinent when emotionally distressed). In regard to smoking motivational processes, there is a large empirical literature that documents smokers attribute their smoking, at least in part, to it mood-regulating functions and believe that smoking will reduce negative affect states (Parrott, 1999; Revel, Warburton, & Wesnes, 1985). Due to their affective vulnerability, smokers with panic disorder may be a subgroup of individuals that is highly motivated to smoke to temporarily escape from negative emotional distress elicited by acute nicotine withdrawal or non-withdrawal states (e.g., anticipatory anxiety). In particular, as persons with panic disorder generally believe negative affect-related cues (e.g., restlessness, bodily agitation, anxiety) are personally dangerous and experience high levels of anxiety when exposed to interoceptive cues, they would presumably be motivated to smoke in response to anxiety-related distress as a way of coping with such affective disturbances (i.e., self-administration aimed principally at terminating or avoiding nicotine withdrawal or related aversive states such as anxiety). Consistent with this perspective, investigations have thus far shown the panic-relevant cognitive risk factor of anxiety sensitivity, defined as the fear of anxiety and anxiety-related sensations (Reiss & McNally, 1985), is correlated with smoking motives to reduce negative affect, but not other reasons (e.g., pleasure, handling, taste), among regular smokers (Brown, Kahler, Zvolensky, Lejuez, & Ramsey, 2001; Comeau, Stewart, & Loba, 2001; Novak, Burgess, Clark, Zvolensky, & Brown, 2003; Stewart, Karp, Pihl, & Peterson, 1997). Additionally, anxiety sensitivity is significantly and incrementally associated with smoking outcome expectancies, as indexed by the Smoking Consequences Questionnaire (Brandon & Baker, 1991), for negative affect reduction; observed effects are over and above the variance accounted for by theoretically relevant smoking history characteristics, gender, and negative affectivity (Zvolensky, Feldner, et al., in press). Although these initial studies identify a link between anxiety sensitivity and coping-oriented smoking motivation and negative affect reduction expectancies, no investigations have examined smoking motivational processes among persons with panic disorder, leaving open questions regarding the applicability of such findings to this clinical condition. Smokers with panic disorder also may be emotionally sensitive to affective symptoms when abstaining from smoking and perceive them as obstacles to quitting. Specifically, by virtue of their affective vulnerability, they may be more apt to be worried about, and attentive to, anxiety-relevant interoceptive sensations that commonly occur during smoking abstinence (e.g., bodily tension, irritability, and anxiety; Hughes, Higgins, & Hatsukami, 1990) and therefore perceive them as relatively more severe problems during quit attempts than non-anxiety symptoms. This type of sensitivity to aversive affective cues is potentially clinically important, as both more intense negative affect (Wetter et al., 1999) and limited tolerance for such symptoms (Brown, Lejuez, Kahler, & Strong, 2001) often are related to problems in abstaining from smoking (e.g., during a quit attempt). Consistent with this perspective, anxiety sensitivity (fear of anxiety) is associated with more intense withdrawal symptoms during the most recent quit attempt (Zvolensky, Baker, et al., in press) among regular smokers with no psychiatric history and (2) a history of (non-clinical) panic attacks is related to more anxiety-related but not non-anxiety-related symptoms (Zvolensky, Lejuez, Kahler, & Brown, 2004) during past quit attempts among regular smokers with no axis I conditions (lifetime). These findings are consistent with an earlier study that found smokers with an anxiety disorder (i.e., not specific to panic-related problems) were more apt to report more intense nicotine withdrawal symptoms than smokers without such problems (Breslau, Kilbey, & Andreski, 1992). Yet, there is no empirical information pertaining to whether individuals with panic disorder have a tendency to report anxiety but not non-anxiety symptoms as relatively more problematic to quitting when attempting to abstain from smoking. Additionally, previous work has not examined whether panic disorder relates to self-confidence in abstaining from smoking. If panic disorder is related to emotion sensitivity factors involved with smoking, it is likely that smokers with this condition may (1) perceive anxiety-relevant symptoms (but not non-anxiety symptoms) as problematic in their attempts to quit smoking and (2) have little confidence in their ability to abstain from smoking when emotionally distressed. Together, the overarching purpose of the present investigation was to examine whether panic disorder would be associated with theoretically relevant emotional sensitivity processes involved with smoking, including (1) specific types of motivation to smoke and (2) biases to report affective problems when abstaining from smoking. First, it was hypothesized that smokers with panic disorder compared to those without this condition would report a greater motivation to smoke to reduce negative affect even after controlling for the variance due to gender, nicotine dependence, and negative affectivity. As a test of specificity, it also was expected that panic disorder would not be associated with smoking motivation for other reasons (e.g., stimulation, addictive reasons), as these factors would theoretically be unrelated to panic-relevant emotional sensitivity processes. Second, it was hypothesized that individuals with panic disorder compared to those without the condition would report greater anxiety-related, but not non-anxiety-related, as problems to successfully abstaining from smoking during past (lifetime) quit attempts (i.e., a bias for perceiving specific types of symptoms as obstacles to quitting); again, it was expected that this effect would be over and above the variance to other theoretically relevant smoking and affect factors. Finally, it was hypothesized that smokers with panic disorder compared to their non-panic counterparts, after controlling for other relevant factors, would report lower levels of self-confidence about remaining abstinent from smoking when emotionally distressed.