Anxiety, depression, and cigarette smoking: A transdiagnostic vulnerability framework to understanding emotion–smoking comorbidity.

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 paper 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 three trandiagnostic emotional vulnerabilities implicated in smoking: (1) anhedonia (Anh; diminished pleasure/interest in response to rewards); (2) anxiety sensitivity (AS; fear of anxiety-related sensations); and (3) 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.

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

“…In the case of smoking, there is basic and applied research to suggest AS is associated with smoking maintenance and relapse by heightening adverse emotional responsitivity to interoceptive cues (Farris, Langdon, DiBello, & Zvolensky, 2015;Leventhal & Zvolensky, 2015). Extant AS research suggests that it serves as a transdiagnostic risk factor for both smoking and asthma, resulting in poorer outcomes in both domains.…”

Acceptance and Commitment Therapy (ACT) for smoking cessation: a synthesis

“…Thus, smokers may be particularly prone to seek out opportunities to escape, avoid, or reduce distressing smoking-relevant thoughts, feelings, and bodily sensations and frequently may do so by (re)engaging in smoking. Importantly, one's individual difference in the ability to flexibly respond to smoking urges, negative mood, or interoceptive states is implicated in the maintenance of smoking [32]. Together, these data highlight the relative importance of considering smoking-specific experiential avoidance (EA) in the maintenance of this problem health behavior.…”

Depressive Symptoms and Tobacco Use: Does Religious Orientation Play a Protective Role?

“…In this regard, Leventhal and Zvolensky (2015) propose that three transdiagnostic emotional vulnerabilities may serve as theoretical bridges that link anxiety/depressive psychopathologies to smoking. Specifically relevant to the depression-smoking association, Leventhal and Zvolensky posit that anhedonia-the diminished pleasure in response to rewards-amplifies the pleasure-enhancing effects of smoking.…”