Intolerance for discomfort among smokers: Comparison of smoking-specific and non-specific measures to smoking history and patterns

Abstract

Introduction Intolerance of discomfort associated with recent smoking cessation has been studied with only one smoking-specific questionnaire. The present study investigates the extent to which the previously validated Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) scales share variance with (a) laboratory measures of distress tolerance (Paced Serial Addition Task and a breath-holding task) that have themselves been validated against smoking history, (b) the cold pressor task (not previously validated for smoking), and (c) an anxiety sensitivity questionnaire previously used for a similar purpose. The study then tests the hypothesis that the IDQ-S scales will have a higher correlation with smoking rate and dependence and with number and length of past smoking cessation attempts than will anxiety sensitivity or behavioral distress tolerance tasks since those measures are not smoking-specific. Methods Sixty daily smokers recruited from the community completed the measures. Results The behavioral tasks and anxiety sensitivity shared little common variance. Anxiety sensitivity correlated more highly with IDQ-S than did the behavioral tasks but only 27% of variance was shared with the IDQ-S Withdrawal Intolerance; no distress tolerance measure correlated significantly with the IDQ-S Lack of Cognitive Coping scale. Only the IDQ-S scales correlated significantly with nicotine dependence, rate and past cessation: Withdrawal Intolerance with nicotine dependence and rate, and Lack of Cognitive Coping with fewer quit attempts. Conclusions The smoking-specific measure of intolerance for discomfort may be more useful in smoking research than the less specific measures of distress tolerance.

Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders

“…The majority of smoking quit attempts do not lead to lasting tobacco abstinence (Fiore et al, 2008). While the aversiveness of tobacco withdrawal plays a role in relapse (Hughes, 2007), individual differences in ability to tolerate or cope with the withdrawal and other stressors from abstinence are also likely to affect success of a smoking quit attempt since some smokers seem better able to endure abstinence distress stoically or to rationalize that the discomforts from abstinence are worth the gains (Sirota, Rohsenow, Dolan, Martin & Kahler, 2013). Beliefs or expectancies, while smoking, about one’s inability to tolerate withdrawal when abstinent from smoking may lead to a decision not to become abstinent.…”

“…This construct has been assessed with persistence on breath holding or cold pressor tasks (Hajek, et al, 1987; Kahler et al, 2013; Sirota et al, 2013), persistence with emotionally stressful tasks (e.g., Quinn, Brandon & Copeland, 1996), and questionnaires of ability to tolerate anxiety (Zvolensky, et al, 2006), feeling distressed or upset in general (Simons & Gaher, 2005) or physical discomfort in general (Schmidt et al, 2006). The behavioral persistence tasks may be reasonable indicators of willingness to persist with the physical or emotional discomfort of smoking cessation, but may not be easily used in clinical settings as part of a busy clinical practice.…”

“…A large pool of items was reduced empirically; the two final subscales derived from principal components analysis, Withdrawal Intolerance and Lack of Cognitive Coping, were found to be reliable and valid, with only 2–7% of variance in common (Sirota et al, 2010). Only 7–25% of variance in the Withdrawal Intolerance scale was shared with nicotine dependence severity and 4% with nicotine withdrawal severity after overnight abstinence (Kahler, McHugh, Metrik, Spillane, & Rohsenow, 2013; Sirota et al, 2010; 2013). In a direct comparison of the IDQ-S with three laboratory measures of physical and emotional distress tolerance and an anxiety sensitivity questionnaire, only the IDQ-S showed a consistent relationship to smoking dependence and rate measures and to number of past smoking quit attempts, suggesting it might also be a predictor of outcome (Sirota et al, 2013).…”

“…Only 7–25% of variance in the Withdrawal Intolerance scale was shared with nicotine dependence severity and 4% with nicotine withdrawal severity after overnight abstinence (Kahler, McHugh, Metrik, Spillane, & Rohsenow, 2013; Sirota et al, 2010; 2013). In a direct comparison of the IDQ-S with three laboratory measures of physical and emotional distress tolerance and an anxiety sensitivity questionnaire, only the IDQ-S showed a consistent relationship to smoking dependence and rate measures and to number of past smoking quit attempts, suggesting it might also be a predictor of outcome (Sirota et al, 2013). Withdrawal Intolerance was more strongly related to measures of smoking dependence and cigarettes per day, while Lack of Cognitive Coping was more strongly related to number of past quit attempts, with none of the other measures of more general tolerance for discomfort being significant.…”

Anxiety Sensitivity and Negative Urgency

“…Perhaps high-AS individuals perceive anxiety-related states (triggered by any stimulus, including nicotine withdrawal) as being more harmful and consequently are more prone to act on impulse in order to reduce those states (such as by smoking), which is manifested in the form of beliefs that smoking alleviates negative affect and abstinence exacerbates it. Indeed, high-AS smokers report stronger affective reactions to affect-eliciting stimuli, including nicotine withdrawal (Sirota et al, 2013) and a CO 2 challenge during tobacco abstinence (Vujanovic and Zvolensky, 2009). Another possibility is that smoking reduces anxiety to a greater extent for high-AS individuals, which increases impulsive smoking and in turn strengthens negative reinforcement-related smoking expectancies.…”