Posttraumatic stress symptom severity and cognitive-based smoking processes among trauma-exposed treatment-seeking smokers: The role of perceived stress

Abstract

Trauma exposure and smoking co-occur at an alarmingly high rate. However, there is little understanding of the mechanisms underlying this clinically significant relation. The present study examined perceived stress as an explanatory mechanism linking posttraumatic stress symptom severity and smoking-specific avoidance/inflexibility, perceived barriers to smoking cessation, and negative affect reduction/negative reinforcement expectancies from smoking among trauma-exposed smokers. Participants were trauma-exposed, treatment-seeking daily cigarette smokers (n = 179; 48.0% female; Mage = 41.17; SD = 12.55). Results indicated that posttraumatic stress symptom severity had an indirect significant effect on each of the dependent variables via perceived stress. The present results provide empirical support that perceived stress may be an underlying mechanism that indirectly explains posttraumatic symptoms relation to smoking-specific avoidance/inflexibility, perceived barriers to smoking cessation, and negative affect reduction/negative reinforcement expectancies among trauma-exposed smokers. These findings suggest that there may be clinical utility in targeting perceived stress among trauma-exposed smokers via stress management psychoeducation and skills training.

Posttraumatic stress disorder and cigarette smoking: A systematic review

“…For example, extant work indicates that ethnicity may play a moderating role in smoking lapse, with white smokers without PTSD lapsing at a significantly slower rate (i.e., longer time to lapse) than white smokers with PTSD and black smokers with and without PTSD (Wilson et al, 2014). Other work has highlighted perceived stress (Garey et al, 2016), abstinence self-efficacy , and emotional reactivity (Calhoun, Dennis, & Beckham, 2007) as influential to longevity and success of quitting attempts among individuals with PTSD. Further, Dedert et al (2012) found that smokers with PTSD endorsed greater cravings, more withdrawal symptoms, and increased negative affect following overnight abstinence, highlighting negative reinforcement motives as another potential mediator to failed smoking cessations.…”

The sequential pathway between trauma-related symptom severity and cognitive-based smoking processes through perceived stress and negative affect reduction expectancies among trauma exposed smokers

“…11 Drawing from self-regulation and coping theories for tobacco use, 12,13 trauma-exposed smokers with higher levels of perceived stress may expect that smoking will lessen their experiential discomfort. Indeed, empirical evidence supports this theoretical model 5 . Thus, robust theoretical and empirical data demonstrate an effect of perceived stress on increased negative reduction smoking expectancies among trauma-exposed smokers.…”

“…While past work has provided evidence for trauma-related symptoms and perceived stress 5 and perceived stress and negative affect reduction expectancies for smoking 9 separately, the current study broadens this corpus of work by jointly examining the sequential path from trauma-related symptom severity to perceived stress to negative affect reduction expectancies for smoking, and finally to smoking. Thus, this initial work elucidates a conceptual and empirically supported pathway that explains, in part, the relation between trauma-related symptoms and maladaptive smoking behavior and cognition.…”

“…5 Perceived stress reflects perceptions of global life stress 6 and is unique from negative affect because it taps into the stress appraisal process. 7 Biologically, smoking alters stress management systems, including the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, which subsequently contributes to smoking maintenance and more difficulty quitting.…”

“…8 Among trauma-exposed smokers, perceived stress appears to be related to greater trauma-related symptom severity. 5 Indeed, greater perceived stress serves as a linking mechanism between trauma-related symptom severity and problematic smoking cognition and behavior, including inflexibility/avoidance in the presence of aversive smoking-related thoughts, feelings, or internal sensations, perceived barriers to smoking cessation, and negative affect reduction smoking expectancies. 5 …”