Posttraumatic Stress Symptoms and Cigarette Deprivation in the Prediction of Anxious Responding among Trauma-Exposed Smokers: A Laboratory Test

Abstract

regard to self-reported anxious responding, among traumaexposed smokers, during a challenge paradigm. IntroductionOne promising avenue for better understanding the association between posttraumatic stress and smoking may involve exploring the role(s) of cigarette deprivation and nicotine withdrawal symptoms (i.e., symptoms elicited by nicotine deprivation among smokers). The nicotine withdrawal syndrome, experienced between smoked cigarettes and more intensively during a cessation attempt or longer period of cigarette smoking deprivation, is characterized by a consistent set of symptoms. Smokers experiencing posttraumatic stress symptoms are likely to report (a) increased nicotine withdrawal symptom severity in response to aversive interoceptive sensations (e.g., autonomic arousal) elicited by trauma-related stimuli (Beckham et al., 1995) and (b) greater levels of withdrawal-related anxious and depressive symptoms during periods of cigarette deprivation (Pomerleau, Marks, & Pomerleau, 2000). Thus, nicotine withdrawal symptoms may amplify anxious and fearful responding to aversive internal sensations among trauma-exposed cigarettedeprived smokers. This enhanced anxious responding to aversive internal cues, such as bodily sensations, may increase the probability of smoking in response to negative affect and may, in turn, lead to lower rates of smoking cessation.In one relevant study, Feldner, Vujanovic, Gibson, and Zvolensky (2008) found that nicotine withdrawal symptom severity, among daily smokers undergoing 12 hr of cigarette deprivation, significantly mediated the association between posttraumatic stress disorder (PTSD) diagnostic status AbstractIntroduction: The present investigation examined the main and interactive effects of posttraumatic stress symptom severity and 12-hr cigarette deprivation (cf. smoking as usual) in the prediction of anxious responding during a 4-min 10% carbon dioxide (CO 2 )-enriched air laboratory challenge. It was hypothesized that 12-hr cigarette deprivation would exacerbate the effects of posttraumatic stress symptom severity with regard to anxious responding during the challenge.Methods: Participants were 63 daily smokers (46.0% women; M age = 30.79, SD = 13.12, range = 18-60) who reported experiencing one or more traumatic events. The study consisted of two laboratory sessions. At the first session, participants were administered a structured diagnostic interview and completed self-reported measures. Eligible participants were randomly assigned to one of two conditions for the second session: (a) 12-hr cigarette deprivation or (b) noncigarette deprivation (i.e., smoking as usual). At the second session, participants' smoking status was biochemically verified, and all eligible participants then were administered the 10% CO 2 -enriched air laboratory challenge protocol. Results:The main and interactive effects of posttraumatic stress symptom severity and the smoking-as-usual conditionnot the hypothesized 12-hr cigarette deprivation conditionwere significantly predictive of peri-ch...

Predicted Impact of Nicotine Reduction on Smokers with Affective Disorders

“…One study, in smokers who had endorsed a DSM-IV- TR-defined PTSD Criterion A traumatic event, found that those with higher PTSD symptoms at baseline had higher anxiety levels during a smoke-as- usual condition, but not following 12-hour abstinence. 81 A study comparing anxiety levels during a biological challenge after 12-hour abstinence found that persons with a current panic disorder responded similarly to those who did not. 82 …”

The interaction of nicotine withdrawal and panic disorder in the prediction of panic-relevant responding to a biological challenge.

“…Additionally, in terms of nicotine withdrawal, the present study utilized a longer period of smoking deprivation than past work (e.g., 12 hours versus 2 hours; Marshall et al, 2009). Some work suggests longer compared to shorter periods of smoking deprivation may not be related to as dramatic increases in risk for anxious and fearful responding (Abrams et al, 2008; Piper & Curtin, 2006; Vujanovic, Marshall-Berenz, Beckham, Bernstein, & Zvolensky, 2010; Vujanovic & Zvolensky, 2009). Based upon these results, it may be useful to complete a dose-response study of smoking deprivation (e.g., 2 hours versus 4 hours versus 12 hours of smoking deprivation) in terms of anxious and fearful responding to bodily sensations and other anxiety-provoking stressors.…”

Basolateral amygdala, nicotinic cholinergic receptors, and nicotine: Pharmacological effects and addiction in animal models and humans

“…Additionally, the ventromedial prefrontal cortex and its projection to BLA, which mediate fear extinction, are hypoactive in PTSD (Hayes, Hayes, & Mikedis, ). During abstinence, smokers with PTSD experience more severe withdrawal and show increased sensitivity to both anxiety (i.e., fear of anxiety symptoms) and arousal associated with anxiety (Vujanovic, Marshall‐Berenz, Beckham, Bernstein, & Zvolensky, ). Based on the abnormal expression of BLA nAChRs in mild TBI (Almeida‐Suhett et al., ), the co‐occurrence of TBI and PTSD, and the intrinsic regulation of BLA neural circuitry by nAChRs (Jiang et al., ), increased sensitivity to anxiety and anxious arousal in abstinent smokers with PTSD may, in part, reflect the effects of nicotine on the regulation of dysfunctional BLA circuitry by nAChRs in PTSD.…”