Anxiety sensitivity risk reduction in smokers: A randomized control trial examining effects on panic

Norman B Schmidt, Amanda M Raines, Nicholas P Allan, Michael J Zvolensky, Norman B Schmidt, Amanda M Raines, Nicholas P Allan, Michael J Zvolensky

Abstract

Empirical evidence has identified several risk factors for panic psychopathology, including smoking and anxiety sensitivity (AS; the fear of anxiety-related sensations). Smokers with elevated AS are therefore a particularly vulnerable population for panic. Yet, there is little knowledge about how to reduce risk of panic among high AS smokers. The present study prospectively evaluated panic outcomes within the context of a controlled randomized risk reduction program for smokers. Participants (N = 526) included current smokers who all received a state-of-the-art smoking cessation intervention with approximately half randomized to the AS reduction intervention termed Panic-smoking Program (PSP). The primary hypotheses focus on examining the effects of a PSP on panic symptoms in the context of this vulnerable population. Consistent with prediction, there was a significant effect of treatment condition on AS, such that individuals in the PSP condition, compared to those in the control condition, demonstrated greater decreases in AS throughout treatment and the follow-up period. In addition, PSP treatment resulted in lower rates of panic-related symptomatology. Moreover, mediation analyses indicated that reductions in AS resulted in lower panic symptoms. The present study provides the first empirical evidence that brief, targeted psychoeducational interventions can mitigate panic risk among smokers.

Keywords: Anxiety sensitivity; Intervention; Panic; Prevention; Smokers.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
CONSORT chart of participants detailing patient flow, assignment, and dropout. CONSORT = consolidated standards of reporting trials.

References

    1. Abrams DB, Niaura R. The tobacco dependence treatment handbook: A guide to best practices. Guilford Press; 2003.
    1. Allan NP, Short NA, Albanese BJ, Keough ME, Schmidt NB. Direct and mediating effects of an anxiety sensitivity intervention on post-traumatic stress disorder symptoms in trauma exposed individuals. Cognitive Behavior Therapy. doi: 10.1080/16506073.2015.1075227. in press.
    1. Association, A. P. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) American Psychiatric Pub; 2013.
    1. Barlow DH, Craske MG, Cerny JA, Klosko JS. Behavioral treatment of panic disorder. Behavior Therapy. 1989;20(2):261–282.
    1. Breslau N, Johnson EO, Hiripi E, Kessler R. Nicotine dependence in the United States: prevalence, trends, and smoking persistence. Archives of general psychiatry. 2001;58(9):810–816.
    1. Breslau N, Klein DF. Smoking and panic attacks: an epidemiologic investigation. Archives of general psychiatry. 1999;56(12):1141–1147.
    1. Broman-Fulks JJ, Storey KM. Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety, Stress, & Coping. 2008;21(2):117–128.
    1. Brown RA, Kahler CW, Niaura R, Abrams DB, Sales SD, Ramsey SE, Miller IW. Cognitive–behavioral treatment for depression in smoking cessation. Journal of consulting and clinical psychology. 2001;69(3):471.
    1. Brown RA, Kahler CW, Zvolensky MJ, Lejuez CW, Ramsey SE. Anxiety sensitivity: Relationship to negative affect smoking and smoking cessation in smokers with past major depressive disorder. Addictive behaviors. 2001;26(6):887–899.
    1. Chou C, Yang D, Pentz MA, Hser Y. Piecewise growth curve modeling approach for longitudinal prevention study. Computational Statistics & Data Analysis. 2004;46(2):213–225.
    1. Cinciripini PM, Lapitsky L, Seay S, Wallfisch A, Meyer WJ, Van Vunakis H. A placebo-controlled evaluation of the effects of buspirone on smoking cessation: differences between high-and low-anxiety smokers. Journal of clinical psychopharmacology. 1995;15(3):182–191.
    1. Cudeck R, Harring JR. Developing a random coefficient model for nonlinear repeated measures data. Statistical methods for modeling human dynamics: An interdisciplinary dialogue. 2010:289–318.
    1. Ehlers A. A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. Journal of abnormal psychology. 1995;104(1):164.
    1. Farris SG, DiBello AM, Allan NP, Hogan J, Schmidt NB, Zvolensky MJ. Evaluation of the Anxiety Sensitivity Index-3 among treatment-seeking smokers. Psychological assessment in press.
    1. Farris SG, Langdon KJ, DiBello AM, Zvolensky MJ. Why Do Anxiety Sensitive Smokers Perceive Quitting as Difficult? The Role of Expecting “Interoceptive Threat” During Acute Abstinence. Cognitive Therapy and Research. 2015;39(2):236–244.
    1. Feingold A. Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological methods. 2009;14(1):43.
    1. Feldner MT, Zvolensky MJ, Babson K, Leen-Feldner EW, Schmidt NB. An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: Theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy. Journal of anxiety disorders. 2008;22(7):1227–1243.
    1. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, Lando HA. Treating tobacco use and dependence: a clinical practice guideline. Publications Clearinghouse; 2000.
    1. First M, Spitzer R, Gibbon M, Williams J. User’s guide for the Structured clinical interview for DSM-IV axis I disorders SCID-I: clinician version. American Psychiatric Pub; 1997.
    1. Gardenswartz CA, Craske MG. Prevention of panic disorder. Behavior Therapy. 2001;32(4):725–737.
    1. Graham JW. Missing data analysis: Making it work in the real world. Annual review of psychology. 2009;60:549–576.
    1. Hall SM, Muñoz RF, Reus VI. Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. Journal of consulting and clinical psychology. 1994;62(1):141.
    1. Hayward C, Killen JD, Kraemer HC, Taylor CB. Predictors of panic attacks in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry. 2000;39(2):207–214.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström K. The Fagerström test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. British journal of addiction. 1991;86(9):1119–1127.
    1. Houck PR, Spiegel DA, Shear MK, Rucci P. Reliability of the self-report version of the panic disorder severity scale. Depression and anxiety. 2002;15(4):183–185.
    1. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1–55.
    1. Keough ME, Schmidt NB. Refinement of a brief anxiety sensitivity reduction intervention. Journal of consulting and clinical psychology. 2012;80(5):766.
    1. Kline RB. Principles and practice of structural equation modeling. Guilford press; 2011.
    1. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. Jama. 2000;284(20):2606–2610.
    1. Leen-Feldner EW, Feldner MT, Bernstein A, McCormick JT, Zvolensky MJ. Anxiety sensitivity and anxious responding to bodily sensations: A test among adolescents using a voluntary hyperventilation challenge. Cognitive Therapy and Research. 2005;29(5):593–609.
    1. MacCallum RC, Browne MW, Sugawara HM. Power analysis and determination of sample size for covariance structure modeling. Psychological methods. 1996;1(2):130.
    1. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate behavioral research. 2004;39(1):99–128.
    1. Maller RG, Reiss S. Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of anxiety disorders. 1992;6(3):241–247.
    1. McNally RJ. Anxiety sensitivity and panic disorder. Biological psychiatry. 2002;52(10):938–946.
    1. McNally RJ, Eke M. Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge. Journal of abnormal psychology. 1996;105(1):146.
    1. Mueser KT, Kavanagh D. Treating comorbidity of alcohol problems and psychiatric disorder. The essential handbook of treatment and prevention of alcohol problems. 2004:139.
    1. Muthen LK, Muthen BO. Mplus User’s Guide. 5. Los Angeles, CA: 1998–2008.
    1. Norr AM, Allan NP, Macatee RJ, Keough ME, Schmidt NB. Effect of a computerized anxiety sensitivity intervention on anxiety, depression, and worry: Mediation through affect tolerances. Behaviour research and therapy. 2014;59:12–19. doi: 10.1016/j.brat.2014.05.011.
    1. Osher FC. A vision for the future: Toward a service system responsive to those with co-occurring addictive and mental disorders. American Journal of Orthopsychiatry. 1996;66(1):71.
    1. Otto M, Pollack M, Sachs G, Reiter S, Meltzer-Brody S, Rosenbaum J. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry. 1993;150(10):1485–1490.
    1. Parrott AC. Does cigarette smoking cause stress? American Psychologist. 1999;54(10):817.
    1. Pechter BM, Miller NS. Psychopharmacotherapy for addictive and comorbid disorders: Current studies. Journal of addictive diseases. 1997;16(4):23–40.
    1. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior research methods. 2008;40(3):879–891.
    1. Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of consulting and clinical psychology. 2004;72(6):1144.
    1. Rabian B, Embry L, MacIntyre D. Behavioral validation of the Childhood Anxiety Sensitivity Index in children. Journal of Clinical Child Psychology. 1999;28(1):105–112.
    1. Reiss S, McNally RJ. Expectancy model of fear. In: Reiss S, Bootzin RR, editors. Theoretical issues in behavior therapy inside. San Diego, CA: Academic Press; 1985.
    1. Schmidt NB, Capron DW, Raines AM, Allan NP. Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns. Journal of consulting and clinical psychology. 2014;82(6):1023.
    1. Schmidt NB, Eggleston AM, Woolaway-Bickel K, Fitzpatrick KK, Vasey MW, Richey A. Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability. Journal of anxiety disorders. 2007;21(3):302–319.
    1. Schmidt NB, Joiner TE. Structure of the Anxiety Sensitivity Index psychometrics and factor structure in a community sample. Journal of anxiety disorders. 2002;16(1):33–49.
    1. Schmidt NB, Lerew DR, Jackson RJ. The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. Journal of abnormal psychology. 1997;106(3):355.
    1. Schmidt NB, Lerew DR, Jackson RJ. Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of abnormal psychology. 1999;108(3):532.
    1. Schmidt NB, Woolaway-Bickel K, Trakowski J, Santiago H, Storey J, Koselka M, Cook J. Dismantling cognitive–behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of consulting and clinical psychology. 2000;68(3):417.
    1. Schmidt NB, Zvolensky MJ, Maner JK. Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of psychiatric research. 2006;40(8):691–699.
    1. Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Papp LA. Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry 1997
    1. Smits J, Powers MB, Cho Y, Telch MJ. Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis. Journal of consulting and clinical psychology. 2004;72(4):646.
    1. Taylor S. Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. Routledge; 2014.
    1. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, Stewart SH. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological assessment. 2007;19(2):176.
    1. Telch MJ, Lucas JA, Schmidt NB, Hanna HH, Jaimez TL, Lucas RA. Group cognitive-behavioral treatment of panic disorder. Behaviour research and therapy. 1993;31(3):279–287.
    1. Weems CF, Hayward C, Killen JD, Taylor CB. A longitudinal investigation of anxiety sensitivity in adolescence. Journal of abnormal psychology. 2002;111(3):471.
    1. Westling BE, Öst L. Brief cognitive behaviour therapy of panic disorder. Scandinavian Journal of Behaviour Therapy. 1999;28(2):49–57.
    1. Wothke W. Longitudinal and multigroup modeling with missing data. 2000:219–281.
    1. Zvolensky MJ, Bernstein A. Cigarette smoking and panic psychopathology. Current Directions in Psychological Science. 2005;14(6):301–305.
    1. Zvolensky MJ, Feldner MT, Eifert GH, Stewart SH. Evaluating differential predictions of emotional reactivity during repeated 20% carbon dioxide-enriched air challenge. Cognition & Emotion. 2001;15(6):767–786.
    1. Zvolensky MJ, Schmidt NB. Panic disorder and smoking. Clinical Psychology: Science and Practice. 2003;10(1):29–51.
    1. Zvolensky MJ, Schmidt NB, Antony MM, McCabe RE, Forsyth JP, Feldner MT, Kahler CW. Evaluating the role of panic disorder in emotional sensitivity processes involved with smoking. Journal of anxiety disorders. 2005;19(6):673–686.
    1. Zvolensky MJ, Stewart SH, Vujanovic AA, Gavric D, Steeves D. Anxiety sensitivity and anxiety and depressive symptoms in the prediction of early smoking lapse and relapse during smoking cessation treatment. Nicotine & Tobacco Research. 2009;11(3):323–331.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere