Breath holding duration and self-reported smoking abstinence intolerance as predictors of smoking lapse behavior in a laboratory analog task

Anxiety Sensitivity and Distress Tolerance in Relation to Smoking Abstinence Expectancies Among Black Individuals Who Smoke

OBJECTIVE

Black individuals who smoke in the United States experience significant tobacco-related disparities. Although prior work has established that smoking abstinence expectancies play an important role in smoking-related outcomes, few studies have examined potential individual difference factors that may be relevant to smoking abstinence expectancies among Black individuals who smoke. The present study investigated anxiety sensitivity and distress tolerance in relation to smoking abstinence expectancies among a sample of Black individuals who smoke.

METHOD

Participants were 86 Black adults who smoke cigarettes daily (M age = 46.07 years, SD = 10.37; 26.7% female). Four separate linear regression analyses were conducted to evaluate the relation between anxiety sensitivity, distress tolerance, and their interaction with each of the four smoking abstinence expectancies (i.e., somatic symptoms, positive consequences, harmful consequences, and negative mood).

RESULTS

Results indicated that higher anxiety sensitivity was related to higher somatic symptoms, harmful consequences, and negative mood abstinence expectancies, whereas distress tolerance was related to higher positive consequences. Further, anxiety sensitivity and distress tolerance interacted to confer greater expectancies for the positive consequences of quitting.

CONCLUSIONS

The current findings are among the first to document that anxiety sensitivity and distress tolerance are clinically relevant factors to consider when tailoring smoking cessation treatments for Black individuals who smoke. Future research is needed to examine distress tolerance and anxiety sensitivity as longitudinal predictors of smoking abstinence expectancies among Black individuals who smoke.

Interactive effects of financial strain and distress tolerance on prequit tobacco withdrawal symptoms in smokers preparing to initiate a quit attempt

Smokers experiencing greater financial strain are less likely to successfully quit smoking, possibly due to greater severity of tobacco withdrawal. However, limited research has explored whether individual-level psychological factors (i.e., distress tolerance) may buffer the deleterious effects of financial strain on withdrawal. This study examined the main and interactive effects of financial strain and distress tolerance on tobacco withdrawal experienced prior to quitting smoking among smokers preparing to initiate a quit attempt. Fifty-nine adult smokers completed a baseline session including a financial strain measure and subjective and behavioral assessments of distress tolerance. Participants were then instructed to initiate a quit attempt, without any behavioral or pharmacological assistance, 14 days following baseline. Prequit tobacco withdrawal symptoms were assessed once per day for 3 days prior to quit date. Linear regression models tested main and interactive effects between financial strain and distress tolerance on experiences and perceptions of prequit withdrawal. Findings demonstrated significant interactions between financial strain, distress tolerance, and perceptions of tolerating withdrawal. Negative associations found between higher distress tolerance and lower perceptions of tobacco withdrawal and negative mood as being "intolerable" prior to quitting were stronger for those experiencing greater levels of financial strain. Financial strain may negatively impact one's perceived ability to tolerate mood- and tobacco-related withdrawal prior to quitting. Yet, higher distress tolerance may buffer the effects of financial strain on smoking cessation processes. Psychosocial interventions designed to promote tolerance of distress from both internal and external stressors may benefit cessation efforts among smokers experiencing high financial strain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms

It has been suggested that nighttime nicotine withdrawal may help to explain why tobacco cigarette smokers are more likely than nonsmokers to experience clinically significant insomnia. There is also reason to believe that intolerance for withdrawal symptoms could play a role in withdrawal-related sleep disturbance. However, we are not aware of any previous research that examined whether smokers who endorse greater intolerance for smoking abstinence also report greater difficulty initiating and/or maintaining sleep. To address this question, 224 adult cigarette smokers (42.9% female, Mcigarettes per day = 21.3) completed the baseline portion of an experimental study that included assessment of current/historical smoking behavior, perceived intolerance for smoking abstinence, and insomnia severity and impact on functioning. The results indicated that, after accounting for general distress intolerance and sociodemographic factors, smokers who endorsed greater intolerance for nicotine withdrawal also reported greater insomnia severity and impact. Logistic regression further revealed that, for every 1-point increase in nicotine withdrawal intolerance scores, smokers were nearly twice as likely to score above threshold for clinically significant insomnia (p = .001). Collectively, these initial findings suggest that intolerance for nicotine withdrawal may warrant consideration as a potentially modifiable mechanistic factor in comorbid insomnia and nicotine/tobacco dependence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How laboratory studies of cigarette craving can inform the experimental alcohol craving literature

Interest in alcohol and other drug craving has flourished over the past two decades, and evidence has accumulated showing that craving can be meaningfully linked to both drug use and relapse. Considerable human experimental alcohol craving research since 2000 has focused on craving as a clinical phenomenon. Self-reported craving to drink typically has served as a catch-all for the craving construct in these studies, whereas few studies have considered craving as a process (or hypothetical construct) that interacts with other phenomena to affect use. In contrast to alcohol, we believe that recently there has been more mechanistic work targeting cigarette craving-related processes. Here, we briefly present a narrative review of studies of acute alcohol craving in humans that have been conducted during the past two decades. We then specify important ways in which alcohol and tobacco differ (e.g., the role of withdrawal), and we note the unique challenges in inducing robust alcohol craving states in the laboratory. Finally, we offer recommendations for how the alcohol field might advance its conceptual understanding of craving by adopting ideas and methods drawn from the smoking research literature. Specifically, we suggest that researchers extend their studies to not only examine the link between alcohol craving and relapse but also to focus on why and, in some instances, how alcohol cravings matter clinically, and the circumstances under which craving especially matters. We propose research to investigate the shifts in alcohol-related cognitive and affective processing that occur during alcohol craving states. Furthermore, we highlight the value of research examining the level of insight that individuals with varying levels of alcohol involvement possess about their own craving-related processing shifts. We believe that laboratory studies can provide rich opportunities to examine conceptual questions about alcohol craving that are central to addiction.

Distress Tolerance is Indirectly Related to Nicotine Use through the Smoking Motives

BACKGROUND AND OBJECTIVES

Previous research has shown that low ability to tolerate distress is indirectly related to problematic substance use through the substance use motives. This topic has been previously researched in alcohol and cannabis use; however, it has not yet been explored in tobacco use. We studied whether distress tolerance is indirectly associated with nicotine dependence through motives of tension reduction and habitual smoking.

DESIGN AND METHODS

A total sample of 451 (230 of which were women) daily and occasional Polish smokers (aged from 18 to 60 years) reported distress tolerance, motives for smoking, and nicotine dependence. We then conducted a mediation analysis with bootstrapping using PROCESS macro.

RESULTS

Distress tolerance was indirectly related to nicotine dependence through both motives independently. In terms of the sequential model, there was a significant indirect effect of distress tolerance on nicotine dependence through smoking motives: tension reduction and habit. The total effect of distress tolerance on nicotine dependence was insignificant.

CONCLUSIONS

Our findings suggest that individuals with low distress tolerance are especially prone to nicotine dependence if they use smoking as a coping mechanism and it becomes habitual. The current study highlights the importance of a multidimensional approach in dealing with nicotine dependence.

Very Light Daily Smoking in Young Adults: Relationships Between Nicotine Dependence and Lapse

INTRODUCTION

Very light daily smoking is increasingly common among young adults. Evidence suggests that levels of nicotine dependence vary significantly among young adults who engage in very light daily smoking. However, the links between dependence and clinically relevant outcomes (eg, lapse) in this population remain unclear. The goal of this study was to address this gap by evaluating how well different nicotine dependence scales predict lapse behavior among very light daily smoking young adults.

AIMS AND METHODS

Very light daily smokers (1-5 cigarettes/day) aged 18-25 participated in an initial laboratory session, during which nicotine dependence was assessed using four commonly used measures: the Fagerstrӧm Test for Cigarette Dependence (FTCD), the Hooked On Nicotine Checklist (HONC), the Transdisciplinary Tobacco Use Research Centers (TTURC) Nicotine Dependence Inventory, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). After a baseline period, eligible participants (n = 40) completed a 10-day abstinence incentive period in which they attempted to refrain from smoking to earn monetary rewards. Cox proportional hazards models were used to test whether dependence predicted days to first lapse.

RESULTS

FTCD scores significantly predicted days to lapse, as did scores on the FTCD item assessing time to first cigarette of the day (TTFC). No other dependence measures predicted time to lapse. Both the FTCD and TTFC continued to independently predict time to lapse after controlling for smoking frequency and duration.

CONCLUSIONS

The FTCD may be a particularly useful tool for capturing clinically meaningful variability in nicotine dependence among young adults who engage in very light daily smoking.

IMPLICATIONS

This is the first study to directly link self-reported nicotine dependence with the ability to achieve and maintain abstinence among very light daily smoking young adults. The results may aid clinicians in selecting among variable measures of nicotine dependence when assessing and treating this population.

Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity

Exposure to stress is associated with poor outcomes in people with chronic pain. Dispositional variables, such as pain catastrophizing and distress intolerance, may impact reactivity to stressors. Importantly, these variables can be modified with treatment. The aim of this study was to investigate whether pain catastrophizing and distress intolerance were associated with tolerance of a pain stressor or a psychosocial stressor, and heightened negative affect following these stressors. A sample of 50 adults with chronic pain completed self-report measures and pain and psychosocial stress inductions. Results indicated that pain catastrophizing was associated with heightened anxiety during pain induction. Distress intolerance was associated with negative affect following a psychosocial stressor, and with poorer tolerance of the psychosocial stressor. Pain catastrophizing and distress intolerance are related factors, however, they exhibit distinct associations with amplification of pain and psychosocial stress reactivity. These variables may be important treatment targets in people with chronic pain.

Anxiety Sensitivity and Distress Tolerance in Smokers: Relations With Tobacco Dependence, Withdrawal, and Quitting Success†

INTRODUCTION

This study examined relations of two affective vulnerabilities, high anxiety sensitivity (AS) and low distress tolerance (DT), with tobacco dependence, withdrawal, smoking cessation, and pharmacotherapy response.

METHODS

Smokers interested in quitting (N = 1067; 52.2% female, 28.1% African American) were randomized to 12 weeks of nicotine patch, nicotine patch plus nicotine lozenge, or varenicline. Baseline questionnaires assessed AS, DT, negative affect, anxiety, and dependence. Withdrawal was assessed the first-week post-quit via ecological momentary assessment.

RESULTS

DT, but not AS, predicted biochemically confirmed point-prevalence abstinence at multiple endpoints: weeks 4, 12, 26, and 52 post-quit (ps < .05); relations remained after controlling for pharmacotherapy treatment, AS, baseline negative affect, anxiety, and anxiety disorder history (ps < .05). Additional exploratory analyses examining week 4 abstinence showed DT predicted abstinence (p = .004) even after controlling for baseline dependence, post-quit withdrawal (craving and negative affect), and treatment. DT moderated treatment effects on abstinence in exploratory analyses (interaction p = .025); those with high DT were especially likely to be abstinent at week 4 with patch plus lozenge versus patch alone.

CONCLUSIONS

DT, but not AS, predicted abstinence over 1 year post-quit (higher DT was associated with higher quit rates), with little overlap with other affective measures. DT also predicted early abstinence independent of dependence and withdrawal symptoms. Results suggest low DT may play a meaningful role in motivation to use tobacco and constitute an additional affective risk factor for tobacco cessation failure beyond negative affect or clinical affective disorders.

IMPLICATIONS

People in a stop-smoking study who reported a greater ability to tolerate distress were more likely to quit smoking and remain smoke-free 1 year later. Smokers with high DT were more likely to be smoke-free 4 weeks after their target quit day if they received nicotine patch plus nicotine lozenge rather than nicotine patch alone.

TRIAL REGISTRATION

NCT01553084.

Distress Intolerance and Smoking Topography in the Context of a Biological Challenge

INTRODUCTION

Distress intolerance (DI), one's perceived or behavioral incapacity to withstand distress, is implicated in psychopathology and smoking. This study evaluated the effect of DI on smoking reinforcement in the context of a carbon dioxide (CO2) biological challenge.

METHODS

Adult daily smokers (n = 90; 48.9% female) were randomized to receive a single inhalation/breath of 35% CO2-enriched air (n = 45) or compressed room air (n = 45). Perceived DI was assessed before the challenge. Smoking reinforcement was examined via average post-challenge puff volume across puffs and at the puff-to-puff level.

RESULTS

Higher DI was associated with an increased average puff volume (b = -4.7, p = .031). CO2 produced decreased average puff volume compared with room air (b = -7.7, p = .018). There was a DI* condition interaction (ƒ2 = 0.02), such that CO2 decreased average puff volume compared with room air in smokers with higher DI (b = -13.9, t = -3.06, p = .003), but not lower DI. At the puff-to-puff level, there was a significant interaction between DI, condition, and cubic time (b = 0.0003, p =. 037). Specifically, room air produced large initial puff volumes that decreased from puff to puff over the cigarette for high- and low-DI smokers. CO2 produced persistent flat volumes from puff to puff over the cigarette for higher DI smokers, whereas CO2 produced puff volumes like that of room air in lower DI smokers.

DISCUSSION

Findings suggest DI heightens smoking reinforcement generally, and in the context of intense cardiorespiratory distress, is associated with stable and persistent smoking. DI is a promising therapeutic target that, if addressed through psychological intervention, may improve cessation outcomes by decreasing smoking reinforcement.

IMPLICATIONS

This study contributes to our understanding of the relationship between DI and smoking reinforcement, via examining these processes in response to acute cardiorespiratory distress. Specifically, we found that smokers who are less tolerant of distress, as opposed to those who are more tolerant, evince a decrease in average puff volume, and consistently low puff-to-puff volume, in response to a biological stressor. These findings suggest that smokers high in DI alter smoking behavior following acute cardiorespiratory distress, perhaps to reduce overstimulation, yet also persist in smoking in a manner that suggests an inability to achieve satiation.

Distress tolerance in relation to cessation history and smoking characteristics among adult daily smokers

INTRODUCTION

Distress tolerance (DT) is linked to smoking initiation, maintenance, and difficulty quitting. However, there is a lack of consistency in prior findings on DT's relations with conceptually linked smoking variables, and few studies have examined differences across DT domains. We examined interrelations between cessation history, smoking characteristics, and a full battery of multimethod DT measures.

METHODS

We conducted a two-session laboratory assessment with 106 adult, daily smokers with moderate or lower smoking-specific DT, assessed by the Intolerance for Smoking Abstinence Discomfort Questionnaire. Additional DT indices included the Distress Tolerance Scale and four validated behavioral measures (mirror-tracing, serial addition, cold pressor, and breath-holding tasks). Participants reported on cessation history (length and number of prior quit attempts, withdrawal severity at previous attempt) as well as years smoking, cigarettes per day, and nicotine dependence.

RESULTS

Withdrawal severity and nicotine dependence were consistently associated with lower self-reported DT, and associations were strongest with perceived tolerance of smoking-specific versus general distress. Length and number of prior quit attempts, years smoking, and cigarettes per day demonstrated a lack of robust associations with behavioral DT measures.

CONCLUSIONS

Findings suggest that perceived tolerance of smoking-specific distress may be the most robust indicator of cessation history and smoking characteristics.

Distress intolerance and withdrawal severity among daily smokers: The role of smoking abstinence expectancies

BACKGROUND

Distress intolerance (DI), the perceived inability to withstand distress, is implicated in cigarette smoking maintenance. Greater DI may contribute to anticipation of negative outcomes from smoking abstinence, which in turn could contribute to withdrawal symptom severity. The current study aimed to evaluate (1) the association between DI and acute abstinence expectancies and (2) the potential mediating role of abstinence expectancies in the relationship between DI and withdrawal symptom severity.

METHOD

Participants (n = 444) were daily smokers who reported at least one prior quit attempt, participating in a larger online study on distress and smoking. DI, subjective nicotine withdrawal, and smoking abstinence expectancies were assessed using the Distress Tolerance Scale (DTS), Minnesota Nicotine Withdrawal Scale (MNWS), and Smoking Abstinence Expectancies Questionnaire (SAEQ).

RESULTS

DTS was significantly negatively associated with SAEQ, specifically Negative Mood (r = -0.37, p < .001), Somatic Symptoms (r = -0.47, p < .001), and Harmful Consequences (r = -0.59, p < .001) subscales, but was not associated with Positive Expectancies subscale (r = 0.05, p = .31). Results indicated a significant effect of DTS on withdrawal symptom severity via SAEQ. Follow-up analyses indicated that the indirect effects were driven specifically by SAEQ Negative Mood and Harmful Consequences subscales.

DISCUSSION

DI is related to more negative abstinence expectancies, particularly affective aspects of abstinence, which may contribute to the severity of nicotine withdrawal symptoms. This study provides initial evidence of a specific cognitive process that may explain why DI contributes to heightened subjective experience of nicotine withdrawal symptoms.

Multi-method assessment of distress tolerance and smoking-related factors among adult daily smokers

Although distress tolerance (DT) is associated with smoking lapse and relapse outcomes, few studies have conducted a rigorous assessment of DT across domain and method in the context of acute abstinence. In a human laboratory-based study of 106 adult daily smokers, we examined between multiple indices of DT and smoking lapse, withdrawal processes, and motivation to quit. We expected that low DT would be associated with shorter latency to smoke, greater withdrawal severity, and lower motivation to quit. Following a smoking abstinence period (≥ 6 hr deprived), participants completed an assessment battery including both behavioral (mirror-tracing, serial addition, cold pressor, and breath-holding tasks) and self-report measures of DT (general and smoking-specific), withdrawal processes (craving, negative affect, and positive affect), and motivation to quit. Latency to smoke (range = 0-50 min) was assessed in a laboratory analogue task in which delaying smoking was monetarily rewarded. Behavioral and self-report DT indices displayed only modest intercorrelations, indicating different facets of this construct by domain and method of assessment. Tolerance of physical pain was uniquely associated with smoking choice. Both self-report DT measures were associated with abstinence-induced increases in negative affect, while only smoking-specific DT was positively associated with craving. Results are discussed within the context of guiding targeted behavioral interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development and validation of a contextual behavioral distress intolerance task in cigarette smokers

INTRODUCTION

Distress intolerance, an individual's perceived or actual inability to withstand negative emotional or physical distress, contributes to the maintenance of smoking. However, there is limited understanding of the contextual factors that impact distress intolerance in general or among smokers specifically. This study aimed to adapt and test a computerized behavioral persistence task that requires re-typing a passage while adhering to specific instructions (Contextual-Frustration Intolerance Typing Task [C-FiTT]). C-FiTT was designed to model contextual factors that influence distress intolerance, negative affect, and smoking urges.

METHOD

Daily smokers (n = 550) were recruited through the use of Qualtrics Panels. Using a 2 × 2 + 1 experimental design, participants were randomly assigned to one of four C-FiTT conditions that crossed task difficulty (low or high difficulty) with passage content (neutral or tobacco withdrawal text), or a neutral control group.

RESULTS

C-FiTT produced an average persistence time of 94.1 ± 114.3 s and 64.7% of participants self-terminated the task. C-FiTT also produced small to medium sized-increases in negative affect and smoking urges. Between-condition comparisons indicated that the high-difficulty C-FiTT produced shorter behavioral persistence, greater self-termination likelihood, and larger increases in negative affect and smoking urges. The combination of high-difficulty and withdrawal content resulted in the shortest persistence time, 100% self-termination rate, and largest increases in negative affect and smoking urges, compared to other conditions CONCLUSIONS: Findings provide initial evidence for the validity of C-FiTT in smokers within the context of tobacco withdrawal at low and high levels of task difficulty. Avenues for refinement and use of C-FiTT are discussed.

Intolerance for smoking abstinence among nicotine-deprived, treatment-seeking smokers

INTRODUCTION

The Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) assesses distress tolerance specific to nicotine withdrawal. Though developed to assess withdrawal-related distress, the IDQ-S has not been validated among nicotine-deprived, treatment-seeking smokers. The present study extended previous research by examining the predictive utility of the IDQ-S among abstinent, motivated-to-quit smokers.

METHODS

Abstinent, treatment-seeking smokers completed the IDQ-S Withdrawal Intolerance and Lack of Cognitive Coping scales, assessments of nicotine dependence and reinforcement, and smoking history at baseline. At baseline and at 24-h, 2-week, and 1-month follow-up, participants completed a smoking cue-reactivity task (collection of cue-elicited craving and negative affect), and assessments of cigarettes per day (CPD; daily diaries at follow-up), carbon monoxide (CO), and cotinine.

RESULTS

Greater IDQ-S Withdrawal Intolerance was associated with younger age, higher nicotine dependence and reinforcement, and less smoking years (ps < .03). Greater IDQ-S Lack of Cognitive Coping was associated with less education, lower nicotine dependence and reinforcement, higher baseline CPD, and no prior quit attempts (ps < .04). IDQ-S scales did not significantly predict cue-elicited craving or negative affect, CPD, CO, or cotinine levels at follow-up (ps > .10).

CONCLUSIONS

Withdrawal intolerance and lack of cognitive coping did not predict smoking outcomes among nicotine-deprived, treatment-seeking smokers, but were associated with smoking characteristics, including nicotine dependence and reinforcement. Withdrawal intolerance and lack of cognitive coping may not be especially useful in predicting craving and smoking behavior, but future studies should replicate the present study's findings and assess the stability of the IDQ-S before forming firm conclusions about its predictive utility.

Breath holding endurance: stability over time and relationship with self-assessed persistence

Breath holding (BH) endurance has been suggested as a measure of the distress tolerance that could predict the outcome of attempts to implement behavior changes, such as stopping smoking or illicit substance use. It is not known however, to what degree BH endurance is a variable trait that may vary depending on situational context, or a stable state characteristic. We measured BH in two groups of participants at baseline and 22 and 89 days (N = 62 and N = 41) post-baseline and in a third group at multiple times points across a 5-week period (N = 44). Participants also filled out a questionnaire created to assess their perceived persistence compared to peers. Correlations were found between baseline and final BH measures (r's > 0.67, p's < 0.0001) at all time points. When groups were combined, regardless of time point, Spearman's rank correlation showed a strong positive correlation (r_s = 0.66, p < 0.0001). Self-assessed persistence was not related to BH endurance. This study provides evidence of the stability of BH across time when tested under the same conditions in young adults. Further research is needed to clarify whether BH is linked to behavioral outcomes.

Distress tolerance dimensions and smoking behavior among Mexican daily smokers: A preliminary investigation

INTRODUCTION

Distress intolerance has been implicated in various aspects of smoking maintenance and quit behavior, although past work has been conducted almost exclusively among European American samples.

METHOD

The present study sought to extend past work by exploring distinct subdimensions of distress tolerance (Tolerance, Appraisal, Regulation, and Absorption) among a sample of 113 (53.1% female; M_age=22.81, SD=2.13) adult daily smokers from Mexico City, Mexico in regard to multiple indices of problematic smoking.

RESULTS

Results indicated that the Appraisal dimension of distress intolerance was associated with smoking more cigarettes per day, a greater number of (lifetime) failed quit attempts, and an increased likelihood of early smoking relapse. These findings remained significant after controlling for negative affectivity, gender, alcohol usage as well as the variance accounted for by other distress tolerance dimensions.

CONCLUSIONS

Such results provide novel preliminary empirical evidence that lesser perceived ability to tolerate distress because it is appraised as 'unacceptable' may be a particularly important element of the construct in terms of better understanding multiple public health relevant indicators of smoking for Mexican smokers. Overall, the present findings uniquely contribute to a growing body of research related to distress intolerance and its implications for explicating the nature of the maintenance of smoking behavior among a highly understudied segment of the smoking population (Mexican smokers).

Abstinence expectancies and quit attempts

INTRODUCTION

Several scales have been developed to measure expectancies about smoking cessation. This secondary analysis tested the reliability and validity of one of the most commonly used expectancy measures - the Perceived Risks and Benefits of Quitting Scale (PRBQ).

METHODS

Smokers (n=143) who planned to quit at some point in the next 3months entered an observational study in which they called an Interactive Voice Response system nightly for 3months to report quit attempts and abstinence. They completed the PRBQ at baseline and the end of 1, 2 and 3months. No treatment was provided.

RESULTS

The Risks scores and Benefit scores of the PRBQ had high internal reliability (alpha=0.88-0.96 across administrations) and high test-retest stability (ICC=0.67-0.80), but poor to moderate concurrent validity (correlation with other cessation measures=0.09-0.52), and poor predictive validity (no significant prediction of quit attempts or duration of abstinence). Results were similar for men and women.

CONCLUSIONS

The PRBQ appears to be reliable but, similar to other scales of cessation expectancies, its validity appears to be poor. The face valid notion that expectations influence quitting requires further testing.

Distress intolerance during smoking cessation treatment

Distress intolerance is a key vulnerability factor implicated in the maintenance and relapse of cigarette smoking. Yet, past work has not examined changes in these processes during smoking cessation treatment or their relation to smoking cessation outcomes. The aim of the present study was to examine the effect of two smoking cessation interventions on changes in self-report and behavioral distress intolerance indices during treatment, and whether these changes are associated with smoking cessation outcomes. Treatment-seeking smokers (N = 384) were randomly assigned to one of two 4-session smoking cessation treatment programs: Standard Cessation Program (SCP) or Smoking Treatment and Anxiety Management Program (STAMP). Quit dates were scheduled to coincide with the final treatment session. Physical domains of distress intolerance were assessed at baseline and at each weekly session, via the Discomfort Intolerance Scale (DIS; higher scores indicate more intolerance for discomfort) and Breath Holding Duration Task (shorter durations indicate more intolerance for respiratory distress). The STAMP condition produced a greater rate of reduction in DIS scores than did the SCP condition. Changes in DIS scores during treatment mediated the effect of STAMP treatment on 7-day point prevalence abstinence at Month 3 post-quit attempt. There were no treatment conditions differences in changes in Breath-Holding duration. Data suggest self-reported distress intolerance is malleable in the context of stress sensitivity reduction treatment, but not standard smoking cessation treatment, and such reductions may result in promotion of smoking abstinence.

Acute effects of cannabis on breath-holding duration

Distress intolerance (an individual's perceived or actual inability to tolerate distressing psychological or physiological states) is associated with cannabis use. It is unknown whether a biobehavioral index of distress intolerance, breath-holding duration, is acutely influenced (increased or decreased) by cannabis. Such information may further inform understanding of the expression of psychological or physiological distress postcannabis use. This within-subjects study examined whether smoked marijuana with 2.7%-3.0% delta-9-tetrahydrocannabinol (THC), relative to placebo, acutely changed duration of breath holding. Participants (n = 88; 65.9% male) were nontreatment-seeking frequent cannabis users who smoked placebo or active THC cigarette on two separate study days and completed a breath-holding task postsmoking. Controlling for baseline breath-holding duration and participant sex, THC produced significantly shorter breath-holding durations relative to placebo. There was a significant interaction of drug administration × frequency of cannabis use, such that THC decreased breath-holding time among less frequent but not among more frequent users. Findings indicate that cannabis may exacerbate distress intolerance (via shorter breath-holding durations). As compared to less frequent cannabis users, frequent users display tolerance to cannabis' acute effects including increased ability to tolerate respiratory distress when holding breath. Objective measures of distress intolerance are sensitive to contextual factors such as acute drug intoxication, and may inform the link between cannabis use and the expression of psychological distress. (PsycINFO Database Record

Does smoking abstinence influence distress tolerance? An experimental study comparing the response to a breath-holding test of smokers under tobacco withdrawal and under nicotine replacement therapy

Distress tolerance has been operationalized as task persistence in stressful behavioral laboratory tasks. According to the distress tolerance perspective, how an individual responds to discomfort/distress predicts early smoking lapses. This theory seems weakly supported by experimental studies since they are limited in number, show inconsistent results, do not include control conditions. We tested the response to a stressful task in smokers under abstinence and under no abstinence to verify if tobacco abstinence reduces task persistence, thus distress tolerance. A placebo-controlled, double-blind, randomized, cross-over design was used. Twenty smokers underwent a breath holding test after the administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline and directly before and after each challenge. Abstinence induced a statistically significant shorter breath holding duration relative to the nicotine condition. No different response to the breath holding test was observed when nicotine and placebo conditions were compared. No response to the breath holding test was found when pre- and post-test values of heart rate, blood pressure, Visual Analogue Scale for fear or discomfort were compared. In brief, tobacco abstinence reduces breath holding duration but breath holding test does not influence discomfort.

The role of distress intolerance for panic and nicotine withdrawal symptoms during a biological challenge

BACKGROUND

Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems.

METHOD

Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms.

RESULTS

The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity.

CONCLUSIONS

Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.

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

Identifying predictors of abstinence with voucher-based treatment is important for improving its efficacy. Smokers with substance use disorders have very low smoking cessation rates so identifying predictors of smoking treatment response is particularly important for these difficult-to-treat smokers. Intolerance for Smoking Abstinence Discomfort (IDQ-S), motivation to quit smoking, nicotine dependence severity (FTND), and cigarettes per day were examined as predictors of smoking abstinence during and after voucher-based smoking treatment with motivational counseling. We also investigated the relationship between IDQ-S and motivation to quit smoking. Smokers in residential substance treatment (n=184) were provided 14days of vouchers for complete smoking abstinence (CV) after a 5-day smoking reduction lead-in period or vouchers not contingent on abstinence. Carbon monoxide readings indicated about 25% of days abstinent during the 14days of vouchers for abstinence in the CV group; only 3-4% of all participants were abstinent at follow-ups. The IDQ-S Withdrawal Intolerance scale and FTND each significantly predicted fewer abstinent days during voucher treatment; FTND was nonsignificant when controlling for variance shared with withdrawal intolerance. The one significant predictor of 1-month abstinence was pretreatment motivation to quit smoking, becoming marginal (p<.06) when controlling for FTND. Lower withdrawal intolerance significantly predicted 3month abstinence when controlling for FTND. Higher withdrawal intolerance pretreatment correlated with less motivation to quit smoking. Implications for voucher-based treatment include the importance of focusing on reducing these expectancies of anticipated smoking withdrawal discomfort, increasing tolerance for abstinence discomfort, and increasing motivation.

Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity

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 article 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 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) 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.

Distress intolerance and worry: the mediating role of cognitive variables

BACKGROUND AND OBJECTIVES

Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions.

DESIGN

A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry.

METHODS

An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures.

RESULTS

Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry.

CONCLUSIONS

Results provide initial evidence that DI may be associated with worry via unique risk factors.

Prefrontal hemodynamic changes during cigarette smoking in young adult smokers with and without ADHD

Individuals with attention-deficit/hyperactivity disorder (ADHD) have elevated smoking prevalence and reduced cessation rates compared to the general population. However, the effects of cigarette smoking on underlying brain activity in smokers with ADHD are not well characterized. Non-invasive near-infrared spectroscopy (NIRS) was used to characterize how cigarette smoking affects prefrontal brain hemodynamics in smokers with and without ADHD. Prefrontal changes of oxy- and deoxyhemoglobin (HbO2 and HHb) were measured in six male adult smokers with ADHD and six age- and gender-matched control smokers. NIRS measurements were separated into four sequential time intervals, i.e., before smoking, during smoking, after smoking, and during a breath hold. Prefrontal HbO2 was lower during smoking in smokers with ADHD compared to control smokers. More specifically, smokers with ADHD showed decreased prefrontal HbO2 during smoking compared to breath hold, before and after smoking periods. In contrast, control smokers showed increased prefrontal HbO2 from before smoking to breath hold. Decreased prefrontal HbO2 in smokers with ADHD may reflect a smoking-induced change in prefrontal brain activity and microvasculature, which is not found in smokers without ADHD. The lower prefrontal HbO2 may be a biomarker for increased susceptibility to tobacco smoke in smokers with ADHD. Smoking in individuals with ADHD may increase vasoconstriction of cerebral arteries in the prefrontal cortex, which may contribute to a reduction in HbO2. The findings highlight the importance of smoking cessation, in particular in those smokers who use nicotine to self-medicate ADHD symptoms.