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An Examination of Anxiety Sensitivity as a Moderator of the Relationship Between Smoking Level and Posttraumatic Stress Symptoms among Trauma-Exposed Adults

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Abstract

The present investigation tested the prediction that global and lower-order factors of anxiety sensitivity (AS) would moderate the relationship between cigarette smoking level and posttraumatic stress symptom levels among 78 (59 female) traumatic event-exposed adults. Consistent with prediction, global levels of AS and levels of AS mental incapacitation and physical concerns moderated the association between smoking level and posttraumatic stress symptoms; the combination of high levels of AS and greater number of cigarettes smoked per day was associated with higher symptom levels than any other combination of these factors. In a test of specificity, these three aspects of AS did not moderate the relation between smoking level and depressive symptoms. These findings increase our understanding of the association between smoking and posttraumatic symptoms by integrating cognitive factors, such as AS, into current models of this common overlap. Theoretical and treatment implications are discussed.

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References

  • Acierno, R., Kilpatrick, D. G., Resnick, H. S., Saunders, B. E., Arellano, M. D., & Best, C. L. (2000). Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: Findings from the national survey of adolescents. Journal of Traumatic Stress, 13, 381–396.

    Article  PubMed  CAS  Google Scholar 

  • Acierno, R., Kilpatrick, D. G., Resnick, H. S., Saunders, B. E., & Best, C. L. (1996). Violent assault, posttraumatic stress disorder, and depression. Behavior Modification, 20, 363–384.

    Article  PubMed  CAS  Google Scholar 

  • Aiken, L. S., & West, S. G. (1991). Multiple Regression: Testing and interpreting interactions. Newbury Park, CA: Sage.

    Google Scholar 

  • American Cancer Society. (1999). Cancer facts and figures-1999. Atlanta: American Cancer Society.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author.

    Google Scholar 

  • Anda, R. F., Williamson, D. F., Escobedo, L. G., Mast, E. E., Giovino, G. A., & Remington, P. L. (1990). Depression and the dynamics of smoking: A national perspective. The Journal of the American Medical Association, 264, 1541–1545.

    Article  CAS  Google Scholar 

  • Asmundson, G. J. G., Norton, G. R., Allderdings, M. D., Norton, P. J., & Larsen, D. K. (1998). Posttraumatic stress disorder and work-related injury. Journal of Anxiety Disorders, 12, 57–69.

    Article  PubMed  CAS  Google Scholar 

  • Beckham, J. C., Kirby, A. C., Feldman, M. E., Hertzberg, M. A., Moore, S. D., Crawford, A. L., et al. (1997). Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder. Addictive Behaviors, 22, 637–647.

    Article  PubMed  CAS  Google Scholar 

  • Beckham, J. C., Roodman, A. A., Shipley, R. H., Hertzberg, M. A., Cunha, G. H., Kudler, H. S., et al. (1995). Smoking in Vietnam combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 8, 461–472.

    Article  PubMed  CAS  Google Scholar 

  • Bernstein, A., Zvolensky, M. J., Feldner, M. T., Lewis, S. F., Fauber, A. L., Leen-Feldner, E. W., et al. (2005). Anxiety sensitivity taxon and trauma: Discriminant associations for posttraumatic stress and panic symptomatology among young adults. Depression and Anxiety, 22, 138–149.

    Article  PubMed  Google Scholar 

  • Bernstein, A., Zvolensky, M. J., Feldner, M. T., Lewis, S. F., & Leen-Feldner, E. W. (2005). Anxiety sensitivity taxonicity: A concurrent test of cognitive vulnerability for posttraumatic stress symptomatology among young adults. Cognitive Behaviour Therapy, 34, 229–241.

    Article  PubMed  Google Scholar 

  • Breslau, N., Davis, G. C., & Schultz, L. R. (2003). Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Archives of General Psychiatry, 60, 289–294.

    Article  PubMed  Google Scholar 

  • Buckner, J. C., & Mandell, W. (1990). Risk factors for depressive symptomatology in a drug using population. American Journal of Public Health, 80, 580–585.

    Article  PubMed  CAS  Google Scholar 

  • Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Escobedo, L., Kirch, D., & Anda, R. (1996). Depression and smoking initiation among US Latinos. Addiction, 91, 113–119.

    Article  PubMed  CAS  Google Scholar 

  • Fedoroff, I. C., Taylor, S., Asmundson, G. J. G., & Koch, W. J. (2000). Cognitive factors in traumatic stress reactions: Predicting PTSD symptoms from anxiety sensitivity and beliefs about harmful events. Behavioural and Cognitive Psychotherapy, 28, 5–15.

    Google Scholar 

  • Feldner, M. T., Babson, K. A., & Zvolensky, M. J. (2007). Smoking, traumatic event exposure, and posttraumatic stress: A critical review of the empirical literature. Clinical Psychology Review, 27, 14–45.

    Article  PubMed  Google Scholar 

  • Feldner, M. T., Babson, K. A., Zvolensky, M. J., Vujanovic, A. A., Lewis, S. F., Gibson, L. E., et al. (2007). Posttraumatic stress symptoms and smoking to reduce negative affect: An investigation of trauma-exposed daily smokers. Addictive Behaviors, 32, 214–227.

    Article  PubMed  Google Scholar 

  • Feldner, M. T., Lewis, S. F., Leen-Feldner, E. W., Schnurr, P. P., & Zvolensky, M. J. (2006). Anxiety sensitivity as a moderator of the relation between trauma exposure frequency and posttraumatic stress symptomatology. Journal of Cognitive Psychotherapy: An International Quarterly, 20, 201–213.

    Article  Google Scholar 

  • Foa, E. (1995). Posttraumatic stress diagnostic scale. Minneapolis, MN: National Computer Systems.

    Google Scholar 

  • Foa, E., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic stress diagnostic scale. Psychological Assessment, 9, 445–451.

    Article  Google Scholar 

  • Frederick, T., Frerichs, R., & Clark, V. (1988). Personal health habits and symptoms of depression at the community level. Preventive Medicine, 17, 173–182.

    Article  PubMed  CAS  Google Scholar 

  • Friedman, M. J. (2002). Future pharmacotherapy for post-traumatic stress disorder: Prevention and treatment. The Psychiatric Clinics of North America, 25, 427–441.

    Article  PubMed  Google Scholar 

  • Gilboa-Schechtman, E., & Foa, E. B. (2001). Patterns of recovery from trauma: The use of intraindividual analysis. Journal of Abnormal Psychology, 110, 392–400.

    Article  PubMed  CAS  Google Scholar 

  • Griffin, M. G., Uhlmansiek, M. H., Resick, P. A., & Mechanic, M. B. (2004). Comparison of the posttraumatic stress disorder scale versus the Clinician-administered posttraumatic stress disorder scale in domestic violence survivors. Journal of Traumatic Stress, 17, 497–503.

    Article  PubMed  Google Scholar 

  • Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27, 87–96.

    Article  PubMed  Google Scholar 

  • Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2004). Monitoring the future national survey results on drug use, 1975-2003. Volume I: Secondary school students (NIH Publication No. 04-5507). Bethesda, MD: National Institute on Drug Abuse.

  • Keogh, E., Ayers, S., & Francis, H. (2002). Does anxiety sensitivity predict post-traumatic stress symptoms following childbirth? A preliminary report. Cognitive Behaviour Therapy, 31, 145–155.

    Article  Google Scholar 

  • Kessler, R., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

    PubMed  CAS  Google Scholar 

  • Kilpatrick, D. G., & Resnick, H. S. (1993). Posttraumatic stress disorder associated with exposure to criminal victimization in clinical and community populations. In J. R. T. Davidson, & E. B. Foa (Eds.), Posttraumatic stress disorder: DSM-IV and beyond (pp. 113–143). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Lang, A. J., Kennedy, C. M., & Stein, M. B. (2002). Anxiety sensitivity and PTSD among female victims of intimate partner violence. Depression and Anxiety, 16, 77–83.

    Article  PubMed  Google Scholar 

  • Leen-Feldner, E. W., Zvolensky, M. J., van Lent, J., Vujanovic, A. A., Bleau, T., Bernstein, A., et al. (in press). Anxiety sensitivity moderates tobacco smoking in regard to panic attack symptoms and bodily complaints: A concurrent test among adolescents. Journal of Psychopathology and Behavioral Assessment.

  • Maltby, N., Mayers, M. F., Allen, G. J., & Tolin, D. F. (2005). Anxiety sensitivity: Stability in prospective research. Journal of Anxiety Disorders, 19, 708–716.

    Article  PubMed  Google Scholar 

  • McClernon, F. J., Beckham, J. C., Mozley, S. L., Feldman, M. E., Vrana, S. R., & Rose, J. E. (2005). The effects of trauma recall on smoking topography in posttraumatic stress disorder and non-posttraumatic stress disorder trauma survivors. Addictive Behaviors, 30, 247–257.

    Article  PubMed  Google Scholar 

  • McMillen, R. C., Ritchie, L. A., Frese, W., & Cosby, A. G. (2000). Smoking in America: 35 years after the Surgeon General’s Report: A Report on the 2000 National Social Climate Survey. Tobacco Control. Surveys and Program Evaluations from Outside UCSF. Paper NSC1. http://repositories.cdlib.org/tc/surveys/NSC1.

  • Miller, G. A., & Chapman, J. P. (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology, 110, 40–48.

    Article  PubMed  CAS  Google Scholar 

  • Morissette, S. B., Brown, T. A., Kamholz, B. W., & Gulliver, S. B. (2006). Differences between smokers and nonsmokers with anxiety disorders. Journal of Anxiety Disorders, 20, 597–613.

    Article  PubMed  Google Scholar 

  • Morissette, S. B., Tull, M. T., Gulliver, S. B., Kamholz, B. W., & Zimering, R. T. (2007). Anxiety, anxiety disorders, tobacco use, and nicotine: A critical review of interrelationships. Psychological Bulletin, 133, 245–272.

    Article  PubMed  Google Scholar 

  • Peterson, R. A., & Reiss, S. (1992). Anxiety sensitivity index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.

    Google Scholar 

  • Pfefferbaum, B., Vinekar, S. S., Trautman, R. P., Lensgraf, S. J., Reddy, C., Patel, N., et al. (2002). The effect of loss and trauma on substance use behavior in individuals seeking support services after the 1995 Oklahoma City bombing. Annals of Clinical Psychiatry, 14, 89–95.

    Article  PubMed  Google Scholar 

  • Pomerleau, O. F., Pomerleau, C. S., & Marks, J. L. (2000). Abstinence effects and reactivity to nicotine during 11 days of smoking deprivation. Nicotine and Tobacco Research, 2, 149–157.

    Article  PubMed  CAS  Google Scholar 

  • Pomerleau, O. F., Pomerleau, C. S., Mehringer, A. M., Snedecor, S. M., Ninowski, R., & Sen, A. (2005). Nicotine dependence, depression, and gender: Characterizing phenotypes based on withdrawal discomfort, response to smoking, and ability to abstain. Nicotine and Tobacco Research, 7, 91–102.

    Article  PubMed  Google Scholar 

  • Presley, C. A., Meilman, P. W., & Leichliter, J. S. (2002). College factors that influence drinking. Journal of Studies on Alcohol, 14, 82–90.

    Google Scholar 

  • Rapee, R., & Medoro, L. (1994). Fear of physical sensations and trait anxiety as mediators of the response to hyperventilation in nonclinical subjects. Journal of Abnormal Psychology, 4, 693–699.

    Article  Google Scholar 

  • Reiss, S. (1991). An expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153.

    Article  Google Scholar 

  • Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107–121). San Diego, CA: Academic Press.

    Google Scholar 

  • Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.

    Article  PubMed  CAS  Google Scholar 

  • Schnurr, P. P., Spiro, A., Vielhauer, M. J., Findler, M. N., & Hamblen, J. L. (2002). Trauma in the lives of older men: Findings from the normative aging study. Journal of Clinical Geropsychology, 8, 175–187.

    Article  Google Scholar 

  • Schnurr, P. P., & Vielhauer, M. J. (1999). Personality as a risk factor for PTSD. In R. Yehuda (Eds.), Risk factors for posttraumatic stress disorder (pp. 191–222). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Sechrest, L. (1963). Incremental validity: A recommendation. Educational and Psychological Measurement, 23, 153–158.

    Article  Google Scholar 

  • Shalev, A., Bleich, A., & Ursano, R. J. (1990). Posttraumatic stress disorder: Somatic comorbidity and effort tolerance. Psychosomatics, 31, 197–203.

    PubMed  CAS  Google Scholar 

  • State of Vermont Department of Health. (2000). Retrieved October 3, 2006, from http://healthvermont.gov/research/2003pop/RACENOTE03.PDF.

  • Stewart, S. H., Conrod, P. J, Samoluk, S. B., Pihl, R. O., & Dongier, M. (2000). Posttraumatic stress disorder symptoms and situation-specific drinking in women substance abusers. Alcoholism Treatment Quarterly, 18, 31–47.

    Article  Google Scholar 

  • Stewart, S. H., Taylor, S., & Baker, J. M. (1997). Gender differences in dimensions of anxiety sensitivity. Journal of Anxiety Disorders, 11, 179–200.

    Article  PubMed  CAS  Google Scholar 

  • Taylor, S. (2003). Anxiety sensitivity and its implications for understanding and treating PTSD. Journal of Cognitive Psychotherapy: An International Quarterly, 17, 179–186.

    Article  Google Scholar 

  • Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., Jaimez, T. L., & Lucas, R. (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31, 279–287.

    Article  PubMed  CAS  Google Scholar 

  • United States Department of Health and Human Services. (1994). Preventing tobacco use among young people: A report of the Surgeon General. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease and Prevention and Health Promotion, Office on Smoking and Health.

  • United States Department of Health and Human Services. (2004). The health consequences of smoking: A report of the Surgeon General. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease and Prevention and Health Promotion, Office on Smoking and Health.

  • Vlahov, D., Galea, S., Resnick, H., Ahern, J., Boscarino, J. A., Bucuvalas, M., et al. (2002). Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks. American Journal of Epidemiology, 155, 988–996.

    Article  PubMed  Google Scholar 

  • Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.

    Article  PubMed  Google Scholar 

  • Watson, D., Weber, K., Assenheimer, J. S., Clark, L. A., Strauss, O., & McCormick, J. (1995). Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. Journal of Abnormal Psychology, 104, 3–14.

    Article  PubMed  CAS  Google Scholar 

  • Weaver, T. L., & Etzel, J. C. (2003). Smoking patterns, symptoms of PTSD and depression: Preliminary findings from a sample of severely battered women. Addictive Behaviors, 28, 1665–1679.

    Article  PubMed  Google Scholar 

  • Wechsler, H., Rigotti, N. A., Gledhile-Hoyt, J., & Lee, H. (1998). Increased levels of cigarette use among college students: A cause for national concern. The Journal of the American Medical Association, 280, 1673–1678.

    Article  CAS  Google Scholar 

  • Zatzick, D. F., Kang, S., Müller, H., Russo, J. E., Rivara, F. P., Katon, W., et al. (2002). Predicting posttraumatic distress in hospitalized trauma survivors with acute injuries. American Journal of Psychiatry, 159, 941–946.

    Article  PubMed  Google Scholar 

  • Zinbarg, R. E., Barlow, D. H., & Brown, T. A. (1997). Hierarchical structure and general factor structure saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277–284.

    Article  Google Scholar 

  • Zinbarg, R. E., Mohlman, J., & Hong, N. N. (1999). Dimensions of anxiety sensitivity. Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 83–114). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Zvolensky, M. J., Baker, K. M., Leen-Feldner, E. W., Bonn-Miller, M. O., Feldner, M. T., & Brown, R. A. (2004). Anxiety sensitivity: Association with intensity of retrospectively-rated smoking-related withdrawal symptoms and motivation to quit. Cognitive Behaviour Therapy, 33, 114–125.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Bonn-Miller, M. O., Feldner, M. T., Leen-Feldner, E., McLeish, A. C., & Gregor, K. (2006). Anxiety sensitivity: Concurrent association with negative affect smoking motives and abstinence self-confidence among young adult smokers. Addictive Behaviors, 31, 429–439.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Kotov, R., Antipova, A. V., & Schmidt, N. B. (2003). Cross cultural evaluation of smokers risk for panic and anxiety pathology: A test in a Russian epidemiological sample. Behaviour Research and Therapy, 41, 1199–1215.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Kotov, R., Antipova, A. V., & Schmidt, N. B (2005). Diathesis-stress model for panic-related distress: A test in a Russian epidemiological sample. Behaviour Research and Therapy, 43, 521–532.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Sachs-Ericsson, N., Feldner, M. T., Schmidt, N. B., & Bowman, C. (2006). Neuroticism moderates the effect of maximum smoking level on lifetime panic disorder: A test using an epidemiologically defined national sample of smokers. Psychiatry Research, 141, 321–332.

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors would like to thank Dr E.W. Leen-Feldner for her comments on earlier drafts of this manuscript.

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Authors and Affiliations

  1. Intervention Sciences Laboratory, Division of the Anxiety Research Center, Department of Psychology, University of Arkansas, 216 Memorial Hall, Fayetteville, AR, 72701, USA

    Matthew T. Feldner & Kimberly A. Babson

  2. University of Vermont, Burlington, VT, USA

    Michael J. Zvolensky, Marcel O. Bonn-Miller & Laura E. Gibson

  3. VA National Center for PTSD, Women’s Health Sciences Division and Boston University School of Medicine, Boston, MA, USA

    Candice M. Monson

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  1. Matthew T. Feldner
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  2. Kimberly A. Babson
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  3. Michael J. Zvolensky
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  4. Candice M. Monson
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  5. Marcel O. Bonn-Miller
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  6. Laura E. Gibson
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Correspondence to Matthew T. Feldner.

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Feldner, M.T., Babson, K.A., Zvolensky, M.J. et al. An Examination of Anxiety Sensitivity as a Moderator of the Relationship Between Smoking Level and Posttraumatic Stress Symptoms among Trauma-Exposed Adults. Cogn Ther Res 32, 116–132 (2008). https://doi.org/10.1007/s10608-007-9138-x

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