Anxiety Sensitivity and Smoking Topography: A Multi-Method Experimental Investigation

Introduction: Anxiety sensitivity, the tendency to catastrophically interpret the meaning of anxiety-relevant interoceptive sensations, is implicated in the acquisition and maintenance of anxiety symptoms/disorders and aspects of cigarette smoking. Smokers who tend to perceive interoceptive sensations as harmful or dangerous may be more likely to smoke for affect-regulatory purposes. The present study tested an experimental model of negative reinforcement-based smoking motivation by examining the extent to which laboratory-induced physiological arousal impacts smoking urges, craving, smoking topography (puff style), and the moderating role of anxiety sensitivity. Method: Adult daily smokers (n = 90; Mage = 43.6 [SD = 9.7]; average 15.8 cigarettes per day) were recruited to participate in a single-session experimental study. Participants were randomly assigned to complete a biological challenge procedure, used as an experimental emotion-provocation task that consisted of a single vital capacity inhalation of 35% CO2-enriched air mixture or compressed room air (control condition). Smoking urges and smoking topography (puff behavior) were assessed before and after the challenge. Results: Exposure to the 35% CO2-enriched air experimental condition, relative to room air, elicited significantly higher levels of subjective distress (b = 0.72, p = .013), panic attack symptoms (b = 1.13, p < .0001), heart rate (b = 0.14, p = .002), and respiration rate (b = 0.47, p < .038). All effects were medium to large in size (Cohen’s d range = 0.53 – 1.13). Results revealed a main effect of experimental condition in terms of self-report smoking urges post-challenge (b = -81.26, p = .048; d = -0.45), such that smokers exposed to the 35% CO2-enriched air reported significantly lower smoking urges post-challenge, relative to the room air condition. There was a significant interaction between anxiety sensitivity and experimental condition (b = -9.96, p = .014; d = -.56), such that high anxiety sensitive smokers exposed to 35% CO2-enriched air reported significantly lower levels of smoking urges, relative to low anxiety sensitive smokers, and anxiety sensitivity did not differentially impact smoking urges for those exposed to room air. Regarding smoking topography, results revealed a non-significant main effect of experimental condition in terms of latency to smoking initiation or average inter-puff interval post-challenge. There was a significant condition effect for average puff volume (b = -8.11, p = .048) and puff duration (b = -144.39, p = .050), such that exposure to 35% CO2-enriched air relative to room air, resulted in significantly smaller and shorter puff inhalations while smoking (Cohen’s d = -0.43). There were no significant interaction effects of experimental condition by anxiety sensitivity for any of the smoking topography outcomes. Discussion: The experience of abrupt physiological distress may immediately result in decreased subjective smoking urges and changes in puff behavior (smaller volume; shorter duration), likely due to intensity of the cardiorespiratory distress experienced from the 35% CO2-enriched air manipulation. This appeared to be particularly true for smokers high in anxiety sensitivity, at least in the case of subjective smoking urges. Findings are contextualized with the existing literature examining mechanistic factors linking panic attacks and smoking.