Impact of Posttraumatic Stress Disorder on early smoking lapse and relapse during a self-guided quit attempt among community-recruited daily smokers
Abstract
The present investigation examined whether daily smokers with posttraumatic stress disorder (PTSD), as compared to daily smokers with either anxiety psychopathology or no current Axis I psychopathology, have decreased success in the early phases of a self-guided smoking quit attempt. Participants were 140 daily smokers (81 women; M (age) = 29.5; SD = 11.9; range = 18-65 years); approximately one-third of the sample met criteria for current PTSD (n = 47), one-third met criteria for other current anxiety disorders (without PTSD; n = 33), and one-third did not meet criteria for any current Axis I disorder (n = 60). Consistent with prediction, membership in the PTSD group, compared to membership in the other anxiety disorders group and the group with no current Axis I psychopathology, was associated with increased risk of lapse during the first week following quit day. Additionally, daily smokers with PTSD and other anxiety disorders were at significantly increased risk of relapse during the first week post-cessation compared to persons without Axis I psychopathology. However, the PTSD group and the other anxiety disorders group did not differ from one another in terms of relapse. Results suggest that PTSD is associated with increased risk of smoking lapse and relapse compared to smokers with no current Axis I psychiatric problems, and increased risk of early smoking lapse but not relapse, as compared to those with other anxiety disorders. Findings provide novel evidence that PTSD, and perhaps anxiety disorders more generally, may be important factors in reducing the odds of successful unaided quit attempts in the early phases of cessation.
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Depression and anxiety place smokers at increased risk for cessation failure, though some studies suggest the evidence is inconclusive.
“Considerable research has assessed the impact of depression and anxiety on cessation outcomes, with a number of studies reporting that depression and anxiety place smokers at increased risk for cessation failure [9-14], with other studies suggesting that the evidence is inconclusive [6,15-18].”
From Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study (2023) · cites this paper as [14]
Anxiety and depressive pathology significantly impair cessation success.
“anxiety and depressive pathology significantly impair cessation success (Piper et al., 2010; Zvolensky et al., 2008; Leventhal & Zvolensky, 2015; Piper et al., 2011).”
From A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation. (2019) · cites this paper as Zvolensky et al., 2008
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“Finally, some research suggests that anxiety disorders may reduce quitting success [2,13], although the evidence is mixed on this point [9,12].”
BackgroundTobacco addiction and the dysregulation of brain stress systems
Bruijnzeel, A. W. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.02.015 · Cited by 172 · see citing works
“However, both the PTSD patients and the patients with other anxiety disorders were more likely to relapse than the control subjects and there was no difference in relapse rates between the PTSD patients and the patients with other anxiety disorders (Zvolensky et al., 2008).”
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“Although effort has been made to address anxiety sensitivity ( Zvolensky, Lejuez, Kahler, & Brown, 2003 ; Zvolensky et al., 2008 ) and depressive problems ( Muñoz, Marín, Posner, & Pérez-Stable, 1997 ; Thorsteinsson et al., 2001 ) in smoking cessation treatments, integrated, multirisk factor…”
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“This is notable, given prior evidence implicating some anxiety and substance use disorders as risk factors for smoking relapse (Breslau, Peterson, Schultz, Andreski, & Chilcoat, 1996; Piper, Cook, Schlam, Jorenby, & Baker, 2011; Zvolensky et al., 2008).”
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“Little is known about the experience of withdrawal symptoms in smokers with a current Axis I disorder although two recent studies suggest that smokers with current anxiety disorders endorse a greater number of withdrawal symptoms (Zvolensky et al., 2008) and report more severe withdrawal (Marshall et al.”
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“Multiple studies have also shown that higher pre-quit depressive and anxiety symptoms and syndromes predict poorer smoking outcomes (Brown et al., 2001; Cinciripini et al., 2003; Haas et al., 2004; Leventhal et al., 2008a; Piper et al., 2010, 2011; Zvolensky et al., 2008).”
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BackgroundResultInfluentialCommunity Engaged Leadership to Advance Health Equity and Build Healthier Communities
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“Moreover, PTSD smokers are less able to quit smoking and have a shorter time to first smoking lapse within the first week of a quit attempt (Zvolensky et al., 2008).”
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Malte, C. A., Dennis, P. A., Saxon, A. J., McFall, M., Carmody, T. P., Unger, W. S., & Beckham, J. C. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.10.034 · Cited by 10 · see citing works
Individual and Combined Impact of Cigarette Smoking, Anxiety, and Mood Disorders on Asthma Control
Ouellet, K., Bacon, S., Boudreau, M., Plourde, A., Moullec, G., & Lavoie, K. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntr315 · Cited by 10 · see citing works
Zvolensky, M. J., Farris, S. G., Leventhal, A. M., Ditre, J. W., & Schmidt, N. B. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.08.012 · Cited by 9 · see citing works
Self-citationGarey, L., Bakhshaie, J., Vujanovic, A. A., Reitzel, L. R., Schmidt, N. B., & Zvolensky, M. J. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.03.038 · Cited by 9 · see citing works
“Additionally, contrary to prior research, no association emerged between posttraumatic stress symptom severity and smoking rate (Feldner et al., 2007; Zvolensky et al., 2008); this finding suggests that these variables may not be related in trauma-exposed, treatment seeking smokers.”
Self-citationChase, T. E., Teng, E. J., Schmidt, N. B., & Zvolensky, M. J. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000866 · Cited by 8 · see citing works
Self-citationJapuntich, S. J., Lee, L. O., Pineles, S. L., Gregor, K. L., Joos, C. M., Patton, S. C., Krishnan‐Sarin, S., & Rasmusson, A. M. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.10.042 · Cited by 9 · see citing works
“These results compare favorably to a study of unaided smoking cessation in which only 6% of participants with PTSD maintained abstinence for a week (Zvolensky et al., 2008).”
ResultSelf-citationBakhshaie, J., Zvolensky, M. J., Langdon, K. J., Leventhal, A. M., Smits, J. A. J., Allan, N. P., & Schmidt, N. B. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.009 · Cited by 8 · see citing works
“Various types of emotional disorders, including major depression (Leventhal et al., 2012), posttraumatic stress disorder (Zvolensky et al., 2008), and anxiety disorders (Piper et al., 2011) demonstrate an association with smoking behavior.”
Self-citationLabbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., Norton, P. J., & O’Cleirigh, C. (2017) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.03.009 · Cited by 8 · see citing works
Self-citationAsnaani, A., Farris, S. G., Carpenter, J. K., Zandberg, L. J., & Foa, E. B. (2015) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9685-5 · Cited by 8 · see citing works
“2008), and poorer outcomes in smoking cessation programs (Zvolensky et al. 2008; Beckham et al. 2013).”
BackgroundLeyro, T. M., Zvolensky, M. J., Vujanovic, A. A., Johnson, K., & Gregor, K. L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902767621 · Cited by 7 · see citing works
“These exclusionary criteria were evaluatedwitha standardized interview that has been successfully used in past work (Zvolensky et al., 2008).”
MethodSelf-citationAnxiety Sensitivity and Smoking Behavior Among Trauma-Exposed Daily Smokers
Bakhshaie, J., Zvolensky, M. J., Salazar, A. M. R., Vujanovic, A. A., & Schmidt, N. B. (2015) · Behavior Modification · doi:10.1177/0145445515612402 · Cited by 7 · see citing works
Self-citationDedert, E. A., Hicks, T. A., Dennis, P. A., Calhoun, P. S., & Beckham, J. C. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.04.007 · Cited by 6 · see citing works
“In addition, smokers with PTSD tend to lapse more quickly during quit attempts edical Center, 3022 Croasdaile (Zvolensky et al., 2008),making thefirstweek of the quit attempt a critical time period for understanding the factors influencing smoking lapse.”
BackgroundFlanagan, J. C., Hakes, J. K., McClure, E. A., Snead, A. L., & Back, S. E. (2016) · American Journal on Addictions · doi:10.1111/ajad.12381 · Cited by 7 · see citing works
“The six IPV items (using the victimization phrasing; each item was also posed to elicit endorsement of perpetration of IPV) were “How often did your spouse/partner (1) push, grab, or shove you in the past year, (2) slap, kick, bite, or hit you in the past year?, (3) threaten you with a weapon like a knife or gun in th…”
MethodGarey, L., Bakhshaie, J., Vujanovic, A. A., Leventhal, A. M., Schmidt, N. B., & Zvolensky, M. J. (2015) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000091 · Cited by 6 · see citing works
“Compared with individuals not exposed to a traumatic event, trauma-exposed individuals (with or without PTSD) are more likely to be smokers, tend to smoke more heavily, have higher levels of nicotine dependence, and show poorer outcomes during quit attempts (Feldner et al., 2007; Zvolensky et al., 2008).”
BackgroundSelf-citationGross, G. M., Colon, R., Bastian, L. A., & Hoff, R. A. (2020) · Women s Health Issues · doi:10.1016/j.whi.2020.03.001 · Cited by 5 · see citing works
Patterns and Predictors of Smoking Cessation
Ditre, J. W., Zale, E. L., & Brandon, T. H. (2015) · Progress in respiratory research/Progress in research in emphysema and chronic bronchitis/Progress in respiration research · doi:10.1159/000369500 · Cited by 5 · see citing works
Zvolensky, M., Shepherd, J., Clausen, B. K., Robison, J. H., Cano, M., de Dios, M. A., & Correa-Fernández, V. (2024) · Journal of behavioral medicine · doi:10.1007/s10865-024-00480-8 · Cited by 4 · see citing works
Self-citationProactive tobacco treatment for veterans with posttraumatic stress disorder.
Hammett, P. J., Japuntich, S. J., Sherman, S. E., Rogers, E., Danan, E. R., Noorbaloochi, S., Shahawy, O. E., Burgess, D. J., & Fu, S. S. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000613 · Cited by 4 · see citing works
“Furthermore, smokers with PTSD are less likely to quit smoking successfully and relapse more quickly after attempting to quit (Beckham, Calhoun, Dennis, Wilson, & Dedert, 2013; Hapke et al., 2005; Zvolensky et al., 2008).”
BackgroundLabbe, A. K., Wilner, J. G., Coleman, J. N., Marquez, S. M., Kosiba, J. D., Zvolensky, M. J., Smits, J. A. J., Norton, P. J., Rosenfield, D., & O'Cleirigh, C. (2019) · AIDS Care · doi:10.1080/09540121.2018.1533225 · Cited by 3 · see citing works
“, 2008), and anxiety and depressive pathology significantly impair cessation success (Leventhal & Zvolensky, 2015; Piper, Cook, Schlam, Jorenby, & Baker, 2011; Piper, Smith et al., 2010; Zvolensky et al., 2008).”
BackgroundSelf-citationStephenson, K. R., Latimer, S. R. E., Zippan, N., & Brotto, L. A. (2023) · Archives of Sexual Behavior · doi:10.1007/s10508-023-02685-5 · Cited by 3 · see citing works
“In some cases, researchers have found that a history of trauma may predict poorer response to treatment for disorders such as nicotine abuse or depression (Lewis et al., 2010; Sbrilli et al., 2020; Zvolensky et al., 2008).”
BackgroundSantiago-Torres, M., Mull, K. E., Sullivan, B. M., Prochaska, J. J., Zvolensky, M. J., & Bricker, J. B. (2024) · Depression and Anxiety · doi:10.1155/2024/1055801 · Cited by 3 · see citing works
“Considering the profound in fl uence of negative affect states and regulatory challenges in managing symptoms of mental illness [9, 16, 17, 18], smoking cessation treatments that address these inner psychological experiences could hold promise.”
Self-citationCorrea-Fernández, V., Blalock, J. A., Piper, M. E., Canino, G., & Wetter, D. W. (2023) · JMIR Research Protocols · doi:10.2196/44146 · Cited by 2 · see citing works
“Considerable research has assessed the impact of depression and anxiety on cessation outcomes, with a number of studies reporting that depression and anxiety place smokers at increased risk for cessation failure [9-14], with other studies suggesting that the evidence is inconclusive [6,15-18].”
ResultMathew, A. R., Cook, J. W., Japuntich, S. J., & Leventhal, A. M. (2014) · American Journal on Addictions · doi:10.1111/j.1521-0391.2014.12170.x · Cited by 2 · see citing works
Feldner, M. T., Leen‐Feldner, E. W., Knapp, A. A., Dutton, C. E., & Bujarski, S. J. (2014) · Addiction Research & Theory · doi:10.3109/16066359.2014.920014 · Cited by 1 · see citing works
“Consistent with past work (Brown, Lejuez, Kahler, & Strong, 2002; Feldner, Zvolensky, Babson, LeenFeldner, & Schmidt, 2008; Zvolensky et al., 2008), parental smoking was measured via an adapted Smoking History Questionnaire, which includes standardized smoking history and current status indices as…”
MethodSelf-citationEpidemiology of Trauma- and Stressor-Related Disorders
Benedek, D. M. (2018) · doi:10.1093/med/9780190457136.003.0007 · Cited by 1 · see citing works
Reinventing Healthy Communities: Implications for Individual and Societal Well-Being
Marx, J. (2016) · MDPI eBooks · doi:10.3390/books978-3-03842-263-1 · Cited by 1 · see citing works
Correa-Fernández, V., Tavakoli, N., Motsenbocker, M., Kim, H., Wetter, D. W., Blalock, J. A., Canino, G., & Piper, M. E. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100776 · Cited by 1 · see citing works
Commentary on Hajek et al. (2010): Investigating the stress reduction in smoking cessation
Dempsey, J. P., & Cohen, L. M. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.03084.x
An Inclusive Model of Posttraumatic Stress Disorder and Substance Use Disorder Comorbidity
Kenner, F. (2012) · OhioLink ETD Center (Ohio Library and Information Network)
Investigating Tobacco Withdrawal In Opioid-Maintained Smokers And Smokers With Other Vulnerabilities
Streck, J. M. (2020) · ScholarWorks -A service of University of Vermont Libraries (University of Vermont)
Zvolensky, M. J., Johnson, K., Yartz, A. R., & Leen‐Feldner, E. W. (2009) · Springer eBooks · doi:10.1007/978-0-387-09757-2_33
Self-citation
- Authors
- Zvolensky, M., Gibson, L., Vujanovic, A., Gregor, K., Bernstein, A., Kahler, C., Legues, C. W., Brown, R., & Feldner, M.
- Affiliations
- University of Vermont (US)
- VA Palo Alto Health Care System (US)
- Brown University (US)
- University of Maryland, College Park (US)
- Butler Hospital (US)
- University of Arkansas at Fayetteville (US)
- Corresponding author
- Zvolensky, Michael
- ORCID
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-08
- Volume
- 10
- Issue
- 8
- Pages
- 1415-1427
- ISSN
- 1462-2203 (ISSN-L)
- OpenAlex
- W2049931274
- Cited by
- 104
- References
- 0
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 2 · 2021: 6 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 14 · 2015: 12 · 2014: 11 · 2013: 5 · 2012: 7
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01da018734-03)
- National Institute of Mental Health (MH 076629-01, R01MH076629)
- National Institute on Drug Abuse (DA 00101-01, R03DA016307, DA 16307-01, DA018734--01A1)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- post-traumatic stress disorder, smoking cessation, smoking relapse, smoking lapse, anxiety disorders, daily smokers, psychiatric comorbidity, nicotine dependence
- MeSH terms
- Smoking Prevention, Adult, Aged, Anxiety, Female, Humans, Male, Middle Aged, Motivation, Risk Factors, Self Care, Severity of Illness Index, Smoking, Stress Disorders, Post-Traumatic, Stress, Psychological, Comorbidity, Smoking Cessation, Secondary Prevention
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