Smoking remains the leading cause of preventable death and disability in the United States (US), contributing approximately 480,000 premature deaths annually.1, 2 Given widespread awareness of smoking as a 'chronic health behavior problem,' smoking rates, in general, have declined in the US.2 However, this decline has not extended to smokers with elevated psychiatric symptoms and disorders.3, 4 Here, anxiety and depressive symptoms and syndromes (hereafter termed `emotional disorders' for ease of presentation) are particularly important because they are the most prevalent psychiatric problems in the general population, remarkably comorbid with smoking, and reliably associated with smoking initiation, maintenance, and relapse.5 An integrative, theory-driven approach to address the heterogeneity of emotional disorders associated with smoking is to focus on underlying transdiagnostic processes that underpin both emotional disorders and smoking.6 Distress tolerance is a transdiagnostic vulnerability factor for the etiology and maintenance of negative affect syndromes.7 Distress tolerance is distinct theoretically and empirically from other constructs such as coping, anxiety sensitivity, negative affectivity, emotion dysregulation, neuroticism, and experiential avoidance.7-12 Although distress tolerance is a relatively stable construct,13 it is malleable, making it a prime risk factor to target in prevention/intervention programs.14, 15 Although there has been progress in targeting distress tolerance to decrease risk for emotional disorders16 and facilitate success in quitting smoking,17 no targeted efforts have focused on addressing distress tolerance in 'earlier phases' of the quit process (i.e., Motivation [having motivation to quit], Precessation [thinking about and preparing for quitting]). I seek to adapt and refine (Phase 1) and test in a pilot randomized controlled trial (Phase 2) an integrated, brief, computer-based personalized feedback intervention to: (1) increase motivation, confidence, and intention to quit and reduce perceived barriers for quitting smoking; (2) reduce smoking rate, increase number of quit attempts, and reduce coping-oriented smoking; and (3) increase distress tolerance and willingness to use adaptive coping strategies and reduce anxiety/depressive symptoms. Expanding the reach of health promotion tactics via a computer-delivered intervention is timely and necessary for a multitude of well- documented public health reasons: greater scalability to larger segments of the population; greater cost- effectiveness potential; the ability to enhance the personalized nature of care through the tailoring of therapeutic content to meet the unique needs of high-risk segments of the population; and the ability to reliably deliver brief tobacco use interventions.
People with anxiety and/or depression smoke cigarettes at rates higher than the general population, and therefore, are at higher risk for developing an array of lethal health problems. The proposed study will test whether a brief computer-delivered smoking-distress tolerance intervention can increase intention to quit smoking and reduce smoking rate among individuals with low tolerance for distress and elevated anxiety/depressive symptoms. Such a brief and portable intervention could reduce health risks for this large and vulnerable segment of the population in real-world health settings (e.g., outpatient psychiatric clinics, primary care).
