Cigarette smoking is the leading cause of death and disability in the US, contributing to over 440,000 deaths each year. Despite awareness that smoking is a 'chronic health behavior problem,' smoking rates have stabilized in the US, most notably for smokers with elevated psychiatric symptoms and disorders. Here, anxiety and depressive symptoms and syndromes are particularly important because they are the most prevalent psychiatric symptoms in the general population, remarkably comorbid with smoking, and reliably associated with smoking initiation, maintenance, and relapse. Indeed, 'affectively-vulnerable smokers' (i.e., smokers with elevated negative mood states or psychopathology) often are more nicotine dependent, experience more mood problems when quitting, smoke more to manage negative mood states, and nicotine maintains a relatively more reinforcing effect for this group. There is a general consensus that affective-vulnerable smokers require specialty care options that address their unique 'affective needs.' One promising, integrative approach to address the heterogeneity of negative affect symptoms and disorders for smoking has been to focus on underlying transdiagnostic processes that underpin affective psychopathology and the maintenance of smoking. Anxiety sensitivity (AS), the tendency to fear anxiety-related sensations, is a core transdiagnostic vulnerability factor for the etiology and maintenance of anxiety disorders and other emotional disorders, and is also related to smoking maintenance and relapse. AS is malleable in response to psychosocial interventions, making it a prime risk factor to target in prevention/intervention programs. Although some progress has been made in terms of developing highly intensive, integrated treatments that address affective vulnerability in the context of smoking cessation, no targeted efforts have focused on 'earlier phases' of the quit process (i.e., Motivation [having motivation to quit] or Precessation [thinking about and preparing for quitting] phases) for smokers with elevated AS. Moreover, as smokers infrequently use intensive treatments for smoking cessation (consistently less than 10% across studies) because of such barriers as cost, time commitments, and logistics (e.g., travel, scheduling appointments), there is a major need to develop an accessible, brief, integrated tactic to explicitly address the smoking-affective vulnerability comorbidity. By promoting 'earlier change efforts' through focused, personalized feedback for high-risk segments of the smoking population, there is a greater chance to increase sustained and successful quit behavior. The current proposal seeks to employ a computer- delivered integrated Personalized Feedback Intervention (PFI) that directly addresses smoking-AS in a personalized manner. Smokers with elevated AS (N = 130) will be randomly assigned to receive either a PFI or smoking information control (no personalized feedback) and then will be followed up to 1-month after the one- session intervention. The PFI will focus on feedback about smoking behavior, AS, and adaptive coping strategies.
No computer-delivered (or web-based) brief integrated treatment exists for smokers with elevated anxiety sensitivity, a well-established transdiagnostic affective vulnerability construct associated with a heightened risk for anxiety and depressive symptoms and the maintenance of smoking in laboratory and prospective research, for smokers in the Motivation or Precessation phases of smoking. Developing an accessible, integrated tactic to explicitly address the smoking-affective vulnerability co-occurrence and promote 'earlier change efforts' in a personalized feedback manner is central to larger public health efforts to increase sustained and successful quit behavior for this highly vulnerable smoking population. This focused (integrated) feedback approach may address a crucial 'missing element' in smoking cessation care by providing an initial, yet formative, step in increasing motivation for smoking-related quit behavior (e.g., greater motivation to quit, less perceived barriers for quitting), and increased adaptive coping and greater awareness of psychological vulnerability in smokers with elevated anxiety sensitivity.
