Negative affect and smoking motives sequentially mediate the effect of panic attacks on tobacco-relevant processes

Introduction: Empirical work has documented a robust and consistent relation between panic attacks and smoking behavior. Theoretical models posit smokers with panic attacks may rely on smoking to help them manage chronically elevated negative affect due to uncomfortable bodily states, which may explain higher levels of nicotine dependence and quit problems. Methods: The current study examined the effects of panic attack history on nicotine dependence, perceived barriers for quitting, smoking inflexibility when emotionally distressed, and expired carbon monoxide among 461 treatment-seeking smokers. A multiple mediator path model was evaluated to examine the indirect effects of negative affect and negative affect reduction motives as mediators of the panic attack-smoking relations. Results: Panic attack history was indirectly related to greater levels of nicotine dependence (b=0.039, CI95%=0.008, 0.097), perceived barriers to smoking cessation (b=0.195, CI95%=0.043, 0.479), smoking inflexibility/avoidance when emotionally distressed (b=0.188, CI95%=0.041, 0.445), and higher levels of expired carbon monoxide (b=0.071, CI95%=0.010, 0.230) through the sequential effects of negative affect and negative affect smoking motives. Conclusions: The present results provide empirical support for the sequential mediating role of negative affect and smoking motives for negative affect reduction in the relation between panic attacks and a variety of smoking variables in treatment-seeking smokers. These mediating variables are likely important processes to address in smoking cessation treatment, especially in panic-vulnerable smokers.