Effect of Emotion Regulation Difficulties on Acute Smoking Urges Following a 35% Carbon Dioxide Challenge

Carbon dioxide (CO₂) challenges produce uncomfortable anxious arousal sensations and can be leveraged to study how vulnerability factors influence smoking outcomes in contexts of acute distress. Emotion dysregulation is associated with elevated anxious arousal among smokers, which may acutely reduce smoking motivation following CO₂ exposure as immediate smoking may further amplify CO₂-induced arousal. However, no studies have examined the effect of emotion regulation (ER) difficulties on smoking motivation immediately following CO₂-induced distress. This study examined the role of ER difficulties on the effect of 35% CO₂-induced arousal and acute smoking urges.

Smokers were randomized to receive a single vital capacity breath of either 35% CO₂-enriched or compressed room air. Trait ER difficulties and pre- and immediate post-challenge smoking urges were assessed. Consistent with work showing emotion dysregulation is associated with elevated anxious arousal and reactivity to bodily sensations, we hypothesized that smokers higher in ER difficulties would experience reduced urges immediately following 35% CO₂-exposure (relative to room air).

Analyses showed a significant interaction between challenge condition and ER difficulties on smoking urges. Smokers with greater ER difficulty evidenced reduced urges following CO₂-exposure, whereas urges increased following room air.

This study found that smokers with greater ER difficulties evidenced an acute dampening in smoking urges following 35% CO₂-exposure. These findings may suggest a modification to extant negative reinforcement models of addiction by suggesting that contexts characterized by acute anxious arousal may decrease immediate negative reinforcement smoking.