Regular Article
Integrating an interoceptive exposure-based smoking cessation program into the cognitive-behavioral treatment of panic disorder: Theoretical relevance and case demonstration*

https://doi.org/10.1016/S1077-7229(03)80052-4Get rights and content

A theoretically driven approach to the cognitive-behavioral treatment of panic disorder and smoking is articulated. For persons with panic disorder who smoke, it is suggested that it may be useful to directly integrate smoking cessation within cognitive-behavioral treatment for panic disorder. To illustrate the potential viability of this type of treatment approach, the nature of the panic and smoking co-occurrence is first discussed. Then, a treatment model that integrates an interoceptive exposure-based program of smoking cessation into cognitive-behavioral therapy for panic disorder is presented. Finally, a case example is used to illustrate this approach, followed by a discussion of the potential implications of this therapeutic model.

References (73)

  • PohlR. et al.

    Smoking in patients with panic disorder

    Psychiatry Research

    (1992)
  • ReissS. et al.

    Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness

    Behaviour Research and Therapy

    (1986)
  • StewartS.H. et al.

    Anxiety sensitivity and self-reported reasons for drug use

    Journal of Substance Abuse

    (1997)
  • StewartS.H. et al.

    Introduction to the special issue on “Anxiety sensitivity and addictive behaviors”

    Addictive Behaviors

    (2001)
  • StewartS.H. et al.

    Anxiety sensitivity and alcohol use motives

    Journal of Anxiety Disorders

    (1995)
  • ZvolenskyM.J. et al.

    Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge

    Addictive Behaviors

    (2001)
  • ZvolenskyM.J. et al.

    The impact of smoking on panic disorder: An initial investigation of a pathoplastic relationship

    Journal of Anxiety Disorders

    (2003)
  • Diagnostic and statistical manual of mental disorders

    (1994)
  • BarlowD.H.

    Anxiety and its disorders

    (1988)
  • BarlowD.H. et al.

    Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial

    Journal of the American Medical Association

    (2000)
  • BeckA.T. et al.

    Manual for the Beck Depression Inventory-II

    (1996)
  • BoutonM.E.

    Context, time, and memory retrieval in the interference paradigms of Pavlovian learning

    Psychological Bulletin

    (1993)
  • BoutonM.E.

    A learning theory perspective on lapse, relapse, and the maintenance of behavior change

    Health Psychology

    (2000)
  • BrandonT.H.

    Negative affect as motivation to smoke

    Current Directions in Psychological Science

    (1994)
  • BrandonT.H. et al.

    The Smoking Consequences Questionnaire: The subjective expected utility of smoking in college students

    Psychological Assessment

    (1991)
  • BreslauN. et al.

    Nicotine dependence, major depression, and anxiety in young adults

    Archives of General Psychiatry

    (1991)
  • BreslauN. et al.

    Smoking and panic attacks: An epidemiologic investigation

    Archives of General Psychiatry

    (1999)
  • BrownR.A. et al.

    Distress tolerance and duration of past smoking cessation attempts

    Journal of Abnormal Psychology

    (2002)
  • CarmodyT.P.

    Affect regulation, nicotine addiction, and smoking cessation

    Journal of Psychoactive Drugs

    (1989)
  • Centers for Disease Control and Prevention

    Cigarette smoking among adults—United States, 1997

    Morbidity and Mortality Weekly Report

    (1999)
  • CraskeM.G. et al.

    Mastery of your anxiety and panic

    (2000)
  • DegenhardtL. et al.

    Alcohol, cannabis, tobacco use among Australians: A comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis

    Addiction

    (2001)
  • de GraafR. et al.

    Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: Findings from the Netherlands mental health survey and incidence study

    American Journal of Psychiatry

    (2002)
  • De LeonG.

    Psychopathology and substance abuse: What is being learned from research in therapeutic communities?

    Journal of Psychoactive Drugs

    (1989)
  • DiNardoP.A. et al.

    The Anxiety Disorders Interview Schedule for DSM-IV

    (1994)
  • DohertyK. et al.

    Urges to smoke during first month of abstinence: Relationship to relapse and predictors

    Psychopharmacology

    (1995)
  • Cited by (61)

    • Trauma exposure and smoking outcomes: The indirect effects of anxious and depressive symptoms

      2022, Addictive Behaviors
      Citation Excerpt :

      The Smoking History Questionnaire (SHQ) is a self-report questionnaire used to assess smoking history (e.g., onset of regular daily smoking), pattern (e.g., number of cigarettes consumed per day), and problematic symptoms experienced during past quit attempts (e.g., weight gain, nausea, irritability, and anxiety (Brown et al., 2002). As in past work (Zvolensky et al., 2003), a mean composite score of severity of problematic psychosomatic symptoms experienced during past quit attempts was derived from this measure. Specifically, this measure includes 17 items such as “while trying to quit, how serious have each of the following problems been for you?”

    • Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers

      2019, Addictive Behaviors
      Citation Excerpt :

      The Smoking History Questionnaire (SHQ) was used to assess years of daily smoking, number of past quit attempts, and severity of problems experienced during quit attempts (Brown et al., 2002). As in past work (Zvolensky et al., 2003; Zvolensky, Rogers, Bakhshaie, Viana, et al., 2019), a mean composite score of severity of problem symptoms experienced during past quit attempts was derived from this measure. Specifically, this measure asks, “while trying to quit, how serious have each of the following problems been for you?”

    • Integrative treatment program for anxiety sensitivity and smoking cessation

      2019, The Clinician's Guide to Anxiety Sensitivity Treatment and Assessment
    • Panic attack history and smoking topography

      2017, Drug and Alcohol Dependence
    View all citing articles on Scopus
    *

    This paper was supported, in part, by a NIDA research grant (R03 DA16307-01), a Faculty Research Grant from the Anxiety Disorder Association of America, and a Patient Oriented Research Pilot Project Grant (Fletcher Allen Healthcare) awarded to the first author.

    View full text