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, 78 (6), 930-937

Direct and Indirect Effects of Psychological Distress on Stress-Induced Smoking


Direct and Indirect Effects of Psychological Distress on Stress-Induced Smoking

Atara Siegel et al. J Stud Alcohol Drugs.


Objective: Numerous studies have modeled the effects of stress in the laboratory, demonstrating that smokers who are exposed to experimental stressors exhibit significant increases in acute psychological distress. Whether these stress reactions are predictive of stress-induced smoking during an actual quit attempt, however, has not been examined. Furthermore, the possibility that such effects are particularly strong among smokers with higher ambient levels of distress has not been addressed.

Method: Nicotine-dependent smokers (N = 60; 40 women, 20 men) completed the Brief Symptoms Index (BSI) and then participated in a laboratory stress task 1 week before a quit attempt. Acute psychological distress was measured immediately before and after exposure to stressful and neutral stimuli. After they quit, participants completed a smoking diary for 14 days in which they recorded the degree to which their smoking was precipitated by emotional stress.

Results: Consistent with our hypotheses, BSI scores predicted both exaggerated laboratory stress responses (p < .005) and smoking that was attributable to stress during the 14-day postquit period (p < .01). Laboratory stress reactions were predictive of stress-induced smoking (p < .01), and acute psychological stress reactions mediated the effects of BSI on stress-induced smoking.

Conclusions: Acute psychological stress reactivity is a potential mechanism underlying the effect of stress-induced smoking during a quit attempt.


Figure 1.
Figure 1.
Mean (SE) distress scores before and after exposure to neutral and stress imagery. A 2 × 2 repeated-measures analysis of variance revealed a significant interaction, such that acute distress was higher following the stress imagery, but not following the neutral imagery (p < .0001).
Figure 2.
Figure 2.
Regression of laboratory reactivity to stress and neutral exposures on general distress (Brief Symptoms Index, 18-item version [BSI-18]). BSI-18 significantly predicted increases reactivity to stress imagery (p < .007), but not to neutral imagery (p < .305).

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