Anxiety sensitivity and negative urgency: a pathway to negative reinforcement-related smoking expectancies

Anxiety sensitivity--fear of anxiety symptoms--may increase motivation to smoke by influencing the development of cognitive expectations regarding smoking's negative reinforcing effects; yet, the nature and mechanisms of this pathway are unclear. We hypothesized that relations between anxiety sensitivity and negative reinforcement-related smoking expectancies would be mediated by negative urgency, that is, a trait tendency to act impulsively during negative affect.

In a cross-sectional design, we administered self-report measures of anxiety sensitivity, negative urgency, and negative reinforcement-related smoking outcome and abstinence expectancies to 205 smokers (≥10 cigarettes/d, 34% female, M age = 44.4 years).

Anxiety sensitivity was associated with stronger expectancies that smoking alleviates negative affect (β = 0.30; P < 0.0001) and smoking abstinence exacerbates aversive withdrawal symptoms (β = 0.24; P = 0.0004). Negative urgency partially mediated the relation between anxiety sensitivity and both types of negative reinforcement-related smoking expectancies (βs ≥ 0.057; Ps ≤ 0.007). Results remained significant after statistically controlling for anxiety and nicotine dependence symptoms.

Smokers high in anxiety sensitivity tend to display negative urgency, which in turn is related to greater expectations of negative reinforcement consequences of smoking and smoking abstinence. Treatments that mitigate fear of anxiety symptoms and the tendency to act impulsively in response to negative affect (eg, interoceptive exposure, distress tolerance skills training, and mindfulness training) may be particularly useful in assisting with smoking cessation for high-anxiety sensitivity smokers.