Anxiety, Depression, and Cigarette Smoking: A Transdiagnostic Vulnerability Framework to Understanding Emotion-Smoking Comorbidity
Anxiety, Depression, and Cigarette Smoking: A Transdiagnostic Vulnerability Framework to Understanding Emotion-Smoking Comorbidity
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DOI：
10.1037/bul0000003
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发表时间：
2015-01-01
影响因子：
22.4
通讯作者：
Zvolensky, Michael J.
中科院分区：
文献类型：
--
作者：
Leventhal, Adam M.;Zvolensky, Michael J.
对情绪精神病理学和吸烟之间的共病性的研究通常集中在焦虑和抑郁的明显症状和综合征上，理论和临床进展有限。本文提出了一个新的框架来理解情绪吸烟的并发症。我们提出，transdiagnosis情绪不稳定性核心生物行为特征反映了适应不良反应的情绪状态，支持多种类型的情绪精神病理学链接各种焦虑和抑郁的精神病理学吸烟。该框架应用于对与吸烟有关的3种跨诊断情绪脆弱性的实证文献的回顾和综合：（a）快感缺乏（Anh;对奖励的快乐/兴趣减少），（B）焦虑敏感性（AS;对焦虑相关感觉的恐惧），和（c）痛苦耐受性（DT;承受痛苦状态的能力）。我们的结论是，Anh、AS和DT共同（a）支持多种情绪精神病理学，（B）放大吸烟的预期和实际影响增强特性以及吸烟的其他机制，（c）促进吸烟轨迹的进展（即，开始、升级/进展、维持、停止/复发）和（d）是吸烟干预的有希望的目标。现有的差距被确定后，一个综合模型的transdiagnosis过程中的情绪精神病理学吸烟。该模型的关键前提是，Anh放大了吸烟的预期和实际的快乐增强效果，AS放大了吸烟的抗焦虑效果，而差DT放大了吸烟的痛苦终止效果。总的来说，这些过程增强了吸烟对情绪性精神病理学个体的强化作用，从而增加了吸烟开始、进展、维持、避免戒烟和复发的风险。我们得出结论，从这个框架，可能推广到其他合并症的临床和科学的影响。
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.