Distress intolerance amplifies the effect of momentary anxiety on momentary cigarette craving among females who smoke cigarettes

Abstract

Introduction: Distress intolerance (DI) is an emotional vulnerability factor implicated in the link between anxiety and cigarette craving, which may be particularly important for characterizing persistent smoking in females. However, there is a dearth of prospective work examining how DI influences momentary aspects of anxiety and cigarette craving. This ecological momentary assessment study explored the main and interactive effects of momentary anxiety and DI on momentary cigarette craving.

Methods: Females (N = 50) who reported daily combustible cigarette use completed a daily monitoring study that involved momentary assessments of anxiety and craving across one menstrual cycle. Trait DI was assessed at baseline. Multilevel modeling was used to examine the simultaneous between- and within-person effects of momentary anxiety and the moderating influence of DI on momentary craving. We predicted that between- and within-centered momentary anxiety and DI, as well as their interactions, would be positively associated with momentary craving.

Results: Results indicated that higher momentary anxiety, centered between- and within-person, predicted higher momentary craving. Although no main effect of DI on momentary craving was observed, we found a conditional effect of DI on within-person momentary anxiety in the prediction of momentary craving. The positive effect of within-person increases in momentary anxiety on momentary craving was amplified for those with higher DI relative to lower.

Conclusions: High DI appears to amplify cigarette craving in the context of higher-than-average momentary anxiety. Future studies leveraging momentary methodologies are needed to further elucidate associations between anxiety, DI, and smoking processes to better understand contextual influences on DI. Such data can inform ideographic, in-the-moment interventions.

Keywords: Anxiety; Craving; Distress intolerance.

Fig. 1.

Simple slopes of the interaction between distress intolerance and anxiety on craving. Note: Lower Anxiety Days = Days in which participants’ anxiety is lower than their average momentary anxiety (i.e. centered within-persons); Higher Anxiety Days = Days in which participants’ anxiety is higher than their average momentary anxiety; High Distress Intolerance= Participants with lower scores on the DTS (i.e. 1 SD below the mean; low distress tolerance); Low Distress Intolerance= Participants with scores higher scores on the DTS (i.e. 1 SD above the mean; high distress tolerance). High distress intolerance appears to amplify the strength of the association between momentary anxiety and daily cigarette craving.