Anxiety sensitivity mediates the association between post-traumatic stress symptom severity and interoceptive threat-related smoking abstinence expectancies among World Trade Center disaster-exposed smokers

Introduction: Anxiety sensitivity (fear of internal anxiety-relevant bodily sensations) is an individual difference variable that is associated with the development and maintenance of posttraumatic stress disorder (PTSD) and is also involved in the maintenance/relapse of smoking. Abstinence expectancies are crucial to smoking maintenance, yet, past work has not explored how PTSD symptom severity and anxiety sensitivity contribute to them. Method: Participants were 122 treatment-seeking daily smokers (36.1% female; M_age=49.2, SD=9.7; cigarettes per day: M=18.3, SD=15.2) who were exposed to the World Trade Center disaster on September 11, 2001 and responded to an advertisement for a clinical smoking cessation trial. The indirect effect of anxiety sensitivity was tested in terms of the effect of PTSD symptom severity on smoking abstinence expectancies (i.e., anxiety sensitivity as a statistical mediator). Results: PTSD symptom severity was positively associated with interoceptive threat-related smoking abstinence expectancies: expecting harmful consequences (β=33, p<.001) and somatic symptoms (β=26, p=007). PTSD symptom severity was also significantly associated with anxiety sensitivity (β=27, p=003). Anxiety sensitivity mediated the association between PTSD symptom severity and expectancies about the harmful consequences (β=09, CI_95%=02-21; δR²=076) and somatic symptoms (β=11, CI_95%=02-24; δR²=123) from smoking abstinence, with medium effect sizes (Κ²=08 and .10, respectively). Conclusions: These data document the role of PTSD symptoms in threat-based expectancies about smoking abstinence and suggest anxiety sensitivity may underlie the associations between PTSD symptom severity and abstinence expectancies.