Obsessive-compulsive symptoms and cigarette smoking: An initial cross-sectional test of mechanisms of co-occurrence

According to the World Health Organization, over one billion people in the world engage in smoking behavior, despite the negative consequences. As such, smoking remains a sizable public health challenge that warrants creative approaches to reducing this problem behavior. The current study tested a novel model that links smoking behavior with obsessive-compulsive symptoms (OCS). OCS refers to intrusive thoughts, images, or impulses that cause distress (i.e., obsessions) and the behaviors that are carried out to calm down from that distress (i.e., compulsions). OCS falls on a continuum ranging from normative to disordered.

Compulsive behaviors in OCS are carried out to relieve anxiety or other distress (e.g., washing hands relieves distress from beliefs about being dirty) and often become automatic over time. Similarly, smoking behavior rituals (e.g., lighting a cigarette, hand-to-mouth movements) also relieve distress and become automatic over time. Thus, the motivations to smoke and carry out compulsive behavior in OCS may be similar and represent shared behavioral and cognitive features.

The study examined the association between OCS and six different motives to smoke. We anticipated that three of six common smoking motives would demonstrate a positive association with OCS: (1) smoking to calm negative emotions, (2) smoking to obtain relief from the body rituals associated with smoking (e.g., hand-to-mouth movement), and (3) automatic smoking outside of awareness. We also expected no association between OCS and two smoking motives that are not consistent with OCS behavior: (1) smoking to obtain pleasure, and (2) addiction (e.g., strong cigarette cravings). A final motive—smoking to improve cognition—was also examined, but no specific hypothesis was made because the link between OCS and this type of motive is unclear.

Overall, 458 predominantly White daily smokers enrolled in a smoking cessation study in two recruitment sites in the US (Vermont and Florida). Data for the study were based on baseline data collection. Participants completed a large battery of instruments, including measures for OCS and smoking motives, among others. Multiple regression models were carried out to examine the association between OCS and smoking motives while statistically controlling for a range of other demographic (e.g., sex), substance use (e.g., non-tobacco addiction), and distress (e.g., anxiety, depression) variables.

Results of the study supported the hypotheses and the preliminary model linking OCS and smoking. A pattern emerged in which the smoking motives associated with OCS in the predicted manner. The final smoking motivation—stimulation and cognitive control—was also associated with OCS.

Primary study limitations included the cross-sectional study design, the exclusive use of self-report, and limited generalizability of sample characteristics. Nonetheless, the pattern of findings supports a model linking OCS and smoking behavior and may provide a new avenue for developing smoking prevention and cessation strategies (e.g., targeting the ritualistic smoking behavior in treatment).

Read the full paper: Chasson, G. S., Guillot, C. R., Zvolensy, M. J., Liataud, M. M., Schmidt, N. B., & Leventhal, A. M. (in press). Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence. Cognitive Behaviour Therapy. doi: 10.1080/16506073.2020.1745878

Pictured: Dr. Gregory S. Chasson

Photo by: Marius Mellebye / 276ccm

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