Smoking and social anxiety: The role of false safety behaviors

Cigarette smoking is the leading cause of death and disability in the United States, contributing to over 440,000 deaths each year. Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. For example, over 40% of the 48 million Americans make a serious cessation attempt each year, but less than 5% of them quit.

Smokers with elevated social anxiety often experienced poorer smoking-related outcomes. To illustrate, smokers with elevated social anxiety are more likely to be daily smokers than those with less social anxiety. Those with social anxiety disorder (SAD) also demonstrate a greater likelihood of nicotine dependence and heavy smoking compared to individuals without SAD.

One factor that may play a role in maintaining smoking among individuals with elevated social anxiety are false safety behaviors (FSB). FSB are frequently used across anxiety conditions because they sometimes temporarily alleviate anxiety. However, these behaviors can also maintain or increase anxiety in the long-term. The use of FSB among socially anxious individuals is related to greater anxiety, poorer performance, and diminished treatment effects. Thus, socially anxious smokers may be vulnerable to using FSB to negative emotions. Reliance on such strategies may increase their vulnerability to smoking and continuing to smoke despite negative smoking-related outcomes.

The current study tested whether FSB would be related to more smoking among smokers generally, regardless of trait social anxiety. Second, we tested whether FSB would be related to smoking after controlling for social anxiety, depression, and other relevant variables. Third, we tested whether the relationship between social anxiety and smoking would be explained by FSB use. Hypotheses were tested in a non-treatment-seeking sample of predominately female (73.2%) undergraduates (N = 71) given that most smokers do not seek smoking cessation treatment and smoking rates tend to peak at this age.

Results indicated that regardless of trait social anxiety, nearly all smokers use FSB (i.e., they engage in maladaptive attempts to regulate anxiety). Further, FSB characterized by avoidance behaviors were strongly related to more cigarettes smoked per day (CPD). Importantly, greater social anxiety symptom severity was indirectly related to CPD via FSB-avoidance, suggesting that avoidance-related behaviors may play an especially important role in smoking among smokers with elevated social anxiety.
Overall, findings highlight the important role of avoidance-related FSB in smoking, especially among smokers with elevated social anxiety. Results can inform future work aimed at understanding the ways in which avoidance plays a role in smoking and to inform prevention and treatment efforts regarding smoking among individuals generally and high-risk individuals, such as those with elevated social anxiety.

Read the full article: Buckner, J. D., Zvolensky, M. J., & Lewis, E. M. (in press). Smoking and social anxiety: The role of false safety behaviors. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506073.2019.1696396

Pictured: Dr. Julia D. Buckner

Photo by: Dr. Per Carlbring

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