The indirect effect of panic disorder on smoking cognitions via difficulties in emotion regulation

- Panic Disorder (PD) and cigarette smoking are highly comorbid and associated with worse panic and smoking outcomes.
- Smokers with PD may develop maladaptive beliefs and expectancies about the utility of smoking to cope with panic symptoms.
- Difficulties in emotion regulation (ER) may underlie the relation between PD and smoking cognitions in daily smokers.
- We found an indirect relation between of PD and greater maladaptive smoking cognitions through difficulties in ER.
- Targeting ER difficulties in smokers with PD may help reduce maladaptive beliefs about smoking.

Panic disorder (PD) and cigarette smoking are highly comorbid and associated with worse panic and smoking outcomes. Smoking may become an overlearned automatized response to relieve panic-like withdrawal distress, leading to corresponding smoking cognitions, which contribute to its reinforcing properties and difficultly abstaining. Difficulties in emotion regulation (ER) may underlie this relation such that in the absence of adaptive emotion regulatory strategies, smokers with PD may more readily rely upon smoking to manage affective distress. In the current study, the indirect relation between PD status and smoking cognitions through ER difficulties was examined among daily smokers (N = 74). We found evidence for an indirect relation between PD status and negative affect, addictive and habitual smoking motives, and anticipating smoking will result in negative reinforcement and personal harm, through self-reported difficulties with ER. Our findings are aligned with theoretical models on anxiety and smoking, and suggest that reports of greater smoking cognitions may be due to ER difficulties.