Roles of inter-individual differences and intra-individual acute elevations in early smoking lapse in people with posttraumatic stress disorder

Existing models of the role of posttraumatic stress disorder (PTSD) symptoms and smoking have almost exclusively examined mean symptom levels, rather than the acute elevations that might trigger smoking lapse immediately or increase risk of a smoking lapse in the next few hours. We examined ecological momentary assessments (EMA) of PTSD symptom clusters and smoking in the first week of a quit attempt in 52 people with PTSD. In multilevel models including PTSD symptom means, acute elevations, and lagged acute elevations together as simultaneous predictors of odds of smoking in the same models, pre-quit smoking occasions were significantly related to acute elevations in symptoms, including PTSD totals (OR = 1.20; 95% CI, 1.10 to 1.31), PTSD re-experiencing symptoms (OR = 1.16; 95% CI, 1.06 to 1.27), PTSD avoidance symptoms (OR = 1.20; 95% CI, 1.10 to 1.31), PTSD numbing symptoms (OR = 1.14; 95% CI, 1.04 to 1.24), and PTSD hyperarousal symptoms (OR = 1.20; 95% CI, 1.09 to 1.31). In contrast, post-quit smoking was related to lagged acute elevations in PTSD re-experiencing (OR = 1.24, 95% CI, 1.03 to 1.50) avoidance (OR = 1.27, 95% CI, 1.05 to 1.53), and numbing symptoms (OR = 1.24, 95% CI, 1.02 to 1.51). During a quit attempt, individuals with PTSD delayed smoking in response to acute elevations in PTSD re-experiencing and Avoidance. This period presents an opportunity to use mobile health interventions to prevent smoking lapse and to use coping skills acquired in trauma-focused therapy to respond to acute PTSD symptom elevation.