title: The effect of social anxiety on urge and craving among smokers with and without anxiety disorders.
abstract: BACKGROUND
  Despite the often social nature of smoking, relatively little research has been conducted on the relationship between smoking and social anxiety disorder (SAD).
  
  
  METHODS
  Participants (N=99) included 34 smokers without current mental health disorders, 37 smokers with SAD, and 28 smokers who met criteria for other anxiety disorder diagnoses (e.g., panic disorder or generalized anxiety disorder, but not SAD). Nicotine and placebo patches were administered to participants in a counterbalanced manner across two assessment days. Urge and craving were assessed before and after a 5-h nicotine absorption/deprivation period.
  
  
  RESULTS
  Compared to smokers without current mental health disorders, smokers with SAD did not report greater nicotine dependence, but did endorse greater motivation to use nicotine to avoid negative outcomes. In addition, after controlling for demographic variables, smoking characteristics, pre-deprivation urge and craving, and other anxiety/depression symptoms, social anxiety symptoms uniquely predicted urge and craving in the placebo patch condition; however, social anxiety had no influence on urge and craving in the nicotine patch condition.
  
  
  CONCLUSIONS
  These findings suggest that one potential reason that smokers with SAD may have worse cessation outcomes is that they may experience higher levels of craving and urge to smoke during quit attempts. Thus, during a quit attempt, particularly in the absence of nicotine replacement therapy, smokers with SAD are likely to benefit from additional treatment aimed at managing or reducing their social anxiety symptoms.
authors: Durham Veterans Affairs Medical Center, Durham, NC, USA; The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Texas A&M Health Science Center, College Station, TX, USA. Electronic address: Nathan.Kimbrel@va.gov.
authors: Nathan A
authors: NA
authors: Kimbrel
authors: Texas A&M Health Science Center, College Station, TX, USA; VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
authors: Sandra B
authors: SB
authors: Morissette
authors: Texas A&M Health Science Center, College Station, TX, USA; Scott & White Brain Research for American Veterans and Emergency Responders, Waco, TX, USA.
authors: Suzy B
authors: SB
authors: Gulliver
authors: National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
authors: Kirsten J
authors: KJ
authors: Langdon
authors: University of Houston, Houston, TX, USA; MD Anderson Cancer Center, Houston, TX, USA.
authors: Michael J
authors: MJ
authors: Zvolensky
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology*; D016739:Behavior, Addictive / Q000453:epidemiology / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D012919:Social Behavior
keywords: Anxiety; Craving; Nicotine; Smoking; Social anxiety; Tobacco