title: The role of distress intolerance for panic and nicotine withdrawal symptoms during a biological challenge.
abstract: BACKGROUND
  Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems.
  
  
  METHODS
  Smokers (n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms.
  
  
  RESULTS
  The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge (β = -0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = -0.485, CI95% (-1.095, -0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = -0.515, CI95% (-0.888, -0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction (β = 0.37, p = 0.009), but not panic symptom severity.
  
  
  CONCLUSIONS
  Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA sgfarris@uh.edu.
authors.forename: Samantha G
authors.initials: SG
authors.lastname: Farris
authors.affiliation: Department of Psychology, University of Houston, Houston, TX, USA Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zvolensky
authors.affiliation: Department of Psychology, Boston University, Boston, MA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.affiliation: Department of Psychology, Rutgers - The State University of New Jersey, New Brunswick, NJ, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Leyro
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D002245:Carbon Dioxide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D010200:Panic / Q000502:physiology; D016584:Panic Disorder / Q000209:etiology / Q000523:psychology*; D012720:Severity of Illness Index; D012907:Smoking / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: CO2; Distress intolerance; biological challenge; panic disorder; withdrawal