Burning anxiety: New treatment targets smokers with panic disorder

November 11, 2004

Not everyone who tries to quit the habit on the Great American Smokeout Nov. 18 will have the same odds of success. The 2.4 million Americans who have panic disorders not only smoke at a disproportionately high rate--about 40 percent vs. 24 percent of the general population--they also have a harder time quitting and relapse more often. Another 5 percent of American smokers--2.4 million more people--may develop panic-related symptoms or even panic disorder when they try to quit. Interventions such as nicotine replacement therapy and counseling don't address their symptoms, but new programs pioneered by University of Vermont psychologists are offering hope.

Research suggesting that smoking often precedes panic disorder and may increase risks of developing the malady led Michael Zvolensky, assistant professor of psychology and director of UVM's Anxiety Health and Research Laboratory, to pioneer new prevention and treatment programs now being duplicated at other institutions. Participants learn to deal with their panic-related symptoms through gradual exposure, coping strategies and mentally correcting illogical fears.

"Once conditioning has happened, you can't undo it," says Zvolensky, who initiated the programs. "We don't try to remove panic-related symptoms, but we offer an alternative model to teach people to tolerate and/or alleviate symptoms."

Smokers with panic disorder "appear to be super-motivated to quit," says Zvolensky, "but they also seem to have a harder time quitting, and are more likely to relapse." That's not hopeful news, considering that more than 90 percent of smokers in the general population who quit on their own and up to 85 percent who attend traditional treatment programs relapse within a year.

Zvolensky believes that mental health professionals have largely ignored cigarette smoking. Little is understood of how smoking relates to anxiety disorders other than panic disorder, but studies indicate that a history of heavy smoking may increase the chance of developing a variety of emotional disorders.

As a result of his research in the United States and Russia, Zvolensky and his team are currently evaluating a brief prevention program and a 16-week treatment protocol that targets smokers who are vulnerable to panic psychology. By inducing panic symptoms through such methods as having patients hyperventilate or breathe CO2-enriched air, smokers learn to tolerate panic symptoms and react differently to those sensations. For instance, they learn to recognize that a racing heartbeat isn't the onset of a heart attack.

Citizens of Nova Scotia are trying out Zvolensky's treatment model through a collaboration with the Psychiatry Department at Dalhousie University, and laboratories elsewhere are duplicating his studies, which have been documented in more than 30 articles in peer-reviewed journals such as Addictive Behaviors and Clinical Psychology Review. Although long-term data are not yet available, Zvolensky hopes his research will lead to targeted, more effective methods to help people with panic sensitivities quit the habit - and in some cases, help them to avoid developing the disorder in the first place.
For more information on Zvolensky's studies, contact him at Michael.Zvolensky@uvm.edu or call 802-656-3831. For more on the Nova Scotia trials of the study, contact Sherry Stewart of Dalhousie University at sherry.stewart@dal.ca.

University of Vermont

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