Michael Zvolensky has focused much of his time untangling the interrelated relationship between anxiety and addiction with numerous grants and millions of dollars from the National Institute of Mental Health. He started in academia as an anxiety specialist, but when working with addicts, he noticed an overlooked link.
"There's evidence that anxiety and tobacco use co-occur at a higher rate than would have been expected," explains Zvolensky, "higher than would typically be found for mood and other emotional disorders."
Zvolensky's research explores a distinction between "anxiety sympathy" and actual symptoms of anxiety in cigarette addiction and the act of quitting. Anxiety sensitivity reflects the belief or expectancy that when you experience internal distress like anxiety symptoms they will cause you harm.
Medical literature has traditionally focused on symptoms but the subject's belief in what those symptoms could actually do seems to be more important in explaining behavior, according to Zvolensky. In the case of tobacco users with anxiety sensitivity, when they are about to go on a quit attempt and prompt internal stress like withdrawal symptoms, they reflexively catastrophize.
Zvolensky has found that smoking can actually cause anxiety disorders.
"While tobacco use is related to a more anxiety-sensitive personality type compared to nonsmokers, the more you smoke the worse it gets. It's also an important predictor of who will go on to develop problems like panic attacks and agoraphobia."