Transcript Smoking and Nonclinical Anxiety

Project ECHO
Managing Anxiety Associated
with Withdrawal
Patricia Figueroa, M.Ed., LPC
Cho Lam, Ph.D.
Smoking and Anxiety Disorders
• Current smoking rate among adults in the
U.S. is 16.8%
• Significantly higher smoking rates among
individuals with anxiety disorders
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Panic disorder: 19%-47%
Post-traumatic stress disorder: 44%-66%
Social anxiety disorder: 14%-32%
Generalized anxiety disorder: 17%-55%
Smoking and Nonclinical Anxiety
• Empirical findings suggest that smoking
reduces anxiety
• The anxiolytic, or anxiety-alleviating,
effect of nicotine varies by
• Route of administration
• Inhaled (e.g., smoking) vs. transdermal (e.g., nicotine
patch)
• Timing of administration
Anxiety: A Common
Withdrawal Symptom
• Anxiety is one of the most common symptoms
of nicotine withdrawal
• If smoking is anxiolytic, then smoking
abstinence would likely increase anxiety
• Previous findings suggest that, on average,
anxiety increases in the first 1-3 days
postcessation (the increase can be as long as 2
weeks).
• Smokers who quit often reported anxiety as the
risk factor for relapse
“If I don’t smoke, I can’t
manage my anxiety”
Integrating Motivational Interviewing
• Avoid immediately jumping into
offering strategies and techniques
• Clients as experts on themselves
• Elicit – Provide – Elicit
• Always ask for permission
• Provide information as options rather than
directives
• Ask for feedback
Strategies for Reducing Anxiety
• Remind patient that anxiety will pass
with time
• Often builds for the first 3 days
• May last 2 weeks, and begin to later subside
• Engaging in physical activity can help
• Reducing caffeine by limiting or
avoiding coffee, soda, tea
• Using NRT
• Relaxation techniques
Diaphragmatic Breathing
• Technique to help to slow down breathing
when anxious or stressed
• Our breathing changes when we are anxious
• We take short, quick, shallow breaths
• 6-8 breathing cycles per minute are
recommended to help reduce anxiety
• 5 minutes, twice per day OR as needed
• Suggest that patients start by using this
technique when in a calm or relaxed state.
Diaphragmatic Breathing
• Breathe from the diaphragm or abdomen
• Shoulders and chest area should be
relaxed and still
• If difficult to keep upper body still while
expanding abdomen:
• Advise patient to try laying down with one hand on
abdomen and the other on the chest
• Ask the patient to watch the hand on the abdomen
rise as they inhale. Hand on the chest should barely
move.
Diaphragmatic Breathing
Patient Instructions:
• Gently close your eyes
• Take a slow breath in through your nose, filling
your abdomen with air
• Hold your breath for a couple of seconds
• Exhale slowly through your mouth
• Wait a couple of seconds before taking another
breath
• LET’S TRY IT!
• See Patient Handout
Progressive Muscle Relaxation
• When we are anxious, we often experience
muscle tension
• PMR teaches the patient to monitor and
control muscle tension
• Through practice patients can learn to
distinguish between the feeling of a tensed
muscle and a relaxed muscle.
• Eventually patients can begin to “cue” this
relaxed state at the first sign of muscle
tension that is experienced when anxious.
Progressive Muscle Relaxation
• 2 step process
• STEP 1: Systematically tensing particular
muscle groups.
• STEP 2: Release the tension and pay attention
to how the muscles feel when relaxed.
• TIPS:
• Patients should start by practicing when in a relaxed
state.
• Walk the patient through this exercise when being
done for the first time.
• See Patient Handout
Thank you!