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Blunted vagal reactivity predicts stress-precipitated tobacco smoking

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Abstract

Rationale

Long-term smoking can lead to changes in autonomic function, including decreased vagal tone and altered stress responses. One index of the inability to adapt to stress may be blunted vagal reactivity. Stress is a primary mechanism involved in relapse to smoking, but mechanisms leading to stress-precipitated relapse are not well understood.

Objectives

Using an experimental paradigm of stress-precipitated smoking behavior, we examined whether autonomic reactivity mediates the relationship between stress and smoking. High-frequency heart rate variability (HF-HRV), a putative measure of vagal tone, and the ratio of low-to-high frequency HRV (LF/HF), a measure of sympathovagal balance, were assessed.

Methods

Using a within-subjects design, 32 nicotine–dependent, 15-h abstinent smokers (a subgroup from McKee et al. (J Psychopharmacol 25(4):490–502, 2011)) were exposed to individualized script-driven imagery of stressful and relaxing scenarios and assessed on the ability to resist smoking and subsequent ad-lib smoking. HRV was monitored throughout each laboratory session (maximum 60 min following imagery).

Results

As expected, stress and ad-lib smoking additively decreased HF-HRV and increased LF/HF. Blunted stress-induced HF-HRV responses reflecting decreased vagal reactivity were associated with less time to initiate smoking and increased craving relief and reinforcement from smoking. These relationships were specific to HF-HRV following stress as neither baseline HF-HRV, HF-HRV following relaxing imagery, or LF/HF predicted smoking behavior.

Conclusions

The current findings are the first to experimentally demonstrate that stress-precipitated decreased vagal reactivity predicts the ability to resist smoking. Findings suggest that strategies that normalize vagal reactivity in early abstinent smokers may lead to improved smoking cessation outcomes.

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Notes

  1. Results from the parent study were re-analyzed with the current subset of 32 participants. Main findings (i.e., stress reduced the time to resist smoking) remained significant, p = 0.02; stress mean = 26.4 min (SD = 23.4, relaxing mean = 34.2 min (SD = 20.4).

  2. Due to a data reading error, n = 31 for LF/HF ratio analysis.

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Acknowledgements

The authors declare that this work was supported by the NIH Roadmap for Medical Research Common Fund through the following grants: RL1DA024857, UL1DE019586, PL1DA024859, and PL1DA024860. Additional NIH grants include R21DA017234, K12DA000167, and R25DA020515. This publication was also made possible by CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH roadmap for Medical Research.

Financial disclosures

The authors declare that RS is on the Scientific Advisory Board for Embera Neurotherapeutics and is also a consultant for Glaxo-Smith Kline, Pharmaceuticals. All other authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, 2 Church St. South, Suite 109, New Haven, CT, 06519, USA

    Rebecca L. Ashare, Rajita Sinha, Andrea H. Weinberger, Meaghan E. Lavery, Katherine Yanagisawa & Sherry A. McKee

  2. Department of Internal Medicine, Cardiology, Yale University School of Medicine, New Haven, CT, USA

    Rachel Lampert

  3. The Child Study Center, Yale University School of Medicine, New Haven, CT, USA

    Rajita Sinha & George M. Anderson

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  1. Rebecca L. Ashare
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  2. Rajita Sinha
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Correspondence to Sherry A. McKee.

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Ashare, R.L., Sinha, R., Lampert, R. et al. Blunted vagal reactivity predicts stress-precipitated tobacco smoking. Psychopharmacology 220, 259–268 (2012). https://doi.org/10.1007/s00213-011-2473-3

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