HEALTH Research Institute

Research into the comorbidity between emotional psychopathology and cigarette smoking has oftenfocused upon anxiety and depression’s manifest symptoms and syndromes, with limited theoretical andclinical advancement. This article presents a novel framework to understanding emotion–smokingcomorbidity. We propose that transdiagnostic emotional vulnerabilities—core biobehavioral traits re-flecting maladaptive responses to emotional states that underpin multiple types of emotional psychopa-thology—link various anxiety and depressive psychopathologies to smoking. This framework is appliedin a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilitiesimplicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b)anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability towithstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multipleemotional psychopathologies, (b) amplify smoking’s anticipated and actual affect-enhancing propertiesand other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e.,initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets forsmoking intervention. After existing gaps are identified, an integrative model of transdiagnostic pro-cesses linking emotional psychopathology to smoking is proposed. The model’s key premise is that Anhamplifies smoking’s anticipated and actual pleasure-enhancing effects, AS amplifies smoking’s anxio-lytic effects, and poor DT amplifies smoking’s distress terminating effects. Collectively, these processesaugment the reinforcing properties of smoking for individuals with emotional psychopathology toheighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. Weconclude by drawing clinical and scientific implications from this framework that may generalize to othercomorbidities