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The findings contradict a widely held belief that smoking relieves stress and giving up makes people feel more on edge.

“The commonly held belief that smoking helps relieve stress is almost certainly wrong. Smokers need to understand how their experience of smoking affects them, and that in many people, smoking actually increases levels of anxiety,” says Máirtín McDermott, lead author of the study and researcher at the Florence Nightingale School of Nursing and Midwifery at King’s College London.

The study, published in the British Journal of Psychiatry, followed 491 smokers attending NHS smoking cessation clinics in England. All participants were given a nicotine patch and attended eight weekly appointments.

Of the sample, 106 people (21.6 %) had a diagnosed mental health problem, primarily mood and anxiety disorders.

All participants were assessed for their anxiety levels at the start of the research, and were also asked whether their motives for smoking were “mainly for pleasure,” “mainly to cope,” or “about equal.”

Six months after the start of the trial, 68 of the smokers (14%) had managed to quit smoking—10 of these had a current psychiatric disorder. The researchers found a significant difference in anxiety between those who had successfully quit and those who had relapsed.

All of those who had quit smoking showed a decrease in anxiety. People who had previously smoked to cope showed a more significant decrease in anxiety compared to those who had previously smoked for pleasure.

Among the smokers who relapsed, those smoking for enjoyment showed no change in anxiety, but those who smoked to cope and those with a diagnosed mental health problem showed an increase in anxiety.

Interpreting their findings, the researchers state that those who smoked to cope were more likely to have a cigarette soon after waking up—behavior intended to stave off withdrawal symptoms, including anxiety. By quitting, they removed these repeated episodes of anxiety and felt less anxious as a result.

Among those who relapsed and showed an increase in anxiety, the researchers say that there was no obvious causal mechanism other than those who relapsed may feel concerned about the continuing health risks of smoking.

The Medical Research Council UK, Cancer Research UK, the National Institute of Health Research (NIHR) UK Centre for Tobacco Control Studies (UKCTCS), the British Heart Foundation, the Economic and Social Research Council, and the Department of Health funded the research.

Source: King’s College London