Giving up smoking doesn’t cause you to stress out

By Lilian Anekwe

BMJ Group News

What do we know already?

It’s a common belief among people who smoke, and even among some doctors, that smoking helps you feel less stressed and that giving up smoking can cause you to be more stressed. Almost half of smokers in England say this is one of their main reasons for smoking. This can discourage people from trying to give up smoking, and might dissuade doctors from offering some people, such as those with mental or psychiatric illnesses, advice on how to give up smoking.

But there haven’t been studies that have backed up this belief. The feeling of stress relief smokers experience might be because going without a cigarette can cause withdrawal symptoms, like feeling irritable. So continuing to smoke helps them avoid these symptoms and feel less stressed. And although there is evidence to show that anxiety and stress can increase in the first few hours and days after you give up smoking, we don’t know if this continues in the weeks and months after giving up.

To explore the link between smoking and anxiety, researchers looked at 491 people who asked their GPs for help to give up smoking and who attended an NHS smoking cessation clinic in England. These clinics can give a combination of advice, counselling, and treatments (in this study, drugs called nicotine replacement therapy) to help people give up smoking. People filled out a specially designed questionnaire that measured their levels of anxiety at the first of eight weekly appointments at the clinic, and then again six months after treatment. The researchers then compared the anxiety levels in people who had not smoked with people who had relapsed.

What does the new study say?

People who gave up smoking, and had still given up six months later, had less anxiety than people who had given up smoking but later relapsed.

After six months, people who had given up smoking scored around 12 points lower on a scale of anxiety than people who had relapsed. The scale, called the State Trait Anxiety Inventory (STAI), measures anxiety on a scale of 20 to 80. The average person has a score of around 35, while someone with anxiety usually scores 50 or higher. A change of seven points is what doctors usually class as meaningful.

People who gave up smoking reduced their anxiety score by nine points compared to before they gave up. But in people who relapsed, their anxiety score increased by three points.

The researchers also looked at whether the reasons people smoked made a difference to how stressed they felt. Among people who relapsed, those who said they smoked either partly or mainly to cope with stress had increases in anxiety, while those who said they smoked for enjoyment had no change in anxiety. In people who gave up smoking, the decrease in anxiety was larger in people who smoked to help cope with stress compared to people who smoked for other reasons.