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Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study


1.    Máirtín S. McDermott,

2.    Theresa M. Marteau,

3.    Gareth J. Hollands,

4.    Matthew Hankins and

5.    Paul Aveyard

+ Author Affiliations

1.    Máirtín S. McDermott, PhD, Florence Nightingale School of Nursing and Midwifery, King’s College London; Theresa M. Marteau, PhD, Gareth J. Hollands, PhD, Psychology Department (at Guy’s), Health Psychology Section, King’s College London; Matthew Hankins, PhD, Faculty of Health Sciences, University of Southampton; Paul Aveyard, PhD, Primary Care Clinical Sciences, The University of Birmingham, Edgbaston, UK.

1.    Correspondence: Máirtín S. McDermott, Florence Nightingale School of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. Email:

Declaration of interest

P.A. has done consultancy and research on smoking cessation for pharmaceutical companies.



Despite a lack of empirical evidence, many smokers and health professionals believe that tobacco smoking reduces anxiety, which may deter smoking cessation.


The study aim was to assess whether successful smoking cessation or relapse to smoking after a quit attempt are associated with changes in anxiety.


A total of 491 smokers attending National Health Service smoking cessation clinics in England were followed up 6 months after enrolment in a trial of pharmacogenetic tailoring of nicotine replacement therapy (ISRCTN14352545).


There was a points difference of 11.8 (95% CI 7.7–16.0) in anxiety score 6 months after cessation between people who relapsed to smoking and people who attained abstinence. This reflected a three-point increase in anxiety from baseline for participants who relapsed and a nine-point decrease for participants who abstained. The increase in anxiety in those who relapsed was largest for those with a current diagnosis of psychiatric disorder and whose main reason for smoking was to cope with stress. The decrease in anxiety on abstinence was larger for these groups also.


People who achieve abstinence experience a marked reduction in anxiety whereas those who fail to quit experience a modest increase in the long term. These data contradict the assumption that smoking is a stress reliever, but suggest that failure of a quit attempt may generate anxiety.



This study was funded as part of a grant from the Medical Research Council, UK (Risk communication in preventive medicine: Optimizing the impact of DNA risk information; G0500274; principal investigator: T.M.M). M.S.M was funded by Cancer Research UK as part of a Cancer Research UK Studentship (Ref: C4770/A7173). P.A is funded by a personal award from the National Institute of Health Research UK Centre for Tobacco Control Studies (UKCTCS). Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the Department of Health, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Royal College of Psychiatrists

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