In order to isolate possible therapeutic targets and transdiagnostic mechanisms for treatment development, we and others have explored numerous factors that could account for why anxiety is often associated with smoking relapse (for example, severity of nicotine dependence, age of smoking onset, broad-based tendency to experience negative mood). Here, some of the strongest and most consistent evidence has been evident for anxiety sensitivity (AS) [
25]. AS is defined as the fear of anxiety or related sensations (for example, racing heart, chest pain, rapid breathing, dizziness). This fear is often fueled by concerns about physical (for example, heart attack, stroke, death), social (for example, embarrassment), or mental (for example, going crazy, losing control) catastrophes. Historically, AS has been studied to better understand the etiology and maintenance of anxiety and its disorders, particularly panic disorder and PTSD [
26‐
33]. More recent work suggests that AS also plays a formative role in smoking behavior. For example, AS is positively correlated with smoking to reduce negative affect, but often not with other smoking motives (for example, handling, taste [
34‐
39]). Other studies have found that AS is related to negative affect reduction expectancies for smoking (beliefs that smoking will reduce negative affect [
40,
41]). Additionally, smokers high in AS perceive the prospect of quitting as both a more difficult and personally threatening experience [
42], possibly due to a hypersensitivity to aversive internal sensations such as nicotine withdrawal symptoms [
43] or elevated state anxiety [
44‐
46]. High AS smokers compared to those low in AS also experience greater increases in positive affect from pre- to post-cigarette consumption and report greater smoking satisfaction [
47]. Perhaps most notably, AS is significantly associated with less success during smoking cessation attempts [
48]. Specifically, higher levels of AS are related to greater odds of early lapse [
40] and relapse during quit attempts [
49‐
51]; these effects are not explained by smoking rate or nicotine dependence, nicotine withdrawal symptoms, or trait-like negative mood propensity [
50].
Collectively, these studies suggest that AS is associated with problems during cessation and is correlated with smoking to reduce negative affect. Moreover, AS moderates the risk of smoking in terms of the development of panic attacks, suggesting that regular smokers with higher AS are at increased risk for experiencing panic-related problems [
52]. Unlike many other panic risk factors (for example, family history of psychiatric illness), AS is malleable in response to exposure-based intervention and can therefore be specifically targeted for therapeutic change. As we now discuss, exercise is one method for reducing AS and thereby promoting abstinence for this high-risk group.