Enhancing Panic and Smoking Reduction Treatment with D-Cycloserine

使用 D-环丝氨酸增强恐慌和减少吸烟治疗

• 批准号: 8790514
• 负责人: Michael W. Otto
• 金额: $ 21.98万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8790514
• 关键词: Enhancing; Panic; Smoking; Reduction; Treatment

DESCRIPTION (provided by applicant): Approximately 9-15 million smokers in the U.S. meet criteria for at least one anxiety disorder during their lifetime (Kessler et al., 2005) and these persons experience significant challenges quitting tobacco (Piper et al., 2010a; Zvolensky et al., 2008). Yet, little attention has been given to the maintenance of tobacco use among persons with anxiety disorders, and in particular, smokers with a history of panic attacks. This group is especially important to study because research shows that they have significantly lower quit rates than smokers with no history of panic attacks, and that they respond the same to placebo, single cessation, and combination cessation pharmacotherapy (Piper et al., 2010a). The goal of the current research is to pilot test the efficacy of the addition of d-cycloserine (DCS) versus pil placebo to a cognitive-behavioral program (CBT) targeting the role of anxiety sensitivity, distress intolerance, and panic attacks in smoking maintenance. The proposed project builds directly from our basic and clinical research as well as corresponding pilot work on (a) tobacco-panic relations; (b) intensive cognitive-behavioral intervention (CBT) for panic- and anxious-prone smokers; and (c) DCS enhancement of CBT for panic reduction. The project aims to obtain initial effect sizes and perform an initial test of putative mechanisms of our specialized behavioral group protocol, Panic and Smoking Reduction Treatment (PSRT), combined with DCS as compared to PSRT plus placebo. The PSRT program integrates interceptive exposure, cognitive restructuring, and psycho education exercises with standard smoking cessation strategies and nicotine replacement therapy. Adult smokers (n = 80) with panic attacks will be recruited and randomly assigned to either: (1) PSRT plus DCS or (2) PSRT plus pill placebo. Primary outcome measures will be point prevalence abstinence, time to first smoking lapse, and time to smoking relapse, assessed at 2, 4, 8, 10, 16, and 24 weeks after quit date. Proposed mediators include panic attacks, distress intolerance, anxiety sensitivity, nicotine withdrawal symptoms, and negative effect. These variables will be assessed at baseline, weekly during the treatment phase, and at 2, 4, 8, 10, 16, and 24 weeks after quit date. The proposed study represents a crucial and important stage in translating basic research to strategies for treating nicotine dependence. The investigation addresses an important public health issue by testing an integrated intervention --- informed by basic research --- that may lead to a more effective and efficient treatment for at-risk smokers while simultaneously isolating explanatory mechanisms. The expected findings should: (1) guide advances in the theoretical conceptualization of the mechanisms involved in panic- and anxiety-smoking relations; and (2) provide initial effect size data for the addition of DCS to an integrated psychosocial/behavioral and pharmacological smoking cessation intervention for smokers with panic attacks, and thus provide the necessary data for a large-scale follow-up trial.

描述（由申请人提供）：美国大约有 9-1500 万吸烟者在其一生中至少符合一种焦虑症的标准（Kessler 等人，2005 年），并且这些人在戒烟方面面临重大挑战（Piper 等人，2010a）兹沃伦斯基等人，2008）。然而，很少有人关注患有焦虑症的人，特别是有惊恐发作史的吸烟者维持烟草使用。这一群体的研究尤其重要，因为研究表明，他们的戒烟率明显低于没有惊恐发作史的吸烟者，而且他们对安慰剂、单一戒烟和联合戒烟药物治疗的反应相同（Piper 等，2010a） 。当前研究的目标是初步测试在针对焦虑敏感性、痛苦的认知行为计划 (CBT) 中添加 d-环丝氨酸 (DCS) 与 pil 安慰剂的效果 吸烟维持中的不耐受和恐慌发作。拟议的项目直接建立在我们的基础和临床研究以及相应的试点工作的基础上：(a) 烟草与恐慌的关系； (b) 对容易惊慌和焦虑的吸烟者进行强化认知行为干预（CBT）； (c) DCS 增强 CBT 以减少恐慌。该项目旨在获得初步效果大小，并对我们的专业行为组方案、恐慌和减少吸烟治疗 (PSRT) 结合 DCS 的假定机制进行初步测试，并与 PSRT 加安慰剂进行比较。 PSRT 计划将拦截暴露、认知重建和心理教育练习与标准戒烟策略和尼古丁替代疗法结合起来。将招募患有惊恐发作的成年吸烟者 (n = 80) 并随机分配至：(1) PSRT 加 DCS 或 (2) PSRT 加安慰剂安慰剂。主要结果指标是戒烟率、首次戒烟时间和复吸时间，在戒烟后 2、4、8、10、16 和 24 周进行评估。提出的中介因素包括惊恐发作、痛苦不耐受、焦虑敏感性、尼古丁戒断症状和负面影响。这些变量将在基线、治疗阶段每周以及戒烟后第 2、4、8、10、16 和 24 周进行评估。拟议的研究代表了将基础研究转化为治疗尼古丁依赖策略的关键且重要的阶段。该调查通过测试基于基础研究的综合干预措施来解决一个重要的公共卫生问题，该干预措施可能会为高危吸烟者提供更有效和高效的治疗，同时隔离解释机制。预期的结果应该：（1）指导恐慌和焦虑吸烟关系机制的理论概念化进展； (2) 提供将 DCS 添加到针对惊恐发作的吸烟者的综合心理社会/行为和药物戒烟干预中的初始效果大小数据，从而为大规模后续试验提供必要的数据。