Integrated Smoking Cessation Treatment for Emotional Dysregulation

针对情绪失调的综合戒烟治疗

• 批准号: 8650809
• 负责人: MICHAEL J. ZVOLENSKY
• 金额: $ 21.9万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-15 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8650809
• 关键词: Abstinence; Acute; Address; Adult; Anhedonia; Anxiety; Anxiety Disorders; Basic Science; Behavior Therapy; Behavioral; Cause of Death; Cessation of life; Characteristics; Cognitive; Comorbidity; Depressed mood; Depressive disorder; Development; Disease; Disease remission; Distress; Emotional; Etiology; Exhibits; Exposure to; Failure; Feedback; Goals; Guidelines; Individual; Intervention; Lead; Manuals; Mediating; Mediator of activation protein; Mental Depression; Mental disorders; Modeling; Nicotine Dependence; Nicotine Withdrawal; Outcome; Participant; Persons; Phase; Population; Prevalence; Procedures; Process; Protocols documentation; Public Health; Recording of previous events; Relapse; Relative (related person); Research; Research Personnel; Risk; Smoker; Smoking; Smoking Cessation Intervention; Staging; Symptoms; Therapeutic; Time; Translating; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Withholding Treatment; Work; arm; bodily sensation; cigarette smoking; clinically significant; depressive symptoms; design; disability; improved; neglect; novel; psychosocial; public health relevance; smoking cessation; smoking intervention; smoking prevalence; smoking relapse; standard care; therapy development; treatment effect

DESCRIPTION (provided by applicant): Cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 440,000 deaths each year (U. S. Department of Health and Human Services [USDHHS], 2004).The selection hypothesis of smoking prevalence posits that smokers who are able to quit successfully are not "burdened" by specific characteristics that make it more challenging to quit (Coambs et al., 1989; Hughes, 1993; Hughes & Brandon, 2003). Notably, cigarette smoking rates and rates of cessation failure are disproportionately higher among those with elevated depressive or anxiety symptoms and disorders relative to persons with no psychiatric history, and those with many types of psychiatric conditions (Bejerot & Humble, 1999; Lasser 2000). Researchers have started to develop specialized behavioral interventions for smokers with depressive (e.g., Brown et al., 2001; Hall et al., 1998) and certain anxiety characteristics (e.g., high anxiety sensitivity; Zvolensky, Bernstein, Yartz, McLeish, & Feldner, 2008). Yet, central barriers to such work are that existing treatments for this population address only a single psychiatric comorbidity with smoking and therapeutic tactics are absent for smokers with multiple anxiety disorders or co-occurring elevated depressive and anxiety symptoms or disorders. Such neglect is unfortunate, as multiple depression and anxiety symptoms and disorders: (a) frequently co-occur in smokers (Mykletun et al., 2003), (b) are among the most common groups of psychiatric disorders (Kessler et al., 2005), (c) appear to share common (transdiagnostic) vulnerability processes implicated in the etiology of smoking (e.g., distress intolerance, anxiety sensitivity, and anhedonia; Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009), and (d) exhibit considerable phenomenological overlap (Mineka, Watson, & Clark, 1998). Accordingly, we are proposing a 3-year study to develop an integrated treatment for smoking cessation for anxiety-depressive vulnerable smokers. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions, with the proposed research representing a Stage IB study. Specifically, during the first year, startup activities will include piloting the integrated intervention on a subset of individuals (N 12), soliciting internal and external expert consultant and participant feedback, and development of the final treatment manual and procedures. The goal during this phase will be to establish feasibility of treatment delivery, participant acceptability, and potential for an effect. During te following two years, a small two-arm efficacy study (N = 60) will be undertaken comparing the new intervention to a control intervention. This study represents an important step in the larger landscape of translating basic research to more efficacious strategies for treating nicotine dependence. This study addresses an important public health issue by assessing an intervention that may lead to a more effective application for the treatment of psychiatrically at-risk smokers. The expected findings should: (1) Guide advances in the theoretical conceptualization of the mechanisms involved in anxiety-depression- smoking relations. (2) Directly inform the development of a novel and psychosocial/behavioral and pharmacological smoking cessation intervention(s) for smokers with anxiety and depressive disorders.

描述（由申请人提供）：吸烟是美国（美国）死亡和残疾的主要原因，每年造成440,000多人死亡（美国卫生和公共服务部[USDHHS]，2004年）。选择假设吸烟的假设使吸烟者的戒烟者能够成功地戒烟。休斯，1993年；休斯和布兰登，2003年）。值得注意的是，相对于没有精神病病史的人，抑郁症状或焦虑症状和疾病升高的人，抑郁症状或疾病的戒烟率和戒烟失败的速度不成比例地更高，并且患有多种类型的精神病患者（Bejerot＆Humble，1999; Lasser 2000）。研究人员已开始为抑郁症的吸烟者开发专门的行为干预措施（例如，Brown等，2001； Hall等，1998）和某些焦虑特征（例如，高焦虑敏感性； Zvolensky，Zvolensky，Bernstein，Yartz，Yartz，McLeish，McLeish和Feldner，＆Feldner，2008）。然而，这项工作的主要障碍是，对于患有多种焦虑症或同时发生的抑郁症状和焦虑症状或疾病的同时发生的吸烟者，缺乏吸烟和治疗策略的单一精神病合并症和治疗策略。 Such neglect is unfortunate, as multiple depression and anxiety symptoms and disorders: (a) frequently co-occur in smokers (Mykletun et al., 2003), (b) are among the most common groups of psychiatric disorders (Kessler et al., 2005), (c) appear to share common (transdiagnostic) vulnerability processes implicated in the etiology of smoking (e.g., distress intolerance, anxiety敏感性和Anhedonia；因此，我们提出了一项为期3年的研究，以开发一种综合治疗方法，用于戒烟，以缓解焦虑症的脆弱吸烟者。干预开发方法将遵循与NIH制定和标准化行为干预指南一致的分阶段模型，拟议的研究代表了IB阶段的研究。具体而言，在第一年，启动活动将包括对个人的一部分（n 12）进行综合干预，征集内部和外部专家顾问以及参与者的反馈，以及开发最终的治疗手册和程序。在此阶段的目标是确定治疗交付，参与者的可接受性和效果的潜力的可行性。在TE之后两年中，将进行一项小型两臂疗效研究（n = 60），将新干预与对照干预进行比较。这项研究代表了将基础研究转化为更有效治疗尼古丁依赖性的更有效策略的更大景观中的重要一步。 这项研究通过评估一种干预措施来解决一个重要的公共卫生问题，该干预措施可能会导致更有效的精神病患者吸烟者的治疗。预期的发现应：（1）指导在焦虑抑制吸烟关系中涉及的机制的理论概念化方面的进步。 （2）直接为患有焦虑和抑郁症的吸烟者提供新颖和社会心理/行为和药理学戒烟干预的发展。