Integrated Smoking Cessation Treatment for Emotional Dysregulation

针对情绪失调的综合戒烟治疗

基本信息

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
项目类别：
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

项目摘要

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 (U.S.) 死亡和残疾的主要原因，每年导致超过 440,000 人死亡（美国卫生与公众服务部 [USDHHS]，2004 年）。选择假设吸烟流行率的研究表明，能够成功戒烟的吸烟者不会因特定特征而“负担”，从而使戒烟更具挑战性（Coambs 等人， 1989；休斯，1993；休斯和布兰登，2003）。值得注意的是，与没有精神病史和患有多种精神疾病的人相比，抑郁或焦虑症状和疾病加重的人的吸烟率和戒烟失败率要高得多（Bejerot & Humble，1999；Lasser 2000）。研究人员已开始为患有抑郁症（例如，Brown 等人，2001 年；Hall 等人，1998 年）和某些焦虑特征（例如，高度焦虑敏感性；Zvolensky、Bernstein、Yartz、McLeish 和 Feldner）的吸烟者开发专门的行为干预措施，2008）。然而，此类工作的主要障碍是，针对该人群的现有治疗方法仅解决与吸烟有关的单一精神合并症，并且对于患有多种焦虑症或同时出现抑郁和焦虑症状或障碍的吸烟者缺乏治疗策略。这种忽视是不幸的，因为多种抑郁和焦虑症状和疾病：(a) 经常在吸烟者中同时发生（Mykletun 等人，2003 年），(b) 属于最常见的精神疾病群体（Kessler 等人， 2005），（c）似乎具有与吸烟病因有关的共同（跨诊断）脆弱性过程（例如，痛苦不耐受、焦虑敏感性和(d) 表现出相当大的现象学重叠（Mineka, Watson, & Clark, 1998）。因此，我们提议进行一项为期三年的研究，为患有焦虑抑郁的易感吸烟者开发一种综合戒烟疗法。干预开发方法将遵循与 NIH 指导方针一致的分阶段模型，用于开发和标准化行为干预，拟议的研究代表 IB 阶段研究。具体来说，在第一年，启动活动将包括对一部分个人（N 12）进行综合干预试点，征求内部和外部专家顾问和参与者的反馈，以及制定最终的治疗手册和程序。此阶段的目标是确定治疗实施的可行性、参与者的可接受性以及效果的潜力。在接下来的两年中，将进行一项小型双臂疗效研究（N = 60），将新干预措施与对照干预措施进行比较。这项研究代表了将基础研究转化为治疗尼古丁依赖的更有效策略的重要一步。这项研究通过评估干预措施来解决一个重要的公共卫生问题，该干预措施可能会更有效地应用于治疗有精神病风险的吸烟者。预期的结果应该：（1）指导焦虑-抑郁-吸烟关系机制的理论概念化进展。 (2) 直接为患有焦虑症和抑郁症的吸烟者开发新型的心理社会/行为和药物戒烟干预措施提供信息。