Sensitivity to Unpredictable Threat and Smoking Lapse Behavior

对不可预测的威胁和戒烟行为的敏感性

• 批准号: 9442942
• 负责人: Stewart Aaron Shankman
• 金额: $ 24.37万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9442942
• 关键词: Abstinence; Adopted; Adult; Affective; American; Anxiety; Anxiety Disorders; Behavior; Categories; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; Cognitive; Development; Diagnosis; Dimensions; Disease; Event-Related Potentials; Evoked Potentials; Functional disorder; Hour; Individual; Individual Differences; Knowledge; Laboratories; Measures; Modeling; National Institute of Mental Health; Outcome; Panic Disorder; Participant; Patient Self-Report; Pharmacological Treatment; Pharmacology; Physiology; Play; Process; Psychopathology; Public Health; Relapse; Research Domain Criteria; Risk; Role; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Speed; Stress; Testing; Uncertainty; Withdrawal; Withdrawal Symptom; addiction; analog; anxiety-related disorders; base; biological adaptation to stress; craving; deprivation; disability; experience; high risk; high risk population; individual patient; innovation; lens; meetings; multimodality; neuroadaptation; novel; precision medicine; premature; programs; psychosocial; smoking cessation; smoking prevalence; therapy development; trait

Project Summary Smoking is responsible for over 40% of premature deaths and disability in the US CDC. Although over 40% of the 48 million Americans that still smoke make a serious quit attempt each year, either on their own (i.e., self-guided quit) or with assistance from formal treatment, less than 5% are able to abstain from smoking for greater than 3 months. The selection hypothesis of smoking prevalence posits that smokers who are not able to quit successfully are “burdened” by specific characteristics that make it more challenging to quit. For example, those less successful in quitting smoking may be more likely to suffer from cognitive or affective vulnerabilities associated with psychiatric or other disorders. Smokers who suffer from anxiety are among the largest of these high-risk groups. Anxiety, however, is a broad construct that encompasses many mechanisms. New strategies targeting specific vulnerabilities (and not just general self-reported anxiety) are therefore needed to identify, understand, and ultimately, intervene with anxiety-prone smokers. One vulnerability for anxiety that is likely to play a role in smoking lapse behavior is sensitivity to unpredictable threat (SUT), an individual difference factor that is central to many anxiety disorders. SUT may be particularly predictive of smoking lapse as it has been proposed to be a manifestation of neuroadaptations of the stress response that has been observed across addictions. This project is therefore devoted to understanding the role of SUT in smoking lapse behavior and smoking topography (e.g., greater puff velocity, and shorter inter-puff intervals) using an innovative, multimethod assessment of sensitivity to unpredictable threat (i.e., EMG startle, evoked potentials, and self-report). The proposed project is significant from a public health standpoint because it can directly guide the development of novel psychosocial or pharmacologic smoking cessation interventions to help this and similar high-risk populations of smokers quit by targeting unique biologic vulnerability processes that result in poorer cessation outcomes. Meeting the specific aims will help validate the importance of the innovative laboratory assessment, demonstrate the importance of specific targets for assessment for at-risk smokers, and will contribute to the treatment development for smokers with anxiety and related disorders. Hence, the present project will significantly expand knowledge about the process and outcomes of smoking cessation as a function of a core biologic mechanism of dysfunction of anxiety, including the identification of specific mechanisms that impede quitting. In addition, this project will help expand the scope and usefulness of a lab assessment of relapse behavior to speed psychosocial/pharmacologic treatment development. Clinically, this approach will represent highly innovative and significant progress toward precision medicine where the selection of a smoking cessation program is tailored to the individual patient based on their attributes.

项目概要 根据美国疾病预防控制中心 (CDC) 的数据，吸烟导致 40% 以上的过早死亡和残疾。 4800 万仍在吸烟的美国人中，有 40% 每年都会认真尝试戒烟，无论是靠自己戒烟 （即自我引导戒烟）或在正规治疗的帮助下，不到 5% 的人能够戒烟 吸烟率超过 3 个月的选择假设假设不吸烟的人。 能够成功戒烟的人都受到特定特征的“负担”，这些特征使戒烟变得更具挑战性。 例如，那些戒烟不太成功的人可能更有可能患有认知或情感障碍 患有焦虑症的吸烟者也属于与精神疾病或其他疾病相关的脆弱性。 然而，这些高风险群体中最大的一个是焦虑症，它是一个涵盖许多方面的广泛概念。 针对特定脆弱性（而不仅仅是一般的自我报告的焦虑）的新策略正在出现。 因此需要识别、理解并最终对容易焦虑的吸烟者进行干预。 一种可能在戒烟行为中发挥作用的焦虑脆弱性是对以下因素的敏感性： 不可预测的威胁（SUT）是许多焦虑症的核心个体差异因素。 特别可以预测戒烟，因为它被认为是神经适应的表现 因此，该项目致力于研究成瘾者所观察到的压力反应。 了解 SUT 在吸烟行为和吸烟地形中的作用（例如，更大的抽吸速度、 和更短的抽吸间隔）使用创新的多方法评估对不可预测的敏感性 威胁（即肌电图惊吓、诱发电位和自我报告）。拟议的项目对公众来说意义重大。 健康观点，因为它可以直接指导新的心理社会或药理学的发展 戒烟干预措施旨在帮助此类吸烟者和类似的高危吸烟者人群戒烟 导致戒烟结果较差的独特生物脆弱性过程将有助于验证创新实验室评估的重要性，证明对高危吸烟者进行评估的具体目标的重要性，并将有助于针对吸烟者的治疗开发。因此，本项目将显着扩展关于戒烟过程和结果的知识，作为焦虑功能障碍的核心生物学机制，包括识别阻碍戒烟的具体机制。将有助于扩大范围以及对复发行为进行实验室评估以加速心理社会/药物治疗开发的有用性在临床上，这种方法将代表着在选择吸烟的情况下向精准医学迈进的高度创新和重大进展。 戒烟计划是根据患者的特点量身定制的。