Distress Tolerance and Smoking Cessation

摘要 烟草成瘾是一个代价高昂、往往是致命的问题。即使有心理咨询和尼古丁替代疗法， 大多数吸烟者在尝试戒烟后会复发。对于许多吸烟者来说，吸烟是由情感引起的 苦恼。应对这种痛苦并保持节制的能力可能取决于一个人的痛苦程度 宽容，这是一种在体验身体或情感的同时坚持目标导向的活动的能力 不舒服。然而，人们对造成痛苦的神经机制的认识还存在差距。 宽容。识别这些神经机制并了解个体在痛苦耐受性上的差异 为新疗法的开发和通过以下途径提高戒烟成功率提供了希望 个性化干预。 过去的研究表明，对香烟的渴望和其他形式的情感困扰激活了脑岛， 它可能是将情感痛苦的意识与认知控制区域联系起来的神经中枢 确定随后的行为反应(例如，吸烟以缓解渴望)。然而，在那里 对于岛的连通性是否构成现实世界的痛苦容忍度，这是一个重大的知识差距 为戒烟服务的行为。基于实验室的遇险容忍度测量提供了标准化 对个人进行比较，并可用于确定哪些吸烟者将受益最大 干预措施。一种补充的方法，生态瞬时评估，可以捕捉到时间 情感困扰、渴望和吸烟之间的关系，因为它们实时发生在吸烟者的日常生活中。 这项研究的目的是测试基于实验室的痛苦容忍度测量的预测有效性 真实世界压力/吸烟的关系，并确定吸烟者中与以下方面相关的神经差异 痛苦耐受性和可以预测戒烟结果(即复发与未复发)。 为了解决这一知识差距，我们将调查三个目标：目标1)联合实验室措施 对岛屿连接的痛苦容忍度。目的2)将实验室测量的遇险容忍度与真实世界联系起来 使用生态瞬时评估来评估压力和吸烟。目标3)探讨半岛连接如何与 现实生活中的压力和吸烟。通过提供清晰的证据来证明耐受性、大脑连通性和 日常压力与戒烟结果有关，这项研究将极大地提高我们对为什么一些吸烟者的理解 在别人故态复萌的时候成功戒烟。这项研究将推广到其他吸毒成瘾和 因身体或情感上的痛苦而恶化的精神状态。成功完成这项工作 研究将为个性化吸烟干预的发展提供信息，并确定神经 可以通过新的治疗技术进行靶向的机制。

ABSTRACT Tobacco addiction is a costly and often fatal problem. Even with counseling and nicotine replacement therapy, most smokers relapse following a quit attempt. For many smokers, cigarette smoking is provoked by affective distress. The ability to cope with this distress and remain abstinent may depend on one's level of distress tolerance, which is the ability to persist in a goal-directed activity while experiencing physical or affective discomfort. However, a gap in knowledge exists regarding the neural mechanisms that underlie distress tolerance. Identifying these neural mechanisms and understanding individual differences in distress tolerance holds promise for the development of new therapies and the improvement of cessation success through personalized interventions. Past research has shown that cigarette cravings and other forms of affective distress activate the insula, which may be the neural hub that connects the awareness of affective distress to cognitive control regions that determine the subsequent behavioral response (e.g., smoking a cigarette to relieve cravings). However, there is a significant gap in knowledge concerning whether insula connectivity underlies real-world distress tolerance behavior in the service of smoking cessation. Lab-based measures of distress tolerance provide standardized comparisons across individuals and could be used to identify smokers who would most benefit from interventions. A complementary approach, ecological momentary assessment, can capture temporal relationships among affective distress, craving, and smoking as they occur in smoker's daily lives, in real time. The goal of this research is to test the predictive validity of lab-based measures of distress tolerance against the real-world stress/smoking relationship, and to identify neural differences within smokers that relate to distress tolerance and could predict quit outcomes (i.e., relapsed vs nonrelapsed). To address this gap in knowledge, we will investigate three aims: Aim 1) Associate lab measures of distress tolerance to insula connectivity. Aim 2) Relate lab measures of distress tolerance with real-world stress and smoking using ecological momentary assessment. Aim 3) Explore how insula connectivity relates to real-world stress and smoking. By providing clear evidence of how distress tolerance, brain connectivity, and daily stress relate to quit outcomes, this study will greatly increase our understanding of why some smokers succeed in quitting while others relapse. This research will be generalizable to other drug addictions and psychiatric conditions that are exacerbated by physical or affective distress. Successful completion of this study will inform the development of personalized smoking interventions, as well as identify neural mechanisms that can be targeted by novel therapeutic techniques.