Distress Tolerance and Smoking Cessation

摘要 烟草成瘾是一个代价高昂且往往致命的问题。即使有咨询和尼古丁替代疗法， 大多数吸烟者在尝试戒烟后又复吸。对于许多吸烟者来说，吸烟是由情感因素引起的。 痛苦科普这种痛苦并保持禁欲的能力可能取决于一个人的痛苦程度 容忍，这是一种坚持目标导向的活动，同时经历身体或情感的能力。 不适然而，关于痛苦背后的神经机制， 宽容识别这些神经机制并理解痛苦耐受力的个体差异 为开发新的治疗方法和提高戒烟成功率提供了希望， 个性化的干预。 过去的研究表明，烟瘾和其他形式的情感困扰会激活大脑皮层， 它可能是连接情感痛苦意识和认知控制区域的神经中枢， 确定随后的行为响应（例如，抽支烟来缓解烟瘾）。但 在关于网络连通性是否是现实世界灾难容忍度的基础方面， 在戒烟服务中的行为。以实验室为基础的痛苦容忍度的测量提供了标准化的 在个人之间进行比较，并可用于确定吸烟者谁将最受益于 干预措施。一个补充的方法，生态瞬时评估，可以捕捉时间 在真实的时间内，在吸烟者的日常生活中发生的情感困扰、渴望和吸烟之间的关系。 本研究的目的是测试基于实验室的痛苦容忍度的预测有效性， 现实世界的压力/吸烟的关系，并确定吸烟者的神经差异， 痛苦耐受性并可预测戒烟结果（即，复发vs非复发）。 为了解决这一知识差距，我们将研究三个目标：目标1） 遇险容忍度的能力。目标2）将实验室的遇险容忍度测量与现实世界相关联 压力和吸烟使用生态瞬时评估。目标3）探索网络连接与 现实生活中的压力和吸烟通过提供明确的证据，证明痛苦耐受力，大脑连接， 日常压力与戒烟结果有关，这项研究将大大增加我们对为什么一些吸烟者 成功戒烟，而其他人复发。这项研究将推广到其他药物成瘾， 因身体或情感上的痛苦而恶化的精神状况。成功完成本 这项研究将为个性化吸烟干预措施的发展提供信息，并确定神经 这些机制可以通过新的治疗技术来靶向。

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.