Negative affect in relapse: Withdrawal and treatment medication

描述：(申请者的描述)在过去的20年里，已经开发出了许多戒烟疗法。不幸的是，在同一时期，这些并没有导致戒毒率的显著上升。理性的、以经验为基础的吸烟治疗方法的一个障碍是，我们对治疗的有效性知之甚少。这项拟议的研究将使用电子日记(EDS；掌上电脑)来收集关于变量的细粒度、几乎实时的信息，这些变量被认为是有效的戒烟治疗效果的中介。此外，最近的研究表明，影响/戒断的紧张性变化有力地预测了复发；这个项目将允许对这种关系进行敏感的测试。在这项研究中，390名有戒烟动机的吸烟者将被随机分为三组。在安非他酮组，吸烟者将尝试借助安非他酮药物疗法(150毫克，每天两次)戒烟。在合并的情况下，吸烟者将接受安非他酮药物治疗，并将参加包含已知疗效的治疗要素(即社会支持和应对技能培训)的团体治疗课程。最后一组吸烟者将被分配到安慰剂状态；这些受试者将不参加小组会议，并将接受安慰剂药物治疗。所有受试者都将在戒烟日期前4天和戒烟尝试的前8周使用EDS收集有关冲动、戒烟、负面情绪、吸烟率等的实时信息。研究设计允许对短期事件和长期趋势进行敏感的描述性和预测性检查，这些趋势包括理论上突出的变量，如负面情绪、退缩、压力源、诱惑和冲动。它还允许进行调解测试，以确定安非他酮药物治疗和/或咨询是否通过改变这些变量的时间、频率、趋势和/或严重性而起作用。

DESCRIPTION: (Applicant's Description) Numerous smoking cessation treatments have been developed over the past 20 years. Unfortunately, these have not led to a notable increase in cessation rates over the same period. One impediment to a rational, empirically-based approach to smoking treatment is that we know very little about how effective treatments work. The proposed research will use Electronic Diaries (EDs; palmtop computers) to gather fine-grained, virtually real-time information on variables thought to mediate the effects of efficacious smoking cessation treatments. In addition, recent research suggests that tonic change in affect/withdrawal powerfully predicts relapse; this project will permit sensitive tests of this relation. In this research, 390 smokers motivated to quit will be randomized to one of three groups. In the Bupropion group, smokers will attempt to quit smoking with the aid of bupropion pharmacotherapy (150 mg b.i.d.). In the Combined condition, smokers will receive bupropion pharmacotherapy and will participate in group therapy sessions comprising therapeutic elements of known efficacy (i.e., social support and coping-skills training). A final group of smokers will be assigned to a Placebo condition; these subjects will not attend group sessions and will be given placebo pharmacotherapy. All subjects will use EDs to collect real-time information about urges, withdrawal, negative affect, smoking rates, etc -- during a 4-day period prior to the quit date and for the first 8 weeks of the cessation attempt. The study design allows for sensitive descriptive and predictive examinations of both short-term episodes and longer-term trends in theoretically prominent variables such as negative affect, withdrawal, stressors, temptations, and urges. It also permits tests of mediation to determine whether bupropion pharmacotherapy and/or counseling work through modifying the timing, frequency, trends, and/or severity of such variables.