Smoking-Based Prevention Program for Panic Disorder

描述（由申请人提供）：当前提案的总体目标是通过专门的焦虑戒烟干预来发展有关预防恐慌障碍（PD）的知识。该计划将在一个随机控制的预防计划的背景下，针对PD发展的两个可塑脆弱性因素-焦虑敏感性（对焦虑和焦虑相关感觉的恐惧）和吸烟。惊恐障碍是一种常见的、严重的慢性疾病，其特征是反复发作的惊恐发作和对未来可能经历惊恐发作的担忧[美国精神病学协会（APA）， 1994]。在北美，吸烟是导致死亡和残疾的主要原因[疾病控制和预防中心，1994]，在患有或有患帕金森风险的人群中尤为普遍；大约40%的PD患者目前经常吸烟，超过60%的PD患者有终生吸烟史（Amering et al., 1999; Lasser et al., 2000）。有经验证据表明，吸烟与恐慌因素之间存在双向关联，符合正反馈循环过程，导致各种负面影响。这个问题的背景是，我更广泛地认识到，尽管物质使用问题经常与恐慌和其他形式的精神病理学同时发生，但很少有人努力制定理论综合方案，以针对导致这种共病的行为过程（Otto, Powers, & Fischmann, in press; Zvolensky & Schmidt, 2004）。目前的建议旨在通过前瞻性评估戒烟行为和恐慌结果在一个控制随机选择的预防计划的背景下开始填补这一空白。该预防计划将在两个地点实施，将利用认知重组和内感受暴露策略，特别侧重于减少对焦虑和相关焦虑过程的恐惧，以便：(1)减少恐慌发作和恐慌障碍的发展；(2)促进成功戒烟。这个恐慌-吸烟预防项目（PSPP）将整合内感受性暴露、认知重构和心理教育练习，为恐慌预防和治疗项目开发，并提供标准的戒烟咨询。PSPP计划将与标准焦虑敏感性改善干预、标准戒烟和健康信息控制条件进行比较。

DESCRIPTION (provided by applicant): The overall aim of the current proposal is to develop knowledge about the prevention of panic disorder (PD) using a specialized anxiety-smoking cessation intervention. This program will target, within the context of a controlled randomized selected prevention program, two malleable vulnerability factors for the development of PD - anxiety sensitivity (the fear of anxiety and anxiety-related sensations) and cigarette smoking. Panic disorder is a common, severe, and chronic condition characterized by recurrent panic attacks and worry about the possibility of experiencing a future panic attack [American Psychiatric Association (APA), 1994]. Cigarette smoking, the leading cause of death and disability in North America [Centers for Disease Control and Prevention (CDC), 1994], is particularly common among those with, or at risk for, developing PD; approximately 40% of individuals with PD are currently regular smokers and over 60% have a lifetime history of smoking (Amering et al., 1999; Lasser et al., 2000). There is empirical evidence that suggests bi-directional associations between smoking and panic factors, consistent with a positive feedback loop process, resulting in a variety of negative effects. This issue sits on the backdrop of me larger recognition that, although substance use problems frequently co-occur with panic and other forms of psychopathology, there has been little effort to develop theoretically-integrated programs to target behavioral processes that contribute to this comorbidity (Otto, Powers, & Fischmann, in press; Zvolensky & Schmidt, 2004). The present proposal aims to begin to fill this gap in the existing literature by prospectively evaluating quitting behavior and panic outcomes within the context of a controlled randomized selected prevention program. The prevention program, implemented across two sites, will utilize cognitive restructuring and interoceptive exposure strategies with a specific focus on reducing the fear of anxiety and related anxiety processes in order to (1) decrease the development of panic attacks and panic disorder; and (2) facilitate successful cessation. This Panic-Smoking Prevention Program (PSPP) will integrate interoceptive exposure, cognitive restructuring, and psychoeducation exercises developed for panic prevention and treatment programs with standard smoking cessation counseling. The PSPP program will be compared to a standard anxiety sensitivity amelioration intervention, standard smoking cessation, and a health information control condition.