Self-report and behavioral reactivity to combined smoking cues

描述(由申请人提供)：基于线索的吸烟研究清楚地表明，吸烟者在接触到与吸烟有关的刺激时，会报告强烈的条件性反应(最常见的形式是渴望)。这项工作已被用于提供基于线索暴露的治疗方法，旨在通过消退训练消除对线索的反应性，以此作为降低复发可能性的一种手段。然而，过去的线索-反应性研究在揭示线索如何影响实际吸烟行为方面出人意料地有限。造成这一限制的两个关键原因包括：(1)主要关注近端吸烟线索(例如，点燃的香烟、吸烟的图片刺激)，而忽略那些与吸烟行为不太连续的远端线索(例如，个人吸烟环境和通常吸烟的周围人)；(2)在缺乏评估实际吸烟行为的衡量标准(吸烟潜伏期和接触线索时临时吸烟)的情况下，强烈依赖自我报告措施(例如，渴望)。为了解决前者的局限性，我们最近在先前的探索性R21(DA017582)下的工作表明，吸烟者对环境和人的标准近端吸烟线索和个性化远端吸烟线索的渴望反应同样强烈。此外，发出戒烟信号的个人环境和周围从不吸烟的人似乎对吸烟的渴望起到了保护作用。然而，继续单独研究每一种线索类型并不能提供线索在现实世界中如何发挥作用的完整图景，在现实世界中，这些线索往往是共存的。为了以一种更接近于在实验室外遇到线索的方式来检验线索，拟议的研究将评估单独和组合对近端和个人远端线索的反应性。关于后一种限制，有一个普遍的假设，即自我报告对暗示(例如，渴望)的反应与实际的吸烟行为直接相关；然而，这一概念在很大程度上是未经检验的。因此，这项研究的第二个主要目标是考察不同线索的组合如何影响吸烟者的自我报告和行为反应，以及这些线索反应指数之间是如何联系的。这项拟议的研究将导致对吸烟者在现实生活中面临的显著线索如何单独和协同作用以增强或减弱他们的自我报告和行为线索反应性的新理解。此外，这项工作将允许审查这两个关键线索反应性指标之间的联系和/或差异。这项工作将直接为基于线索的吸烟治疗提供新的信息，包括那些专注于帮助吸烟者识别和避免特定吸烟触发因素的治疗方法，以及那些旨在消除冲动反应以减少戒烟后复发的治疗方法。此外，这些程序可能提供了一种在任何类型的戒烟治疗后早期成功的指标，因为治疗后对近端或个人远端暗示的认知或行为反应较少的个人预计不太可能复发。与公共健康相关：尼古丁以外的因素被认为在继续吸烟和一些吸烟者无法戒烟方面发挥了关键作用。研究表明，吸烟者在接触到与过去吸烟经历有关的线索时，会报告强烈的渴望。这样的线索可以是近端的(例如，香烟、烟灰缸)，也可以是远端的(例如，环境和人)。这个项目考察了这两种类型的线索如何单独和联合作用来影响吸烟者的思想和感觉，以及他们实际的吸烟行为。这项研究将回答有关不同类型的线索反应之间的关系的重要问题，并将直接为未来吸烟的行为治疗提供参考。

DESCRIPTION (provided by applicant): Cue-based smoking research has clearly demonstrated that smokers report robust conditioned responding (most often in the form of craving) when exposed to smoking-related stimuli. This work has been used to inform cue-exposure based treatments aimed at eliminating reactivity to cues via extinction training as a means of decreasing the likelihood of relapse. However, past cue-reactivity work is surprisingly limited in what it reveals about how cues affect actual smoking behavior. Two key reasons for this limitation include: (1) focusing primarily on proximal smoking cues (e.g., lit cigarettes, pictorial stimuli of smoking) while ignoring distal cues those less contiguous to the act of smoking (e.g., personal smoking environments and the people around whom one typically smokes), and (2) a strong reliance on self-report measures (e.g., craving) in the absence of measures that assess actual smoking behavior (latency to smoke and ad lib smoking when exposed to cues). In addressing the former limitation, our recent work under a previous exploratory R21 (DA017582) has revealed that smokers respond with equally robust craving to both standard proximal smoking cues and personalized distal smoking cues of environments and people. Additionally, personal environments that signal not smoking and personal people around whom one would never smoke appear to serve a protective function on craving to smoke. However, continuing to study each of these cue type alone fails to offer a complete picture of how cues might function in the real world where such cues more often than not co- exist. In order to examine cues in a manner that more closely mimics how cues are encountered outside of the lab, the proposed research will assess reactivity to both proximal and personal distal cues alone and in combination. Regarding the latter limitation, there is a common assumption that self-report responding to cues (e.g., craving) is directly related to actual smoking behavior; however, this notion is largely untested. Therefore, the second main objective of the proposed studies is to examine how combinations of various cues affect both self-report and behavioral reactivity in smokers, and how those indices of cue responding relate to one another. The proposed studies will result in new understanding of how salient cues that smokers confront in their real lives function alone and in concert to augment or attenuate both their self- report and behavioral cue-reactivity. Moreover, this work will allow for examination of associations and/or disparities between those two key measures of cue reactivity. This work will directly inform new cue-based smoking treatments, both those focused on helping smokers identify and avoid specific smoking triggers, and those aimed at extinguishing urge-responding to reduce relapse post-quit. Furthermore, these procedures may provide a means to index early success following cessation treatment of any kind, as individuals less reactive cognitively or behaviorally to proximal or personal distal cues post-treatment would be expected to be less likely to relapse. PUBLIC HEALTH RELEVANCE: Factors other than nicotine are thought to play key roles in the continuation of smoking and the inability of some smokers to quit. Research has shown that smokers report robust craving when exposed to cues related to past experiences with smoking. Such cues can be both proximal (e.g., cigarette, ashtrays) and distal (e.g., environments and people). This project examines how both types of cues function alone and in combination to affect smokers' thoughts and feelings, as well as their actual smoking behavior. This research will answer important questions about the relationship between different types of cue responding, and will directly inform future behavioral treatments for smoking.