Behavioral activation intervention, reward processing and youth smoking cessation

描述(申请人提供)：有证据表明，相当大比例的青少年定期吸烟者有兴趣尝试戒烟，并经常尝试戒烟，但未能成功地自行戒烟。尽管许多青少年真心希望戒烟，但较年长青少年的吸烟率却在不断上升，这与一般人减少吸烟的总体趋势背道而驰。不幸的是，心理社会和药理学吸烟干预措施尚未显示出对年轻人的明显效果。此外，与抑郁相关的脆弱性，特别是目前上升的抑郁症状，与吸烟行为高度共存，并极大地降低了戒烟率。因此，目前抑郁症状加重的青少年吸烟者需要新的戒烟方法。行为激活(BA)是一种可能与年轻人特别相关的方法。BA已被证明通过增加与积极强化事件的接触来减少抑郁症状，从而有效地治疗抑郁症患者。在吸烟方面，BA是一种基于强化理论的实用治疗方法，帮助个人养成更健康、更积极的生活方式，同时解决抑郁症状和戒烟。在考虑BA的关键理论方面及其在强化理论中的基础时，奖赏敏感度的构建是非常重要的。由于奖励敏感度在不同的个体和不同的发展阶段存在很大差异，目前的应用程序将采取翻译方法。最后，尽管有大量研究支持成人使用BA上瘾，但在将成人衍生治疗模式应用于青少年时，发展方面的考虑是至关重要的。该项目的目标是开发一种针对18-21岁抑郁症状升高的青少年吸烟的专门行为激活疗法(BATSY)。该项目将分两个阶段进行。在第一阶段，我们将利用焦点小组和15名青年的试点测试来制定BATSY治疗方案。在第二阶段，我们将对30名年轻人进行BATSY加尼古丁替代疗法的开放标签试验。在测试这种新开发的BA治疗青少年吸烟者抑郁症状加剧的背景下，我们将使用复杂的功能磁共振成像方法来检查基线奖励敏感性与治疗反应的关联程度。为了实现这些多学科目标，将神经发育和神经行为方法与青少年吸烟者的行为治疗开发相结合，根据RFA-DA-10-003，我们将建立一个由马里兰大学、NIMH和耶鲁大学的研究人员组成的翻译合作。 公共卫生相关性：抑郁症状加重的青少年吸烟者发展为慢性成年吸烟者的风险很大，但缺乏专门针对他们需求的吸烟治疗。该应用程序是首次尝试使用翻译的多学科团队建设方法，为这一极具风险的青年群体开发和测试专门的行为激活(BA)基础协议。

DESCRIPTION (provided by applicant): Evidence suggests a significant percentage of adolescent regular smokers are interested in trying to quit smoking and frequently make attempts to quit, yet are unsuccessful in maintaining abstinence on their own. Despite a genuine desire to quit on the part of many adolescents, there is an increasing incidence of smoking among older adolescents that runs counter to the overall trends of smoking reduction seen in the general population. Unfortunately, psychosocial and pharmacological smoking interventions have yet to indicate clear effectiveness with youth. Moreover, depression-related vulnerabilities, particularly currently elevated depressive symptoms, are highly comorbid with smoking behavior and dramatically reduce cessation rates. As a result, new approaches to smoking cessation are needed for adolescent smokers with currently elevated depressive symptoms. Behavioral activation (BA) is an approach that may be especially relevant for youth. BA has been shown to effectively treat those with depressive disorders through reduction of depressive symptoms by increasing contact with positive reinforcing events. In its application to smoking, BA is a practical, treatment approach based on reinforcement theory that helps individuals develop a more healthy and active lifestyle to simultaneously address depressive symptoms and quit smoking. In considering key theoretical aspects of BA and its basis in reinforcement theory, the construct of reward sensitivity is of great importance. Because reward sensitivity differs greatly across individuals and different stages of development, the current application will take a translational approach. Finally, despite a strong body of work supporting the use of BA with addictions in adults, developmental considerations are critical when applying adult derived-treatment models to adolescents. The objective of the proposed project is to develop a specialized behavioral activation treatment for smoking in youth ages 18-21 with elevated depressive symptoms (BATSY). The project will take place in two phases. In the first phase, we will utilize focus groups and pilot testing with 15 youth to develop the BATSY treatment protocol. In Phase II, we will conduct an open-label trial of BATSY plus nicotine replacement therapy with 30 youth. In the context of testing this newly developed BA treatment for adolescent smokers with elevated depressive symptoms, we will use sophisticated fMRI methodology to examine the extent to which baseline reward sensitivity is associated with treatment response. To achieve these multidisciplinary goals at the integration of neurodevelopmental and neurobehavioral methods with behavioral treatment development for adolescent smokers, in line with RFA-DA-10-003, we will establish a translational collaboration of researchers from University of Maryland, NIMH, and Yale University. PUBLIC HEALTH RELEVANCE: Adolescent smokers with elevated depressive symptoms are at significant risk to develop into chronic adult smokers, yet smoking treatments specifically targeted to their needs are absent. This application represents the first effort to develop and test a specialized behavioral activation (BA) base protocol for this extremely at- risk group of youth using a translational, multidisciplinary team-building approach.