Integrated Treatment for Smoking Cessation & Anxiety in People with HIV

描述（由申请人提供）：在美国，吸烟是导致死亡和残疾的主要原因，每年造成超过44万人死亡。尽管吸烟与发病率和死亡率有明显的联系，但目前美国仍有4000多万成年人吸烟。研究表明，艾滋病毒阳性的成年人成为吸烟者的风险更高，对于有焦虑问题的人来说，戒烟可能特别困难。尽管恐慌和相关焦虑症经常与吸烟同时发生，并且在艾滋病毒感染者中很普遍，但很少有人关注如何改善这一艾滋病毒+吸烟者高危群体的戒烟结果。这种忽视存在于戒烟文献中一个更大的问题的背景下：在针对尼古丁依赖的有效心理社会治疗方面普遍缺乏创新，尤其是在艾滋病毒感染者中。研究人员经常呼吁人们注意吸烟和焦虑相关状态之间的联系。最近的证据表明，焦虑障碍和相关的焦虑易感性因素，特别是焦虑敏感性（或对躯体唤醒的恐惧），对戒烟有负面影响。这些发现表明，针对艾滋病毒阳性吸烟者的焦虑症状来改善戒烟结果具有临床和理论价值。越来越多的研究表明，焦虑症可以通过跨诊断认知行为治疗（CBT）得到有效治疗。因此，我们建议进行一项为期3年的研究，为易受焦虑影响的艾滋病毒阳性吸烟者开发戒烟综合治疗方案。干预发展方法将遵循与NIH制定和标准化行为干预指南一致的阶段模型，拟议的研究代表IB阶段研究。具体来说，在第一年，启动活动将包括对一小部分个人（N = 12）进行综合干预试验，征求内部和外部专家顾问和参与者的反馈，以及制定最终的治疗手册和程序。这一阶段的目标是确定治疗交付的可行性、参与者的可接受性和潜在的效果。在接下来的两年中，将进行一项小型的两组疗效研究（N = 60），将新干预措施与对照干预措施进行比较。这项研究代表了将基础研究转化为更有效的治疗艾滋病毒尼古丁依赖策略的重要一步。本研究通过评估一项干预措施，解决了一个重要的公共卫生问题，该干预措施可能导致更有效地应用于治疗高危HIV+吸烟者。预期的发现应该：(1)指导艾滋病毒焦虑-吸烟关系机制的理论概念化进展。(2)直接告知发展一种新的社会心理/行为和药物戒烟干预HIV+吸烟者的焦虑障碍。这是一项跨学科的研究计划，涉及临床心理学家、医生和心理健康/艾滋病毒咨询师之间的合作。

DESCRIPTION (provided by applicant): Cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 440,000 deaths each year. Still, over 40 million adults in the U.S. currently smoke despite well-established links to morbidity and mortality. Studies suggest HIV+ adults are at a higher risk for being current smokers and that quitting smoking may be particularly difficult for individuals with anxiety problems. Although panic and related anxiety disorders frequently co-occur with smoking and are prevalent among persons living with HIV, there has been very little attention given to improving cessation outcome among this high-risk group of HIV+ smokers. This neglect sits on the backdrop of a larger issue in the smoking cessation literature: a general lack of innovation in efficacious psychosocial treatments for nicotine dependence, particularly among persons living with HIV. Researchers have frequently called attention to the links across smoking and anxiety-related states. Recent evidence suggests that anxiety disorders and related anxiety vulnerability factors, specifically anxiety sensitivity (or fear of somatic arousal), negatively impact cessation. These findings indicate that there is clinical and theoretical merit to targeting anxiety symptoms among HIV+ smokers to improve cessation outcomes. A growing body of work suggests that anxiety disorders can be effectively treated with transdiagnostic cognitive behavioral treatment (CBT). Accordingly, we are proposing a 3-year study to develop an integrated treatment for smoking cessation for anxiety-vulnerable HIV+ smokers. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions, with the proposed research representing a Stage IB study. Specifically, during the first year, startup activities will include piloting the integrated intervention on a subset of individuals (N = 12), soliciting internal and external expert consultant and participant feedback, and development of the final treatment manual and procedures. The goal during this phase will be to establish feasibility of treatment delivery, participant acceptability, and potential for an effect. During the following two years, a small two-arm efficacy study (N = 60) will be undertaken comparing the new intervention to a control intervention. This study represents an important step in the larger landscape of translating basic research to more efficacious strategies for treating nicotine dependence in HIV. This study addresses an important public health issue by assessing an intervention that may lead to a more effective application for the treatment of at-risk HIV+ smokers. The expected findings should: (1) Guide advances in the theoretical conceptualization of the mechanisms involved in HIV-anxiety-smoking relations. (2) Directly inform the development of a novel and psychosocial/behavioral and pharmacological smoking cessation intervention(s) for HIV+ smokers with anxiety disorders. This is an interdisciplinary research proposal that involves collaboration between clinical psychologists, physicians, and mental health/HIV counselors. PUBLIC HEALTH RELEVANCE: This trial will provide important information regarding the potential efficacy and mechanisms of an integrated intervention for and at risk group of HIV+ smokers, namely those who also have clinically significant anxiety problems (>60% of HIV+ smokers). Identifying efficacious treatments for smoking cessation for HIV+ adults has considerable public health significance because cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 440,000 deaths each year, and HIV+ smokers comprise an overrepresented group among smokers. Moreover, this study will guide advances in the theoretical conceptualization of the mechanisms involved in HIV-anxiety- smoking relations.