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Treatment of Smoking Among Individuals with PTSD

创伤后应激障碍 (PTSD) 患者吸烟的治疗

基本信息

批准号：
8265316
负责人：
EDNA B FOA
金额：
$ 45.88万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8265316
关键词：
Abstinence Address Affect Alcohol dependence Anger Anxiety Applications Grants Area Arousal Behavior Bupropion Cessation of life Chronic Chronic Post Traumatic Stress Disorder Cigarette Cognitive Therapy Comorbidity Consumption Data Dependence Development Disease Distress Epidemiology Fright Guidelines Health Health Policy Individual Institute of Medicine (U.S.)International Lead Light Maintenance Measures Mental Depression Mental disorders Naltrexone Nicotine Nicotine Dependence Outcome Measure Persons Pharmaceutical Preparations Pharmacotherapy Pilot Projects Placebos Population Post-Traumatic Stress Disorders Prevalence Process Psychological reinforcement Psychopathology Psychotherapy Public Health Publishing Randomized Randomized Controlled Trials Recommendation Recording of previous events Relapse Research Research Design Risk Risk Factors Role Smoke Smoker Smoking Smoking Cessation Intervention Staging Study models Substance Use Disorder Surveys Symptoms Testing Theoretical model Time Tobacco Dependence Withdrawal Withdrawal Symptom Withholding Treatment base cigarette smoking combat comparative efficacy cost effectiveness dependence relapse drinking evidence base experience follow-up improved innovation model development multi-site trial nicotine craving placebo controlled study premature primary outcome programs randomized trial secondary outcome smoking cessation smoking prevalence success treatment program varenicline

项目摘要

DESCRIPTION (provided by applicant): This study will evaluate an innovative program for smokers with Post-Traumatic Stress Disorder (PTSD) that integrates the most effective medication for smoking cessation (varenicline) with prolonged exposure (PE), a highly efficacious cognitive behavioral therapy for PTSD. The development of specifically tailored and more efficacious smoking cessation treatments for smokers with psychiatric disorders, whose cigarette smoking is disproportionately high, has been identified as a high priority in public health policy. PTSD is a common mental disorder with a lifetime prevalence of 6.8%. The prevalence of smoking in people with current PTSD is 44.6% -- double the rate of those with no history of a psychological disorder (22.5%). Smokers with PTSD are more likely to be nicotine dependent, smoke heavily, experience more severe withdrawal symptoms, and relapse after a quit attempt. In fact, the quit rate for smokers with PTSD is among the lowest compared to other mental disorders. Factors that may contribute to smokers' progression to nicotine dependence and relapse include negative affect, fear, anxiety sensitivity, increased arousal, irritability, and anger. Therefore, the integration of treatment for smoking cessation with treatment for PTSD that reduces these factors is hypothesized to improve success of smoking cessation about smokers with PTSD. To test this hypothesis, we will randomly assign smokers with PTSD to either the "best practice" pharmacotherapy for smoking cessation (varenicline) alone or to a treatment that integrates varenicline with PE. The primary outcome measure will be biochemically confirmed abstinence rates at the end of treatment and at follow-up 6-months post quit date. Secondary outcome measures will be continuous abstinence, prolonged abstinence, and time to relapse. We will also obtain measures of PTSD and associated psychopathology (e.g. depression and anxiety) and risk factors (e.g. anxiety sensitivity). Collectively, our research group has expertise in the development of efficacious treatments for PTSD, including PE (Foa, Cahill, Hembree), the epidemiology of smoking and psychiatric disorders (Breslau), and smoking cessation (Lerman, O'Brian, Gariti). The proposed research affords a unique opportunity to combine experts from diverse areas with the aim of developing an innovative, integrated approach to the treatment of people who are likely to fail using existing treatments. PUBLIC HEALTH RELEVANCE: Cigarette smoking is the single most preventable cause of premature death in the US; approximately 50% of long-term smokers die of a disease caused by their dependence, shortening lives by an average of 13-14 years. Smokers with Post Traumatic Stress Disorder (PTSD) are more likely to be nicotine dependent, to smoke heavily (25 cigarettes per day or more), experience more severe withdrawal symptoms, and relapse following a quit attempt than smokers without PTSD. In this grant application, we propose to evaluate an innovative treatment program for smokers with PTSD that integrates varenicline, the most effective medication for smoking cessation, with prolonged exposure therapy, a highly effective form of psychotherapy for PTSD.

描述(申请人提供)：这项研究将评估一项针对患有创伤后应激障碍(PTSD)的吸烟者的创新计划，该计划将最有效的戒烟药物(Varenicline)与长期暴露(PE)相结合，后者是一种治疗创伤后应激障碍的高效认知行为疗法。为患有精神障碍的吸烟者开发专门定制和更有效的戒烟治疗，其吸烟比例高得不成比例，已被确定为公共卫生政策的高度优先事项。创伤后应激障碍是一种常见的精神障碍，终生患病率为6.8%。目前患有创伤后应激障碍的人的吸烟率为44.6%，是那些没有心理障碍病史的人(22.5%)的两倍。患有创伤后应激障碍的吸烟者更有可能依赖尼古丁，吸烟严重，经历更严重的戒断症状，并在戒烟尝试后复发。事实上，与其他精神障碍相比，患有创伤后应激障碍的吸烟者的戒烟率是最低的。可能导致吸烟者发展为尼古丁依赖和复发的因素包括负面情绪、恐惧、焦虑敏感、觉醒增加、易怒和愤怒。因此，假设将戒烟治疗与创伤后应激障碍治疗相结合，以减少这些因素，以提高患有创伤后应激障碍的吸烟者的戒烟成功率。为了验证这一假设，我们将随机地将患有创伤后应激障碍的吸烟者分配到单独使用戒烟药物(Varenicline)或将varenicline与PE相结合的治疗中。主要的结果衡量标准将是在治疗结束时和戒烟后6个月的随访中生化确认的戒毒率。次要结果指标将是持续禁欲、长期禁欲和复发时间。我们还将获得创伤后应激障碍和相关的精神病理学(如抑郁和焦虑)和风险因素(如焦虑敏感性)的测量结果。总体而言，我们的研究小组在开发有效的创伤后应激障碍治疗方法方面拥有专业知识，包括PE(Foa、CaHill、Hembree)、吸烟和精神障碍的流行病学(Breslau)以及戒烟(Lerman、O‘Brian、Gariti)。拟议的研究提供了一个独特的机会，可以将来自不同领域的专家结合起来，目的是开发一种创新的、综合的方法来治疗使用现有治疗方法可能失败的人。与公共健康相关：在美国，吸烟是导致过早死亡的最可预防的单一原因；大约50%的长期吸烟者死于依赖引起的疾病，平均缩短寿命13-14年。与没有创伤后应激障碍(PTSD)的吸烟者相比，患有创伤后应激障碍(PTSD)的吸烟者更有可能依赖尼古丁，吸烟严重(每天25支或更多)，经历更严重的戒断症状，并在戒烟尝试后复发。在这项拨款申请中，我们建议评估一项针对患有创伤后应激障碍的吸烟者的创新治疗计划，该计划将最有效的戒烟药物varenicline与长期暴露疗法相结合，后者是治疗创伤后应激障碍的一种高效心理疗法。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

创伤相关认知可预测患有 PTSD 的吸烟者的治疗反应：来自交叉滞后面板分析的证据。

DOI：
10.1016/j.addbeh.2020.106376
发表时间：
2020
期刊：
Addictive behaviors
影响因子：
4.4
作者：
Mu,Wenting;Narine,Kevin;Farris,Samantha;Lieblich,Shari;Zang,Yinyin;Bredemeier,Keith;Brown,Lily;Foa,Edna
通讯作者：
Foa,Edna

The Relationship between Anxiety Sensitivity and Posttraumatic Stress Disorder: What is the Impact of Nicotine Withdrawal?

焦虑敏感性与创伤后应激障碍之间的关系：尼古丁戒断有何影响？