Integrated Smoking Cessation Treatment for Emotional Dysregulation

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（美国卫生与公众服务部[USDHHS]， 2004年）。吸烟率的选择假说认为，能够成功戒烟的吸烟者不会受到使戒烟更具挑战性的特定特征的“负担”（Coambs et al., 1989; Hughes, 1993; Hughes & Brandon, 2003）。值得注意的是，与没有精神病史的人以及患有多种精神疾病的人相比，患有抑郁或焦虑症状和疾病的人的吸烟率和戒烟失败率不成比例地高（Bejerot & Humble, 1999; Lasser 2000）。研究人员已经开始为患有抑郁症（例如，Brown et al., 2001; Hall et al., 1998）和某些焦虑特征（例如，高焦虑敏感性；Zvolensky, Bernstein, Yartz, McLeish, & Feldner, 2008）的吸烟者开发专门的行为干预措施。然而，这项工作的主要障碍是，针对这一人群的现有治疗方法仅针对吸烟的单一精神共病，而对于患有多种焦虑障碍或同时发生的抑郁和焦虑症状或障碍升高的吸烟者，缺乏治疗策略。这种忽视是不幸的，因为多种抑郁和焦虑症状和障碍：(a)经常同时发生在吸烟者身上（Mykletun等人，2003），(b)是最常见的精神疾病群体之一（Kessler等人，2005），(c)似乎具有与吸烟病因相关的共同（跨诊断）脆弱性过程(例如，痛苦不耐受、焦虑敏感和快感缺乏；Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009)和(d)表现出相当大的现象重叠（Mineka, Watson, & Clark, 1998）。因此，我们建议进行一项为期3年的研究，为焦虑抑郁的弱势吸烟者开发戒烟的综合治疗方法。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尼古丁依赖策略的重要一步。本研究通过评估一种干预措施来解决一个重要的公共卫生问题，这种干预措施可能会导致更有效地应用于治疗精神上有风险的吸烟者。预期的研究结果应：(1)指导焦虑-抑郁-吸烟关系相关机制的理论概念化。(2)直接告知针对焦虑和抑郁障碍吸烟者的新型、心理/行为和药物戒烟干预措施的发展。

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 (U. S. Department of Health and Human Services [USDHHS], 2004).The selection hypothesis of smoking prevalence posits that smokers who are able to quit successfully are not "burdened" by specific characteristics that make it more challenging to quit (Coambs et al., 1989; Hughes, 1993; Hughes & Brandon, 2003). Notably, cigarette smoking rates and rates of cessation failure are disproportionately higher among those with elevated depressive or anxiety symptoms and disorders relative to persons with no psychiatric history, and those with many types of psychiatric conditions (Bejerot & Humble, 1999; Lasser 2000). Researchers have started to develop specialized behavioral interventions for smokers with depressive (e.g., Brown et al., 2001; Hall et al., 1998) and certain anxiety characteristics (e.g., high anxiety sensitivity; Zvolensky, Bernstein, Yartz, McLeish, & Feldner, 2008). Yet, central barriers to such work are that existing treatments for this population address only a single psychiatric comorbidity with smoking and therapeutic tactics are absent for smokers with multiple anxiety disorders or co-occurring elevated depressive and anxiety symptoms or disorders. Such neglect is unfortunate, as multiple depression and anxiety symptoms and disorders: (a) frequently co-occur in smokers (Mykletun et al., 2003), (b) are among the most common groups of psychiatric disorders (Kessler et al., 2005), (c) appear to share common (transdiagnostic) vulnerability processes implicated in the etiology of smoking (e.g., distress intolerance, anxiety sensitivity, and anhedonia; Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009), and (d) exhibit considerable phenomenological overlap (Mineka, Watson, & Clark, 1998). Accordingly, we are proposing a 3-year study to develop an integrated treatment for smoking cessation for anxiety-depressive vulnerable 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 te 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. This study addresses an important public health issue by assessing an intervention that may lead to a more effective application for the treatment of psychiatrically at-risk smokers. The expected findings should: (1) Guide advances in the theoretical conceptualization of the mechanisms involved in anxiety-depression- smoking relations. (2) Directly inform the development of a novel and psychosocial/behavioral and pharmacological smoking cessation intervention(s) for smokers with anxiety and depressive disorders.