Tobacco treatment as augmentation to Cognitive Processing Therapy for PTSD

研究背景和当前研究兴趣：我从事烟草研究已有十年， 从本科生开始，一直到博士后工作。我的研究背景包括 制定、评估和实施烟草依赖的治疗方法。我目前是一个项目 国家创伤后应激障碍中心(NCPTSD)女性健康科学主任 组织。与患有创伤后应激障碍的退伍军人一起工作让我警觉到在这个国家烟草使用的高流行率 人口和烟草使用与创伤后应激障碍康复之间的相互作用。我在烟草治疗方面的背景 对其他高危精神疾病和医学人群的开发和评估使我非常适合 研究烟草依赖和创伤后应激障碍共病患者的治疗方法。为了追求这一点 研究，我需要以下方面的培训：创伤后应激障碍的研究方法；创伤后应激障碍的手工化治疗开发和 戒烟；临床试验研究，包括试验设计、管理和复杂的数据 分析。NCPTSD是获取这些领域知识的理想环境。CDA-2奖将允许 我接受了必要的培训，以继续研究共患创伤后应激障碍的治疗方案 烟草依赖。 拟议研究摘要：PSTD患者吸烟率高， 烟草相关疾病的流行。烟草使用-创伤后应激障碍共病的机制还没有 已经确定了。两种可能的机制包括：(1)尼古丁干扰创伤后应激障碍的恢复和(2) 烟草被用作治疗创伤后应激障碍的自我药物。动物模型表明尼古丁可能会干扰 通过加强被动回避和情景恐惧条件反射以及抑制来从创伤后应激障碍中恢复 灭绝。这些发现还没有在人类身上进行复制测试。创伤后应激障碍患者报告使用 烟草可以控制创伤后应激障碍症状。然而，关于烟草使用量是否减少的数据不太清楚 创伤后应激障碍症状。戒烟会导致类似创伤后应激障碍的戒断症状，包括病情加重 消极情绪的影响，进一步使烟草使用评估和创伤后应激障碍症状之间的关系复杂化。另外， 创伤后应激障碍症状是烟草使用的诱因，因此可能导致对烟草的渴望和复发。 那些最近戒酒的人。需要研究来研究潜在的相互作用的机制 创伤后应激障碍和烟草使用的影响，以便开发治疗这些经常并存的疾病的方法。 这项拟议的研究旨在检查烟草对创伤后应激障碍症状和创伤后应激障碍恢复的影响。 因为创伤后应激障碍的康复对烟草使用的影响。本研究有三个目的：(1)评估是否使用烟草 在以经验为基础、以创伤为重点的创伤后应激障碍治疗过程中干扰创伤后应激障碍的恢复。(2)收集 关于烟草使用是否缓解持续吸烟者的创伤后应激障碍症状与 最近戒烟的人。(3)探讨创伤后应激障碍的康复对烟草使用量和 频率、戒烟症状和对烟草的渴望。为了测试这些目标，我们提出了一个 随机两组设计，其中50名参与者被分配接受任一烟草治疗 (应急管理加认知行为疗法)或对照治疗(健康教育) 完成创伤后应激障碍的认知加工治疗。研究结果变量将是创伤后应激障碍症状 CPT后的严重程度、戒烟治疗期间的创伤后应激障碍症状严重程度以及烟草使用和 CPT期间戒烟。在此奖项期间接受的培训将使该候选人准备提交 优点审查申请大规模临床试验，重点测试长期疗效和 烟草依赖与创伤后应激障碍共病治疗过程中的变化机制。

Research Background and Current Research Interests: I have been a tobacco researcher for ten years, beginning as an undergraduate and continuing through postdoctoral work. My research background includes treatment development, evaluation and implementation for tobacco dependence. I am currently a Project Director at the National Center for Posttraumatic Stress Disorder (NCPTSD), Women's Health Sciences Division. Working with Veterans with PTSD has alerted me to the high prevalence of tobacco use in this population and the interplay between tobacco use and PTSD recovery. My background in tobacco treatment development and evaluation for other high risk psychiatric and medical populations makes me well suited to investigate treatments for individuals with comorbid tobacco dependence and PTSD. In order to pursue this research, I require training in: PTSD research methods; manualized treatment development for PTSD and tobacco cessation; and clinical trials research including trial design, management and sophisticated data analysis. The NCPTSD is an ideal environment to gain knowledge in these areas. A CDA-2 award would allow me to receive the necessary training to pursue a program of research in treatment for comorbid PTSD and tobacco dependence. Summary of the Proposed Research: Individuals with PSTD use tobacco at high rates and have a high prevalence of tobacco-related disease. The mechanisms for the tobacco use-PTSD comorbidity have not been determined. Two possible mechanisms include: (1) that nicotine interferes with PTSD recovery and (2) that tobacco is used as self-medication for PTSD. Animal models suggest that nicotine may interfere with recovery from PTSD by enhancing passive avoidance and contextual fear conditioning, as well as inhibiting extinction. These findings have not been tested for replication in humans. Individuals with PTSD report using tobacco to manage PTSD symptoms. However, the data is less clear as to whether tobacco use decreases PTSD symptoms. Tobacco cessation results in withdrawal symptoms that mimic PTSD, including exacerbation of negative affect, further complicating assessment of tobacco use and PTSD symptom relations. Additionally, PTSD symptoms serve as triggers for tobacco use and therefore could result in craving for tobacco and relapse in those recently abstinent. Research is needed to investigate the mechanisms underlying potential reciprocal influences of PTSD and tobacco use in order to develop treatments for these often comorbid disorders. The proposed research aims to examine the effect of tobacco on PTSD symptoms and PTSD recovery as well as the effect of PTSD recovery on tobacco use. This study has 3 aims: (1) to evaluate whether tobacco use interferes with recovery from PTSD during empirically based, trauma focused PTSD treatment. (2) To gather preliminary data about whether tobacco use alleviates PTSD symptoms among continued tobacco users vs. recent quitters. (3) To explore the impact of recovery from PTSD treatment on tobacco use quantity and frequency, tobacco withdrawal symptoms, and craving for tobacco. To test these aims, we propose a randomized two group design where 50 participants are assigned to receive either tobacco treatment (Contingency Management plus Cognitive Behavioral Therapy) or control treatment (Health Education) before completing Cognitive Processing Therapy (CPT) for PTSD. Study outcome variables will be PTSD symptom severity following CPT, PTSD symptom severity during tobacco cessation treatment, and tobacco use and tobacco withdrawal during CPT. Training received during this award will prepare this candidate to submit a Merit Review application for a large scale clinical trial focused on testing the long-term efficacy and mechanisms of change of during treatment for comorbid tobacco dependence and PTSD.