Brief mindfulness cessation training with EMA for post-hospital depressed smokers

使用 EMA 对出院后抑郁的吸烟者进行简短的正念戒烟训练

• 批准号: 8828913
• 负责人: RICHARD A BROWN
• 金额: $ 34.27万
• 依托单位: FORDHAM UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8828913
• 关键词: Abstinence; Affect; Association Learning; Cellular Phone; Charge; Cues; Data; Depressed mood; Development; Ecological momentary assessment; Environment; Exercise; Exposure to; General Population; Goals; Home environment; Hospitalization; Hospitals; Incentives; Individual; Inpatients; Intervention; Interview; Learning; Life; Maintenance; Major Depressive Disorder; Mediator of activation protein; Mental Depression; Mental disorders; Modification; Morbidity - disease rate; Outcome; Patient Discharge; Patient Self-Report; Patients; Population; Populations at Risk; Prevalence; Psychiatric Hospitals; Psychological reinforcement; Public Health; Randomized Controlled Trials; Recruitment Activity; Relapse; Relative (related person); Research; Risk; Schedule; Series; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Specific qualifier value; Testing; Time; Tobacco; Tobacco use; Training; Treatment Efficacy; Withdrawal; behavior change; brief advice; contingency management; cost; cost effective; craving; depressed patient; depressive symptoms; effective intervention; experience; high risk; improved; innovation; inpatient psychiatric treatment; interest; mindfulness; mortality; neglect; programs; prototype; public health priorities; public health relevance; response; smoking cessation; stress reactivity; success; theories

DESCRIPTION (provided by applicant): Smoking rates among individuals with depression are disproportionately higher than the general population, as are their rates of tobacco-related morbidity and mortality. The majority of psychiatric hospitals ban smoking on hospital grounds, thus providing an opportunity for inpatients to experience abstinence. Yet, smokers in inpatient psychiatric settings are rarely encouraged to quit and the vast majority return to smoking immediately after discharge. An effective intervention that targets this transition, capitalizing o this valuable experience of abstinence, is needed to increase smoking cessation in this at-risk population. The goal of the proposed study is to develop a mindfulness smartphone intervention with contingency management (MSI-CM) for smoking cessation that can be readily available to depressed smokers transitioning to their natural environment following psychiatric hospitalization. The goal will be accomplished by pursuing three specific aims: 1) to develop and conduct a preliminary pilot test (n=10) of the MSI-CM receiving inpatient psychiatric treatment, 2) to conduct a preliminary randomized controlled trial (RCT) with 60 depressed smokers recruited during inpatient psychiatric treatment, comparing MSI-CM and enhanced brief advice (E-BA), with a prediction that MS-CM relative to E-BA will result in higher rates of smoking cessation at 2-week, 4-week, and 3-month post-discharge follow-ups and have longer periods of continuous abstinence after hospital discharge, and 3) to examine MSI-CM's effects on key mechanisms (hypothesized mediators) and their associations with smoking outcomes at 2-week, 4-week, and 3-month follow-ups. The research proposed is innovative in that: 1) no previous studies have implemented a mindfulness intervention targeting tobacco use among depressed smokers in a psychiatric inpatient setting or have utilized smartphones to facilitate implementation, 2) the proposed intervention targets a neglected period of inpatient-home transition, with intervention components delivered in the context of both the inpatient setting and the patient's own environment, 3) the proposed intervention differs from existing mindfulness interventions in that smokers will practice mindfulness while abstinent and experiencing withdrawal, craving and negative affect, both in the hospital and in their own environment, incentivized by contingency management, 4) the use of contingency management (to reinforce abstinence) in conjunction with mindfulness training, in order to enhance the efficacy of mindfulness intervention for smoking cessation is innovative, and 5) no previous study has collected ecological momentary assessment data on constructs related to smoking and mindfulness in this high-risk population, in both an inpatient setting and after hospital discharge If this intervention is found to be efficacious, the potential impact of this program of research wll be considerable, not only in its innovation, but because its objectives are consistent with a significant public health priority: the ready dissemination of effective, low-cost interventions to reduce morbidity and mortality among individuals with psychiatric disorders.

描述（由申请人提供）：抑郁症患者的吸烟率不成比例地高于一般人群，与烟草相关的发病率和死亡率也是如此。大多数精神病医院禁止在院内吸烟，从而为住院病人提供了体验禁欲的机会。然而，住院精神病患者中的吸烟者很少被鼓励戒烟，绝大多数人在出院后立即恢复吸烟。需要针对这种转变的有效干预，利用这一宝贵的戒烟经验，以增加这一高危人群的戒烟率。拟议研究的目标是开发一种具有应急管理（MSI-CM）的正念智能手机干预戒烟，可以随时提供给精神病住院后过渡到自然环境的抑郁吸烟者。将通过实现三个具体目标来实现这一目标：1）开发并进行MSI-CM接受住院精神病治疗的初步试点试验（n=10），2）对60名在住院精神病治疗期间招募的抑郁症吸烟者进行初步随机对照试验（RCT），比较MSI-CM和增强的简短建议（E-BA），预测MS-CM相对于E-BA在出院后2周、4周和3个月随访时的戒烟率更高，并且出院后持续戒烟的时间更长，和3）在2周、4周和3个月的随访中检查MSI-CM对关键机制（假设的介质）的影响及其与吸烟结果的关联。这项研究的创新之处在于：1）以前的研究没有针对精神病住院环境中抑郁吸烟者的烟草使用实施正念干预，也没有利用智能手机促进实施，2）拟议的干预针对被忽视的住院-家庭过渡期，在住院环境和 患者自身的环境，3）所提出的干预措施与现有的正念干预措施不同，因为吸烟者将在禁欲和经历戒断、渴望和负面影响的同时练习正念，无论是在医院还是在他们自己的环境中，都受到应急管理的激励，4）应急管理的使用（以强化戒断）配合正念训练，以提升正念干预戒烟的功效是创新的，以及5）没有先前的研究收集到关于在该高危人群中与吸烟和正念相关的结构的生态瞬时评估数据，无论是在住院环境中还是在出院后。如果发现这种干预有效，这一研究计划的潜在影响将是相当大的，不仅是因为它的创新，而且因为它的目标与一个重要的公共卫生优先事项是一致的：迅速传播有效的、低成本的干预措施， 降低精神疾病患者的发病率和死亡率。