Web-Delivered Acceptance & Commitment Therapy for Smokers with Bipolar Disorder

网络交付验收

• 批准号: 8951982
• 负责人: Jaimee Heffner
• 金额: $ 18.96万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8951982
• 关键词: Abstinence; Acceptance Process; Address; Adult; Aftercare; Behavioral; Belief; Bipolar Disorder; Chronic Disease; Cigarette Smoker; Communities; Comorbidity; Consent; Counseling; Data; Development; Disease; District of Columbia; Epidemic; Future; General Population; Goals; Government; Guidelines; Healthcare; Healthcare Systems; High Prevalence; Individual; Internet; Intervention; Life Expectancy; Mediating; Mental Depression; Mental Health; Mental disorders; Modeling; National Cancer Institute; National Institute of Drug Abuse; Office of Assistant Secretary of Health; Online Systems; Outcome; Participant; Pharmacotherapy; Phase; Population; Procedures; Psyche structure; Publishing; Randomized Controlled Trials; Research Infrastructure; Research Priority; Site; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Staging; Strategic Planning; Symptoms; Testing; Therapeutic Intervention; Tobacco; Treatment Efficacy; United States Dept. of Health and Human Services; United States Public Health Service; Withholding Treatment; Work; base; burden of illness; cost effective; efficacy trial; experience; follow-up; health disparity; high risk; improved; innovation; mortality; nicotine patch; nicotine replacement; novel; novel strategies; pilot trial; programs; public health relevance; satisfaction; smoking cessation; smoking prevalence; standard care; theories; therapy development; tobacco control; treatment duration; trial comparing; usability; web site; willingness

 DESCRIPTION (provided by applicant): Up to 70% of adults with bipolar disorder smoke, compared with only 20% of the general population, leading to disproportionately high rates of tobacco-related disease and mortality. Quit rates for smokers with bipolar disorder are less than half that of smokers without psychiatric disorders (17% vs. 43%). Key barriers to improving quit rates in this group are: (1) unique challenges of quitting for smokers with bipolar disorder that are not addressed in standard cessation counseling, such as the commonly held belief that smoking helps to manage symptoms of the disorder, and (2) limited access to tobacco treatment within the mental health care system. New approaches are greatly needed to address both of these barriers. Web-based Acceptance and Commitment Therapy (ACT) is a new model of smoking cessation treatment that more than doubled quit rates compared to the current standard, the US government's Smokefree.gov site (23% vs. 10% at 3-month follow- up). Adding nicotine replacement therapy (NRT)--an effective and accessible pharmacotherapy-and targeting this intervention to address the major barriers to quitting for smokers with bipolar disorder could significantly improve the extremely low quit rates. The proposed project involves development and pilot testing of a targeted, web-based ACT intervention for smokers with bipolar disorder (WebQuit Plus), which builds on our promising pilot data showing 40% quit rate and 90% acceptability for this intervention when delivered as face- to-face, individual therapy. The study will be conducted in two phases. The first phase will consist of intervention development and web site usability testing (n=12). The second phase will be a pilot randomized, controlled trial at three sites within the National Network of Depression Centers (NNDC), comparing WebQuit Plus (n=30) to Smokefree.gov (n=30). Both interventions will be delivered in combination with the nicotine patch. A primary aim of the study is to determine feasible procedures for conducting a larger, multi-site efficacy trial within the NNDC, with primary feasibility outcomes including: (1) recruitment (i.e., number approached, screened, eligible, and consented; reasons for ineligibility or refusal), (2) completion of the intervention and (3) outcom data retention. Another primary aim is to compare WebQuit Plus to Smokefree.gov on treatment satisfaction and utilization, ACT's theory-based mechanism of change smoking cessation outcomes, and bipolar disorder symptoms at the end of the 10-week treatment period and at 1-month post-treatment follow- up. This study is significant and innovative in two key respects: (1) it applies a promising new treatment (ACT) with a novel mechanism of action for smoking cessation (i.e., acceptance) to the problem of low quit rates among smokers with bipolar disorder, and (2) the intervention is web-based, making it accessible, potentially cost-effective, and easily disseminated to mental healthcare settings. If found to be effective in the larger trial that would be informed by this pilot trial, WebQuit Plus could have an enduring, positive impact on the high prevalence of smoking-and smoking-related illnesses-among adults with bipolar disorder.

 描述(申请人提供)：高达70%的患有双相情感障碍的成年人吸烟，而普通人口只有20%，导致与烟草相关的疾病和死亡率不成比例地高。患有双相情感障碍的吸烟者的戒烟率不到非精神障碍吸烟者的一半(17%对43%)。提高这一群体戒烟率的关键障碍是：(1)患有双相情感障碍的吸烟者在戒烟方面面临的独特挑战，这些挑战在标准的戒烟咨询中没有得到解决，例如，人们普遍认为吸烟有助于控制疾病的症状，以及(2)精神卫生保健系统内获得烟草治疗的机会有限。迫切需要新的方法来解决这两个障碍。基于网络的接受和承诺疗法(ACT)是一种新的戒烟治疗模式，与目前的标准--美国政府的Smokefre.gov网站相比，戒烟率翻了一番以上(3个月随访时为23%比10%)。加入尼古丁替代疗法(NRT)--一种有效和可获得的药物疗法--并针对这一干预措施，解决患有双相情感障碍的吸烟者戒烟的主要障碍，可以显著提高极低的戒烟率。拟议的项目包括为患有双相情感障碍的吸烟者开发和试点测试一种有针对性的、基于网络的ACT干预(WebQuit Plus)，该干预建立在我们充满希望的试点数据的基础上，该数据显示，当作为面对面的个人治疗提供时，这种干预措施的戒烟率为40%，可接受性为90%。研究将分两个阶段进行。第一阶段将包括干预开发和网站可用性测试(n=12)。第二阶段将在全国抑郁症中心网络(NNDC)内的三个地点进行试点随机对照试验，比较WebQuit Plus(n=30)和Smokefre.gov(n=30)。这两种干预措施都将与尼古丁贴片结合使用。这项研究的主要目的是确定在NNDC内进行更大规模、多地点疗效试验的可行程序，主要可行性结果包括：(1)招募(即接近、筛选、合格和同意的人数；不合格或拒绝的原因)，(2)完成干预和(3)保留结果数据。另一个主要目的是比较WebQuit Plus和Smokefre.gov在治疗满意度和利用率、ACT基于理论的改变戒烟结果的机制以及在10周治疗结束时和治疗后1个月随访时的双相情感障碍症状方面的差异。这项研究在两个关键方面具有重要意义和创新：(1)它应用了一种有前景的新疗法(ACT)，具有新的戒烟作用机制(即接受)，以解决患有双相情感障碍的吸烟者戒烟率低的问题；(2)干预是基于网络的，使其可访问，潜在的成本效益高，并易于传播到精神卫生保健环境。如果在更大的试验中被发现是有效的 这将从这项试点试验中得到信息，WebQuit Plus可能会对双相情感障碍成年人中吸烟及与吸烟相关的疾病的高患病率产生持久的积极影响。