Sensitivity to Unpredictable Threat and Smoking Lapse Behavior

对不可预测的威胁和戒烟行为的敏感性

• 批准号: 9442942
• 负责人: Stewart Aaron Shankman
• 金额: $ 24.37万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9442942
• 关键词: Abstinence; Adopted; Adult; Affective; American; Anxiety; Anxiety Disorders; Behavior; Categories; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinical; Cognitive; Development; Diagnosis; Dimensions; Disease; Event-Related Potentials; Evoked Potentials; Functional disorder; Hour; Individual; Individual Differences; Knowledge; Laboratories; Measures; Modeling; National Institute of Mental Health; Outcome; Panic Disorder; Participant; Patient Self-Report; Pharmacological Treatment; Pharmacology; Physiology; Play; Process; Psychopathology; Public Health; Relapse; Research Domain Criteria; Risk; Role; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Speed; Stress; Testing; Uncertainty; Withdrawal; Withdrawal Symptom; addiction; analog; anxiety-related disorders; base; biological adaptation to stress; craving; deprivation; disability; experience; high risk; high risk population; individual patient; innovation; lens; meetings; multimodality; neuroadaptation; novel; precision medicine; premature; programs; psychosocial; smoking cessation; smoking prevalence; therapy development; trait

Project Summary Smoking is responsible for over 40% of premature deaths and disability in the US CDC. Although over 40% of the 48 million Americans that still smoke make a serious quit attempt each year, either on their own (i.e., self-guided quit) or with assistance from formal treatment, less than 5% are able to abstain from smoking for greater than 3 months. The selection hypothesis of smoking prevalence posits that smokers who are not able to quit successfully are “burdened” by specific characteristics that make it more challenging to quit. For example, those less successful in quitting smoking may be more likely to suffer from cognitive or affective vulnerabilities associated with psychiatric or other disorders. Smokers who suffer from anxiety are among the largest of these high-risk groups. Anxiety, however, is a broad construct that encompasses many mechanisms. New strategies targeting specific vulnerabilities (and not just general self-reported anxiety) are therefore needed to identify, understand, and ultimately, intervene with anxiety-prone smokers. One vulnerability for anxiety that is likely to play a role in smoking lapse behavior is sensitivity to unpredictable threat (SUT), an individual difference factor that is central to many anxiety disorders. SUT may be particularly predictive of smoking lapse as it has been proposed to be a manifestation of neuroadaptations of the stress response that has been observed across addictions. This project is therefore devoted to understanding the role of SUT in smoking lapse behavior and smoking topography (e.g., greater puff velocity, and shorter inter-puff intervals) using an innovative, multimethod assessment of sensitivity to unpredictable threat (i.e., EMG startle, evoked potentials, and self-report). The proposed project is significant from a public health standpoint because it can directly guide the development of novel psychosocial or pharmacologic smoking cessation interventions to help this and similar high-risk populations of smokers quit by targeting unique biologic vulnerability processes that result in poorer cessation outcomes. Meeting the specific aims will help validate the importance of the innovative laboratory assessment, demonstrate the importance of specific targets for assessment for at-risk smokers, and will contribute to the treatment development for smokers with anxiety and related disorders. Hence, the present project will significantly expand knowledge about the process and outcomes of smoking cessation as a function of a core biologic mechanism of dysfunction of anxiety, including the identification of specific mechanisms that impede quitting. In addition, this project will help expand the scope and usefulness of a lab assessment of relapse behavior to speed psychosocial/pharmacologic treatment development. Clinically, this approach will represent highly innovative and significant progress toward precision medicine where the selection of a smoking cessation program is tailored to the individual patient based on their attributes.

项目摘要 在美国疾病控制和预防中心，吸烟导致超过40%的过早死亡和残疾。虽然在 在4800万仍在吸烟的美国人中，有40%的人每年都会认真尝试戒烟， (i.e.,自我引导戒烟）或在正规治疗的帮助下，不到5%的人能够戒烟 超过3个月。吸烟率的选择假说假定， 能够成功戒烟的人都有一些特定的特征，使戒烟更具挑战性。为 例如，那些戒烟不成功的人可能更容易患上认知或情感障碍， 与精神疾病或其他疾病相关的脆弱性。患有焦虑症的吸烟者是 这些高危人群中最大的。然而，焦虑是一个广泛的概念， 机制等针对特定脆弱性（而不仅仅是一般自我报告的焦虑）的新策略是 因此，需要识别，理解，并最终干预有焦虑倾向的吸烟者。 焦虑的一个弱点可能在吸烟失误行为中发挥作用，那就是对吸烟的敏感性。 不可预测的威胁（SUT）是一种个体差异因素，是许多焦虑症的核心。SUT可能 特别是预测吸烟失效，因为它已被提出是神经适应的表现 在成瘾中观察到的压力反应。因此，该项目致力于 了解SUT在吸烟失效行为和吸烟地形中的作用（例如，更大的抽吸速度， 和更短的喷烟间隔），使用创新的多方法评估对不可预测的 威胁（即，EMG惊吓、诱发电位和自我报告）。该项目对公众来说意义重大 健康观点，因为它可以直接指导新的心理社会或药理学的发展 戒烟干预措施，以帮助这一点和类似的高风险人群的吸烟者戒烟， 独特的生物脆弱性过程导致戒烟效果较差。满足特定目标将有助于验证创新实验室评估的重要性，证明特定目标对高危吸烟者评估的重要性，并将有助于开发焦虑和相关疾病吸烟者的治疗方法。因此，本项目将大大扩展有关戒烟过程和结果的知识，作为焦虑功能障碍的核心生物学机制，包括识别阻碍戒烟的特定机制。此外，该项目将有助于扩大复发行为的实验室评估的范围和实用性，以加快心理社会/药理学治疗的发展。在临床上，这种方法将代表高度创新和重大进展，朝着精确医学，其中选择吸烟 戒烟计划是根据患者的属性为每个患者量身定制的。