Integrated PTSD and Smoking Treatment

描述（由申请人提供）：我的主要研究兴趣集中在开发有效和有效的行为干预措施，用于治疗患有创伤后应激障碍（PTSD）的成年人的物质使用问题。在这里，我的临床和研究经验引导我专注于戒烟。在临床上，我观察到吸烟在接受PTSD治疗的患者中很普遍，而焦虑的过程往往有助于吸烟。越来越多的研究支持这些观点。此外，现有的戒烟干预措施往往未能产生持久的临床变化。这些观察结果相互融合，表明在一个总体模型中开发针对焦虑过程和PTSD的干预措施具有科学和临床价值。 迄今为止，我的研究经验主要是在焦虑症的性质，原因和治疗方面。因此，我提出的研究方向需要进一步的物质使用障碍培训。从短期来看，我的职业目标为进一步的培训提供了明确的方向. 我想利用K 01机制，以三种有意义的方式，在我以前的经验和培训的基础上再接再厉。首先，我选择了两位导师[Smits博士（主要）和Zvolensky博士（共同导师）]，他们可以指导我努力开发一个专注于戒烟的独立研究项目。Smits博士和Zvolensky博士在开发和评估焦虑和相关物质使用问题的干预措施方面具有专业知识。第二，在国际公认的PTSD专家Foa博士的帮助下，我开发了一个课程来建立我在PTSD方面的专业知识。第三，我已经计划了一系列的课程和会议与罗森菲尔德博士，一个生物统计学家，学习统计方法，因为它涉及到测试中介和适度。总之，这些综合培训经验将帮助我实现我的长期目标，这是追求这一独立的工作线作为心理学系终身教职员工。 这个K 01应用程序的研究计划与我向物质使用障碍研究的过渡一致。K 01研究计划旨在开发和测试一种综合干预措施，以改善PTSD成年人戒烟的认知行为疗法（CBT）的结果。PTSD与吸烟增加和戒烟失败有关。2 -7 PTSD患者中吸烟的患病率为44.6%，而无精神疾病的患者中吸烟的患病率为22.5%。8患有PTSD的吸烟者更容易依赖他人，4（每天> 25支），2经历更严重的戒断症状，并在戒烟后复发。2事实上，吸烟者中PTSD患者的戒烟率（23.2%）是所有精神障碍中最低的。8因此，绝大多数PTSD患者试图戒烟并没有从现有的干预方案中获益。显然，有必要为这一群体制定专门或个性化的战略。 可能导致吸烟者发展为尼古丁依赖和戒烟复发的PTSD特征包括负面影响、恐惧、唤醒增加、易怒、愤怒、痛苦耐受不良和焦虑敏感性。PTSD患者的焦虑敏感性高于除惊恐障碍外的任何其他焦虑障碍。9高焦虑敏感性与戒烟期间更大的失误10和复发11 -13的几率独特相关。13痛苦不耐受，一种感知或行为倾向于不容忍痛苦，14与PTSD的维持和戒烟问题有关。15基于恐惧消除的治疗（即，长期暴露[PE]、内感受性暴露[IE]）已显示出降低PTSD 16和痛苦不耐受和焦虑敏感性17 -19的功效，因此成为增强PTSD个体的标准戒烟干预的有希望的候选者。 本申请提出了对患有PTSD的吸烟者的综合和专门治疗进行试点测试。这种综合性PTSD和吸烟治疗（IPST）将认知行为治疗和尼古丁替代治疗（标准治疗; SC）与PE结合起来，以靶向PTSD症状（例如，负面影响、恐惧、唤醒增加、易怒、愤怒）和IE以降低焦虑敏感性和痛苦耐受性。为此，80名患有PTSD的成年吸烟者将被随机分配到：（1）IPST或（2）SC。将在戒烟日期后2、4、8、10、16和24周评估吸烟结果。将在退出日期前后重复评估推定的介导物的测量。

DESCRIPTION (provided by applicant): My primary research interests center around developing efficacious and effective behavioral interventions for substance use problems among adults with post-traumatic stress disorder (PTSD). Here, my clinical and research experiences have guided me to focus on smoking cessation. Clinically, I have observed that smoking is prevalent among patients who present for the treatment of PTSD, and that anxiety processes often serve to smoking. A growing body of research supports these observations. Moreover, extant smoking cessation interventions have often failed to yield lasting clinical change. These observations converge with one another to suggest that there is scientific and clinical merit to developing interventions that target anxiety processes and PTSD in one overarching model. My research experience to date is primarily in the area of the nature, causes, and treatment of anxiety disorders. Thus, my proposed line of research requires further training in substance use disorders. In the short- term, my professional goals provide clear direction for further training. would like to use the K01 mechanism to build upon my previous experience and training in three meaningful ways. First, I selected two mentors [Drs. Smits (Primary) and Zvolensky (Co-Mentor)] who can guide me in my efforts to develop an independent research program focusing on smoking cessation. Dr. Smits and Zvolensky bring expertise in the development and evaluation of interventions for anxiety and related substance use problems. Second, with help of Dr. Foa, an internationally-recognized expert in PTSD, I have developed a curriculum to build my expertise in PTSD. Third, I have planned a series of courses and meetings with Dr. Rosenfield, a biostatistician, to learn about statistical methods as it relates to testing mediatio and moderation. Together, these integrated training experiences will help me reach my long-term goal, which is to pursue this independent line of work as a tenured faculty member in a psychology department. The research plan of this K01 application is consistent with my transition to substance use disorder research. This K01 research plan aims to develop and test an integrated intervention for improving the outcome of cognitive-behavioral therapy (CBT) for smoking cessation in adults with PTSD. PTSD is associated with increased smoking and failed cessation attempts.2-7 The prevalence of smoking in persons with PTSD is 44.6 %, compared to 22.5% in persons with no psychiatric disorder.8 Smokers with PTSD are more likely to be dependent,4 smoke heavily (> 25 cigarettes per day),2 experience more severe withdrawal symptoms, and relapse following a quit attempt.2 In fact, the quit rate in smokers with PTSD (23.2%) is one of the lowest of all mental disorders.8Thus, the vast majority of persons with PTSD attempting to quit smoking do not benefit from existing intervention protocols. Clearly, there is a need for the development of specialized or personalized strategies for this population. Features of PTSD that may contribute to smokers' progression to nicotine dependence and cessation relapse include negative affect, fear, increased arousal, irritability, anger, distress intolerance, and anxiety sensitivity. Anxiety sensitivity is higher in persons with PTSD than in any other anxiety disorder except for panic disorder.9 High anxiety sensitivity is uniquely associated with greater odds of lapse10 and relapse11-13 during quit attempts.13 Distress intolerance, a perceived or behavioral tendency to not tolerate distress,14 is related to both the maintenance of PTSD and problems in quitting smoking.15 Fear extinction-based treatments (i.e., prolonged exposure [PE], interoceptive exposure [IE]) have shown efficacy for reducing PTSD16 and distress intolerance and anxiety sensitivity17-19 and therefore emerge as promising candidates to augment standard smoking cessation interventions for individuals with PTSD. The present application proposes to pilot test an integrated and specialized treatment for smokers with PTSD. This Integrated PTSD and Smoking Treatment (IPST) combines cognitive-behavioral therapy and nicotine replacement treatment for smoking cessation (standard care; SC) with PE to target PTSD symptoms (e.g., negative affect, fear, increased arousal, irritability, anger) and IE to reduce anxiety sensitivity and distress intolerance. To thi end, 80 adult smokers with PTSD will be randomly assigned to either: (1) IPST or (2) SC. Smoking outcomes will be assessed 2, 4, 8, 10, 16, and 24 weeks after quit date. Measure of putative mediators will be assessed repeatedly prior and following the quit date.