CPT-SMART for Treatment of PTSD and Cigarette Smoking

CPT-SMART 用于治疗 PTSD 和吸烟

• 批准号: 10295154
• 负责人: Eric A Dedert
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295154
• 关键词: Abstinence; Aftercare; Behavior Therapy; Behavioral; Biological Testing; Bupropion; Cessation of life; Cigarette; Clinic; Clinical Trials; Cognitive; Cotinine; Counseling; Data; Drug usage; Effectiveness; Evidence based treatment; Financial compensation; Fright; General Population; Goals; Guidelines; Incentives; Individual; Intervention; Manuals; Measures; Mediating; Mental disorders; Monitor; Morbidity - disease rate; Nicotine; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Positive Reinforcer; Post-Traumatic Stress Disorders; Prevalence; Psychological reinforcement; Public Health; Randomized; Relapse; Salivary; Self Efficacy; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Symptoms; Testing; Therapeutic Intervention; Time; Trauma; Treatment Efficacy; United States; Veterans; arm; base; cigarette smoke; cigarette smoking; contingency management; depressive symptoms; disability; discounting; drug abstinence; effective intervention; efficacy evaluation; evidence base; experience; improved; medical specialties; medication compliance; mortality; negative affect; payment; prevent; programs; psychiatric symptom; reduce symptoms; smoking abstinence; smoking cessation; smoking intervention; substance abuse treatment; substance misuse; substance use treatment; test strip; voucher

Smoking is the leading cause of preventable illness, disability, and death in the United States. The rate of smoking is disproportionately higher among Veterans with posttraumatic stress disorder (PTSD). Unfortunately, smoking cessation efforts that are effective in the general population have shown limited effectiveness in smokers with PTSD. The high smoking rate and difficulty with achieving abstinence indicate a critical need to develop effective interventions for PTSD smokers. Our data indicate that negative affect and trauma reminders are a significant antecedent of relapse for PTSD smokers. Further, despite evidence that nicotine may exacerbate PTSD symptoms, many smokers with PTSD expect that smoking helps manage their symptoms. In this context, an ideal strategy may be to combine evidence-based PTSD treatment with intensive smoking cessation treatment to maximize quit rates in this at-risk population. Cognitive processing therapy (CPT) is a well-established evidenced-based treatment for PTSD. We have successfully developed a treatment manual that integrates CPT with guideline-concordant cognitive-behavioral counseling for smoking cessation and is well-tolerated among Veterans with PTSD who smoke cigarettes. The addition of more intensive smoking cessation treatment is expected to maximize quit rates in this population. Contingency management (CM) is an intensive behavioral treatment that has demonstrated efficacy for reducing smoking in a range of difficult-to-treat populations, including individuals with psychiatric disorders. CM provides positive reinforcers (e.g., vouchers, money) to individuals misusing substances contingent upon bioverified abstinence from drug use. In combination with other treatment, CM may provide a potent initial incentive in smokers who experience difficulties early in the quit attempt. The primary goal of the current study is to evaluate the efficacy of an intervention that combines clinic-based CM using twice weekly monitoring with salivary cotinine test strips, cognitive-behavioral smoking cessation counseling, smoking cessation medication, and evidence-based PTSD treatment. Proposed is a randomized, two-arm clinical trial in which 120 Veteran smokers with PTSD will be randomized to either: 1) COGNITIVE PROCESSING THERAPY with SMOKING ABSTINENCE REINFORCEMENT THERAPY (CPT-SMART) – an intervention that combines evidenced- based PTSD treatment with guideline-concordant cognitive-behavioral smoking cessation counseling, bupropion, and intensive behavioral therapy through CM; or 2) COMBINED CONTACT CONTROL: an intervention identical to CPT-SMART in PTSD and smoking treatment, except for using non-contingent payment (i.e., yoked CM) to control for compensation and monitoring. Specific aims include: AIM 1) To evaluate the efficacy of CPT-SMART on rates of short- and long-term abstinence from cigarettes (assessed with multiple measures including bioverified abstinence) measured at 1- week post-treatment, 3-months, and 6 months; AIM 2) To evaluate the impact of CPT-SMART on treatment engagement and utilization; and an EXPLORATORY AIM) To explore mechanisms of CPT-SMART on long- term smoking abstinence, including self-efficacy, salience of smoking, and psychiatric symptom reduction. The VA has already implemented CM for treatment of substance abuse. If shown efficacious, a combined PTSD treatment plus incentive-based approaches for smoking could be implemented into specialty PTSD programs. The positive public health impact of reducing smoking among Veterans with PTSD could be enormous as it would prevent significant smoking-related morbidity and mortality.

吸烟是美国可预防疾病、残疾和死亡的主要原因。率 吸烟在患有创伤后应激障碍（PTSD）的退伍军人中不成比例地高。 不幸的是，在普通人群中有效的戒烟努力有限， 吸烟者患PTSD的有效性高吸烟率和实现戒烟的困难表明， 迫切需要为PTSD吸烟者制定有效的干预措施。我们的数据表明，负面影响和 创伤回忆是PTSD吸烟者复发的重要前因。此外，尽管有证据表明， 尼古丁可能会加剧创伤后应激障碍症状，许多患有创伤后应激障碍的吸烟者认为吸烟有助于控制他们的 症状在这种情况下，一个理想的策略可能是将联合收割机基于证据的PTSD治疗与强化治疗相结合。 戒烟治疗，以最大限度地提高戒烟率在这个高危人群。 认知加工疗法（CPT）是一种公认的基于证据的PTSD治疗方法。我们有 成功开发了一个治疗手册，将CPT与指南一致的认知行为 戒烟咨询，并且在吸烟的创伤后应激障碍退伍军人中耐受良好。的 增加更密集的戒烟治疗有望最大限度地提高这一人群的戒烟率。 应急管理（CM）是一种强化的行为治疗，已被证明有效， 在一系列难以治疗的人群中减少吸烟，包括精神疾病患者。CM 提供了正向干扰（例如，凭单、金钱），以个人滥用物质的情况下， 对药物使用的生物学意义上的禁欲。与其他治疗相结合，CM可以提供有效的初始治疗。 鼓励那些在戒烟尝试早期遇到困难的吸烟者。本研究的主要目的 是评估一种干预措施的有效性，这种干预措施将基于临床的CM（每周两次监测）与 唾液可替宁测试条，认知行为戒烟咨询，戒烟药物， 和基于证据的创伤后应激障碍治疗拟定的是一项随机、双臂临床试验，其中120名退伍军人 患有PTSD的吸烟者将被随机分配到：1）吸烟的认知加工治疗 戒断强化治疗（CPT-SMART）-一种结合证据的干预措施- 基于PTSD治疗与指南一致的认知行为戒烟咨询， 安非他酮和通过CM进行的强化行为治疗;或2）联合接触控制： 在PTSD和吸烟治疗中，干预与CPT-SMART相同，除了使用非偶然性 支付（即，轭CM）来控制补偿和监控。 具体目标包括：目的1）评价CPT-SMART对短期和长期 戒烟（采用多种措施评估，包括生物等效戒烟），测量时间为1- 治疗后1周、3个月和6个月;目的2）评价CPT-SMART对治疗的影响 参与和利用;和探索性目标）探索CPT-SMART对长期 术语戒烟，包括自我效能，吸烟的突出性，和精神症状的减少。的 VA已经实施了用于治疗药物滥用的CM。如果表现出有效， 针对吸烟的治疗加激励的方法可以应用到专门的PTSD项目中。 减少患有创伤后应激障碍的退伍军人吸烟对公共卫生的积极影响可能是巨大的，因为它 将防止与吸烟有关的重大发病率和死亡率。