Evaluating the Casual Pathways from Lapse to Relapse in Smokers

描述（由申请人提供）：绝大多数吸烟失误导致全面复吸。由于失误几乎总是发生，并且不可能总是避免，因此认知行为复吸预防技术专注于帮助吸烟者管理他们对失误的反应，以便他们能够避免复吸。不幸的是，认知行为预防复吸培训在这方面对吸烟者来说并不特别有希望。这可能是由于该领域没有关于导致失误成为复发的心理过程和机制的良好信息。开始完善或开发新的认知行为复发预防干预措施的一种方法是专注于测试和评估更新的复发理论，以便更多地了解导致失误成为复发的心理过程。由复发预防理论的最新修订和实地研究的结果驱动，本申请提出进行两项研究，旨在提供一个临床相关的实验模拟模型，说明失误如何因果地导致复发。在复吸预防理论中，失败之后是自我效能的阶段性变化，并且与吸烟结果预期的紧张水平相结合（相加或交互），有助于复吸。换句话说，自我效能和结果预期介导了失误和复发之间的关系。中介分析，根据定义，模型的直接因果力量，一个初始变量（在我们的情况下，一个失误）施加在一个结果变量（复发）通过一个中介变量（自我效能和结果预期）。中介既由初始变量（失误导致自我效能和结果预期的变化）引起，又引起结果变量（失误导致自我效能和结果预期的变化导致复发可能性的变化）。因此，我们的复吸模拟模型将：1）在程序性戒烟一段时间后实验性地创建一个失效，然后在短暂的14天随访期内测量复吸时间，以确定失效是否与复吸有因果关系，以及自我效能和吸烟结果预期在这种关系中的中介作用（研究1）;和2）在一段时间的程序性禁欲和程序性失误后，实验性地操纵自我效能和结果预期，然后在一个短暂的随访期内测量复发时间，以确定实验控制的自我变化是否有效性和吸烟结果预期因果地促成复发（研究2）。有戒烟动机的吸烟者将参与这些研究，以提高研究结果的临床适用性和外部效度。因此，在完成每项研究的实验部分后，将为所有参与者提供戒烟的临床治疗。本研究的长期目标有三个方面：1）促进对复发预防治疗的拟议作用机制的更好理解; 2）在这些结果的基础上建立更复杂的复发模型; 3）提高吸烟者复发预防培训的临床疗效。在美国，吸烟每年导致50多万人死亡，戒烟大大减少了与吸烟相关的死亡和疾病。然而，不幸的是，大多数试图戒烟的吸烟者不会成功;换句话说，大多数试图戒烟的吸烟者会复发。其中一个原因是，关于导致复发的心理变量，几乎没有什么好的信息。公共卫生相关性：这项研究旨在揭示导致复发的心理变量，其结果将用于为新一代更成功的戒烟治疗提供信息。

DESCRIPTION (provided by applicant): The overwhelming majority of smoking lapses lead to full blown relapse. Because lapses almost always occur and cannot always be avoided, cognitive-behavioral relapse prevention techniques have focused on helping smokers to manage their reactions to lapses so that they can avoid relapses. Unfortunately, cognitive- behavioral relapse prevention training has not been especially promising for smokers in this regard. This may be due to the fact that the field has no good information available about the psychological processes and mechanisms that cause a lapse to become a relapse. One way to begin to refine or to develop new cognitive- behavioral relapse prevention interventions is to focus on testing and evaluating newer theories of relapse in order to understand more about the psychological processes that cause lapses to become relapses. Driven by the recent revision of relapse prevention theory and the results of field research, this application proposes to conduct two studies designed to provide a clinically-relevant experimental analogue model of how lapses causally contribute to relapse. In relapse prevention theory, lapses are followed by phasic changes in self- efficacy and in combination (either additively or interactively) with tonic levels of smoking outcome expectancies, contribute to relapse. In other words, self-efficacy and outcome expectancies mediate the relationship between lapse and relapse. Mediational analyses, by definition, model the direct causal force that an initial variable (in our case, a lapse) exerts on an outcome variable (relapse) through an intervening variable(s) the mediator(s) (self-efficacy and outcome expectancies). The mediator both is caused by the initial variable (lapses cause changes in self-efficacy and outcome expectancies) and causes the outcome variable (lapse induced changes in self-efficacy and outcome expectancies cause changes relapse likelihood). Thus, our analogue model of relapse will: 1) experimentally create a lapse after a period of programmed abstinence and then measure time to relapse over a brief 14-day follow-up period to determine whether lapse is causally related to relapse and what the mediating roles of self-efficacy and smoking outcome expectancies are in this relationship (Study 1); and 2) experimentally manipulate self-efficacy and outcome expectancies after a period of programmed abstinence and a programmed lapse, and then measure time to relapse over a brief follow-up period to determine whether experimentally controlled changes to self-efficacy and smoking outcome expectancies causally contribute to relapse (Study 2). Smokers who are motivated to quit will participate in these studies to enhance the clinical applicability and external validity of the findings. As such, all participants will be offered clinical treatment for smoking cessation after completing the experimental portion of each study. The long range goals of this research are threefold: 1) to promote an improved understanding of the proposed mechanisms of action of relapse prevention treatment; 2) to build on these results to build a more complex model of relapse; and 3) to improve clinical efficacy of relapse prevention training with smokers. Cigarette smoking contributes to over half a million deaths annually in the United States and quitting smoking substantially reduces the death and disease associated with smoking. Unfortunately, however, most smokers who attempt to quit smoking will not be successful; in other words, most smokers who attempt to quit relapse. One reason is that very little good information is available about the psychological variables that cause relapses. PUBLIC HEALTH RELEVANCE: This research seeks to uncover the psychological variables that cause relapses and the results will be used to inform a new generation of more successful smoking cessation treatments.