CPT-SMART for Treatment of PTSD and Cigarette Smoking

CPT-SMART 用于治疗 PTSD 和吸烟

• 批准号: 10594392
• 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/10594392
• 关键词: Abstinence; Aftercare; Behavior Therapy; Behavioral; Biological Testing; Bupropion; Cessation of life; Cigarette; Clinic; Clinical Trials; Cognitive; Compensation; Cotinine; Counseling; Data; Drug usage; Effectiveness; Evidence based treatment; 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; Smoking treatment; Substance Use Disorder; Symptoms; Testing; Therapeutic Intervention; Time; Trauma; Treatment Efficacy; United States; Veterans; arm; cigarette smoke; cigarette smoking; contingency management; depressive symptoms; disability; discounting; drug abstinence; effective intervention; efficacy evaluation; evidence base; experience; improved; long term abstinence; medical specialties; medication compliance; mortality; negative affect; payment; prevent; programs; psychiatric symptom; reduce symptoms; relapse prevention; 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.

在美国，吸烟是可预防的疾病、残疾和死亡的主要原因。这一速度 患有创伤后应激障碍(PTSD)的退伍军人中，吸烟的比例高得不成比例。 不幸的是，在普通人群中有效的戒烟努力显示出有限的效果 对患有创伤后应激障碍的吸烟者的有效性。高吸烟率和实现戒烟的困难表明 迫切需要为创伤后应激障碍吸烟者制定有效的干预措施。我们的数据表明，负面影响和 创伤提醒是创伤后应激障碍吸烟者复发的重要先兆。此外，尽管有证据表明 尼古丁可能会加剧创伤后应激障碍的症状，许多患有创伤后应激障碍的吸烟者希望吸烟有助于管理他们的 症状。在这种情况下，理想的策略可能是将循证的创伤后应激障碍治疗与强化治疗相结合 戒烟治疗，以最大限度地提高这一高危人群的戒烟率。 认知加工疗法(CPT)是一种行之有效的循证治疗创伤后应激障碍的方法。我们有 成功地开发了一本将CPT与指南一致的认知行为相结合的治疗手册 戒烟咨询，在吸烟的创伤后应激障碍退伍军人中得到很好的耐受性。这个 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，已证明对 在一系列难以治疗的人群中减少吸烟，包括精神障碍患者。厘米 向滥用药物的个人提供积极的增强剂(例如，代金券、金钱)，视情况而定 彻底戒除毒品。与其他治疗方法相结合，CM可能提供有效的初始治疗 在戒烟初期遇到困难的吸烟者的激励措施。当前研究的主要目标是 是评估一项干预措施的效果，该干预措施将以临床为基础的CM使用每周两次的监测与 唾液可替宁试纸，认知行为戒烟咨询，戒烟药物， 和循证的创伤后应激障碍治疗。建议的是一项随机的双臂临床试验，120名退伍军人 患有创伤后应激障碍的吸烟者将被随机分为以下两组：1)吸烟的认知处理疗法 戒断强化疗法(CPT-SMART)-一种结合了证据的干预- 以指导方针一致的认知行为戒烟咨询为基础的创伤后应激障碍治疗， 安非他酮和通过CM进行强化行为治疗；或2)联合接触控制： 在创伤后应激障碍和吸烟治疗中与CPT-SMART相同的干预措施，但使用非应急措施 支付(即，连接CM)给控制以进行补偿和监控。 具体目标包括：目的1)评估CPT-SMART-SMART的短期和长期疗效 戒烟(用多种措施评估，包括生物夸大戒烟)，以1- 治疗后1周、3个月和6个月；目的2)评估CPT-SMART对治疗的影响 探索性目的：探索CPT-SMART在长时间内的运行机制。 长期戒烟，包括自我效能感、吸烟的显着性和精神症状的减轻。这个 退伍军人事务部已经实施了治疗药物滥用的CM。如果被证明有效，合并的创伤后应激障碍 治疗加激励为基础的吸烟方法可以实施到专业的创伤后应激障碍项目中。 在患有创伤后应激障碍的退伍军人中减少吸烟对公共健康的积极影响可能是巨大的，因为它 将防止与吸烟相关的重大发病率和死亡率。