Behavioral activation intervention, reward processing and youth smoking cessation

描述（由申请人提供）：有证据表明，相当比例的青少年经常吸烟者有兴趣尝试戒烟，并经常尝试戒烟，但无法自行保持戒烟。尽管许多青少年真心希望戒烟，但年龄较大的青少年吸烟率却在上升，这与一般人口中吸烟减少的总体趋势背道而驰。不幸的是，社会心理和药物吸烟干预措施尚未显示出对青年的明确有效性。此外，抑郁相关的脆弱性，特别是目前升高的抑郁症状，与吸烟行为高度共病，并大大降低戒烟率。因此，对于目前抑郁症状加重的青少年吸烟者来说，需要新的戒烟方法。行为激活（BA）是一种可能与青年特别相关的方法。BA已被证明可以通过增加与积极强化事件的接触来减少抑郁症状，从而有效治疗抑郁症患者。在吸烟的应用中，BA是一种基于强化理论的实用治疗方法，可以帮助个人发展更健康和积极的生活方式，同时解决抑郁症状和戒烟。在考虑BA的关键理论方面及其在强化理论中的基础时，奖励敏感性的构建非常重要。由于奖励敏感度在个体和不同发展阶段之间存在很大差异，因此当前的应用程序将采用转换方法。最后，尽管有大量的工作支持成人成瘾者使用BA，但在将成人衍生治疗模型应用于青少年时，发展方面的考虑至关重要。该项目的目标是开发一种专门的行为激活治疗方法，用于治疗18-21岁的抑郁症状加重的青年吸烟者（BATSY）。该项目将分两个阶段进行。在第一阶段，我们将利用焦点小组和15名青年的试点测试来制定BATSY治疗方案。在第二阶段，我们将在30名青少年中进行一项BATSY+尼古丁替代疗法的开放标签试验。在测试这种新开发的BA治疗抑郁症状升高的青少年吸烟者的背景下，我们将使用复杂的fMRI方法来检查基线奖励敏感性与治疗反应相关的程度。为了实现这些多学科目标，将神经发育和神经行为方法与青少年吸烟者的行为治疗开发相结合，根据RFA-DA-10-003，我们将建立马里兰州大学、NIMH和耶鲁大学研究人员的翻译合作。 公共卫生相关性：抑郁症状加重的青少年吸烟者有很大的风险发展成为慢性成年吸烟者，但缺乏专门针对他们需求的吸烟治疗。该应用程序代表了使用翻译的多学科团队建设方法为这一极高危青年群体开发和测试专门的行为激活（BA）基础协议的第一次努力。

DESCRIPTION (provided by applicant): Evidence suggests a significant percentage of adolescent regular smokers are interested in trying to quit smoking and frequently make attempts to quit, yet are unsuccessful in maintaining abstinence on their own. Despite a genuine desire to quit on the part of many adolescents, there is an increasing incidence of smoking among older adolescents that runs counter to the overall trends of smoking reduction seen in the general population. Unfortunately, psychosocial and pharmacological smoking interventions have yet to indicate clear effectiveness with youth. Moreover, depression-related vulnerabilities, particularly currently elevated depressive symptoms, are highly comorbid with smoking behavior and dramatically reduce cessation rates. As a result, new approaches to smoking cessation are needed for adolescent smokers with currently elevated depressive symptoms. Behavioral activation (BA) is an approach that may be especially relevant for youth. BA has been shown to effectively treat those with depressive disorders through reduction of depressive symptoms by increasing contact with positive reinforcing events. In its application to smoking, BA is a practical, treatment approach based on reinforcement theory that helps individuals develop a more healthy and active lifestyle to simultaneously address depressive symptoms and quit smoking. In considering key theoretical aspects of BA and its basis in reinforcement theory, the construct of reward sensitivity is of great importance. Because reward sensitivity differs greatly across individuals and different stages of development, the current application will take a translational approach. Finally, despite a strong body of work supporting the use of BA with addictions in adults, developmental considerations are critical when applying adult derived-treatment models to adolescents. The objective of the proposed project is to develop a specialized behavioral activation treatment for smoking in youth ages 18-21 with elevated depressive symptoms (BATSY). The project will take place in two phases. In the first phase, we will utilize focus groups and pilot testing with 15 youth to develop the BATSY treatment protocol. In Phase II, we will conduct an open-label trial of BATSY plus nicotine replacement therapy with 30 youth. In the context of testing this newly developed BA treatment for adolescent smokers with elevated depressive symptoms, we will use sophisticated fMRI methodology to examine the extent to which baseline reward sensitivity is associated with treatment response. To achieve these multidisciplinary goals at the integration of neurodevelopmental and neurobehavioral methods with behavioral treatment development for adolescent smokers, in line with RFA-DA-10-003, we will establish a translational collaboration of researchers from University of Maryland, NIMH, and Yale University. PUBLIC HEALTH RELEVANCE: Adolescent smokers with elevated depressive symptoms are at significant risk to develop into chronic adult smokers, yet smoking treatments specifically targeted to their needs are absent. This application represents the first effort to develop and test a specialized behavioral activation (BA) base protocol for this extremely at- risk group of youth using a translational, multidisciplinary team-building approach.