Tobacco treatment as augmentation to Cognitive Processing Therapy for PTSD

烟草治疗作为 PTSD 认知加工疗法的增强

• 批准号: 8822729
• 负责人: Sandra Jane Japuntich
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-01-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8822729
• 关键词: Affect; Animal Model; Animals; Area; Award; Behavioral Mechanisms; Biological; Caring; Clinical Practice Guideline; Clinical Trials; Cognitive; Cognitive Therapy; Combined Modality Therapy; Comorbidity; Cost Savings; Data; Data Analyses; Development; Disease; Environment; Epidemiologic Studies; Evaluation; Extinction (Psychology); Frequencies; Future; General Population; Health; Health Care Costs; Health Sciences; Health education; High Prevalence; Human; Individual; Knowledge; Medical; Mental Health; Methodology; Modeling; Morbidity - disease rate; Nicotine; Occupational; Outcome; Outcome Study; Participant; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Prevalence; Quality of life; Randomized; Recovery; Relapse; Reporting; Research; Research Design; Research Methodology; Research Personnel; Risk; Self Medication; Severities; Smoker; Social Functioning; Societies; Symptoms; System; Testing; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; Trauma; Treatment Efficacy; Veterans; War; Withdrawal; Withdrawal Symptom; Withholding Treatment; Women' s Health; Work; base; cognitive process; conditioned fear; contingency management; cost; craving; design; disability; disorder risk; effective therapy; experience; high risk; interest; mortality; payment; physical conditioning; programs; public health relevance; skills; therapy development; tobacco abstinence; treatment program; trial design

Research Background and Current Research Interests: I have been a tobacco researcher for ten years, beginning as an undergraduate and continuing through postdoctoral work. My research background includes treatment development, evaluation and implementation for tobacco dependence. I am currently a Project Director at the National Center for Posttraumatic Stress Disorder (NCPTSD), Women's Health Sciences Division. Working with Veterans with PTSD has alerted me to the high prevalence of tobacco use in this population and the interplay between tobacco use and PTSD recovery. My background in tobacco treatment development and evaluation for other high risk psychiatric and medical populations makes me well suited to investigate treatments for individuals with comorbid tobacco dependence and PTSD. In order to pursue this research, I require training in: PTSD research methods; manualized treatment development for PTSD and tobacco cessation; and clinical trials research including trial design, management and sophisticated data analysis. The NCPTSD is an ideal environment to gain knowledge in these areas. A CDA-2 award would allow me to receive the necessary training to pursue a program of research in treatment for comorbid PTSD and tobacco dependence. Summary of the Proposed Research: Individuals with PSTD use tobacco at high rates and have a high prevalence of tobacco-related disease. The mechanisms for the tobacco use-PTSD comorbidity have not been determined. Two possible mechanisms include: (1) that nicotine interferes with PTSD recovery and (2) that tobacco is used as self-medication for PTSD. Animal models suggest that nicotine may interfere with recovery from PTSD by enhancing passive avoidance and contextual fear conditioning, as well as inhibiting extinction. These findings have not been tested for replication in humans. Individuals with PTSD report using tobacco to manage PTSD symptoms. However, the data is less clear as to whether tobacco use decreases PTSD symptoms. Tobacco cessation results in withdrawal symptoms that mimic PTSD, including exacerbation of negative affect, further complicating assessment of tobacco use and PTSD symptom relations. Additionally, PTSD symptoms serve as triggers for tobacco use and therefore could result in craving for tobacco and relapse in those recently abstinent. Research is needed to investigate the mechanisms underlying potential reciprocal influences of PTSD and tobacco use in order to develop treatments for these often comorbid disorders. The proposed research aims to examine the effect of tobacco on PTSD symptoms and PTSD recovery as well as the effect of PTSD recovery on tobacco use. This study has 3 aims: (1) to evaluate whether tobacco use interferes with recovery from PTSD during empirically based, trauma focused PTSD treatment. (2) To gather preliminary data about whether tobacco use alleviates PTSD symptoms among continued tobacco users vs. recent quitters. (3) To explore the impact of recovery from PTSD treatment on tobacco use quantity and frequency, tobacco withdrawal symptoms, and craving for tobacco. To test these aims, we propose a randomized two group design where 50 participants are assigned to receive either tobacco treatment (Contingency Management plus Cognitive Behavioral Therapy) or control treatment (Health Education) before completing Cognitive Processing Therapy (CPT) for PTSD. Study outcome variables will be PTSD symptom severity following CPT, PTSD symptom severity during tobacco cessation treatment, and tobacco use and tobacco withdrawal during CPT. Training received during this award will prepare this candidate to submit a Merit Review application for a large scale clinical trial focused on testing the long-term efficacy and mechanisms of change of during treatment for comorbid tobacco dependence and PTSD.

研究背景和目前的研究兴趣：我已经做了十年的烟草研究， 从本科开始，一直到博士后工作。研究背景包括 烟草依赖的治疗开发、评估和实施。我目前是一个项目 国家创伤后应激障碍中心（NCPTSD），妇女健康科学主任 师.与患有创伤后应激障碍的退伍军人一起工作提醒我， 烟草使用与PTSD恢复之间的相互作用。我在烟草治疗方面的背景 为其他高风险精神病和医学人群的发展和评估使我非常适合 研究烟草依赖和创伤后应激障碍共病个体的治疗方法。为了实现这一目标 研究，我需要培训：创伤后应激障碍的研究方法;创伤后应激障碍的手动治疗开发， 戒烟;临床试验研究，包括试验设计、管理和复杂数据 分析. NCPTSD是获得这些领域知识的理想环境。CDA-2裁决将允许 我接受必要的培训，以进行治疗共病创伤后应激障碍的研究计划， 烟草依赖 拟议的研究摘要：PSTD患者使用烟草的比例很高， 烟草相关疾病的流行。烟草使用-PTSD共病的机制还没有 确定了两种可能的机制包括：（1）尼古丁干扰PTSD的恢复，（2） 烟草被用作治疗创伤后应激障碍的自我药物动物模型表明，尼古丁可能会干扰 通过增强被动回避和情境恐惧条件反射以及抑制 灭绝这些发现尚未在人类中进行复制测试。PTSD患者报告使用 烟草来控制PTSD症状然而，数据不太清楚烟草使用是否减少 创伤后应激障碍症状戒烟会导致类似PTSD的戒断症状，包括加重 负面影响的影响，使烟草使用和创伤后应激障碍症状关系的评估进一步复杂化。此外，本发明还 创伤后应激障碍症状是烟草使用的触发因素，因此可能导致对烟草的渴望和复发 在那些最近禁欲。需要研究潜在互惠的机制 研究创伤后应激障碍和烟草使用的影响，以开发治疗这些往往共病的疾病。 这项研究旨在研究烟草对创伤后应激障碍症状和创伤后应激障碍恢复的影响 创伤后应激障碍恢复对烟草使用的影响。本研究有三个目的：（1）评估烟草使用是否 在以经验为基础的创伤为重点的创伤后应激障碍治疗期间，干扰创伤后应激障碍的恢复。(2)收集 关于烟草使用是否会加重持续烟草使用者与 最近放弃的人(3)探讨创伤后应激障碍治疗恢复对烟草使用量的影响， 频率、烟草戒断症状和对烟草的渴望。为了检验这些目标，我们提出了一个 随机两组设计，其中50名参与者被分配接受烟草治疗 （应急管理加认知行为治疗）或控制治疗（健康教育）之前 认知加工疗法（CPT）治疗PTSD。研究结果变量将是PTSD症状 CPT后的严重程度、戒烟治疗期间的PTSD症状严重程度和烟草使用， 在CPT期间戒烟。在此奖项期间接受的培训将使候选人准备提交一份 针对大规模临床试验的Merit Review申请，重点是测试长期疗效， 烟草依赖和创伤后应激障碍共病治疗期间的变化机制。

项目成果

Hormone therapy use in women veterans accessing veterans health administration care: a national cross-sectional study.

接受退伍军人健康管理护理的女性退伍军人中激素疗法的使用：一项全国横断面研究。

• DOI: 10.1007/s11606-014-3073-9
• 发表时间: 2015
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Gerber,MeganR;King,MatthewW;Pineles,SuzanneL;Wiltsey-Stirman,Shannon;Bean-Mayberry,Bevanne;Japuntich,SandraJ;Haskell,SallyG
• 通讯作者: Haskell,SallyG

Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.

• DOI: 10.1007/s11606-016-3687-1
• 发表时间: 2016-08
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Danan ER;Joseph AM;Sherman SE;Burgess DJ;Noorbaloochi S;Clothier B;Japuntich SJ;Taylor BC;Fu SS
• 通讯作者: Fu SS

Contingency management and cognitive behavioral therapy for trauma-exposed smokers with and without posttraumatic stress disorder.

• DOI: 10.1016/j.addbeh.2018.10.042
• 发表时间: 2019-03
• 期刊: Addictive behaviors
• 影响因子: 4.4
• 作者: Japuntich SJ;Lee LO;Pineles SL;Gregor K;Joos CM;Patton SC;Krishnan-Sarin S;Rasmusson AM
• 通讯作者: Rasmusson AM