Personalized Feedback for Smokers with Elevated Anxiety Sensitivity

 描述(申请人提供)：在美国，吸烟是导致死亡和残疾的主要原因，每年导致超过44万人死亡。尽管人们意识到吸烟是一种“慢性健康行为问题”，但美国的吸烟率已经稳定下来，尤其是那些精神症状和精神障碍加重的吸烟者。在这里，焦虑和抑郁症状和综合征特别重要，因为它们是普通人群中最常见的精神症状，与吸烟显著共存，并与吸烟开始、维持和复发可靠地相关。事实上，“易受情感影响的吸烟者”(即有较高负面情绪状态或精神病态的吸烟者)往往更依赖尼古丁，在戒烟时遇到更多情绪问题，吸烟更多是为了管理负面情绪状态，而尼古丁对这一群体保持着相对更强的作用。人们普遍认为，易受情感影响的吸烟者需要针对他们独特的“情感需求”的特殊护理选择。一种有希望的综合方法，以解决吸烟的负面情感症状和疾病的异质性，一直专注于基础的跨诊断过程，以支持情感精神病理学和吸烟的维持。焦虑敏感性(AS)，即对焦虑相关感觉的恐惧倾向，是焦虑症和其他情绪障碍的病因和维持的核心跨诊断易感性因素，也与吸烟维持和复发有关。AS对心理社会干预的反应是可塑性的，使其成为预防/干预计划的主要风险因素。尽管在开发高强度的综合治疗方面取得了一些进展，以解决戒烟背景下的情感脆弱性，但还没有有针对性的努力集中在戒烟过程的早期阶段(即动机[有戒烟的动机]或[思想]) 关于和准备戒烟]阶段)对于AS升高的吸烟者。此外，由于吸烟者由于成本、时间承诺和后勤(例如旅行、日程安排预约)等障碍而很少使用强化戒烟治疗(在研究中始终低于10%)，因此迫切需要开发一种可获得、简短、综合的策略来明确解决吸烟与情感易感性的共病。通过在更早的时候 通过为吸烟人群的高危人群提供有针对性的个性化反馈，有更大的机会增加持续和成功的戒烟行为。目前的提案寻求采用计算机交付的集成个性化反馈干预(PFI)，直接解决吸烟问题--就像以个性化的方式一样。患有AS升高的吸烟者(N=130)将被随机分配到接受PFI或吸烟信息控制(没有个性化反馈)，然后将在一次干预后随访到1个月。PFI将重点关注关于吸烟行为、AS和适应性应对策略的反馈。

 DESCRIPTION (provided by applicant): Cigarette smoking is the leading cause of death and disability in the US, contributing to over 440,000 deaths each year. Despite awareness that smoking is a 'chronic health behavior problem,' smoking rates have stabilized in the US, most notably for smokers with elevated psychiatric symptoms and disorders. Here, anxiety and depressive symptoms and syndromes are particularly important because they are the most prevalent psychiatric symptoms in the general population, remarkably comorbid with smoking, and reliably associated with smoking initiation, maintenance, and relapse. Indeed, 'affectively-vulnerable smokers' (i.e., smokers with elevated negative mood states or psychopathology) often are more nicotine dependent, experience more mood problems when quitting, smoke more to manage negative mood states, and nicotine maintains a relatively more reinforcing effect for this group. There is a general consensus that affective-vulnerable smokers require specialty care options that address their unique 'affective needs.' One promising, integrative approach to address the heterogeneity of negative affect symptoms and disorders for smoking has been to focus on underlying transdiagnostic processes that underpin affective psychopathology and the maintenance of smoking. Anxiety sensitivity (AS), the tendency to fear anxiety-related sensations, is a core transdiagnostic vulnerability factor for the etiology and maintenance of anxiety disorders and other emotional disorders, and is also related to smoking maintenance and relapse. AS is malleable in response to psychosocial interventions, making it a prime risk factor to target in prevention/intervention programs. Although some progress has been made in terms of developing highly intensive, integrated treatments that address affective vulnerability in the context of smoking cessation, no targeted efforts have focused on 'earlier phases' of the quit process (i.e., Motivation [having motivation to quit] or Precessation [thinking about and preparing for quitting] phases) for smokers with elevated AS. Moreover, as smokers infrequently use intensive treatments for smoking cessation (consistently less than 10% across studies) because of such barriers as cost, time commitments, and logistics (e.g., travel, scheduling appointments), there is a major need to develop an accessible, brief, integrated tactic to explicitly address the smoking-affective vulnerability comorbidity. By promoting 'earlier change efforts' through focused, personalized feedback for high-risk segments of the smoking population, there is a greater chance to increase sustained and successful quit behavior. The current proposal seeks to employ a computer- delivered integrated Personalized Feedback Intervention (PFI) that directly addresses smoking-AS in a personalized manner. Smokers with elevated AS (N = 130) will be randomly assigned to receive either a PFI or smoking information control (no personalized feedback) and then will be followed up to 1-month after the one- session intervention. The PFI will focus on feedback about smoking behavior, AS, and adaptive coping strategies.