Quitting starts in the brain: a randomized controlled trial of app-based mindfulness shows decreases in neural responses to smoking cues that predict reductions in smoking
Quitting starts in the brain: a randomized controlled trial of app-based mindfulness shows decreases in neural responses to smoking cues that predict reductions in smoking
复制标题
DOI：
10.1038/s41386-019-0403-y
复制
发表时间：
2019-08-01
影响因子：
7.6
通讯作者：
Brewer, Judson A.
中科院分区：
文献类型：
--
作者：
Janes, Amy C.;Datko, Michael;Brewer, Judson A.
目前对吸烟的治疗效果不佳，部分原因是无法减少线索诱导的吸烟。正念训练(MT)已经显示出戒烟的初步效果，但其神经生物学目标仍不清楚。我们先前对非吸烟者的研究表明，MT降低了后扣带皮质(PCC)的活动。在吸烟的个人中，PCC一直是“默认模式网络”的主要中枢，它会在吸烟提示下激活。在这项随机对照试验中，我们测试了APP传递的MT对PCC对吸烟线索的反应性的影响，以及MT介导的PCC变化的个体差异是否预测了吸烟结果。在基线和接受基于智能手机APP的MT(n=33)和主动对照(国家癌症研究所的QuitGuide，n=34)后1个月，使用功能磁共振成像测量吸烟线索诱导的PCC反应性。评估与治疗相关的PCC活动变化的个体差异是否可以预测吸烟行为。MT组对吸烟提示的PCC反应性降低与香烟消费的减少显著相关(r=0.39，p=0.02)。对照组未发现相关关系(r=0.08，p=0.65)。在PCC和香烟减少方面，单独的组没有发现任何效果。事后分析显示，这种关联是性别特有的(女性，r=0.49，p=0.03；男性：r=-0.08，p=0.79)。这份初步报告表明，MT以特定于受试者的方式特异性地减少吸烟线索诱导的PCC活性，而PCC活性的减少预示着吸烟的同时减少。这些发现将MT对吸烟的假设行为影响与神经机制联系起来，特别是在女性中。这为确定哪些人可能受益于定向数字治疗(如基于智能手机的MT)、产生更好的临床结果奠定了基础。
Current treatments for smoking yield suboptimal outcomes, partly because of an inability to reduce cue-induced smoking. Mindfulness training (MT) has shown preliminary efficacy for smoking cessation, yet its neurobiological target remains unknown. Our prior work with nonsmokers indicates that MT reduces posterior cingulate cortex (PCC) activity. In individuals who smoke, the PCC, consistently a main hub of the "default mode network," activates in response to smoking cues. In this randomized controlled trial, we tested the effects of app-delivered MT on PCC reactivity to smoking cues and whether individual differences in MT-mediated PCC changes predicted smoking outcomes. Smoking cue-induced PCC reactivity was measured using functional magnetic resonance imaging at baseline and 1 month after receiving smartphone app-based MT (n = 33) vs. an active control (National Cancer Institute's QuitGuide, n = 34). Whether individual differences in treatment-related changes in PCC activity predicted smoking behavior was assessed. The MT group demonstrated a significant correlation between a reduction in PCC reactivity to smoking cues and a decline in cigarette consumption (r = 0.39, p = 0.02). No association was found in the control group (r = 0.08, p = 0.65). No effects of group alone were found in PCC or cigarette reduction. Post hoc analysis revealed this association is sex specific (women, r = 0.49, p = 0.03; men: r =-0.08, p = 0.79). This initial report indicates that MT specifically reduces smoking cue-induced PCC activity in a subject-specific manner, and the reduction in PCC activity predicts a concurrent decline in smoking. These findings link the hypothesized behavioral effects of MT for smoking to neural mechanisms particularly in women. This lays the groundwork for identifying individuals who may benefit from targeted digital therapeutic treatments such as smartphone-based MT, yielding improved clinical outcomes.