Behavioral Depression Treatment for Smoking Cessation

描述(由申请人提供)： 复发问题继续困扰着降低吸烟流行率的公共卫生工作。复发对于患有抑郁症相关脆弱性的人来说尤其令人担忧。之前的研究已经检查了将复杂的认知行为策略添加到标准戒烟方案中，重点是那些过去有严重抑郁障碍病史的人。然而，有限的成功表明：(A)与既往有抑郁发作史的人相比，目前抑郁症状加重的人可能是更好的负面情绪缓解策略的目标，以及(B)典型的认知-行为方法可能过于复杂，难以有效地整合到戒烟方案中。考虑到第一个问题，越来越多的证据表明，抑郁症状可能会以各种方式干扰戒烟，因此，有这种担忧的人代表了特定的高危吸烟者群体，他们将受益于满足其独特需求的专门戒烟治疗。关于第二个问题，最近的证据表明，行为激活策略在减少抑郁症状方面可能与更复杂的认知-行为方法一样有效，但可以以一种简单得多的形式做到这一点。总而言之，这项研究计划的总体目标是利用行为激活策略开发一种新的、简单的方法来戒烟，治疗伴有抑郁症状的吸烟者，重点是减少抑郁症状，以促进成功戒烟。该项目将分两个阶段进行。在第一阶段，我们将完成为伴有抑郁症状的吸烟者(BDI-II=或&gt；=13)治疗尼古丁依赖的专门方案的开发，该方案将为治疗抑郁症开发的行为激活策略与标准戒烟策略和尼古丁替代疗法相结合。在这一阶段，20名抑郁症状加重的吸烟者将完成方案，该方案将根据参与者和临床医生的反馈进行修改和完善。还将编写临床医生和参与者手册，以供下一阶段使用。在第二阶段，60名抑郁症状升高的吸烟者将被招募并随机分配到：1)标准戒烟治疗和尼古丁替代疗法(ST)或2)吸烟行为激活治疗(BAT-S)，由ST和旨在减少抑郁症状升高的行为激活策略组成。根据这项初步试验的结果，BAT-S方案将进一步细化，并为更大规模的临床试验做好准备。

DESCRIPTION (provided by applicant): The problem of relapse continues to plague public health efforts to reduce the prevalence of cigarette smoking. Relapse is of particular concern for individuals with depression-related vulnerabilities. Previous research has examined the addition of elaborate cognitive-behavioral strategies into standard smoking cessation protocols, focusing on individuals who have a past history of major depressive disorders. However, limited success suggests that (a) individuals with current elevated depressive symptoms might be a better target for negative affect reduction strategies than individuals with a past history of a depressive episode, and (b) typical cognitive-behavioral approaches may be too complicated for effective integration into smoking cessation protocols. Considering the first issue, converging evidence suggests that depressive symptoms may interfere with smoking cessation in a variety of ways and therefore individuals with such concerns represent a particular high-risk group of smokers who would benefit from specialized smoking cessation treatments that address their unique needs. Regarding the second issue, recent evidence suggests that behavioral activation strategies might be equally effective in reducing depressive symptoms as more elaborate cognitive-behavioral approaches, but can do so in a considerably less complicated and briefer format. Taken together, the overall objective of this research program is to utilize behavioral activation strategies in the development of a novel, uncomplicated approach to smoking cessation treatment for smokers with elevated depressive symptoms, with a focus on reducing depressive symptoms in order to facilitate successful cessation. This project will take place in two phases. In the first phase, we will complete the development of a specialized protocol for the treatment of nicotine dependence for smokers with elevated depressive symptoms (BDI-II = or >= 13), which integrates behavioral activation strategies developed for the treatment of depression with standard smoking cessation strategies and nicotine replacement therapy. During this phase, 20 smokers with elevated depressive symptoms will complete the protocol, which will be modified and refined based upon feedback from participants and clinicians. Clinician and participant manuals also will be developed for use in the next phase. In the second phase, 60 smokers with elevated depressive symptoms will be recruited and randomly assigned to either: 1) standard smoking cessation treatment and nicotine replacement therapy (ST) or 2) a behavioral activation treatment for smoking (BAT-S), comprised of ST and behavioral activation strategies aimed at reducing elevated depressive symptoms. Based on the outcome of this preliminary trial, the BAT-S protocol will be further refined and readied for larger-scale clinical trials.