Anxiety Sensitivity and Smoking

描述(由申请人提供)： 具有恐慌相关脆弱性的吸烟者是吸烟人口中一个共同的、尽管研究不足的群体，他们面临着持续尼古丁依赖及其相关发病率和死亡率的高风险(Lasser等人，2000年)。尽管研究人员试图了解将抑郁症的认知行为治疗整合到标准戒烟方案中的效用(例如，Brown等人，2001；Hall，Munoz，&Reus，1994)，但很少有研究直接针对戒烟中的恐慌易感因素。本提案旨在填补现有文献中的这一空白，为焦虑敏感度升高的吸烟者开发一种新的认知行为戒烟治疗方法，焦虑敏感度升高是恐慌症发作和恐慌症的公认认知风险因素，该方法利用认知重组和内感暴露策略，重点减少对焦虑的恐惧和相关的焦虑过程，以促进成功戒烟。该项目符合NIDA行为疗法开发计划(PA-03-066)第一阶段的目标。在该项目的第一阶段，我们将完成为焦虑敏感度升高的吸烟者治疗尼古丁依赖的专门方案的制定。这一吸烟焦虑敏感计划(ASPS-ST)将把针对恐慌预防和治疗计划开发的内部感觉暴露、认知结构调整和心理教育练习与标准戒烟策略和尼古丁替代疗法结合起来。我们还将编写临床医生和参与者手册，20名焦虑敏感度升高的吸烟者(每组5人)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。在第二阶段，60名焦虑敏感度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)ASPS-ST，它结合了ST和内感暴露、认知重建和旨在减少焦虑相关症状的心理教育练习。根据这项初步试验的结果，ASPS-ST方案将进一步完善，以进行更大规模的临床试验评估。我们期望这个项目的结果是，我们将为高危吸烟者(高焦虑敏感型吸烟者)开发出一种明确的、新颖的认知行为治疗方法，其疗效可以在未来更大规模的随机临床试验中进行测试。

DESCRIPTION (provided by applicant): Smokers with panic-related vulnerabilities represent a common, albeit understudied, segment of the smoking population who are at heightened risk for continued nicotine dependence and its associated morbidity and mortality (Lasser et al., 2000). Although researchers have attempted to understand the utility of integrating cognitive-behavioral treatment of depression into standard cessation protocols (e.g., Brown et al., 2001; Hall, Munoz, & Reus, 1994), little research has directly targeted panic vulnerability factors in smoking cessation. The present proposal aims to fill this gap in the existing literature by developing a novel, cognitive-behavioral approach to smoking cessation treatment for smokers with elevated levels of anxiety sensitivity, a well-established cognitive risk factor for panic attacks and panic disorder, that utilizes cognitive restructuring and interoceptive exposure strategies with a focus on reducing the fear of anxiety and related anxiety processes in order to facilitate successful cessation. This project meets the objectives of Stage I of the NIDA Behavioral Therapies Development Program (PA-03-066). In the first phase of the project, we will complete the development of a specialized protocol for the treatment of nicotine dependence for smokers with elevated levels of anxiety sensitivity. This Anxiety Sensitivity Program for Smoking (ASPS-ST) will integrate interoceptive exposure, cognitive restructuring, and psychoeducation exercises developed for panic prevention and treatment programs with standard smoking cessation strategies and nicotine replacement therapy. We also will develop clinician and participant manuals, and 20 smokers with elevated levels of anxiety sensitivity (in groups of 5 each) will complete the protocol, which will be modified and refined based upon feedback from participants and clinicians. In the second phase, 60 smokers with elevated levels of anxiety sensitivity will be recruited and randomly assigned to either: (1) standard smoking cessation treatment and nicotine replacement therapy (ST) or (2) ASPS-ST, which integrates ST and interoceptive exposure, cognitive restructuring, and psychoeducation exercises aimed at reducing anxiety-related symptoms. Based on the outcome of this preliminary trial, the ASPS-ST protocol will be further refined for larger-scale clinical trial evaluation. We expect that as a result of this project, we will have developed a well-specified and novel cognitive-behavioral treatment for a high-risk group of smokers (high anxiety sensitive smokers), the efficacy of which can be tested in future larger-scale randomized clinical trials.