Smoking-Based Prevention Program for Panic Disorder

描述（由申请人提供）：当前提案的总体目标是使用专门的焦虑-戒烟干预来开发有关预防惊恐障碍（PD）的知识。该计划将在对照随机选择预防计划的背景下，针对PD发展的两个可塑性脆弱因素-焦虑敏感性（焦虑恐惧和焦虑相关感觉）和吸烟。惊恐障碍是一种常见的、严重的慢性疾病，其特征是反复发作的惊恐发作，并担心未来可能发生惊恐发作[美国精神病学协会（阿帕），1994]。吸烟是北美死亡和残疾的主要原因[疾病控制和预防中心（CDC），1994]，在患有PD或有患PD风险的患者中特别常见;大约40%的PD患者目前是经常吸烟者，超过60%的患者有终生吸烟史（Amering et al.，1999; Lasser等人，2000年）。有经验证据表明，吸烟和恐慌因素之间存在双向关联，与正反馈循环过程一致，导致各种负面影响。这个问题的背景是我更大的认识，虽然物质使用问题经常与恐慌和其他形式的精神病理学共同发生，但几乎没有努力开发理论上整合的程序，以针对导致这种并发症的行为过程（Otto，Powers，& Fischmann，出版; Zvolensky &施密特，2004）。目前的建议旨在开始填补这一空白，在现有的文献中，前瞻性地评估戒烟行为和恐慌的结果的背景下，控制随机选择的预防计划。在两个研究中心实施的预防计划将利用认知重建和内感受性暴露策略，特别关注减少对焦虑的恐惧和相关焦虑过程，以（1）减少惊恐发作和惊恐障碍的发展;（2）促进成功戒烟。该恐慌性吸烟预防计划（PSPP）将整合内感受性暴露，认知重建和心理教育练习，这些练习是为恐慌预防和治疗计划而开发的，具有标准的戒烟咨询。将PSPP计划与标准焦虑敏感性改善干预、标准戒烟和健康信息控制条件进行比较。

DESCRIPTION (provided by applicant): The overall aim of the current proposal is to develop knowledge about the prevention of panic disorder (PD) using a specialized anxiety-smoking cessation intervention. This program will target, within the context of a controlled randomized selected prevention program, two malleable vulnerability factors for the development of PD - anxiety sensitivity (the fear of anxiety and anxiety-related sensations) and cigarette smoking. Panic disorder is a common, severe, and chronic condition characterized by recurrent panic attacks and worry about the possibility of experiencing a future panic attack [American Psychiatric Association (APA), 1994]. Cigarette smoking, the leading cause of death and disability in North America [Centers for Disease Control and Prevention (CDC), 1994], is particularly common among those with, or at risk for, developing PD; approximately 40% of individuals with PD are currently regular smokers and over 60% have a lifetime history of smoking (Amering et al., 1999; Lasser et al., 2000). There is empirical evidence that suggests bi-directional associations between smoking and panic factors, consistent with a positive feedback loop process, resulting in a variety of negative effects. This issue sits on the backdrop of me larger recognition that, although substance use problems frequently co-occur with panic and other forms of psychopathology, there has been little effort to develop theoretically-integrated programs to target behavioral processes that contribute to this comorbidity (Otto, Powers, & Fischmann, in press; Zvolensky & Schmidt, 2004). The present proposal aims to begin to fill this gap in the existing literature by prospectively evaluating quitting behavior and panic outcomes within the context of a controlled randomized selected prevention program. The prevention program, implemented across two sites, will utilize cognitive restructuring and interoceptive exposure strategies with a specific focus on reducing the fear of anxiety and related anxiety processes in order to (1) decrease the development of panic attacks and panic disorder; and (2) facilitate successful cessation. This Panic-Smoking Prevention Program (PSPP) will integrate interoceptive exposure, cognitive restructuring, and psychoeducation exercises developed for panic prevention and treatment programs with standard smoking cessation counseling. The PSPP program will be compared to a standard anxiety sensitivity amelioration intervention, standard smoking cessation, and a health information control condition.