Self-report and behavioral reactivity to combined smoking cues

描述（由申请人提供）：基于线索的吸烟研究清楚地表明，吸烟者在暴露于与吸烟有关的刺激时报告了强烈的条件反应（最常以渴望的形式）。这项工作已被用于告知基于线索暴露的治疗，旨在通过消除训练来消除对线索的反应，作为减少复发可能性的一种手段。然而，过去的线索反应性研究在揭示线索如何影响实际吸烟行为方面出奇地有限。造成这种限制的两个关键原因包括：(1)主要关注近端吸烟线索（例如，点燃的香烟，吸烟的图像刺激），而忽略了与吸烟行为不太接近的远端线索（例如，个人吸烟环境和一个人通常吸烟的周围人）；(2)在缺乏评估实际吸烟行为的措施（吸烟潜伏期和暴露于线索时的即兴吸烟）的情况下，强烈依赖自我报告措施（例如，渴望）。为了解决前一种限制，我们最近在之前的探索性R21 （DA017582）下的工作表明，吸烟者对环境和人的标准近端吸烟线索和个性化远端吸烟线索的反应同样强烈。此外，表明不吸烟的个人环境和周围从不吸烟的人似乎对吸烟的渴望起着保护作用。然而，继续单独研究每一种线索类型并不能提供线索在现实世界中如何发挥作用的完整图景，因为这些线索往往是共存的。为了以一种更接近地模仿在实验室之外如何遇到线索的方式来检查线索，拟议的研究将评估对近端和个人远端线索的单独和组合的反应。关于后一种限制，有一种普遍的假设，即自我报告对提示（例如，渴望）的反应与实际吸烟行为直接相关；然而，这种观点在很大程度上未经检验。因此，本研究的第二个主要目的是研究各种线索的组合如何影响吸烟者的自我报告和行为反应，以及这些线索反应指数如何相互关联。拟议的研究将导致对吸烟者在现实生活中面对的显著提示如何单独或协同作用增强或减弱他们的自我报告和行为提示反应的新理解。此外，这项工作将允许检查的关联和/或差异，这两个关键措施的线索反应性。这项工作将直接为新的基于线索的吸烟治疗提供信息，这些治疗既专注于帮助吸烟者识别和避免特定的吸烟诱因，也旨在消除冲动反应以减少戒烟后的复发。此外，这些程序可以提供一种方法来衡量任何类型的戒烟治疗后的早期成功，因为治疗后对近端或个人远端线索的认知或行为反应较小的个体预计不太可能复发。公共卫生相关性：尼古丁以外的因素被认为在吸烟的持续和一些吸烟者无法戒烟中起关键作用。研究表明，当吸烟者接触到与过去吸烟经历有关的线索时，他们会表现出强烈的渴望。这些线索既可以是近端（如香烟、烟灰缸），也可以是远端（如环境和人）。这个项目研究了这两种线索是如何单独或结合起来影响吸烟者的思想和感受，以及他们实际的吸烟行为的。这项研究将回答关于不同类型的暗示反应之间关系的重要问题，并将直接为未来的吸烟行为治疗提供信息。

DESCRIPTION (provided by applicant): Cue-based smoking research has clearly demonstrated that smokers report robust conditioned responding (most often in the form of craving) when exposed to smoking-related stimuli. This work has been used to inform cue-exposure based treatments aimed at eliminating reactivity to cues via extinction training as a means of decreasing the likelihood of relapse. However, past cue-reactivity work is surprisingly limited in what it reveals about how cues affect actual smoking behavior. Two key reasons for this limitation include: (1) focusing primarily on proximal smoking cues (e.g., lit cigarettes, pictorial stimuli of smoking) while ignoring distal cues those less contiguous to the act of smoking (e.g., personal smoking environments and the people around whom one typically smokes), and (2) a strong reliance on self-report measures (e.g., craving) in the absence of measures that assess actual smoking behavior (latency to smoke and ad lib smoking when exposed to cues). In addressing the former limitation, our recent work under a previous exploratory R21 (DA017582) has revealed that smokers respond with equally robust craving to both standard proximal smoking cues and personalized distal smoking cues of environments and people. Additionally, personal environments that signal not smoking and personal people around whom one would never smoke appear to serve a protective function on craving to smoke. However, continuing to study each of these cue type alone fails to offer a complete picture of how cues might function in the real world where such cues more often than not co- exist. In order to examine cues in a manner that more closely mimics how cues are encountered outside of the lab, the proposed research will assess reactivity to both proximal and personal distal cues alone and in combination. Regarding the latter limitation, there is a common assumption that self-report responding to cues (e.g., craving) is directly related to actual smoking behavior; however, this notion is largely untested. Therefore, the second main objective of the proposed studies is to examine how combinations of various cues affect both self-report and behavioral reactivity in smokers, and how those indices of cue responding relate to one another. The proposed studies will result in new understanding of how salient cues that smokers confront in their real lives function alone and in concert to augment or attenuate both their self- report and behavioral cue-reactivity. Moreover, this work will allow for examination of associations and/or disparities between those two key measures of cue reactivity. This work will directly inform new cue-based smoking treatments, both those focused on helping smokers identify and avoid specific smoking triggers, and those aimed at extinguishing urge-responding to reduce relapse post-quit. Furthermore, these procedures may provide a means to index early success following cessation treatment of any kind, as individuals less reactive cognitively or behaviorally to proximal or personal distal cues post-treatment would be expected to be less likely to relapse. PUBLIC HEALTH RELEVANCE: Factors other than nicotine are thought to play key roles in the continuation of smoking and the inability of some smokers to quit. Research has shown that smokers report robust craving when exposed to cues related to past experiences with smoking. Such cues can be both proximal (e.g., cigarette, ashtrays) and distal (e.g., environments and people). This project examines how both types of cues function alone and in combination to affect smokers' thoughts and feelings, as well as their actual smoking behavior. This research will answer important questions about the relationship between different types of cue responding, and will directly inform future behavioral treatments for smoking.