Evaluating the Casual Pathways from Lapse to Relapse in Smokers

描述（由申请人提供）：绝大多数吸烟失败导致完全复发。由于烟瘾几乎总是会发生，而且无法避免，认知行为预防复吸技术的重点是帮助吸烟者控制他们对烟瘾的反应，从而避免复吸。不幸的是，在这方面，认知-行为预防复发训练对吸烟者并没有特别有希望。这可能是由于这个领域没有很好的信息，关于心理过程和机制，导致失误成为复发。开始改进或发展新的认知行为预防复发干预措施的一种方法是专注于测试和评估新的复发理论，以便更多地了解导致过失成为复发的心理过程。在最近对复发预防理论的修订和实地研究结果的推动下，本申请提出进行两项研究，旨在提供一个与临床相关的实验模拟模型，说明失误是如何导致复发的。在预防复吸理论中，自我效能感的阶段性变化紧随其后，并与吸烟结果预期的补偿性水平相结合（或加或交互），导致复吸。换句话说，自我效能感和结果预期介导了失效和复发之间的关系。根据定义，中介分析通过中介变量（自我效能感和结果预期）对初始变量（在我们的案例中是过失）对结果变量（复发）施加的直接因果力进行建模。中介既由初始变量（过失引起自我效能感和结果期望的变化）引起，又引起结果变量（过失引起自我效能感和结果期望的变化引起复发可能性的变化）。因此，我们的复吸模拟模型将：1)在一段时间的程序性戒烟后，通过实验创造一个间隔，然后在一个简短的14天随访期内测量复吸时间，以确定间隔是否与复吸有因果关系，以及自我效能感和吸烟结果预期在这种关系中起什么中介作用（研究1）；2)通过实验控制自我效能感和结果预期，在一段时间的程序性戒烟和程序性戒烟后，然后在一个短暂的随访期间测量复发时间，以确定实验控制的自我效能感和吸烟结果预期的变化是否导致复发（研究2）。有戒烟动机的吸烟者将参与这些研究，以提高研究结果的临床适用性和外部有效性。因此，在完成每项研究的实验部分后，所有参与者都将接受戒烟的临床治疗。本研究的长期目标有三个方面：1)促进对预防复发治疗的作用机制的更好理解；2)在这些结果的基础上建立一个更复杂的复发模型；3)提高吸烟者预防复吸训练的临床效果。在美国，吸烟每年造成50多万人死亡，戒烟大大减少了与吸烟有关的死亡和疾病。然而，不幸的是，大多数试图戒烟的吸烟者都不会成功；换句话说，大多数试图戒烟的人都会复发。一个原因是，关于导致复发的心理变量的有用信息很少。公共卫生相关性：这项研究旨在揭示导致复发的心理变量，其结果将用于告知新一代更成功的戒烟治疗方法。

DESCRIPTION (provided by applicant): The overwhelming majority of smoking lapses lead to full blown relapse. Because lapses almost always occur and cannot always be avoided, cognitive-behavioral relapse prevention techniques have focused on helping smokers to manage their reactions to lapses so that they can avoid relapses. Unfortunately, cognitive- behavioral relapse prevention training has not been especially promising for smokers in this regard. This may be due to the fact that the field has no good information available about the psychological processes and mechanisms that cause a lapse to become a relapse. One way to begin to refine or to develop new cognitive- behavioral relapse prevention interventions is to focus on testing and evaluating newer theories of relapse in order to understand more about the psychological processes that cause lapses to become relapses. Driven by the recent revision of relapse prevention theory and the results of field research, this application proposes to conduct two studies designed to provide a clinically-relevant experimental analogue model of how lapses causally contribute to relapse. In relapse prevention theory, lapses are followed by phasic changes in self- efficacy and in combination (either additively or interactively) with tonic levels of smoking outcome expectancies, contribute to relapse. In other words, self-efficacy and outcome expectancies mediate the relationship between lapse and relapse. Mediational analyses, by definition, model the direct causal force that an initial variable (in our case, a lapse) exerts on an outcome variable (relapse) through an intervening variable(s) the mediator(s) (self-efficacy and outcome expectancies). The mediator both is caused by the initial variable (lapses cause changes in self-efficacy and outcome expectancies) and causes the outcome variable (lapse induced changes in self-efficacy and outcome expectancies cause changes relapse likelihood). Thus, our analogue model of relapse will: 1) experimentally create a lapse after a period of programmed abstinence and then measure time to relapse over a brief 14-day follow-up period to determine whether lapse is causally related to relapse and what the mediating roles of self-efficacy and smoking outcome expectancies are in this relationship (Study 1); and 2) experimentally manipulate self-efficacy and outcome expectancies after a period of programmed abstinence and a programmed lapse, and then measure time to relapse over a brief follow-up period to determine whether experimentally controlled changes to self-efficacy and smoking outcome expectancies causally contribute to relapse (Study 2). Smokers who are motivated to quit will participate in these studies to enhance the clinical applicability and external validity of the findings. As such, all participants will be offered clinical treatment for smoking cessation after completing the experimental portion of each study. The long range goals of this research are threefold: 1) to promote an improved understanding of the proposed mechanisms of action of relapse prevention treatment; 2) to build on these results to build a more complex model of relapse; and 3) to improve clinical efficacy of relapse prevention training with smokers. Cigarette smoking contributes to over half a million deaths annually in the United States and quitting smoking substantially reduces the death and disease associated with smoking. Unfortunately, however, most smokers who attempt to quit smoking will not be successful; in other words, most smokers who attempt to quit relapse. One reason is that very little good information is available about the psychological variables that cause relapses. PUBLIC HEALTH RELEVANCE: This research seeks to uncover the psychological variables that cause relapses and the results will be used to inform a new generation of more successful smoking cessation treatments.