Effects of Mindfulness Training on Impulsivity & Inhibitory Control in Smokers

描述（由申请人提供）：对烟草衍生尼古丁的依赖是一个重大的公共卫生问题。数据显示，吸烟者在自我报告和行为衡量方面都比不吸烟者更冲动。冲动的行为测量预测戒烟期间的结果。与目前的吸烟者相比，成功戒烟者有更好的冲动控制能力。冲动被定义为行为上的一种倾向，即对内部和外部刺激做出快速的、计划外的反应，而不考虑负面后果。冲动性通常在两个主要的行为领域进行测量，延迟折扣，即选择较小的即时奖励而不是较大的延迟奖励，以及反应抑制，一旦反应开始就无法停止。一种减少吸烟者冲动和增强抑制控制的无药物方法可以提高戒烟治疗的持续疗效。整合正念的治疗与成瘾者冲动和药物使用的减少有关。一项初步研究报告显示，100%接受过正念训练、每天至少冥想45分钟的吸烟者在戒烟后6周仍能保持戒烟。初步数据表明，正念训练通过多种认知机制使物质使用障碍患者受益，包括减少自我报告的运动冲动。然而，目前还没有被广泛接受的冲动或抑制控制的行为测量方法被用来衡量正念练习对吸烟者的影响。本项目旨在评估正念与戒烟和早期戒烟中冲动和抑制控制的行为测量之间的关系。正念导向治疗研究的数据表明，在家进行正式的冥想练习是获得积极临床结果的最重要变量。这一结论支持了流行的理论，即高剂量的重复冥想练习可以引起皮质重塑。由于成瘾已被定义为一种阶段性神经可塑性疾病，因此可以诱导加速治疗性神经可塑性的强化行为计划尤其引人注目。目前正念练习自我报告剂量的方法可能容易受到反应偏倚和报告反应率低的影响。我们计划使用Actiwatch Score对正式正念练习进行活动图监测，以行为验证冥想时间，并严格测试冥想剂量效应理论，该理论假设正式冥想练习时间可以预测抑制控制、延迟折扣和吸烟结果的改善。本申请寻求SOAR拨款支持，以提供成功试验所需的力量和精度，允许我们在不延长试验持续时间的情况下增加样本量，并通过提高我们对冥想练习剂量的测量质量。

DESCRIPTION (provided by applicant): Dependence on tobacco derived nicotine is a major public health problem. Data suggest tobacco smokers are more impulsive on both self-report and behavioral measures than non-smokers. Behavioral measures of impulsivity predict outcome during smoking cessation. Successful quitters have better impulse control compared to current smokers. Impulsivity is defined behaviorally as a predisposition toward rapid, unplanned reactions to internal and external stimuli without regard for the negative consequences. Impulsivity is often measured behaviorally in two major domains, delay discounting, i.e., the choice of smaller immediate reward over a larger, delayed reward, and response inhibition, the inability to stop a response once it is initiated. A drug-free method that decreases smokers' impulsivity and enhances inhibitory control could improve sustained efficacy of smoking cessation treatment. Treatments integrating mindfulness have been associated with decreases in impulsiveness and substance use in people with addiction. A preliminary study of reports that 100% of mindfulness-trained smokers that meditated at least 45 minutes daily were still abstinent at 6 weeks post-quit. Preliminary data suggest that mindfulness training benefits people with substance use disorders through multiple cognitive mechanisms, including decreased self-report motor impulsiveness. Yet, no widely accepted behavioral measures of impulsivity or inhibitory control have been used to measure the effect of mindfulness practice in smokers. This project aims to evaluate the relationship between mindfulness and behavioral measures of impulsivity and inhibitory control in smoking cessation and early abstinence. Data from mindfulness-oriented treatment studies suggest at-home formal meditation practice is the most important variable in attaining positive clinical outcomes. This conclusion supports the prevailing theory that high doses of repetitive meditation practice can elicit cortical remodeling. Since addiction has been conceptualized as a disease of staged neuroplasticity, an intensive behavioral program that can induce accelerated therapeutic neuroplasticity is particularly compelling. Current methods for self-reporting dose of formal mindfulness practice may be vulnerable to response bias and poor reporting response rates. We plan to use actigraphic monitoring of formal mindfulness practice using the Actiwatch Score to behaviorally validate meditation time and rigorously test the meditation dose effect theory which hypothesizes that formal meditation practice time will predict improvement in inhibitory control, delay discounting, and smoking outcomes. This application seeks SOAR grant support to provide the power and precision needed for a successful trial, by allowing us to increase the sample size without extending the trial duration, and by improving the quality of our measurement of meditation practice dose. PUBLIC HEALTH RELEVANCE: Dependence on tobacco derived nicotine is a major public health problem. Substance users who complete training in mindfulness subjectively report increased patience and improved motor control over their impulses. Yet, no studies have tested this perceived benefit with behavioral measures of impulse control. We are conducting a randomized controlled clinical trial, which compares Cognitive-Behavioral Therapy and Mindfulness Training for tobacco smokers, using behavioral measures to investigate the effects of mindfulness training on impulsivity and inhibitory control.