Mindfulness training for smoking cessation

描述（由申请人提供）：背景：在美国，吸烟是可预防的发病率和死亡率的最常见原因。压力是戒烟失败的关键因素。来自我们实验室和其他实验室的数据表明，正念训练可能通过专门针对压力来有效治疗成瘾。此外，有人认为我们有一种内在的正念能力，但它被“自然”使用的程度（即，（2）个体之间的差异。这种变化可能会影响一个人处理压力的能力，从而从成瘾中恢复过来。目前还没有研究报告测量吸烟者冥想的神经相关性。在两个不同的正念冥想过程中评估治疗前区域大脑激活模式可能有助于识别个体的正念能力，以及这些模式如何与治疗结果相关。评估冥想过程中的激活模式在治疗前后的变化可能有助于确定正念训练的关键要素及其对压力的影响。研究设计：该提案将为正在进行的尼古丁依赖个体的随机临床试验增加一个fMRI范例，以评估在接受四周正念训练或戒烟治疗之前和之后与冥想训练相关的神经活动（每组n = 20）。研究目标：拟议的fMRI研究将解决以下研究问题。1)尼古丁依赖者的大脑激活模式在两种不同的标准化冥想练习和治疗前的静息状态下是否不同？2)这些冥想过程中的治疗前大脑活动与戒烟治疗结果之间的相关性是什么？3)与标准戒烟治疗相比，正念训练后冥想期间的神经激活是否有可检测到的变化（这些变化与治疗结果是否相关）？预期结果：我们预计，在治疗前，两组中尼古丁依赖的个体将显示与默认模式网络相关的中线结构的激活，并且这种激活将与治疗结果相关。此外，与戒烟治疗组（治疗后与治疗前）相比，正念训练组在冥想期间（治疗后与治疗前）这些皮层区域的大脑激活减少，这些变化将与治疗结果相关。对社会的益处：通过将功能磁共振成像分析纳入正念训练来扩大我们目前的试点工作，将开始描绘两种正念冥想标准化方法的功能机制。还将生成关于测试的两种冥想技术中哪一种与戒烟最相关的数据。这将有助于我们进一步了解正念训练如何影响大脑，什么过程会影响行为变化，以及如何将这些应用于改善尼古丁依赖和其他成瘾的治疗。 公共卫生相关性：作为一项正在进行的随机临床试验的补充，该试验评估了门诊吸烟者的正念训练，拟议的研究将使用功能磁共振成像来解决以下研究问题：1）尼古丁依赖个体的定义大脑激活模式在两种不同的标准化冥想练习和治疗前的休息状态之间是否存在差异？2)这些冥想过程中的治疗前大脑活动与戒烟治疗结果之间的相关性是什么？3)与标准戒烟治疗相比，正念训练后冥想期间的神经激活是否有可检测到的变化（这些变化与治疗结果是否相关）？

DESCRIPTION (provided by applicant): Background: Cigarette smoking is the most common cause of preventable morbidity and mortality in the US. Stress is a key component in the failure to quit. Data from our laboratory and others suggest that mindfulness training may be effective for the treatment of addictions by specifically targeting stress. Also, it has been suggested that we have an inherent capacity for mindfulness, but that the degree to which it is "naturally" used (i.e., trait-like) varies among individuals. This variability may affect one's ability to deal with stress and thus recover from addictions. No studies measuring the neural correlates of meditation in smokers have been reported. Assessment of pre-treatment regional brain activation patterns during two distinct mindfulness meditations may help to identify individual capacities for mindfulness, and how these patterns may relate to treatment outcomes. Evaluating how activation patterns during meditation change pre- to post-treatment may be useful in identifying key elements of mindfulness training and its effects on stress. Study Design: This proposal will add an fMRI paradigm to an ongoing randomized clinical trial of nicotine-dependent individuals in order to evaluate neural activity associated with meditation training before and after undergoing four weeks of mindfulness training or smoking cessation therapy (n = 20 in each group). Research Goals: The proposed fMRI study will address the following research questions. 1) Do defined brain activation patterns in nicotine-dependent individuals differ among two different, standardized meditation practices and the resting state before treatment? 2) What is the correlation between pre-treatment brain activity during each of these meditations and smoking cessation treatment outcomes? 3) Are there detectable changes in neural activation during meditation after mindfulness training versus after standard smoking cessation therapy (and do these changes correlate with treatment outcomes)? Anticipated Results: We anticipate that before treatment, nicotine-dependent individuals in both groups will show activation of midline structures associated with the default-mode network and that this activation will correlate with treatment outcomes. Additionally, the mindfulness training group will show decreased brain activation in these cortical areas during meditation (post- vs. pre-treatment) compared to the smoking cessation therapy group (post- vs. pre-treatment), and these changes will correlate with treatment outcomes. Benefit for Society: Expanding our current pilot work on the use of mindfulness training to augment smoking outcomes by including fMRI analysis will begin to delineate the functional mechanisms through which two standardized approaches to mindfulness meditation operate. Data concerning which of the two meditation techniques tested is most correlated within smoking cessation will also be generated. This will help advance our understanding of how mindfulness training affects the brain, what processes affect behavioral change, and how these can be applied to improve treatment of nicotine dependence and other addictions. PUBLIC HEALTH RELEVANCE: As an adjunct to an ongoing randomized clinical trial evaluating mindfulness training in outpatient smokers, the proposed study will use fMRI to address the following research questions: 1) Do defined brain activation patterns in nicotine-dependent individuals differ among two different, standardized meditation practices and the resting state before treatment? 2) What is the correlation between pre-treatment brain activity during each of these meditations and smoking cessation treatment outcomes? 3) Are there detectable changes in neural activation during meditation after mindfulness training versus after standard smoking cessation therapy (and do these changes correlate with treatment outcomes)?