Integrated Smoking Cessation Treatment for Emotional Dysregulation

说明(申请人提供)：在美国，吸烟是导致死亡和残疾的首要原因，每年导致超过440,000人死亡(美国卫生与公众服务部[USDHHS]，2004)。吸烟率的选择假说假定，能够成功戒烟的吸烟者不会受到使戒烟更具挑战性的特定特征的“负担”(Coambs等人，；休斯，1993年；休斯和布兰登，2003年)。值得注意的是，与没有精神病史的人和有多种精神疾病的人相比，那些抑郁或焦虑症状和障碍增加的人的吸烟率和戒烟失败率高得不成比例(BeJerot&Humble，1999；Lasser 2000)。研究人员已经开始为患有抑郁(例如Brown等人，2001；Hall等人，1998)和某些焦虑特征(例如，高度焦虑敏感性；Zvolensky，Bernstein，Yartz，McLeish和Feldner，2008)的吸烟者开发专门的行为干预措施。然而，这项工作的主要障碍是，针对这一群体的现有治疗方法只能解决吸烟的单一精神共病，而对患有多发性焦虑症或同时出现抑郁和焦虑症状或障碍的吸烟者缺乏治疗策略。这种忽视是不幸的，因为多种抑郁和焦虑症状和障碍：(A)经常在吸烟者中共同出现(Mykletun等人，2003年)，(B)属于最常见的精神障碍群体(Kessler等人，2005年)，(C)似乎有共同的(跨诊断)易受伤害的过程，与吸烟的病因有关(例如，痛苦不耐受、焦虑敏感和快感缺乏；Zvolensky、Stewart、Vujanovic、Gavric和Steeves，2009)，以及(D)表现出相当大的现象学重叠(Mineka、Watson、&Clark，1998)。因此，我们建议进行一项为期3年的研究，为患有焦虑症的脆弱吸烟者开发一种综合戒烟疗法。干预开发方法将遵循与NIH关于开发和标准化行为干预的指南一致的阶段性模式，建议的研究代表了IB阶段的研究。具体地说，在第一年，启动活动将包括对部分个人(N 12人)进行综合干预试点，征求内部和外部专家顾问和参与者的反馈，以及制定最终治疗手册和程序。这一阶段的目标将是确定提供治疗的可行性、参与者的可接受性和潜在的效果。在接下来的两年中，将进行一项小型双臂疗效研究(N=60)，将新干预措施与对照干预措施进行比较。这项研究代表着将基础研究转化为更有效的治疗尼古丁依赖的策略的更大前景中的重要一步。这项研究通过评估一种可能导致更有效地应用于精神高危吸烟者治疗的干预措施，解决了一个重要的公共卫生问题。预期的发现应该：(1)指导焦虑-抑郁-吸烟关系中涉及的机制的理论概念化的进展。(2)为焦虑症和抑郁症吸烟者开发一种新颖的心理社会/行为和药物戒烟干预措施(S)。

DESCRIPTION (provided by applicant): Cigarette smoking is the leading cause of death and disability in the United States (U.S.), contributing to over 440,000 deaths each year (U. S. Department of Health and Human Services [USDHHS], 2004).The selection hypothesis of smoking prevalence posits that smokers who are able to quit successfully are not "burdened" by specific characteristics that make it more challenging to quit (Coambs et al., 1989; Hughes, 1993; Hughes & Brandon, 2003). Notably, cigarette smoking rates and rates of cessation failure are disproportionately higher among those with elevated depressive or anxiety symptoms and disorders relative to persons with no psychiatric history, and those with many types of psychiatric conditions (Bejerot & Humble, 1999; Lasser 2000). Researchers have started to develop specialized behavioral interventions for smokers with depressive (e.g., Brown et al., 2001; Hall et al., 1998) and certain anxiety characteristics (e.g., high anxiety sensitivity; Zvolensky, Bernstein, Yartz, McLeish, & Feldner, 2008). Yet, central barriers to such work are that existing treatments for this population address only a single psychiatric comorbidity with smoking and therapeutic tactics are absent for smokers with multiple anxiety disorders or co-occurring elevated depressive and anxiety symptoms or disorders. Such neglect is unfortunate, as multiple depression and anxiety symptoms and disorders: (a) frequently co-occur in smokers (Mykletun et al., 2003), (b) are among the most common groups of psychiatric disorders (Kessler et al., 2005), (c) appear to share common (transdiagnostic) vulnerability processes implicated in the etiology of smoking (e.g., distress intolerance, anxiety sensitivity, and anhedonia; Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009), and (d) exhibit considerable phenomenological overlap (Mineka, Watson, & Clark, 1998). Accordingly, we are proposing a 3-year study to develop an integrated treatment for smoking cessation for anxiety-depressive vulnerable smokers. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral interventions, with the proposed research representing a Stage IB study. Specifically, during the first year, startup activities will include piloting the integrated intervention on a subset of individuals (N 12), soliciting internal and external expert consultant and participant feedback, and development of the final treatment manual and procedures. The goal during this phase will be to establish feasibility of treatment delivery, participant acceptability, and potential for an effect. During te following two years, a small two-arm efficacy study (N = 60) will be undertaken comparing the new intervention to a control intervention. This study represents an important step in the larger landscape of translating basic research to more efficacious strategies for treating nicotine dependence. This study addresses an important public health issue by assessing an intervention that may lead to a more effective application for the treatment of psychiatrically at-risk smokers. The expected findings should: (1) Guide advances in the theoretical conceptualization of the mechanisms involved in anxiety-depression- smoking relations. (2) Directly inform the development of a novel and psychosocial/behavioral and pharmacological smoking cessation intervention(s) for smokers with anxiety and depressive disorders.