Acceptance & Commitment Therapy for Smoking Cessation

描述（由申请人提供）：虽然有有效的戒烟治疗，但仍有很大的改进空间。即使采用目前标准的咨询加药物治疗，平均仍有81%到86%的吸烟者会复吸。很少有人关注旨在提高戒烟率的新行为戒烟疗法的测试。为了解决这一关键需求，目前的研究将测试一种新出现的咨询方法的有效性，这种方法被称为接受与承诺疗法（ACT）。迄今为止，已进行了三次以青蒿素为基础的戒烟试验。总的来说，这三个试验都很有希望，ACT干预组在干预后12个月的戒烟率约为30%至35%，大约是CBT加NRT干预后12个月戒烟率14%至19%的两倍。每个试验的结果都表明ACT是一种很有前途的戒烟咨询方法。然而，只有一项研究将ACT与标准认知行为咨询（CBT）进行了比较，而且这三项研究都存在主要的方法局限性，这使得很难得出关于ACT对戒烟有效性的明确结论。因此，现在需要进行一项有效的随机试验，比较ACT与CBT在戒烟方面的作用。除了提供有关这些治疗方法相对有效性的重要信息外，这样的试验将允许测试假设ACT发挥其影响的潜在过程。这个为期5年的项目的总体目标是利用强有力的理论和有希望的经验证据，通过比较小组提供的ACT和标准CBT咨询的有效性，将ACT作为戒烟干预措施，当两者都与尼古丁替代疗法（NRT）一起提供时，并在现实世界的卫生保健环境中提供。本研究的具体目的是：(1)与标准护理组提供的CBT咨询加NRT贴片相比，确定ACT作为戒烟干预加NRT贴片的有效性；(2)确定ACT的有效性是否如假设的那样，是由两个关键的基于理论的因素介导的：(a)接受吸烟的内在暗示（感觉、情绪和思想）和(b)尽管有内在暗示吸烟，但仍承诺戒烟。第二个目的是探讨戒烟尝试、酒精使用、性别和最近的抑郁和焦虑症状作为ACT干预效果的调节因素的作用。建议的干预措施是高度创新的，并解决了一个重要的研究需求-评估新的咨询形式，以提高戒烟的结果。如果有效，建议的干预措施将产生重大影响，ACT协议可以在美国其他临床环境中传播

DESCRIPTION (provided by applicant): While effective smoking cessation treatments exist, there is significant room for improvement. Even with the current standard counseling plus pharmacotherapy, an average of 81 percent to 86 percent of smokers will relapse to smoking. Little attention has been placed on testing new behavioral cessation treatments aimed at increasing quit rates. To address this critical need, the current study will test the effectiveness of a newly emerging counseling approach called Acceptance & Commitment Therapy (ACT). To date, three trials of ACT for smoking cessation have been conducted. Overall, these three trials have been promising with the ACT intervention groups obtaining about 30 percent to 35 percent quit rates at 12 months post intervention-about double the 14 percent to 19 percent quit rates at 12 months post intervention for CBT plus NRT. The results of each trial suggest that ACT is a promising counseling approach for smoking cessation. However, only one study compared ACT with standard cognitive behavioral counseling (CBT) and all three studies had major methodological limitations which make it difficult to draw definitive conclusions about ACT's effectiveness for smoking cessation. Accordingly, a well-powered randomized trial comparing ACT with CBT for smoking cessation is now needed. In addition to providing important information about the comparative effectiveness of these treatment approaches, such a trial would allow for testing of the underlying processes through which ACT is hypothesized to exert its impact. The overall aim of this 5-year project is to capitalize on the strong theoretical and promising empirical evidence for ACT as an intervention for smoking cessation by comparing the effectiveness of group-delivered ACT against standard CBT counseling when both are offered with nicotine replacement therapy (NRT) and delivered within a real world health care setting. The specific aims of this research are to: (1) Determine the effectiveness of ACT as a group-delivered smoking cessation intervention plus NRT patch as compared to standard care group-delivered CBT counseling plus NRT patch; (2) Determine if the effectiveness of ACT is, as hypothesized, mediated by two key theory-based factors: (a) acceptance of internal cues to smoke (sensations, emotions, and thoughts) and (b) commitment to quitting smoking despite internal cues to smoke. The secondary aim will be to explore the role of quit attempts, alcohol use, gender, and recent depressive and anxiety symptoms as moderators of the ACT intervention effect. The proposed intervention is highly innovative and addresses an important research need - evaluating novel forms of counseling to enhance smoking cessation outcomes. If effective, the proposed intervention stands to make a significant impact and the ACT protocol could be disseminated in other clinical settings around the U.S.