Combined Smoking Cessation and Cognitive Processing Therapy for PTSD

描述（由申请人提供）： 创伤后应激障碍（PTSD）和吸烟都与退伍军人的重大损害和退伍军人事务部（VA）系统的成本有关。虽然自然主义和实验室研究表明吸烟与PTSD症状有关，但针对PTSD吸烟者的现有戒烟治疗尚未采用标准化的循证PTSD治疗。迄今为止，对PTSD吸烟者最有效的戒烟方法，即戒烟综合护理（ICSC），依赖于个人PTSD治疗提供者提供的戒烟治疗。在最近的一项比较ICSC和VA专业戒烟诊所护理的试验中，ICSC产生了更好的长期戒烟效果。然而，ICSC仅与PTSD症状的适度改善相关，ICSC和单独戒烟治疗之间没有差异，这表明可能有改善ICSC的途径。我们开发了一种干预措施，将基于证据的创伤后应激障碍治疗[认知加工疗法（CPT-C）]与基于证据的创伤后应激障碍戒烟[戒烟综合护理（ICSC）]和维持戒烟的交互式电话技术相结合。该职业发展奖的目的是：1）评估一项随机临床试验（RCT）的研究可行性和治疗实施程序，该试验将CPT-C/ICSC与将以现在为中心的治疗（PCT）与ICSC相结合的对照条件进行比较; 2）描述CPT-C联合干预与PCT/ICSC条件对吸烟和PTSD症状影响的差异。置信区间将围绕计算的效应量构建，以反映效应量可靠性的不确定性; 3）使用可行性试验数据设计一项RCT，结合循证PTSD治疗和ICSC，以改善PTSD患者的戒烟。PCT是一种手动的、积极的PTSD治疗方法，有数据支持其在减少PTSD症状方面的有效性。PCT还控制了治疗时间、支持关系和治疗中的希望灌输，提供了理想的比较条件。五十 患有创伤后应激障碍的老烟民将被随机分配参加14次研究，在计划戒烟日期后6个月结束最后一次随访。联合CPT-C/ICSC干预的发展与既定的经验支持将有利于许多退伍军人与创伤后应激障碍谁吸烟，为他们提供治疗的两个普遍的问题与显着的相关损害。此外，这种治疗可以通过组合施用两种单独治疗而显著降低单独施用两种单独治疗的成本。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and cigarette smoking are both associated with significant impairment in Veterans and cost to the Veterans' Affairs (VA) system. Though naturalistic and laboratory studies suggest smoking is linked with PTSD symptoms, existing smoking cessation treatments targeting PTSD smokers have not utilized standardized, evidence-based PTSD treatment. The most effective smoking cessation approach to date for PTSD smokers, Integrated Care for Smoking Cessation (ICSC), relies on delivery of smoking cessation treatment by the individual's PTSD treatment provider. In a recent trial comparing ICSC to VA specialty Smoking Cessation Clinic care, ICSC produced significantly better prolonged smoking abstinence. However, ICSC was associated with only modest improvements in PTSD symptoms, with no difference between ICSC and smoking cessation treatment alone, suggesting a likely avenue for improving ICSC. We have developed an intervention that combines evidence based treatment for PTSD [cognitive processing therapy (CPT-C)] with evidence based smoking cessation for PTSD [Integrated Care for Smoking Cessation (ICSC)] and interactive phone technology for maintaining smoking abstinence. The objectives of this Career Development Award are to: 1) Evaluate study feasibility and treatment delivery procedures of a randomized clinical trial (RCT) comparing CPT-C/ICSC to a comparison condition combining present-centered therapy (PCT) with ICSC; 2) Characterize the difference between the combined CPT-C intervention and a PCT/ICSC condition in effects on smoking and PTSD symptoms. Confidence intervals will be constructed around calculated effect sizes to reflect uncertainty regarding the reliability of the effect size; and 3) Use feasibility trial datato design a RCT combining evidence-based PTSD treatment and ICSC to improve smoking cessation in PTSD. PCT is a manualized, active treatment for PTSD with data supporting its effectiveness in reducing PTSD symptoms. PCT also controls for treatment time, supportive relationship, and instillation of hope in treatment, providing an ideal comparison condition. Fifty Veteran smokers with PTSD will be randomized to participate in fourteen study sessions, ending with the final follow-up session six months after the scheduled quit date. The development of a combined CPT-C/ICSC intervention with established empirical support would benefit the many Veterans with PTSD who smoke by providing them with treatment of two pervasive problems with significant associated impairment. In addition, this treatment could substantially reduce the cost of administering two individual treatments separately by administering them in combination.