Brief mindfulness cessation training with EMA for post-hospital depressed smokers

描述(由申请人提供)：抑郁症患者的吸烟率比一般人群高得不成比例，与烟草相关的发病率和死亡率也是如此。大多数精神病院在医院内禁止吸烟，从而为住院患者提供了经历戒烟的机会。然而，精神科住院的吸烟者很少被鼓励戒烟，绝大多数人在出院后立即恢复吸烟。需要一种针对这一转变的有效干预措施，利用这一宝贵的戒烟经验，在这一高危人群中增加戒烟。这项拟议研究的目标是开发一种具有应急管理的正念智能手机戒烟干预(MSI-CM)，可供精神病住院后过渡到自然环境的抑郁症吸烟者使用。这一目标将通过追求三个具体目标来实现：1)开发和进行接受住院精神治疗的MSI-CM的初步试点测试(n=10)；2)对60名在住院精神治疗期间招募的抑郁症吸烟者进行初步随机对照试验(RCT)，比较MSI-CM和增强型简短建议(E-BA)，预测MS-CM相对于E-BA将导致出院后2周、4周和3个月的戒烟率更高，出院后持续戒烟时间更长。3)在2周、4周和3个月的随访中，检查MSI-CM对关键机制(假设的中介因素)的影响及其与吸烟结果的关系。所建议的研究是创新的，因为：1)以前的研究没有针对精神病住院环境中抑郁吸烟者的烟草使用实施正念干预，也没有利用智能手机来促进实施；2)所建议的干预针对被忽视的住院-家庭过渡时期，干预部分在住院环境和家庭环境的背景下提供 3)拟议的干预措施与现有的正念干预措施的不同之处在于，吸烟者将在戒烟时练习正念，并在医院和他们自己的环境中经历戒断、渴望和负面影响，由应急管理激励，4)使用应急管理(以加强禁欲)与正念训练相结合，以提高正念干预戒烟的有效性，以及5)先前没有研究收集关于在住院和出院后的高危人群中与吸烟和正念相关的概念的生态瞬时评估数据，如果这种干预被发现是有效的，这一研究计划的潜在影响将是相当大的，不仅是在它的创新方面，而且因为它的目标与一个重要的公共卫生优先事项相一致：随时将有效、低成本的干预措施传播到 减少精神障碍患者的发病率和死亡率。

DESCRIPTION (provided by applicant): Smoking rates among individuals with depression are disproportionately higher than the general population, as are their rates of tobacco-related morbidity and mortality. The majority of psychiatric hospitals ban smoking on hospital grounds, thus providing an opportunity for inpatients to experience abstinence. Yet, smokers in inpatient psychiatric settings are rarely encouraged to quit and the vast majority return to smoking immediately after discharge. An effective intervention that targets this transition, capitalizing o this valuable experience of abstinence, is needed to increase smoking cessation in this at-risk population. The goal of the proposed study is to develop a mindfulness smartphone intervention with contingency management (MSI-CM) for smoking cessation that can be readily available to depressed smokers transitioning to their natural environment following psychiatric hospitalization. The goal will be accomplished by pursuing three specific aims: 1) to develop and conduct a preliminary pilot test (n=10) of the MSI-CM receiving inpatient psychiatric treatment, 2) to conduct a preliminary randomized controlled trial (RCT) with 60 depressed smokers recruited during inpatient psychiatric treatment, comparing MSI-CM and enhanced brief advice (E-BA), with a prediction that MS-CM relative to E-BA will result in higher rates of smoking cessation at 2-week, 4-week, and 3-month post-discharge follow-ups and have longer periods of continuous abstinence after hospital discharge, and 3) to examine MSI-CM's effects on key mechanisms (hypothesized mediators) and their associations with smoking outcomes at 2-week, 4-week, and 3-month follow-ups. The research proposed is innovative in that: 1) no previous studies have implemented a mindfulness intervention targeting tobacco use among depressed smokers in a psychiatric inpatient setting or have utilized smartphones to facilitate implementation, 2) the proposed intervention targets a neglected period of inpatient-home transition, with intervention components delivered in the context of both the inpatient setting and the patient's own environment, 3) the proposed intervention differs from existing mindfulness interventions in that smokers will practice mindfulness while abstinent and experiencing withdrawal, craving and negative affect, both in the hospital and in their own environment, incentivized by contingency management, 4) the use of contingency management (to reinforce abstinence) in conjunction with mindfulness training, in order to enhance the efficacy of mindfulness intervention for smoking cessation is innovative, and 5) no previous study has collected ecological momentary assessment data on constructs related to smoking and mindfulness in this high-risk population, in both an inpatient setting and after hospital discharge If this intervention is found to be efficacious, the potential impact of this program of research wll be considerable, not only in its innovation, but because its objectives are consistent with a significant public health priority: the ready dissemination of effective, low-cost interventions to reduce morbidity and mortality among individuals with psychiatric disorders.