Behavioral Activation for Smoking Cessation in Veterans with PTSD

描述（由申请人提供）： 目的和理由：这项研究的主要目的是产生一种经验验证的治疗方法，增加患有创伤后应激障碍（PTSD）的退伍军人的戒烟，这种方法可以很容易地整合到退伍军人管理局（VA）设施内的戒烟诊所和/或心理健康诊所。创伤后应激障碍（PTSD）在退伍军人管理局（VA）患者群体中非常普遍，并且与吸烟率（53% - 66%）相关，远远超过退伍军人管理局（VA）登记者的总体吸烟率（22%）。创伤后应激障碍也与戒烟治疗失败率异常高有关。患有PTSD的退伍军人之间戒烟结果的差异可能是因为标准戒烟治疗不能解决PTSD特定的脆弱性。患有吸烟-PTSD合并症的退伍军人可能对解决PTSD和相关情感症状的治疗反应最佳，因为这些症状既可以加强吸烟，又可以破坏戒烟尝试。最近的证据表明，行为激活疗法（BA），一种增加参与强化活动的行为治疗，显着减少PTSD症状。BA可能会改善患有PTSD的退伍军人的戒烟结果，因为它降低了整体PTSD症状的严重程度和情感困扰（低积极影响，高消极影响），这可能会导致吸烟复发。拟议的研究将确定BA作为标准戒烟治疗（ST+BA）的辅助治疗是否上级标准戒烟治疗+健康和吸烟教育（ST+HSE）的高强度组合，以改善患有创伤后应激障碍的退伍军人的戒烟结果。HSE干预旨在构成控制接触时间的可信干预。次要目的是确定BA是否改善PTSD的病理学和相关的情感困扰，并确定BA对吸烟结果的潜在介导因素。 方法：共有120名有戒烟动机的PTSD退伍军人将参加初步诊断和基线评估会议。有兴趣、合格且提供知情同意书的受试者将被随机分配接受ST+BA或ST+HSE，并将由其个人研究治疗师联系以安排首次治疗。参与者将根据以下因素分为治疗组：1）重度抑郁症（MDD;存在与不存在），和2）PTSD症状严重程度。所有参与者将获得八个ST+BA或ST+HSE的单独课程。所有参与者将在八个阶段中的每个阶段接受20分钟相同的标准戒烟治疗。ST+BA患者将额外接受30分钟的行为激活治疗; ST+HSE患者将额外接受30分钟的健康教育和吸烟信息。所有参与者将接受8周的尼古丁贴片。将在戒烟日期后2、4、8、16和26周评估戒烟结局。 重要性：这项研究具有重要的临床和公共卫生意义，因为吸烟在患有创伤后应激障碍的退伍军人中特别常见，并且是疾病和残疾的主要可预防原因。减少患有创伤后应激障碍的退伍军人的吸烟率将大大降低这一弱势吸烟群体与吸烟有关的疾病和死亡率。它还将减少向VA收取的与烟草相关的医疗费用。研究方法和发现可能会扩展到对PTSD以外的精神健康障碍患者的戒烟治疗。

DESCRIPTION (provided by applicant): Aims and Rationale: The primary objective of this research is to produce an empirically validated treatment that increases smoking cessation in Veterans with posttraumatic stress disorder (PTSD), one that can be easily integrated into smoking cessation clinics and/or mental health clinics within Veterans Administration (VA) facilities. PTSD is highly prevalent in the VA patient population and is associated with a rate of smoking (53% - 66%) that far exceeds that of VA enrollees in general (22%). PTSD is also associated with unusually high rates of smoking cessation treatment failure. The disparity in smoking cessation outcomes amongst veterans with PTSD may occur because standard smoking cessation treatment does not address PTSD-specific vulnerabilities. Veterans with smoking-PTSD comorbidity may respond optimally to treatment that addresses PTSD and associated affective symptoms, because such symptoms can both reinforce smoking and undermine quit attempts. Recent evidence shows that behavioral activation therapy (BA), a behavioral treatment that increases engagement in reinforcing activities, significantly reduces PTSD symptoms. BA may improve smoking cessation outcomes amongst veterans with PTSD because it reduces overall PTSD symptom severity and affective distress (low positive affect, high negative affect), which can cause smoking relapse. The proposed research will determine whether BA as an adjunct to standard smoking cessation treatment (ST+BA) is superior to a comparably intense combination of standard smoking cessation treatment + health and smoking education (ST+HSE) in improving smoking cessation outcomes among veterans with PTSD. The HSE intervention is intended to constitute a credible intervention that controls for contact time. Secondary objectives are to determine if BA improves PTSD symptomatology and associated affective distress, and to identify potential mediators of BA on smoking outcomes. Methods: A total of 120 veterans with PTSD who are motivated to quit smoking will attend an initial diagnostic and baseline assessment session. Those who are interested, eligible, and who provide consent will be randomly assigned to receive ST+BA or ST+HSE and will be contacted by their individual study therapist to schedule the first treatment session. Participants will be stratified into treatment groups based on: 1) major depressive disorder (MDD; present versus absent), and 2) PTSD symptom severity. All participants will receive eight, individual sessions of ST+BA or ST+HSE. All participants will receive 20 minutes of identical standard smoking cessation treatment in each of the eight sessions. Those in the ST+BA condition will receive an additional 30 minutes of behavioral activation therapy; those in the ST+HSE condition will receive an additional 30 minutes of health education and information about smoking. All participants will receive 8 weeks of the nicotine patch. Smoking cessation outcomes will be assessed 2, 4, 8, 16, and 26 weeks after the quit date. Significance: This research has important clinical and public health significance because smoking is especially common among veterans with PTSD and it is the leading preventable cause of disease and disability. Reducing smoking rates among veterans with PTSD would result in substantially lower smoking-related illness and death in this vulnerable group of smokers. It would also reduce tobacco related healthcare costs charged to the VA. Study methods and findings may potentially be extended to smoking cessation treatment for patients with mental health disorders other than PTSD.