Personalized Feedback for Distress Intolerant Smokers

项目摘要/摘要 在美国，吸烟仍然是可预防的死亡和残疾的主要原因， 每年造成约480,000人过早死亡。1，2鉴于人们对吸烟的普遍认识 美国的吸烟率总体上呈下降趋势，这是一种“慢性健康行为问题”。 没有扩展到精神症状和精神障碍加剧的吸烟者。3，4这里，焦虑和 抑郁症状和症状(以下称为“情绪障碍”，以便于表现) 尤其重要，因为它们是普通人群中最普遍的精神问题， 明显地与吸烟并存，并与吸烟的开始、维持和复发密切相关。 一种综合的、理论驱动的方法来解决与以下因素相关的情绪障碍的异质性 吸烟是关注潜在的跨诊断过程，这些过程既是情绪障碍的基础，也是 吸烟。6痛苦耐受性是一种跨诊断的易损性因素，可导致精神分裂症的病因和维持 负面情绪综合症。7痛苦耐受性在理论和经验上都有别于其他 应对、焦虑敏感、消极情感、情绪失调、 神经质和经验回避。7-12虽然痛苦耐受性是一个相对稳定的结构，13它是 可塑性，使其成为预防/干预计划的主要风险因素。14、15尽管有 在瞄准痛苦耐受性以降低情绪障碍风险16和促进成功方面取得了进展 戒烟，17没有针对性的努力集中在解决痛苦耐受性问题上 戒烟过程(即，动机[有戒烟的动机]、预先[考虑和准备 退出]))。 我寻求适应和改进(阶段1)，并在试点随机对照试验(阶段2)和 集成的、简短的、基于计算机的个性化反馈干预：(1)增加动力、信心、 和戒烟意向，减少戒烟的感知障碍；(2)降低吸烟率，增加 戒烟尝试的次数，并减少以应对为导向的吸烟；以及(3)增加对痛苦的耐受性和 愿意使用适应性应对策略，减少焦虑/抑郁症状。扩大覆盖范围 通过计算机提供的干预来促进健康的策略对于许多健康的人来说是及时和必要的 有记录的公共卫生原因：对更大部分人口的更大可扩展性；更高的成本- 有效性潜力；通过量身定做 治疗内容，以满足高危人群的独特需求；以及可靠地 提供简短的烟草使用干预措施。

Project Summary/Abstract Smoking remains the leading cause of preventable death and disability in the United States (US), contributing approximately 480,000 premature deaths annually.1, 2 Given widespread awareness of smoking as a 'chronic health behavior problem,' smoking rates, in general, have declined in the US.2 However, this decline has not extended to smokers with elevated psychiatric symptoms and disorders.3, 4 Here, anxiety and depressive symptoms and syndromes (hereafter termed `emotional disorders' for ease of presentation) are particularly important because they are the most prevalent psychiatric problems in the general population, remarkably comorbid with smoking, and reliably associated with smoking initiation, maintenance, and relapse.5 An integrative, theory-driven approach to address the heterogeneity of emotional disorders associated with smoking is to focus on underlying transdiagnostic processes that underpin both emotional disorders and smoking.6 Distress tolerance is a transdiagnostic vulnerability factor for the etiology and maintenance of negative affect syndromes.7 Distress tolerance is distinct theoretically and empirically from other constructs such as coping, anxiety sensitivity, negative affectivity, emotion dysregulation, neuroticism, and experiential avoidance.7-12 Although distress tolerance is a relatively stable construct,13 it is malleable, making it a prime risk factor to target in prevention/intervention programs.14, 15 Although there has been progress in targeting distress tolerance to decrease risk for emotional disorders16 and facilitate success in quitting smoking,17 no targeted efforts have focused on addressing distress tolerance in 'earlier phases' of the quit process (i.e., Motivation [having motivation to quit], Precessation [thinking about and preparing for quitting]). I seek to adapt and refine (Phase 1) and test in a pilot randomized controlled trial (Phase 2) an integrated, brief, computer-based personalized feedback intervention to: (1) increase motivation, confidence, and intention to quit and reduce perceived barriers for quitting smoking; (2) reduce smoking rate, increase number of quit attempts, and reduce coping-oriented smoking; and (3) increase distress tolerance and willingness to use adaptive coping strategies and reduce anxiety/depressive symptoms. Expanding the reach of health promotion tactics via a computer-delivered intervention is timely and necessary for a multitude of well- documented public health reasons: greater scalability to larger segments of the population; greater cost- effectiveness potential; the ability to enhance the personalized nature of care through the tailoring of therapeutic content to meet the unique needs of high-risk segments of the population; and the ability to reliably deliver brief tobacco use interventions.