Smoking-Based Prevention Program for Panic Disorder

描述（由申请人提供）：当前修订（第三次提交）提案的总体目标是通过专门的焦虑戒烟干预来发展有关预防恐慌发作和恐慌障碍（PD）的知识。该项目将在控制预防项目的背景下，针对PD发展的两个可塑脆弱性因素——焦虑敏感性（对焦虑和焦虑相关感觉的恐惧）和吸烟。该预防计划将在两个地点实施，将利用认知重组和内感受暴露策略，特别侧重于减少对焦虑的恐惧，以便：(1)减少惊恐发作和惊恐障碍的发展；(2)促进成功戒烟。恐慌和吸烟因素都是寻求改变与这两种结果相关的风险过程的综合干预的主要理论兴趣。值得注意的是，医学研究所关于预防科学的报告（Mrazek & Haggerty, 1994）以及最近NIMH关于精神疾病中烟草使用和戒烟的工作组（Riley, 2005）都将这种“双重”关注推荐为一种理想的策略，以解决共病问题。具体来说，这个恐慌-吸烟项目（PSP）将整合内感受性暴露、认知重构和心理教育练习，这些练习是为恐慌预防和治疗项目开发的，并提供标准的戒烟咨询。为了说明PSP中焦虑相关成分的功效，将该程序与仅包含PSP中吸烟相关成分的程序（SP）进行比较。这种方法旨在建立PSP干预相对于当代戒烟计划的有效性。主要目的是在一个综合的吸烟-恐慌项目中检查心理脆弱因素（焦虑敏感性）和行为风险因素（吸烟）减少的影响，该项目旨在减少恐慌精神病理学的发展并促进戒烟。

DESCRIPTION (provided by applicant): The overall aim of the current revised (third submission) proposal is to develop knowledge about the prevention of panic attacks and panic disorder (PD) using a specialized anxiety-smoking cessation intervention. This program will target, within the context of a controlled prevention program, two malleable vulnerability factors for the development of PD - anxiety sensitivity (the fear of anxiety and anxiety-related sensations) and cigarette smoking. The prevention program, implemented across two sites, will utilize cognitive restructuring and interoceptive exposure strategies with a specific focus on reducing the fear of anxiety in order to (1) decrease the development of panic attacks and panic disorder; and (2) facilitate successful cessation. Both panic and smoking factors are of primary theoretical interest to an integrative intervention that seeks to modify risk processes relevant to both outcomes. It is noteworthy that this "dual" focus has been recommended as an ideal strategy by the Institute of Medicine report on prevention science (Mrazek & Haggerty, 1994) as well as the recent NIMH Workgroup on Tobacco Use and Cessation in Psychiatric Disorders (Riley, 2005) for comorbid problems. Specifically, this Panic-Smoking Program (PSP) will integrate interoceptive exposure, cognitive restructuring, and psychoeducation exercises developed for panic prevention and treatment programs with standard smoking cessation counseling. To address the efficacy of the anxiety-related components of PSP, the program will be compared to a program consisting only of the smoking-related components of PSP (SP). This approach is aimed at establishing the efficacy of the PSP intervention relative to a contemporary smoking-cessation program. The primary aims focus on examining the effects of reductions in a psychological vulnerability factor (anxiety sensitivity) and a behavioral risk factor (smoking) in an integrated smoking-panic program designed to decrease the development of panic psychopathology and to facilitate smoking cessation.