Effects of Mindfulness Training on Impulsivity & Inhibitory Control in Smokers

描述(由申请人提供)：对烟草衍生尼古丁的依赖是一个主要的公共卫生问题。数据表明，吸烟者在自我报告和行为指标上都比不吸烟者更冲动。冲动的行为测量可以预测戒烟期间的结果。与现在的吸烟者相比，成功戒烟的人有更好的冲动控制。冲动在行为上被定义为对内部和外部刺激做出快速的、计划外的反应的倾向，而不考虑负面后果。冲动性通常在两个主要领域进行行为测量，延迟折扣，即选择较小的直接奖励而不是较大的延迟奖励，以及反应抑制，即反应一旦启动就无法停止。一种减少吸烟者冲动和加强抑制控制的无毒方法可以提高戒烟治疗的持续效果。整合正念的治疗与成瘾者冲动和物质使用的减少有关。一项对报告的初步研究表明，每天冥想至少45分钟的接受正念训练的吸烟者在戒烟后6周仍保持戒烟状态。初步数据表明，正念训练通过多种认知机制使物质使用障碍患者受益，包括减少自我报告的运动冲动。然而，还没有被广泛接受的冲动或抑制性控制的行为指标被用来衡量正念练习对吸烟者的影响。该项目旨在评估戒烟和早期戒烟中正念与冲动和抑制控制的行为测量之间的关系。来自正念治疗研究的数据表明，在家中正式的冥想练习是获得积极临床结果的最重要变量。这一结论支持了流行的理论，即高剂量的重复冥想练习可以引发皮质重塑。由于成瘾已经被概念化为一种阶段性神经可塑性疾病，可以诱导加速治疗性神经可塑性的强化行为程序尤其引人注目。目前自我报告剂量的正式正念练习的方法可能容易受到反应偏差和不良报告响应率的影响。我们计划使用Actiwatch评分对正式的正念练习进行动态监测，从行为上验证冥想时间，并严格测试冥想剂量效应理论，该理论假设正式的冥想练习时间将预测抑制控制、延迟折扣和吸烟结果的改善。这项申请寻求高额拨款支持，以提供成功试验所需的力量和精确度，允许我们在不延长试验持续时间的情况下增加样本大小，并通过改善我们冥想练习剂量的测量质量。 公共卫生相关性：对烟草衍生尼古丁的依赖是一个主要的公共卫生问题。完成正念训练的物质使用者主观上报告说，他们的耐心增加了，对冲动的运动控制也得到了改善。然而，还没有研究用冲动控制的行为测量来测试这种感知到的好处。我们正在进行一项随机对照临床试验，比较认知-行为疗法和正念训练对吸烟者的影响，使用行为测量方法来研究正念训练对冲动和抑制控制的影响。

DESCRIPTION (provided by applicant): Dependence on tobacco derived nicotine is a major public health problem. Data suggest tobacco smokers are more impulsive on both self-report and behavioral measures than non-smokers. Behavioral measures of impulsivity predict outcome during smoking cessation. Successful quitters have better impulse control compared to current smokers. Impulsivity is defined behaviorally as a predisposition toward rapid, unplanned reactions to internal and external stimuli without regard for the negative consequences. Impulsivity is often measured behaviorally in two major domains, delay discounting, i.e., the choice of smaller immediate reward over a larger, delayed reward, and response inhibition, the inability to stop a response once it is initiated. A drug-free method that decreases smokers' impulsivity and enhances inhibitory control could improve sustained efficacy of smoking cessation treatment. Treatments integrating mindfulness have been associated with decreases in impulsiveness and substance use in people with addiction. A preliminary study of reports that 100% of mindfulness-trained smokers that meditated at least 45 minutes daily were still abstinent at 6 weeks post-quit. Preliminary data suggest that mindfulness training benefits people with substance use disorders through multiple cognitive mechanisms, including decreased self-report motor impulsiveness. Yet, no widely accepted behavioral measures of impulsivity or inhibitory control have been used to measure the effect of mindfulness practice in smokers. This project aims to evaluate the relationship between mindfulness and behavioral measures of impulsivity and inhibitory control in smoking cessation and early abstinence. Data from mindfulness-oriented treatment studies suggest at-home formal meditation practice is the most important variable in attaining positive clinical outcomes. This conclusion supports the prevailing theory that high doses of repetitive meditation practice can elicit cortical remodeling. Since addiction has been conceptualized as a disease of staged neuroplasticity, an intensive behavioral program that can induce accelerated therapeutic neuroplasticity is particularly compelling. Current methods for self-reporting dose of formal mindfulness practice may be vulnerable to response bias and poor reporting response rates. We plan to use actigraphic monitoring of formal mindfulness practice using the Actiwatch Score to behaviorally validate meditation time and rigorously test the meditation dose effect theory which hypothesizes that formal meditation practice time will predict improvement in inhibitory control, delay discounting, and smoking outcomes. This application seeks SOAR grant support to provide the power and precision needed for a successful trial, by allowing us to increase the sample size without extending the trial duration, and by improving the quality of our measurement of meditation practice dose. PUBLIC HEALTH RELEVANCE: Dependence on tobacco derived nicotine is a major public health problem. Substance users who complete training in mindfulness subjectively report increased patience and improved motor control over their impulses. Yet, no studies have tested this perceived benefit with behavioral measures of impulse control. We are conducting a randomized controlled clinical trial, which compares Cognitive-Behavioral Therapy and Mindfulness Training for tobacco smokers, using behavioral measures to investigate the effects of mindfulness training on impulsivity and inhibitory control.