Improving Functional Outcomes of Veterans with PTSD and Tobacco Dependence

 描述(由申请人提供)： 患有创伤后应激障碍的退伍军人吸烟率很高(34%-86%，而普通人群为18%)，并且在戒烟方面存在很大困难。只有23%的创伤后应激障碍患者戒烟，而总人口的这一比例为50%。因此，患有创伤后应激障碍的退伍军人患上严重健康问题和身体机能不良的风险很高。这些长期吸烟者中有50%会死于与吸烟相关的原因，与不吸烟者相比，他们平均会损失25年的寿命。尽管与吸烟相关的发病率和死亡率很高，但不存在以创伤后应激障碍症状为戒烟障碍的戒烟治疗，尽管这是许多退伍军人戒烟的重大障碍。此外，戒烟治疗在很大程度上强调改善患有创伤后应激障碍和烟草依赖的退伍军人的功能，尽管创伤后应激障碍和烟草使用都会对身体、心理健康和社会领域的功能产生负面影响。该SPIRE项目的目标是评估对患有创伤后应激障碍和烟草使用的退伍军人的接受和承诺治疗(ACT-PT)，这是一种针对患有创伤后应激障碍和烟草依赖的退伍军人的接受和正念戒烟治疗。ACT-PT专门针对与创伤后应激障碍症状和创伤记忆有关的吸烟渴望，以及管理创伤后应激障碍症状的困难。戒烟期间的消极情绪和尼古丁戒断症状。ACT-PT包括结构化干预部分，指导退伍军人用替代应对策略(如正念、接受)取代吸烟作为应对创伤后应激障碍症状和记忆的策略。以及符合退伍军人价值观的健康生活活动(例如，从事工作、扩大社交网络、从事体育锻炼)。这种对大幅提高与健康相关的生活质量和多个领域的功能的重视，使ACT-PT特别具有创新性，与现有的治疗方法不同。然而，还需要对其相对可行性、可接受性和有效性进行研究。 ACT-PT与标准戒烟治疗的比较。拟议的SPIRE(I21)将涉及对50名患有创伤后应激障碍和烟草依赖的资深吸烟者的随机临床试验研究，他们被随机分成两种不同类型的心理社会治疗之一：10次ACT-PT(n=25)与10次美国肺脏协会自由戒烟计划(FFS)(n=25)，所有参与者都接受12周的尼古丁贴片。这项研究有两个主要目的：1)评估两种干预措施的相对可行性和可接受性(包括招募的简易性、随机比例、工作人员和退伍军人对治疗的接受度、保留率、治疗依从性、忠诚度、评估过程的简便性)；2)评估ACT-PT和FFS的初步疗效，包括烟草使用、创伤后应激障碍症状、与健康相关的生活质量和功能损害。

 DESCRIPTION (provided by applicant): Veterans with PTSD have high rates of smoking (34%-86% vs. 18% in the general population) and have substantial difficulties with quitting tobacco. Only 23% of individuals with PTSD quit smoking compared to 50% of the general population. As a result, Veterans with PTSD are at high risk of developing severe health problems and poor physical functioning. Fifty percent of these long-term smokers will die of a smoking-related cause and on average, will lose 25 years of their life compared to non-smokers. Despite the significant morbidity and mortality associated with smoking, no smoking cessation treatments exist that intensively target PTSD symptoms as an obstacle to quit smoking, although this is a significant barrier to quitting for many Veterans. n addition, no smoking cessation treatments have a large emphasis on improving the functioning of Veterans with PTSD and tobacco dependence, although both PTSD and tobacco use negatively affect functioning across physical, mental health, and social domains. The goal of this SPiRE project is to evaluate Acceptance and Commitment Therapy for Veterans with PTSD and Tobacco Use (ACT-PT), which is an acceptance and mindfulness-based smoking cessation treatment for Veterans with PTSD and tobacco dependence. ACT-PT specifically targets smoking cravings related to PTSD symptoms and memories of trauma, in addition to difficulties managing PTSD symptoms. negative affect and nicotine withdrawal symptoms during quit attempts. ACT-PT includes structured intervention components that guide Veterans to replace smoking as a coping strategy for PTSD symptoms and memories with alternative coping strategies (e.g., mindfulness, acceptance). And healthy living activities (e.g., engaging in work, expanding social networks, engaging in physical exercise) that are consistent with Veterans' values. This emphasis on substantially improving health-related quality of life and functioning across several areas makes ACT-PT particularly innovative and different from existing treatments. However, research is needed on the relative feasibility, acceptability, and efficacy of ACT-PT compared to standard smoking cessation treatments. The proposed SPiRE (I21) will involve a randomized clinical trial study of 50 Veteran smokers with PTSD and tobacco dependence randomized to one of two different types of psychosocial treatment 10 individual sessions of ACT-PT (n= 25) versus 10 individual sessions of the American Lung Association's Freedom From Smoking Program [FFS] (n=25) with all participants receiving 12 weeks of the nicotine patch. This study has two primary aims: 1) evaluate the relative feasibility and acceptability of the two interventions (including ease of recruitment, randomization proportion, staff and Veteran acceptance of the treatment, retention rates, treatment adherence, fidelity, ease of the assessment process), and 2) evaluate the preliminary efficacy of ACT-PT vs. FFS with the primary outcomes of tobacco use, PTSD symptoms, health-related quality of life, and functional impairment.