Group Therapy for Nicotine Dependence

描述(由申请人提供)： 在美国，吸烟是导致发病率和死亡率的主要可预防原因，尼古丁依赖是迄今为止最普遍的物质滥用障碍。不幸的是，由于戒烟是一个主要的生活压力来源，可能导致长期的不良后果，戒烟率通常很低(即5-25%)。戒烟治疗需要改善情绪和行为调节，减少戒烟带来的痛苦。这项两组随机临床试验的目的是开发和评估以小组形式提供的基于正念的尼古丁依赖治疗(MBT)。正念反映了有意识地将注意力分配给当下发生的认知、情绪、感知和感觉。也就是说，正念反映了一种有目的的注意力控制，可以通过训练注意力控制程序来学习，其中最常见的是冥想。将基于正念的方法应用于尼古丁依赖治疗的理由是：1)令人信服的证据表明，以小组形式在广泛的条件、障碍和人群中提供的基于正念的治疗是有效的，2)基于正念的治疗效果与戒烟和复发的情感和认知机制相关，以及3)存在用于实施和评估基于正念的治疗交付和内容的完善的手册和材料。 目前吸烟的人(N=300)将被随机分配到健康教育(HE)或MBT。他是一个标准的戒烟小组计划，利用基于复发预防理论和治疗烟草使用和依赖临床实践指南(指南)的问题解决/应对技能方法。MBT是从正念减压和正念认知疗法发展而来的。他和MBT在接触时间上是匹配的，所有参与者都将接受尼古丁贴片治疗和自助材料。MBT的机制和效果将使用“内隐”认知心理测量、结构化访谈和计算机管理的问卷进行评估。参与者将从戒烟日期前的5周到戒烟日期后的26周进行跟踪。 主要的具体目标是： 1.研究MBT对禁酒率的影响， 2.考察MBT在戒烟前后对正念/元认知意识、注意控制、吸烟自动性、记忆中的积极吸烟联系、消极情绪、抑郁、压力、情绪调节期望、自我效能、退缩和应对的影响，以及这些变量是否在MBT对戒烟的影响中起中介作用。 次要的、更具探索性的目标是： 3.考察MBT对群体凝聚力和治疗联盟等治疗过程相关措施的影响，以及这些变量是否在MBT对戒酒的影响中起中介作用。

DESCRIPTION (provided by applicant): Cigarette smoking is the leading preventable cause of morbidity and mortality in the United States and nicotine dependence is by far the most prevalent substance abuse disorder. Unfortunately, because quitting smoking is a major life stressor that can result in prolonged aversive consequences, quit rates are generally low (i.e., 5-25%). Smoking cessation treatments are needed that can improve emotional and behavioral regulation, and reduce the distress of quitting. The purpose of this 2-group randomized clinical trial is to develop and evaluate a Mindfulness-Based Treatment (MBT) for nicotine dependence that is delivered in a group format. Mindfulness reflects an intentional allocation of attention to the cognitions, emotions, perceptions, and sensations occurring in the present moment. That is, mindfulness reflects a purposeful control of attention and can be learned through training in attentional control procedures, the most common of which is meditation. The rationale for applying a mindfulness-based approach to the treatment of nicotine dependence is grounded in: 1) compelling evidence for the efficacy of mindfulness-based treatments delivered in group formats across a wide range of conditions, disorders, and populations, 2) the relevance of mindfulness-based treatment effects to the affective and cognitive mechanisms underlying smoking cessation and relapse, and 3) the existence of well-developed manuals and materials for implementing and evaluating mindfulness-based treatment delivery and content. Current cigarette smokers (N=300) will be randomly assigned to either Health Education (HE) or MBT. HE is a standard smoking cessation group program utilizing a problem-solving/coping skills approach based on relapse prevention theory and the Treating Tobacco Use and Dependence Clinical Practice Guideline (Guideline). MBT is specifically derived from Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. HE and MBT are matched on contact time and all participants will receive nicotine patch therapy and self-help materials. MBT mechanisms and effects will be assessed using "implicit" cognitive psychological measures, structured interviews, and computer-administered questionnaires. Participants will be tracked from 5 weeks prior to their quit date through 26 weeks after their quit date. The primary specific aims are to: 1. Examine the effects of MBT on abstinence rates, 2. Examine the effects of MBT on mindfulness/metacognitive awareness, attentional control, smoking automaticity, positive smoking associations in memory, negative affect, depression, stress, affect regulation expectancies, self-efficacy, withdrawal, and coping across the pre- to postcessation period, and whether these variables mediate MBT effects on abstinence. A secondary and more exploratory aim is to: 3. Examine the effects of MBT on therapeutic process related measures such as group cohesion and therapeutic alliance, and whether these variables mediate MBT effects on abstinence.