Self-report and behavioral reactivity to combined smoking cues

描述（由申请人提供）：基于线索的吸烟研究清楚地表明，吸烟者在暴露于吸烟相关刺激时报告了强烈的条件反射（最常见的形式是渴望）。这项工作已被用于通知线索暴露为基础的治疗，旨在消除反应线索通过灭绝训练作为一种手段，降低复发的可能性。然而，过去的线索反应性工作在揭示线索如何影响实际吸烟行为方面令人惊讶地有限。这种限制的两个关键原因包括：（1）主要关注近端吸烟线索（例如，点燃的香烟，吸烟的图像刺激）而忽略那些不太接近吸烟行为的远端线索（例如，个人吸烟环境和通常吸烟的人周围），和（2）强烈依赖自我报告测量（例如，渴望），而不存在评估实际吸烟行为的措施（吸烟的潜伏期和暴露于暗示时的随意吸烟）。在解决前一个限制，我们最近的工作在以前的探索性R21（DA 017582）已经揭示，吸烟者同样强烈的渴望，以标准的近端吸烟线索和个性化的远端吸烟线索的环境和人。此外，发出不吸烟信号的个人环境和一个人永远不会吸烟的个人周围的人似乎对渴望吸烟起着保护作用。然而，继续单独研究这些线索类型中的每一种并不能提供线索在真实的世界中如何起作用的完整图景，在这个世界中，这些线索往往是共存的。为了以更接近模拟实验室外如何遇到线索的方式检查线索，拟议的研究将评估对近端和个人远端线索单独和组合的反应。关于后一个限制，有一个共同的假设，即自我报告对线索的反应（例如，渴望）与实际吸烟行为直接相关;然而，这一概念在很大程度上未经检验。因此，拟议的研究的第二个主要目标是研究各种线索的组合如何影响吸烟者的自我报告和行为反应，以及这些线索反应的指数如何相互关联。拟议中的研究将使人们对吸烟者在真实的生活中所面临的突出线索如何单独发挥作用以及如何协同增强或减弱他们的自我报告和行为线索反应产生新的理解。此外，这项工作将允许检查这两个关键指标的线索反应之间的关联和/或差异。这项工作将直接为新的基于线索的吸烟治疗提供信息，包括那些专注于帮助吸烟者识别和避免特定吸烟触发因素的治疗，以及那些旨在消除紧急反应以减少戒烟后复发的治疗。此外，这些程序可以提供一种手段，以指数早期成功后停止治疗的任何种类，作为个人的认知或行为反应较低的近端或个人远端线索治疗后，预计将不太可能复发。公共卫生相关性：尼古丁以外的其他因素被认为在吸烟的持续和一些吸烟者无法戒烟方面起着关键作用。研究表明，吸烟者在接触到与过去吸烟经历有关的线索时会报告强烈的渴望。这样的提示可以是近端的（例如，香烟，烟灰缸）和远端（例如，环境与人）。这个项目研究了这两种类型的线索是如何单独和结合起来影响吸烟者的想法和感受，以及他们的实际吸烟行为的。这项研究将回答有关不同类型的提示反应之间关系的重要问题，并将直接为未来的吸烟行为治疗提供信息。

DESCRIPTION (provided by applicant): Cue-based smoking research has clearly demonstrated that smokers report robust conditioned responding (most often in the form of craving) when exposed to smoking-related stimuli. This work has been used to inform cue-exposure based treatments aimed at eliminating reactivity to cues via extinction training as a means of decreasing the likelihood of relapse. However, past cue-reactivity work is surprisingly limited in what it reveals about how cues affect actual smoking behavior. Two key reasons for this limitation include: (1) focusing primarily on proximal smoking cues (e.g., lit cigarettes, pictorial stimuli of smoking) while ignoring distal cues those less contiguous to the act of smoking (e.g., personal smoking environments and the people around whom one typically smokes), and (2) a strong reliance on self-report measures (e.g., craving) in the absence of measures that assess actual smoking behavior (latency to smoke and ad lib smoking when exposed to cues). In addressing the former limitation, our recent work under a previous exploratory R21 (DA017582) has revealed that smokers respond with equally robust craving to both standard proximal smoking cues and personalized distal smoking cues of environments and people. Additionally, personal environments that signal not smoking and personal people around whom one would never smoke appear to serve a protective function on craving to smoke. However, continuing to study each of these cue type alone fails to offer a complete picture of how cues might function in the real world where such cues more often than not co- exist. In order to examine cues in a manner that more closely mimics how cues are encountered outside of the lab, the proposed research will assess reactivity to both proximal and personal distal cues alone and in combination. Regarding the latter limitation, there is a common assumption that self-report responding to cues (e.g., craving) is directly related to actual smoking behavior; however, this notion is largely untested. Therefore, the second main objective of the proposed studies is to examine how combinations of various cues affect both self-report and behavioral reactivity in smokers, and how those indices of cue responding relate to one another. The proposed studies will result in new understanding of how salient cues that smokers confront in their real lives function alone and in concert to augment or attenuate both their self- report and behavioral cue-reactivity. Moreover, this work will allow for examination of associations and/or disparities between those two key measures of cue reactivity. This work will directly inform new cue-based smoking treatments, both those focused on helping smokers identify and avoid specific smoking triggers, and those aimed at extinguishing urge-responding to reduce relapse post-quit. Furthermore, these procedures may provide a means to index early success following cessation treatment of any kind, as individuals less reactive cognitively or behaviorally to proximal or personal distal cues post-treatment would be expected to be less likely to relapse. PUBLIC HEALTH RELEVANCE: Factors other than nicotine are thought to play key roles in the continuation of smoking and the inability of some smokers to quit. Research has shown that smokers report robust craving when exposed to cues related to past experiences with smoking. Such cues can be both proximal (e.g., cigarette, ashtrays) and distal (e.g., environments and people). This project examines how both types of cues function alone and in combination to affect smokers' thoughts and feelings, as well as their actual smoking behavior. This research will answer important questions about the relationship between different types of cue responding, and will directly inform future behavioral treatments for smoking.