Powers Mark B, Kauffman Brooke Y, Kleinsasser Anne L, Lee-Furman Eunjung, Smits Jasper A J, Zvolensky Michael J, Rosenfield David
Department of Psychology, Institute of Mental Health Research, University of Texas at Austin, Austin, TX, United States.
Department of Psychology, University of Houston, Houston, TX, United States.
Contemp Clin Trials. 2016 Sep;50:213-21. doi: 10.1016/j.cct.2016.08.012. Epub 2016 Aug 25.
Posttraumatic stress disorder (PTSD) is related to an increased risk of smoking cessation failure. In fact, the quit rate in smokers with PTSD (23.2%) is one of the lowest of all mental disorders. Features of PTSD that contribute to smokers' progression to nicotine dependence and cessation relapse include negative affect, fear, increased arousal, irritability, anger, distress intolerance, and anxiety sensitivity. Anxiety sensitivity is higher in people with PTSD than in any other anxiety disorder except for panic disorder. High anxiety sensitivity is uniquely associated with greater odds of lapse and relapse during quit attempts. Distress intolerance, a perceived or behavioral tendency to not tolerate distress, is related to both the maintenance of PTSD and problems in quitting smoking. Prolonged exposure (PE) and interoceptive exposure (IE) reduce PTSD symptoms, distress intolerance, and anxiety sensitivity. Thus, they emerge as promising candidates to augment standard smoking cessation interventions for individuals with PTSD. The present study tests a 12-session specialized treatment for smokers with PTSD. This Integrated PTSD and Smoking Treatment (IPST) combines cognitive-behavioral therapy and nicotine replacement treatment for smoking cessation (standard care; SC) with PE to target PTSD symptoms and IE to reduce anxiety sensitivity and distress intolerance. Adult smokers (N=80) with PTSD will be randomly assigned to either: (1) IPST or (2) SC. Primary outcomes are assessed at weeks 0, 6, 8, 10, 14, 16, 22, and 30.
创伤后应激障碍（PTSD）与戒烟失败风险增加有关。事实上，患有PTSD的吸烟者的戒烟率（23.2%）是所有精神障碍中最低的之一。导致吸烟者发展为尼古丁依赖和戒烟复发的PTSD特征包括消极情绪、恐惧、觉醒增加、易怒、愤怒、痛苦不耐受和焦虑敏感性。除惊恐障碍外，PTSD患者的焦虑敏感性高于任何其他焦虑症。高焦虑敏感性与戒烟尝试期间复吸和复发的几率增加有着独特的关联。痛苦不耐受，即一种感知到的或行为上的不能容忍痛苦的倾向，与PTSD的维持以及戒烟问题都有关。延长暴露疗法（PE）和内感受暴露疗法（IE）可减轻PTSD症状、痛苦不耐受和焦虑敏感性。因此，它们有望成为增强针对PTSD患者的标准戒烟干预措施的方法。本研究测试了一种针对患有PTSD的吸烟者的为期12节的专门治疗。这种综合PTSD与吸烟治疗（IPST）将认知行为疗法和用于戒烟的尼古丁替代治疗（标准护理；SC）与PE相结合，以针对PTSD症状，与IE相结合以降低焦虑敏感性和痛苦不耐受。患有PTSD的成年吸烟者（N = 80）将被随机分配到以下两组之一：（1）IPST组或（2）SC组。在第0、6、8、10、14、16、22和30周评估主要结局。
