Gonzalez Adam, Friedberg Fred, Li Xiaotong, Zvolensky Michael J, Bromet Evelyn J, Mahaffey Brittain L, Vujanovic Anka A, Luft Benjamin J, Kotov Roman
Department of Psychiatry, Stony Brook University, Stony Brook, NY.
Department of Psychology, University of Houston, Houston, TX.
Nicotine Tob Res. 2017 Aug 1;19(8):968-975. doi: 10.1093/ntr/ntw384.
The main objective was to evaluate the efficacy of an 8-session, group-based comprehensive smoking cessation and trauma management (CSC-T) treatment among daily smokers (≥5 cigarettes/day) exposed to the World Trade Center (WTC) disaster with elevated WTC-related post-traumatic stress disorder (PTSD) symptoms.
Participants (N = 90) were randomly assigned to CSC-T (N = 44; 63.6% white; 27.3% female; mean age = 51.32 ± 7.87) or comprehensive smoking cessation (CSC) alone (N = 46; 71.7% white; 28.3% female; mean age = 48.74 ± 10.66), which was comparable in length and time. Assessments included a diagnostic clinical interview and self-report measures of PTSD and respiratory symptoms, and smoking behavior, and biologically confirmed smoking abstinence. Evaluations occurred at a baseline visit, each treatment session, and at 1-, 2-, 4-, 12-, and 26-weeks post-treatment.
The two treatments did not differ in regard to PTSD symptom improvement. After quit day (week 6), the two groups had similar 7-day (15%) and 6-month (20%) abstinence rates as well as average number of cigarettes smoked, and PTSD and respiratory symptoms.
It is possible that the Cognitive Behavioral Therapy skills specific to quitting smoking, group-based support, and degree of therapist contact, that were available in both treatments may have played a role in equalizing the abstinence rates between the two conditions. Although the current study found no evidence that the CSC-T was superior to the CSC alone treatment, the abstinence rates observed were high relative to previous trials of smokers with diagnosed PTSD. Further development of smoking cessation programs tailored to the needs of smokers with PTSD symptoms continues to be needed.
This study suggests that a CSC program aids in smoking abstinence for smokers with PTSD symptoms and that incorporating trauma management skills, may not add additional benefits for abstinence and PTSD and respiratory symptom relief. Further work is needed to improve smoking cessation efforts for smokers with PTSD symptoms.
主要目的是评估一项为期8节的、基于小组的综合戒烟与创伤管理（CSC-T）治疗对世贸中心（WTC）灾难受害者中每日吸烟者（≥5支/天）的疗效，这些吸烟者患有与世贸中心相关的创伤后应激障碍（PTSD）且症状有所加重。
参与者（N = 90）被随机分配至CSC-T组（N = 44；63.6%为白人；27.3%为女性；平均年龄 = 51.32 ± 7.87）或仅接受综合戒烟（CSC）组（N = 46；71.7%为白人；28.3%为女性；平均年龄 = 48.74 ± 10.66），两组在时长和时间安排上具有可比性。评估包括诊断性临床访谈以及PTSD、呼吸症状、吸烟行为的自我报告测量，还有经生物学确认的戒烟情况。评估在基线访视、每次治疗 session 以及治疗后1周、2周、4周、12周和26周进行。
两种治疗在PTSD症状改善方面无差异。在戒烟日（第6周）后，两组的7天（约15%）和6个月（约20%）戒烟率以及平均吸烟支数、PTSD和呼吸症状均相似。
两种治疗中都具备的特定于戒烟的认知行为疗法技能、基于小组的支持以及治疗师接触程度，可能在使两种治疗条件下的戒烟率趋于相等方面发挥了作用。尽管当前研究未发现CSC-T优于单纯CSC治疗的证据，但观察到的戒烟率相对于之前针对已诊断PTSD吸烟者的试验而言较高。仍需要针对有PTSD症状吸烟者的需求进一步开发戒烟项目。
本研究表明，CSC项目有助于有PTSD症状的吸烟者戒烟，且纳入创伤管理技能可能不会为戒烟、缓解PTSD和呼吸症状带来额外益处。需要进一步开展工作以改善针对有PTSD症状吸烟者的戒烟努力。
