Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.
Department of Psychology, University of South Florida, Tampa, FL.
Nicotine Tob Res. 2018 Sep 4;20(10):1189-1197. doi: 10.1093/ntr/ntx203.
Varenicline reduces smoking satisfaction during the pre-cessation run-in period, which may contribute to extinction of cravings and smoking behavior. Research indicates that efficacy is enhanced when the run-in period is increased from 1 to 4 weeks, providing a longer extinction opportunity. We hypothesized that efficacy could be further enhanced by harnessing basic and applied research on extinction. We developed a pre-cessation extinction-facilitating intervention and tested its feasibility in a pilot trial.
The facilitated extinction (FE) intervention comprised brief counseling and workbook-recommending strategies to maximize extinction processes during the run-in, including instructions to smoke at a normal rate across contexts and cues, and use of an extinction cue to enhance generalization. Participants were randomly assigned to one of three varenicline interventions: standard (1-week run-in), extended (4-week run-in), and extended + FE. Interventions were delivered prior to the target quit date (TQD). Assessments were conducted in weeks 1 and 4 pre-TQD and 1 and 3 months post-TQD, with focus on feasibility indices.
Recruitment and retention goals were met (N = 58). Treatment satisfaction was high across groups. The majority of FE participants adhered to instructions and maintained their usual smoking rate during the run-in period. Greater decreases in craving and smoking satisfaction were observed among participants in both extended groups versus the standard group (p < .005).
Feasibility was demonstrated. Participants adhered to the FE intervention, thereby optimizing the number and variety of extinction trials. Findings support testing the novel FE smoking cessation intervention in a fully powered trial.
This study expands the research on the clinical benefits of extending the pre-cessation run-in period of varenicline. It introduces the hypothesis that further benefit might be achieved by translating basic behavioral research, as well as cue-exposure research and therapy for other disorders, to improve the extinction and generalization processes thought to underlie much of varenicline's effect. A FE intervention was developed and found acceptable to smokers and feasible to implement in a research setting. The study sets the stage for a subsequent randomized controlled trial.
伐伦克林可在戒烟前的适应期内降低吸烟的满足感，这可能有助于消除对烟瘾的渴望和吸烟行为。研究表明，将适应期从 1 周延长至 4 周可以提高疗效，为消除烟瘾提供更长的机会。我们假设，通过利用关于消除的基础和应用研究，可以进一步提高疗效。我们开发了一种戒烟前的消除促进干预措施，并在一项试点试验中测试了其可行性。
促进消除（FE）干预包括简短的咨询和推荐工作手册的策略，以最大限度地提高适应期内的消除过程，包括在不同情境和线索下以正常速度吸烟的指令，以及使用消除线索来增强泛化。参与者被随机分配到三种伐伦克林干预组之一：标准（1 周适应期）、延长（4 周适应期）和延长+FE。干预措施在目标戒烟日期（TQD）之前进行。在 TQD 前的第 1 周和第 4 周以及 TQD 后第 1 个月和第 3 个月进行评估，重点是可行性指标。
达到了招募和保留目标（N=58）。各组的治疗满意度都很高。大多数 FE 参与者在适应期内遵守了指令并保持了他们的正常吸烟率。与标准组相比，延长组的参与者在第 1 个月和第 3 个月的渴望和吸烟满足感都有更大的下降（p<0.005）。
可行性得到了证明。参与者遵守了 FE 干预措施，从而优化了消除试验的数量和种类。研究结果支持在一项全面的试验中测试新型 FE 戒烟干预措施。
本研究扩展了关于延长伐伦克林戒烟前适应期的临床益处的研究。它提出了一个假设，即通过将基础行为研究以及其他障碍的线索暴露研究和治疗转化为改善被认为是伐伦克林大部分疗效基础的消除和泛化过程，可能会获得进一步的益处。开发了一种 FE 干预措施，并发现吸烟者可以接受并在研究环境中可行。该研究为随后的随机对照试验奠定了基础。
