Department of Psychology, Institute for Mental Health Research, The University of Texas at Austin, 305 E. 23rdStreet, Austin, TX, 78712, United States.
Department of Psychology, University of Houston, 3695 Cullen Boulevard, Suite 104, Houston, TX, 77204, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States.
Drug Alcohol Depend. 2020 Mar 1;208:107877. doi: 10.1016/j.drugalcdep.2020.107877. Epub 2020 Jan 22.
In this placebo-controlled randomized clinical trial, we examined the efficacy of 250 mg d-cycloserine (DCS) for enhancing the effects of cognitive behavior therapy targeting anxiety sensitivity reduction in the context of smoking cessation treatment among adults with a history of panic attacks. We hypothesized that DCS would enhance treatment of our mechanistic targets-anxiety sensitivity and panic and related symptoms-and result in greater smoking abstinence. A total of 53 smokers were randomized to a 7-week integrated treatment and received study medication (DCS or placebo) prior to sessions 3-5; these sessions emphasized interoceptive exposure practice. Nicotine replacement therapy was initiated at session 5 (quit date). We found that DCS augmentation led to greater reductions of one (anxiety sensitivity) of two of our mechanistic targets at early but not late assessments, and that engaging that target predicted better smoking outcomes. However, there was no evidence of group (DCS vs. placebo) differences in smoking cessation success at treatment endpoint or follow-up evaluations. Hence, although we found that DCS can enhance treatment targeting a smoking maintaining factor, additional strategies appear to be needed to significantly affect smoking outcomes.
在这项安慰剂对照随机临床试验中，我们研究了 250 毫克 D-环丝氨酸（DCS）在针对惊恐发作史成年人的戒烟治疗中增强认知行为治疗针对焦虑敏感性降低的效果。我们假设 DCS 将增强我们的机制靶点——焦虑敏感性、惊恐和相关症状——的治疗效果，并导致更高的戒烟率。共有 53 名吸烟者被随机分配到为期 7 周的综合治疗中，并在第 3-5 次治疗前接受研究药物（DCS 或安慰剂）；这些课程强调了内脏暴露练习。尼古丁替代疗法在第 5 次治疗时开始（戒烟日期）。我们发现，DCS 增强导致了两个机制靶点中的一个（焦虑敏感性）在早期而不是晚期评估中更大的降低，并且该靶点的参与预测了更好的吸烟结果。然而，在治疗终点或随访评估时，DCS 组与安慰剂组在戒烟成功率方面没有差异。因此，尽管我们发现 DCS 可以增强针对吸烟维持因素的治疗，但似乎需要额外的策略才能显著影响吸烟结果。
