Mu Wenting, Narine Kevin, Farris Samantha, Lieblich Shari, Zang Yinyin, Bredemeier Keith, Brown Lily, Foa Edna
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States.
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States.
Addict Behav. 2020 Sep;108:106376. doi: 10.1016/j.addbeh.2020.106376. Epub 2020 Feb 29.
Compared to smokers without posttraumatic stress disorders (PTSD), smokers with PTSD smoke more heavily and are less successful in quitting smoking. However, limited research has examined the cognitive pathways underlying this heightened comorbidity. The current study is the first to simultaneously model the cross-sectional and lagged relationships between trauma-related cognitions and cigarette smoking, as well as between trauma-related cognitions and PTSD severity, in smokers with comorbid PTSD receiving treatment.
Participants (n = 142) were seeking treatment for smoking cessation and PTSD as part of a randomized controlled trial of varenicline and smoking cessation counseling with or without adjunctive Prolonged Exposure (varenicline + PE vs. varenicline only) (Foa et al., 2017). Data were available for both baseline and end-of-treatment assessments of trauma cognitions severity of cigarette smoking and PTSD symptoms. We conducted both cross-sectional and lagged analysis to simultaneously examine the bidirectional relationship from trauma cognitions and 1) cigarette smoking and 2) PTSD symptoms.
Trauma cognitions (specifically, negative beliefs about the self and the world) were significantly associated with cigarette/day at the end of treatment for participants who received varenicline only. However, baseline trauma cognitions did not predict post-treatment cigarettes/day. Baseline trauma cognitions (specifically negative beliefs about the self and world) were associated with PTSD severity at both baseline and end of treatment; furthermore, these negative cognitions at baseline positively and prospectively predicted end-of-treatment PTSD severity, but not vice versa. Wald tests revealed that there were no treatment effects on these cross-lagged relationships. Conclusions These findings provide novel empirical support for the importance of addressing trauma-related cognitions in the smoking cessation treatment efforts for patients with comorbid PTSD and cigarette smoking.
与没有创伤后应激障碍（PTSD）的吸烟者相比，患有PTSD的吸烟者吸烟量更大，且戒烟成功率更低。然而，针对这种高共病率背后的认知途径的研究有限。本研究首次同时对接受治疗的PTSD合并症吸烟者中创伤相关认知与吸烟之间的横断面及滞后关系，以及创伤相关认知与PTSD严重程度之间的关系进行建模。
参与者（n = 142）正在寻求戒烟和PTSD治疗，这是一项关于伐尼克兰及戒烟咨询（有或无辅助延长暴露疗法）（伐尼克兰 + 延长暴露疗法对比仅伐尼克兰疗法）的随机对照试验的一部分（Foa等人，2017年）。有关于创伤认知、吸烟严重程度和PTSD症状的基线及治疗结束时评估的数据。我们进行了横断面和滞后分析，以同时检验创伤认知与1）吸烟和2）PTSD症状之间的双向关系。
仅接受伐尼克兰治疗的参与者在治疗结束时，创伤认知（特别是对自我和世界的消极信念）与每日吸烟量显著相关。然而，基线创伤认知并不能预测治疗后的每日吸烟量。基线创伤认知（特别是对自我和世界的消极信念）在基线和治疗结束时均与PTSD严重程度相关；此外，这些基线时的消极认知正向且前瞻性地预测了治疗结束时的PTSD严重程度，但反之则不然。Wald检验显示，这些交叉滞后关系没有治疗效果。结论这些发现为在患有PTSD和吸烟合并症的患者的戒烟治疗中解决创伤相关认知的重要性提供了新的实证支持。
