安非他酮和认知行为治疗对戒烟治疗期正向情感、负向情感及吸烟冲动的影响
2009/09/17
前言:研究已经发现,采用安非他酮和认知行为疗法(CBT)治疗抑郁,能有效缓解吸烟者戒烟期的情绪紊乱。对戒烟前治疗相关的情感及吸烟冲动变化的研究有助于评价上述治疗作用的可能机制。
方法:524例吸烟者随机接受安非他酮或安慰剂联合CBT,或联合标准戒烟CBT治疗,研究戒烟前、戒烟期及戒烟后的情感轨迹和吸烟冲动。
结果:安非他酮和/或CBT并不影响戒烟前正向情感的下降和负向情感的增加。然而,安非他酮组患者在戒烟期,负向情感及吸烟冲动显著下降。戒烟前正向情感下降,戒烟期正向情感较低、负向情感和吸烟冲动增加均与较高的复吸风险相关。抑郁倾向是正向情感较低和负向情感较高的独立预测因子,但这不会影响安非他酮的治疗结果。中期分析结果显示,安非他酮的作用部分来源于戒烟期负向情感和吸烟冲动的下降。
讨论:本研究结果显示,安非他酮能有效降低与吸烟冲动和负向情感相关的复吸。有必要进一步了解低水平正向情感作为早期复吸危险因子在复吸中的作用。
(刘国梁 审校)
Nicotine Tob Res. 2009 Jul 2. [Epub ahead of print]
Impact of bupropion and cognitive-behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment.
Introduction: Bupropion and cognitive-behavioral treatment (CBT) for depression have been used as components of treatments designed to alleviate affective disturbance during smoking cessation. Studies of treatment-related changes in precessation affect or urges to smoke are needed to evaluate the proposed mechanisms of these treatments.
Methods: The present report examines affective trajectories and urges to smoke prior to, on quit day, and after quitting in a sample of 524 smokers randomized to receive bupropion versus placebo and CBT versus standard smoking cessation CBT.
Results: Bupropion and/or CBT did not affect the observed decreases in positive affect and increases in negative affect prior to cessation. However, on quit day, observed levels of negative affect and urges to smoke were diminished significantly among individuals receiving bupropion. Decreases in positive affect prior to quitting, lower levels of positive affect, and increased levels of negative affect and urges to smoke on quit day were each related to higher risk of smoking lapse. Depression proneness was an independent predictor of lower positive affect and higher negative affect but did not moderate the effects of bupropion on outcomes. In mediational analyses, the effect of bupropion was accounted for in part by lower negative affect and urges to smoke on quit day.
Discussion: Results support the efficacy of bupropion in reducing relapse risk associated with urges to smoke and negative affect and suggest the need to better understand the role of low positive affect as a risk factor for early lapse.
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酒精治疗期间戒烟:联合使用尼古丁贴剂和尼古丁口香糖的随机试验
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怀孕吸烟者使用尼古丁贴剂或尼古丁鼻喷剂对体内尼古丁和可替宁浓度的影响