Final Report Summary - PTSD AND SMOKING (Posttraumatic Stress Disorder and Smoking Cessation)
The completed EU FP-7 Marie Curie fellowship research contributes to field-wide effort to elucidate the bio-psycho-behavioral mechanisms underlying the relations between traumatic stress, trauma-related psychopathology, and cigarette smoking/cessation. The research was carried out in Israel, a region of the world in which conflict and war, traumatic stress, and smoking and related mental health problems are prevalent and significant burdens on the nation’s public health. These problems result in immeasurable emotional suffering, physical illness and premature death. Thus, insights gained though the completed research contribute not only to the scientific literature focused on these topics but also guide innovation in clinical prevention and intervention efforts. Due to the prevalence, suffering and cost associated with the studied phenomena, these findings also have potential implications for national and international public health and related public policy issues.
The program of research was carried in 3 inter-related studies. STUDY 1. We carried out a controlled laboratory multi-method investigation testing the relations between traumatic stress, trauma-related psychopathology, and responding to smoking deprivation. In this investigation we deprived smokers exposed to traumatic stress from smoking and then studied a number of key outcomes and processes, including: (a) their capacity to abstain from smoking (bio-chemically verified abstention or relapse); (b) bio-psycho-behavioral predictors of early cessation success/relapse; (c) individual differences in responding to controlled laboratory anxiogenic stressor (paced hyperventilation), and the bio-psycho-behavioral predictors of adaptive/maladaptive responding to this stressor; and (d) individual differences in attentional bias to smoking and negative emotion cues in the first 24-hrs of cessation, and the role of such information processing bias for smoking rate, risk for relapse, and related outcomes.
STUDY 2. We carried out a longitudinal study of bio-psycho-behavioral risk processes and adjustment among a community sample of smokers and non-smokers exposed to a recent (past 1-month) traumatic stress. In this investigation we prospectively studied smokers and non-smokers immediately following exposure to a potentially traumatic stressor, and then over an 18-month period of time tracked their smoking and mental health outcomes. In so doing, we focused on identification and study of promising bio-psycho-behavioral risk processes – studied also in Study 1 – with respect to real-world prospective smoking, substance-related and mental health (e.g. psychopathology symptoms) outcomes.
STUDY 3. Based on the preliminary findings from studies 1 and 2, we carried out a pilot randomized controlled early intervention study among smokers and non-smokers recently exposed to traumatic stress. We focused on the candidate bio-psycho-behavioral risk and protective processes identified in Studies 1 and 2 with respect to smoking, substance-related and mental health (e.g. psychopathology symptoms) outcomes.
We are now in the initial phase of analyzing these data and developing scientific papers reporting our findings. However, initial findings from these investigations have already begun to yield novel theoretical and clinical insights regarding bio-psycho-behavioral risk and protective processes underlying trauma-related substance use and mental health problems. Most notably, we have learned from these studies that a number of malleable bio-psycho-behavioral processes are promising therapeutic targets for novel prevention and intervention approaches targeting trauma-related substance use and mental health problems, including: (a) attentional bias to threat, negative emotion and smoking cues; (b) present moment attention and related meta-cognitive processes linked to self-distance; (c) self-referential cognition and related forms of cognitive over-engagement (e.g. rumination, thought suppression); and (d) anxiety sensitivity and emotional distress tolerance. Based on these initial findings, we are now working to develop and study novel intervention methods to therapeutically target key bio-psycho-behavioral risk and protective processes underlying trauma-related substance use and mental health problems. These include: (a) a novel computerized intervention methodology targeting attentional biases to threat, negative emotion and smoking cues; and (b) a mindfulness-based intervention targeting present moment attention and related meta-cognitive processes, self-referential cognition and cognitive over-engagement, and anxiety sensitivity and emotional distress tolerance.
In many respects, our work has only begun. We will continue to analyze the collected data so as to gain and disseminate as much knowledge as possible from these investigations, and thereby translate these insights into much-needed advances in clinical prevention and intervention science and practice.