Computerized Anger-Reduction Treatment for Smoking Cessation

Study Overview
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Brief Summary
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Problematic anger is a strong predictor of failed attempts at smoking cessation. The investigators proposed study seeks to evaluate whether a novel 8-session computerized anger-reduction treatment improves quit rates among smokers. Smokers with elevated trait anger will be administered transdermal nicotine patch therapy and either anger-reduction treatment or a control intervention. They will be assessed throughout treatment and up until three months after a scheduled mid- treatment quit date. The investigators propose to test whether, compared to the control condition, the anger-reduction treatment will lead to: 1) greater reductions in anger and 2) greater abstinence rates at post-cessation and at follow-up assessments. The investigators will also test whether changes in anger-related symptoms account for group differences in abstinence rates.

Detailed Description
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The current proposal seeks to evaluate an eight-session, computerized, anger-focused intervention for smokers (Anger Reduction Treatment or ART). The investigators will administer this intervention to smokers (N = 114) who are interested in quitting and have elevated levels of trait anger. Participants will be randomly assigned to receive either: (1) computerized ART, consisting of interpretation bias modification, or (2) a computerized control condition, which consists of health education and relaxing video clips. The computerized sessions (eight total) will take place twice a week for four weeks. All participants will have a scheduled quit date for the beginning of the third week of treatment (i.e., at mid-treatment). All participants will also receive nicotine patch therapy to use at their scheduled quit date. Anger symptoms, smoking cravings, and smoking frequency will be assessed throughout treatment. Smoking status, anger, and other measures of negative affect will also be assessed at baseline and regularly for 12-weeks following the scheduled quit date. The investigators will test whether, compared to the control condition, the anger-reduction treatment will lead to: 1) greater reductions in anger and 2) greater abstinence rates at post-cessation and at follow-up assessments. The investigators will also test whether changes in anger-related symptoms account for group differences in abstinence rates.

Official Title
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Computerized Anger-Reduction Treatment for Smoking Cessation

Conditions
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Anger, Smoking Cessation

Intervention / Treatment
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* Behavioral: Anger Reduction Treatment
* Behavioral: Control Condition


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elevated levels of trait anger (scoring 22 or higher on the STAXI-trait) Currently smoking an average of 8 cigarettes per day Must be a regular (daily) smoker for at least 1 year Willing to make a serious attempt to quit smoking Must report motivation to quit in the next month (30 days) of at least 5 on a 10 point scale (0 = no motivation and 10 = extreme motivation) Have not decreased the number of cigarettes by more than half in the past six months Must be an English speaker Exclusion Criteria: Current substance dependence (excluding nicotine dependence) Current use of other tobacco products Currently receiving cognitive therapy or therapy for problematic anger Evidence of serious suicidal intent requiring hospitalization or immediate treatment Limited mental competency and the inability to give informed, written consent Evidence of psychotic-spectrum disorders Changes in medication over the last month

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Anger Reduction Treatment<br>The treatment consists of eight 30-minute IBM sessions. Participants will be presented with ambiguous scenarios and asked imagine themselves in these situations. In the first task, the scenario will be followed by a benign interpretation of the situation. Participants will answer a comprehension question designed to have participants endorse this benign interpretation. In the second task, participants will be presented with a word denoting an interpretation with either a negative/hostile or positive/benign connotation. Following this word, an ambiguous scenario will appear. Participants will indicate whether the word and the scenario were related. They will receive feedback training them to endorse positive interpretations and reject negative interpretations. | Behavioral: Anger Reduction Treatment<br>* Eight 30-minute sessions of interpretation modification to reduce angry interpretation biases.<br>|
| Placebo Comparator: Control Condition<br>Participants assigned to the control condition will complete eight computerized sessions consisting of psychoeducation on healthy behaviors (i.e., topics of exercise, diet, hygiene, social support, healthy activities, and sleep, taken from protocols developed from our ongoing research). These participants will also view relaxing videos consisting of brief guided meditation instructions, pictures of nature scenes, and soft music. These sessions (psychoeducation and relaxing videos) will be matched for time with the active treatment condition, lasting 30 minutes each. | Behavioral: Control Condition<br>* Eight 30-minute sessions of informative videos on healthy living and relaxation videos.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| State-Trait Anger Expression Inventory-2 (STAXI-2; Spielberger, 1999) state and trait subscales |  | up to 14-weeks following treatment initiation. | 
| Self-reported smoking frequency |  | up to 14-weeks following treatment initiation. | 
| Carbon monoxide levels |  | up to 14-weeks following treatment initiation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Minnesota Nicotine Withdrawal Scale (Hughes & Hatsukami, 1986) |  | up to 14-weeks following treatment initiation. | 
| Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) |  | Baseline and regularly for 14-weeks following treatment initiation. | 
| Clinical Anger Scale (CAS; Snell, Gum, Shuck, Mosley, & Hite, 1995) |  | up to 14-weeks following treatment initiation. | 
| WSAP-Hostility Scale (Dillon, Cougle, & Fincham, 2015) |  | up to 14-weeks following treatment initiation. | 
| Hostile Automatic Thoughts Scale (Snyder, Crowson, Houston, Kurylo, & Piorier, 1997) |  | up to 14-weeks following treatment initiation | 
| Questionnaire of Smoking Urges (Tiffany & Drobes, 1991) |  | up to 14-weeks following treatment initiation. |