Multimodal smoking cessation treatment combining repetitive transcranial magnetic stimulation, cognitive behavioral therapy, and nicotine replacement in veterans with posttraumatic stress disorder: A feasibility randomized controlled trial protocol.

Autor: Young JR; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Polick CS; Durham VA Health Care System, Durham, North Carolina, United States of America.; School of Nursing, Duke University, Durham, North Carolina, United States of America., Michael AM; Duke Institute for Brain Sciences, Duke University, Durham, North Carolina, United States of America., Dannhauer M; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; National Institute of Mental Health, National Institutes of Health, Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, Bethesda, Maryland, United States of America., Galla JT; Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, United States of America., Evans MK; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Troutman A; Durham VA Health Care System, Durham, North Carolina, United States of America., Kirby AC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Dennis MF; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Papanikolas CW; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Deng ZD; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; National Institute of Mental Health, National Institutes of Health, Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, Bethesda, Maryland, United States of America., Moore SD; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Dedert EA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America., Addicott MA; Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America., Appelbaum LG; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, United States of America., Beckham JC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America.; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, United States of America.; Durham VA Health Care System, Durham, North Carolina, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Sep 06; Vol. 19 (9), pp. e0291562. Date of Electronic Publication: 2024 Sep 06 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0291562
Abstrakt: Tobacco-related deaths remain the leading cause of preventable death in the United States. Veterans suffering from posttraumatic stress disorder (PTSD)-about 11% of those receiving care from the Department of Veterans Affairs (VA)-have triple the risk of developing tobacco use disorder (TUD). The most efficacious strategies being used at the VA for smoking cessation only result in a 23% abstinence rate, and veterans with PTSD only achieve a 4.5% abstinence rate. Therefore, there is a critical need to develop more effective treatments for smoking cessation. Recent studies suggest the insula is integrally involved in the neurocircuitry of TUD. Thus, we propose a feasibility phase II randomized controlled trial (RCT) to study a form of repetitive transcranial magnetic stimulation (rTMS) called intermittent theta burst stimulation (iTBS). iTBS has the advantage of allowing for a patterned form of stimulation delivery that we will administer at 90% of the subject's resting motor threshold (rMT) applied over a region in the right post-central gyrus most functionally connected to the right posterior insula. We hypothesize that by increasing functional connectivity between the right post-central gyrus and the right posterior insula, withdrawal symptoms and short-term smoking cessation outcomes will improve. Fifty eligible veterans with comorbid TUD and PTSD will be randomly assigned to active-iTBS + cognitive behavioral therapy (CBT) + nicotine replacement therapy (NRT) (n = 25) or sham-iTBS + CBT + NRT (n = 25). The primary outcome, feasibility, will be determined by achieving a recruitment of 50 participants and retention rate of 80%. The success of iTBS will be evaluated through self-reported nicotine use, cravings, withdrawal symptoms, and abstinence following quit date (confirmed by bioverification) along with evaluation for target engagement through neuroimaging changes, specifically connectivity differences between the insula and other regions of interest.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze: MEDLINE
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