Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking. Method: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, n = 25) or enhanced standard treatment (EST, n = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day. Results: Of the 49 participants, 63.3% were Latinx and 30.6% Black;

The results from the feasibility study indicated high levels of acceptability and satisfaction with SMI-CM. The ongoing RCT will allow evaluation of the efficacy and mechanisms of action underlying SMI-CM for improving cessation rates among smokers with mood disorders.

Background Problems in learning that sights, sounds, or situations that were once associated with danger have become safe (extinction learning) may explain why some individuals suffer prolonged psychological distress following traumatic experiences. Although simple learning models have been unable to provide a convincing account of why this learning fails, it has recently been proposed that this may be explained by individual differences in beliefs about the causal structure of the environment. Methods Here, we tested two competing hypotheses as to how differences in causal inference might be related to trauma-related psychopathology, using extinction learning data collected from clinically well-characterised individuals with varying degrees of post-traumatic stress (N = 56). Model parameters describing individual differences in causal inference were related to multiple post-traumatic stress disorder (PTSD) and depression symptom dimensions via network analysis. Results Individuals with more severe PTSD were more likely to assign observations from conditioning and extinction stages to a single underlying cause. Specifically, greater re-experiencing symptom severity was associated with a lower likelihood of inferring that multiple causes were active in the environment. Conclusions We interpret these results as providing evidence of a primary deficit in discriminative learning in participants with more severe PTSD. Specifically, a tendency to attribute a greater diversity of stimulus configurations to the same underlying cause resulted in greater uncertainty about stimulus-outcome associations, impeding learning both that certain stimuli were safe, and that certain stimuli were no longer dangerous. In the future, better understanding of the role of causal inference in trauma-related psychopathology may help refine cognitive therapies for these disorders.

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Problems in learning that sights, sounds, or situations that were once associated with danger have become safe (extinction learning) may explain why some individuals suffer prolonged psychological distress following traumatic experiences. Although simple associative learning models have been unable to provide a convincing account of how and why this learning fails, it has recently been proposed that this may be explained by individual differences in beliefs about the causal structure of the environment. Here, we tested two competing hypotheses as to how differences in causal inference might be related to trauma-related psychopathology, using extinction learning data collected from clinically well-characterized individuals with varying degrees of post-traumatic stress (N=56). Latent cause modelling revealed that individuals with more severe PTSD were more likely to assign observations from conditioning and extinction stages to a single underlying cause. Specifically, multivariate analysis incorporating multiple PTSD and depression symptom dimensions revealed a negative relationship between tendency to infer multiple causes were active in the environment and re-experiencing symptom severity. We interpret these results as providing evidence of a primary deficit in discriminative learning in participants with more severe PTSD re-experiencing symptoms. Specifically, in these individuals, a greater tendency to attribute all stimulus configurations to the same underlying cause resulted in greater uncertainty about stimulus-outcome associations, and impeded learning both that certain stimuli were safe, and that certain stimuli were no longer dangerous. Better understanding of the role of causal inference in trauma-related psychopathology may have relevance for the refinement of cognitive therapies for these disorders.

Smoking was related to several psychiatric and substance use problems. Notably, adolescent psychiatric inpatient smokers reported intention to quit smoking regardless of psychiatric disorders, psychiatric symptom severity, or other substance use.

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