Addressing Psychological Risk Factors Underlying Smoking Persistence in COPD Patients

Chronic Obstructive Pulmonary Disease (COPD) is caused primarily by smoking and nearly half of patients continue to smoke following diagnosis. Although smoking cessation is the first-line treatment for slowing the progression of the disease, rates of successful cessation among COPD patients are low. Further, COPD patients commonly experience elevated symptoms of depression and anxiety, suggesting that common behavioral factors may drive both smoking persistence and emotional distress. Treatment approaches informed by basic social science and psychological research represent a novel strategy for improving on stagnant quit rates among COPD patients. The proposed research will conduct the design and preliminary testing of a novel behavioral treatment to foster smoking cessation among COPD patients. Primary aims of the proposed research are to: 1) Refine behavioral treatment components through qualitative interviews with patients and providers, 2) Develop a combined behavioral treatment to address psychological risk factors among COPD patients using a series of within-subject time series analyses, and 3) Examine the effects of psychological risk factor reduction on smoking outcome. The proposed project will be the first to adapt a behavioral treatment to specifically target psychological risk factors among COPD patients. By addressing pre-existing risk factors, the combined behavioral treatment may help buffer against stress associated with disease progression and prevent development of full-scale psychiatric disorders. Effectively addressing psychological conditions is also shown to increase COPD patients’ exercise tolerance, engagement in pulmonary rehabilitation, and quality of life. Thus, this early intervention has potential to obviate a large number of health burdens among COPD patients. Amanda Mathew, PhD, a Research Assistant Professor at Northwestern University Feinberg School of Medicine, is seeking five years of support through the K23 Mentored Patient-Oriented Research Career Development Award for training and research related to intervention development and randomized controlled trial design for smoking cessation targeted to psychological risk factors among COPD patients. Dr. Mathew’s overarching career goals are to elucidate the mechanisms by which psychological factors impact cigarette smoking, develop novel interventions for smokers with medical and psychiatric comorbidities, and reduce tobacco-related health disparities. Through the proposed training plan, Dr. Mathew will expand her knowledge and skills related to intervention development; behavioral RCT design, conduct, and analysis; and smoking cessation and treatment needs specific to individuals with COPD. Dr. Mathew’s multidisciplinary mentorship team has demonstrated expertise in these content areas, and is committed to Dr. Mathew’s career development. Dr. Mathew’s proposed work is also well-aligned with behavioral medicine research priorities within the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine.