Differential cigarette-related startle cue reactivity among light, moderate, and heavy smokers

The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls

Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.

Age-dependent effects of tobacco smoke and nicotine on cognition and the brain: A systematic review of the human and animal literature comparing adolescents and adults

Cigarette smoking is often initiated during adolescence and an earlier age of onset is associated with worse health outcomes later in life. Paradoxically, the transition towards adulthood also marks the potential for recovery, as the majority of adolescents are able to quit smoking when adulthood emerges. This systematic review aimed to evaluate the evidence from both human and animal studies for the differential impact of adolescent versus adult repeated and long-term tobacco and nicotine exposure on cognitive and brain outcomes. The limited human studies and more extensive yet heterogeneous animal studies, provide preliminary evidence of heightened fear learning, anxiety-related behaviour, reward processing, nicotinic acetylcholinergic receptors expression, dopamine expression and serotonin functioning after adolescent compared to adult exposure. Effects of nicotine or tobacco use on impulsivity were comparable across age groups. These findings provide novel insights into the mechanisms underlying adolescents' vulnerability to tobacco and nicotine. Future research is needed to translate animal to human findings, with a focus on directly linking a broader spectrum of brain and behavioural outcomes.

Emotional Impact of Graphic Health Warnings on Tobacco Packaging: Analysis of Their Content

The use of graphic health warnings (GHWs) on tobacco packaging is one of the most widely used public health strategies worldwide, but there is little evidence of the emotional impact of its content and craving they generate. The objective of the present study was to evaluate the emotional and craving responses to GHW content. The study included 300 men and women of different ages (adolescents, young adults, and adults), both smokers and non-smokers. We evaluated the participants' emotional and craving responses to 16 GHWs with different content (i.e., cancer, cardiovascular disease, abortion, and childhood illness). We analyzed the effects of sex, smoking status, and age. GHWs exhibited the capacity to elicit aversive emotional states, with low levels of arousal and high levels of dominance and did not produce craving. GHWs that showed images of cancer and abortion had the greatest emotional impact. Non-smoking adolescent females experienced the greatest emotional impact of GHWs. The results suggest that GHWs effectively reduce the attractiveness of cigarette packages and discourage consumption, and increasing the size of GHWs may favor avoidance of the package. GHWs that depicted explicit threats had a greater emotional impact, especially in women.

Bases psicofisiológicas del sistema de clasificación de fumadores Basado en el reflejo asombroso de las tasas relacionadas con el tabaco

Se han descrito los factores psicológicos y socioculturales relacionados con la adicción a la nicotina. El objetivo de este estudio comparativo es obtener bases psicofisiológicas del Sistema de Clasificación de Fumadores a partir de la comparación del reflejo de sobresalto provocado por señales relacionadas con el tabaco en personas con diferentes niveles de consumo de tabaco. El reflejo de sobresalto se registró a partir de una muestra seleccionada de 39 participantes: 16 hombres y 23 mujeres de entre 20 y 29 años con una media de 24,36 y una desviación estándar de 2,88, que fumaban de 5 a 15 cigarrillos al día. Fueron clasificados mediante la evaluación Criterios del Sistema de Clasificación de Fumadores, basado en el cuestionario C4-R, en el que fueron expuestos a 21 imágenes del Sistema Internacional de Imágenes Afectivas y a un estímulo sonoro de sobresalto de 105 dB. Se midió la electromiografía del orbicularis oculi para evaluar la magnitud del reflejo de sobresalto. La topografía del consumo y los resultados de los registros psicofisiológicos se analizaron utilizando estadística comparativa de medias mediante modelos de ecuaciones estructurales. Se concluyó que existen diferencias significativas en el grado de implicación fisiológica en los cuatro niveles de consumo del sistema descrito. Finalmente, se analizan las limitaciones y orientaciones futuras de este estudio.

Executive Functions in Tobacco Use Disorder: New Challenges and Opportunities

There is increasing evidence that executive functions have significative effects on nicotine abuse. An unresolved challenge for smoking cessation interventions is the detection of factors associated with nicotine use. In order to understand how cognition is affected by nicotine abuse, this study was designed to determine the relationship between years of smoking addiction and several variables of executive functions. The sample was composed of 174 smokers, whose age ranged between 27 and 69 years old (M = 47.44; SD = 8.48). Smokers were assessed at baseline with measures of cognitive inhibition [Go/No Go Task and Five Digit Test (FDT)], updating [Visual Search and Attention Test (VSAT) and Letter-Number Sequencing (WAIS IV)] and shifting [Delay Discounting Task (DDT) and Iowa Gambling Task (IGT)] while the outcome measure was years of smoking. The linear regression and correlation analysis highlighting that the variable which has the strongest association with years of smoking is updating. Multivariate analysis of variance (MANCOVA) followed by Tukey post-hoc tests revealed significant differences such that heavy smoking indicated worse performance than light smoking on updating tasks. These findings report the ability of working memory to predict years of smoking and suggest that cigarette packaging warning may experience a loss of effectiveness in heavy smokers.

A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults

Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.

The impact of nicotine dose and instructed dose on smokers' implicit attitudes to smoking cues: An ERP study

It is unclear whether nicotine and perceived nicotine exposure can influence automatic evaluations of cigarette stimuli. In the present study, we investigated the effects of nicotine dose and instructed dose on motivational responses to smoking cues. Forty overnight nicotine-deprived smokers completed an Implicit Association Test (IAT) at each of the four laboratory sessions in a balanced-placebo design that crossed nicotine dose (Given-NIC [given nicotine] vs. Given-DENIC [given denicotinized]) with instructed dose expectancy (Told-NIC [told-nicotine] vs. Told-DENIC. [told-denicotinized]). We measured participants' behavioral performance, including reaction time (RT) and accuracy rate, and the early posterior negativity (EPN) component using the event-related potential (ERP) technique to the target pictures. During congruent trials when the categorization condition was smoking or unpleasant, smokers had greater classification accuracy, shorter RT latency, and greater EPN amplitudes compared to the incongruent trials when the categorization condition was smoking or pleasant. The Given-NIC condition was associated with increased classification accuracy, longer RT latency, and decreased EPN amplitudes compared to the Given-DENIC condition. Similarly, the Told-NIC condition was associated with increased accuracy and decreased EPN amplitudes compared to the Told-DENIC condition, but with shorter RT latency. Cigarette-related pictures produced greater EPN amplitudes than neutral pictures. Both behavioral and ERP results suggest that smokers have negative implicit attitudes toward smoking. While both nicotine dose and expected dose facilitated stimulus categorization, there was no evidence that either factor altered smokers' negative attitudes toward smoking cues. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Affective startle modulation and psychopathology: Implications for appetitive and defensive brain systems

Startle reflex potentiation versus startle attenuation to unpleasant versus pleasant stimuli likely reflect priming of the defensive versus appetitive motivational systems, respectively. This review summarizes and systemizes the literature on affective startle modulation related to psychopathologies with the aim to reveal underlying mechanisms across psychopathologies. We found evidence for psychopathologies characterized by increased startle potentiation to unpleasant stimuli (anxiety disorders), decreased startle potentiation to unpleasant stimuli (psychopathy), decreased startle attenuation to pleasant stimuli (ADHD), as well as a general hyporeactivity to affective stimuli (depression). Increased versus decreased startle responses to disorder-specific stimuli characterize specific phobia and drug dependence. No psychopathology is characterized by increased startle attenuation to standard pleasant stimuli or a general hyperreactivity to affective stimuli. This review indicates that the defensive and the appetitive systems operate independently mostly in accordance with the motivational priming hypothesis and that affective startle modulation is a highly valuable paradigm to unraveling dysfunctions of the defensive and appetitive systems in psychopathologies as requested by the Research Domain Criteria initiative.

[Effectiveness of cigarette-pack warning labels in capturing the attention of smokers and nonsmokersEficácia das tarjas de advertência em maços de cigarro para atrair a atenção de fumantes e não fumantes]

Objective

To determine the ability of cigarette-pack warning labels, of the minimum size required by the World Health Organization, to capture the attention of smokers and nonsmokers.

Methods

In this study, 30 smokers and 30 nonsmokers completed a dot-probe task in which they simultaneously observed images of cigarette packs split in two: the top contained the cigarette brand and the bottom contained the warning label. During the task, brain activity was recorded through two event-related potentials of the negative-polarity type--the potential that occurs in the posterior-contralateral zone approximately 200 ms after a stimulus (N2pc) and the sustained posterior contralateral negativity (SPCN) response--which are indicators of early and sustained attention.

Results

In both groups, a greater amplitude of N2pc and SPCN potentials was found for the part of the pack containing the cigarette brand. However, during the dot-probe task, reaction times were shorter for the warning label.

Conclusions

These results suggest that, initially, attention is focused on the cigarette brand, and only then on the warning label. The inability of warning labels to capture early-phase attention decreases their effectiveness, especially in smokers. We suggest that warning labels be enlarged to facilitate increased attention response.

Size matters in the case of graphic health warnings: Evidence from physiological measures

OBJECTIVES

>50 countries use graphic health warnings (GHWs) with the minimum size that is recommended by the World Health Organization (WHO). The aim of the present study was to evaluate the effect of the size of GHWs on physiological responses that serve as indices of arousal and aversive motivation in nonsmokers, weekly smokers, and daily smokers.

METHODS

The skin conductance response, corrugator muscle activity, and startle reflex were recorded in 35 nonsmokers, 35 weekly smokers, and 35 daily smokers while they observed pictures of cigarette packs without GHWs, cigarette packs with GHWs that covered 30% of the pack, and cigarette packs with GHWs that covered 60% of the pack.

RESULTS

Cigarette packs with 30% GHWs did not generate significantly higher responses on any of the physiological measures compared with cigarette packs without GHWs. Conversely, cigarette packs with GHWs that covered 60% of the pack generated a greater skin conductance response, greater corrugator muscle activity, and an increase in the startle reflex compared with cigarette packs without GHWs. No significant differences were found between groups in any of the physiological measures.

CONCLUSIONS

The minimum size of GHW that is recommended by the WHO is insufficient to generate an emotional response that favors avoidance of the cigarette pack. GHW that cover 60% of the cigarette pack significantly reduced the attractiveness of the tobacco packaging and generated greater arousal responses.

Appetitive startle modulation in the human laboratory predicts Cannabis craving in the natural environment

RATIONALE

Drug-related cues evoke craving and stimulate motivational systems in the brain. The acoustic startle reflex captures activation of these motivational processes and affords a unique measure of reactivity to drug cues.

OBJECTIVES

This study examined the effects of cannabis-related cues on subjective and eye blink startle reactivity in the human laboratory and tested whether these effects predicted youth's cue-elicited cannabis craving in the natural environment.

METHODS

Participants were 55 frequent cannabis users, ages 16 to 24 years (M = 19.9, SD = 1.9; 55% male; 56% met criteria for cannabis dependence), who were recruited from a clinical trial to reduce cannabis use. Eye blink electromyographic activity was recorded in response to acoustic probes that elicited startle reactivity while participants viewed pleasant, unpleasant, neutral, and cannabis picture cues. Following the startle assessment, participants completed an ecological momentary assessment protocol that involved repeated assessments of cue-elicited craving in real time in their real-world environments.

RESULTS

Multilevel models included the presence or absence of visible cannabis cues in the natural environment, startle magnitude, and the cross-level interaction of cues by startle to test whether cue-modulated startle reactivity in the laboratory was associated with cue-elicited craving in the natural environment. Analyses showed that cannabis-related stimuli evoked an appetitive startle response pattern in the laboratory, and this effect was associated with increased cue-elicited craving in the natural environment, b = - 0.15, p = .022, 95% CI [- 0.28, - 0.02]. Pleasant stimuli also evoked an appetitive response pattern, but in this case, blunted response was associated with increased cue-elicited craving in the natural environment, b = 0.27, p < .001, 95% CI [0.12, 0.43].

CONCLUSIONS

Our findings support cue-modulated startle reactivity as an index of the phenotypic expression of cue-elicited cannabis craving.

Pharmacological intervention and abstinence in smokers undergoing cessation treatment: A psychophysiological study

As a composite concept, negative affect comprises various aversive emotional experiences, such as irritability and nervousness. It is a critical motivational factor that helps maintain smoking behavior, and contributes significantly to smoking cessation failure as a core withdrawal symptom. Prior research has indicated an important role of nicotinic mechanisms in negative affect processing. The most effective smoking cessation medication, varenicline, targets nicotinic acetylcholine receptors (nAChRs) as a partial agonist, while another first-line cessation medication, bupropion, has shown antagonistic effects on nAChRs. Therefore, it is possible that both medications work to reduce smoking behavior through modulating negative affect processing. To evaluate this hypothesis, we examined the impact of varenicline tartrate and bupropion hydrochloride sustained-release on electrophysiological responses to affective, cigarette-related, and neutral cues before and during smoking cessation treatment in a randomized placebo-controlled clinical trial. The participants were 206 smokers, a subset of 294 participants that were enrolled in a larger smoking cessation clinical trial who were randomly assigned to one medication group for 12weeks. Orbicularis oculi (startle eyeblink response) and corrugator supercilii facial electromyographic (EMG) reactivity toward emotional pictures (i.e., pleasant and unpleasant) in a picture-viewing task were measured before treatment and 2 and 6weeks after treatment was started. The startle and corrugator EMG activities increase with the exposure to unpleasant cues, and served as indices for negative emotional reactivity (NER). We found that after 6weeks, drug reduced startle-related NER in the varenicline group, but not in the bupropion or placebo group. Independent of medication treatment, lower baseline NER, as measured by the corrugator EMG activity, predicted a higher likelihood of smoking abstinence 1 and 3months after quitting smoking. These findings indicate the important roles of varenicline in negative affect processing and negative emotional reactivity in the course of smoking cessation.

From appetitive to aversive: motivational interviewing reverses the modulation of the startle reflex by tobacco cues in smokers not ready to quit

Motivational Interviewing (MI) is a treatment method that has proven effective for increasing motivation to change and decreasing the consumption of different drugs. However, the results of studies examining the impact of MI on tobacco consumption are contradictory. Moreover, evidence of the effectiveness of MI for modifying well-validated psychophysiological indices of motivational change is still lacking. The aim of the present study was to use the startle probe paradigm and self-report measures of motivational change to assess the effectiveness of MI, compared to Prescriptive Advice (PA) and no treatment, in a sample of 53 smokers (28 male) who were not ready to quit smoking. After the intervention, the MI group reported increased motivation to change compared to both the PA and control groups. MI participants also had a potentiated startle reflex in response to tobacco-related pictures compared to the other two groups. These findings provide evidence that MI reverses the underlying motivational system activated by tobacco related cues.

Randomized trial of telephone-delivered acceptance and commitment therapy versus cognitive behavioral therapy for smoking cessation: a pilot study

OBJECTIVE

We conducted a pilot randomized trial of telephone-delivered acceptance and commitment therapy (ACT) versus cognitive behavioral therapy (CBT) for smoking cessation.

METHOD

Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers (at least 10 cigarettes/day) and who wanted to quit within the next 30 days. Participants were randomized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy (NRT).

RESULTS

ACT participants completed more calls than CBT participants (M = 3.25 in ACT vs. 2.23 in CBT; p = .001). Regarding satisfaction, 100% of ACT participants reported their treatment was useful for quitting smoking (vs. 87% for CBT; p = .03), and 97% of ACT participants would recommend their treatment to a friend (vs. 83% for CBT; p = .06). On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postrandomization, the quit rates were 31% in ACT versus 22% in CBT (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.7-3.4). Among participants depressed at baseline (n = 47), the quit rates were 33% in ACT versus 13% in CBT (OR = 1.2, 95% CI = 1.0-1.6). Consistent with ACT's theory, among participants scoring low on acceptance of cravings at baseline (n = 57), the quit rates were 37% in ACT versus 10% in CBT (OR = 5.3, 95% CI = 1.3-22.0).

CONCLUSIONS

ACT is feasible to deliver by phone, is highly acceptable to quitline callers, and shows highly promising quit rates compared with standard CBT quitline counseling. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.

Cue-induced cigarette craving and mixed emotions: a role for positive affect in the craving process

Craving is an important component of nicotine addiction, and extant research has demonstrated a clear link between cue-induced craving and negative affect, with mixed results in the positive affect domain. The current study was designed to test the idea that cue-reactive craving might be associated with a mixed emotional process, or the simultaneous experience of positive and negative affect. Participants were 86 non-deprived regular smokers and tobacco chippers who provided simultaneous ratings of positive and negative affect during cue exposure to pleasant, unpleasant, neutral and cigarette cues. Results indicated that self-reported craving was elevated in response to cigarette cues compared to other valenced cue types and craving was higher to pleasant cues than either neutral or unpleasant cues. Mixed emotional responses were higher to cigarette cues than other cue types. In addition, mixed emotional responses to cigarette cues predicted craving even after controlling for smoker type, difficulties regulating negative emotion, baseline craving level and mixed emotional responses to neutral cues. As the first study to investigate mixed emotions and cigarette craving, our results highlight the importance of examining the relationship between cue-reactive craving and emotional response using models of emotion that allow for measurement of nuanced emotional experience. In addition, our findings suggest that positive affect processes may indeed play a role in craving among non-deprived smokers.

Alpha oscillations in response to affective and cigarette-related stimuli in smokers

INTRODUCTION

The presence of cigarette-related cues has been associated with smoking relapse. These cues are believed to activate brain mechanisms underlying emotion, attention, and memory. Electroencephalography (EEG) alpha desynchronization (i.e., reduction in alpha power) has been suggested to index the engagement of these mechanisms. Analyzing EEG alpha desynchronization in response to affective and smoking cues might improve our understanding of how smokers process these cues, and the potential impact of this processing on relapse.

METHODS

Before the start of a medication-assisted cessation attempt, we recorded EEG from 179 smokers during the presentation of neutral, pleasant, unpleasant, and cigarette-related pictures. Wavelet analysis was used to extract EEG alpha oscillations (8-12 Hz) in response to these pictures. Alpha oscillations were analyzed as a function of picture valence and arousal dimensions.

RESULTS

Emotional and cigarette-related stimuli induced a higher level of alpha desynchronization (i.e., less power in the alpha frequency band) than neutral stimuli. In addition, the level of alpha desynchronization induced by cigarette-related stimuli was similar to that induced by highly arousing stimuli (i.e., erotica and mutilations).

CONCLUSIONS

These results suggest that, for smokers, cigarette-related cues are motivationally significant stimuli that may engage emotional, attentional, and memory-related neural mechanisms at a level comparable to that seen in response to highly arousing stimuli. This finding suggests that activation of emotional, attentional, and memory-related brain mechanisms may be an important contributor to cue-induced smoking relapse.