Do the affective properties of smoking-related cues influence attentional and approach biases in cigarette smokers?

Avoidance biases for vaping stimuli among college students with electronic-cigarette use

Previous research has suggested that individuals who smoke demonstrate a behavioral tendency to approach rather than avoid smoking-related stimuli (i.e., approach bias). This study assessed whether 149 undergraduates with varying levels of e-cigarette use demonstrated an approach bias for vaping-related stimuli on an Approach-Avoidance Task (AAT). In contrast to our hypotheses, participants with e-cigarette use demonstrated a significant avoidance bias to vaping-related stimuli, and this effect appeared to be primarily driven by female e-cigarette users. Further, we found that more severe e-cigarette use was associated with numerous adverse outcomes, including reduced quality of life and increased vaping cravings, depressive symptoms, perceived stress, and cannabis use severity. Overall, our findings elucidate various negative impacts of e-cigarette use and suggest a potential role for sex differences in approach-avoidance tendencies toward vaping-related stimuli among young adults.

Reliability of and associations between cognitive bias measures and response inhibition in smoking

BACKGROUND AND OBJECTIVE

Theoretical models propose that different cognitive biases are caused by a common underlying mechanism (incentive salience/"wanting") and should, therefore, be interrelated. Additionally, stronger impulsive processes should be related to weaker inhibitory abilities. However, these assumptions have hardly been empirically tested and key psychometric information have hardly been reported in samples of smokers. To extent previous research, the present study aimed (1) to estimate the reliability (split-half) of different cognitive bias measures and (2) to investigate associations between attention, approach and associative biases, response inhibition, and smoking-related variables.

METHODS

Eighty current, non-deprived smokers completed the following tasks in random order: Approach-Avoidance Task (AAT), Stimulus-Response Compatibility Task (SRCT), Implicit-Association Tests (IAT, approach-avoid, valence), Dotprobe Task, Go-/NoGo Task (GNGT). Additionally, different smoking-related variables were assessed. Split-half reliabilities of the different cognitive (bias) measures and correlations between them were calculated.

RESULTS

Split-half reliabilities of the AAT, the SRCT, and the Dotprobe Task were unacceptable whereas both IATs and the GNGT showed good to excellent reliability. Smoking-approach associations were significantly related to nicotine dependence; however, none of the cognitive bias measures correlated with response inhibition or smoking-related variables.

LIMITATIONS

Pictorial stimuli were the same across paradigms and might not have been relevant to all participants.

CONCLUSIONS

This is the first study to investigate the association between different cognitive biases, response inhibition, and smoking-related variables. Although findings are at odds with theoretical assumptions, their interpretation is clearly restricted by the low reliability of the cognitive bias measures.

Attentional bias modification in male college smokers: The changes of facilitated attention, difficulty in disengagement and the transfer effects of training

BACKGROUND

Attentional bias modification (ABM) has been used to modify the attentional bias (AB) towards smoking-related cues. Still, the effects of ABM are extensively controversial. The present study aimed to investigate the effects of ABM on AB and its two sub-processes named facilitated attention and difficulty in disengagement at two different stimulus durations, as well as test whether the effects of ABM could transfer to new measures of AB.

METHOD

Forty-six male college smokers were allocated to either ABM group using a modified visual probe task (n = 24), or the corresponding placebo training (PT) group (n = 22). Participants performed three sessions of training in one week. The pre- and post-training AB and its sub-processes were measured using visual probe task. Cue-target task and pictorial Stroop task were used for testing the transfer effects of ABM.

RESULTS

The AB in ABM group was significantly decreased compared with the PT group. Specifically, the facilitated attention was significantly reduced at 200 ms stimulus duration, while the difficulty in disengagement was significantly decreased at 500 ms stimulus duration. The benefit of ABM training could transfer to the cue-target task, but not to the pictorial Stroop task. Meanwhile, no effects of ABM were observed on smoking craving and nicotine dependence.

CONCLUSIONS

These findings suggested that the stimulus duration is a crucial factor for the efficacy of ABM on the facilitated attention and the difficulty in disengagement in male college smokers and detected the transfer effects between different measures of AB to some extent. Future studies need to further explore the influence mechanism in distinct stimulus durations.

Comparing cigarette-cue attentional bias between people with HIV/AIDS and people with opioid use disorder who smoke

Background

Special populations like people living with HIV/AIDS (PLWHA) and people with opioid use disorder (OUD) smoke tobacco cigarettes at rates three to four times greater than the general population. Patients with tobacco use disorder exhibit attentional bias (AB) for cigarette cues. Eye tracking can quantify this bias by measuring fixation time (FT) on cigarette and matched neutral cues, to calculate an AB score. Although previous studies have measured this bias in people who smoke without any other comorbid conditions, no study, to our knowledge, has measured or compared this bias in special populations.

Methods

We performed exploratory analyses on eye tracking data collected in two separate randomized clinical trials (RCTs) (NCT05049460, NCT05295953). We compared FT and cigarette-cue AB score (measured by subtracting FT on neutral cues from FT on cigarette cues) between PLWHA and people with OUD who smoke, using a visual probe task and Tobii Pro Fusion eye tracker. We used two cigarette cue types, one encompassing people smoking cigarettes and the other consisting of cigarette paraphernalia. We used two cue presentation times, 1000 and 2000 milliseconds (ms).

Results

Cues of people smoking cigarettes elicited greater AB than cues of cigarette paraphernalia across both subject groups when cues were presented for 2000 ms, but not 1000 ms. PLWHA who smoke exhibited greater AB for cues of people smoking cigarettes than cigarette paraphernalia when presented for 2000 ms compared to people with OUD who smoke.

Conclusion

We use cigarette-cue AB to quantify craving and cigarette consumption in two populations smoking at elevated rates. The addition of social cues potentiates cigarette cue AB, based on cue type and stimulus presentation time. Understanding the neurobiology of this relationship can help design novel smoking cessation treatments that target AB and prevent relapse in these populations with suboptimal response to smoking cessation treatments.

Trial registration

Clinical trials that provided the data for post hoc analyses are NCT05049460 and NCT05295953.

Comparison of Alcohol Attentional Bias and Alcohol Craving Among Alcohol Abusers and Non-Abusers

The aim of this research is to investigate implicit cognitive process underlying alcohol craving and relationship between alcohol attentional bias and alcohol craving by using visual probe task. Current study examined whether alcohol abusers show attentional bias toward alcohol related task compared with non- abusers and causal relationship between alcohol attentional bias and alcohol craving. Firstly, participants were divided two groups (non abusers- abusers) and they were completed alcohol craving scale to determinate their alcohol craving level. Then, participants alcohol attentional bias was investigated using the visual probe task. In this task, images (alcohol-related and neutral) were presented for 500 ms on a computer screen. After that, probe (*, asterisk) was presented. Participants were asked to decide the place of the probe place by using keyboard keys within 1500 ms. Participants reaction time and number of correct and incorrect answers during the test. According to results, alcohol abuser group’s reaction times were faster than non-abuser when probe was associated with alcohol picture but not in neutral trials. These results suggested that, alcohol abusers showed significantly greater attentional bias to alcohol related pictures than non- abusers. From this point, investigation of alcohol attentional bias might be important component of alcohol dependence in terms of the alcohol relapse risk and determination of the alcohol craving.

Evidence for the embodiment of the automatic approach bias

Tendencies of approach and avoidance seem to be a universal characteristic of humans. Specifically, individuals are faster in avoiding than in approaching negative stimuli and they are faster in approaching than in avoiding positive stimuli. The existence of this automatic approach-avoidance bias has been demonstrated in many studies. Furthermore, this bias is thought to play a key role in psychiatric disorders like drug addiction and phobias. However, its mechanisms are far from clear. Theories of embodied cognition postulate that the nature of gestures plays a key role in this process. To shed light on the role of the involved gesture we employed a 2 × 2 factorial design with two types of stimuli. Participants had either to approach positive and avoid negative stimuli (congruent conditions) or to avoid positive stimuli and approach negative stimuli (incongruent conditions). Further, they responded either with a joystick or a button press on a response pad. Participants reacted faster in congruent conditions, i.e., avoiding negative stimuli and approaching positive stimuli, than in incongruent conditions. This replicates the known approach and avoidance bias. However, direct analysis of the button press condition revealed no reaction time advantage for congruent trials compared to incongruent trials. In contrast, in the joystick condition participants were significantly faster performing congruent reactions than incongruent reactions. This interaction, a significant reaction time advantage, when the response is enacted by moving a joystick towards or away from the body provides evidence that approach-avoidance tendencies have a crucial bodily component.

Self-reported mask-related worrying reduces relative avoidance bias toward unmasked faces in individuals with low Covid19 anxiety syndrome

Facial masks have become and may remain ubiquitous. Though important for preventing infection, they may also serve as a reminder of the risks of disease. Thus, they may either act as cues for threat, priming avoidance-related behavior, or as cues for a safe interaction, priming social approach. To distinguish between these possibilities, we assessed implicit and explicit evaluations of masked individuals as well as avoidance bias toward relatively unsafe interactions with unmasked individuals in an approach-avoidance task in an online study. We further assessed Covid19 anxiety and specific attitudes toward mask-wearing, including mask effectiveness and desirability, hindrance of communication from masks, aesthetic appeal of masks, and mask-related worrying. Across one sample of younger (18-35 years, N = 147) and one of older adults (60+ years, N = 150), we found neither an average approach nor avoidance bias toward mask-wearing compared to unmasked individuals in the indirect behavior measurement task. However, across the combined sample, self-reported mask-related worrying correlated with reduced avoidance tendencies toward unmasked individuals when Covid19 anxiety was low, but not when it was high. This relationship was specific to avoidance tendencies and was not observed in respect to explicit or implicit preference for mask-wearing individuals. We conclude that unsafe interaction styles may be reduced by targeting mask-related worrying with public interventions, in particular for populations that otherwise have low generalized Covid19 anxiety.

Efectos de algunas señales visuales y olfativas sobre el consumo de cigarrillo y el ansia para fumar

Las señales inductoras para el consumo (SIC) son uno de los factores que inciden en que un fumador encienda, o no, el próximo cigarrillo. Las SIC impactan más a los fumadores no dependientes de la nicotina (FND) que a los fumadores dependientes (FD). Los FND no son dependientes de la nicotina y sus niveles de monóxido de carbono tienden a ser más bajos. Los FD muestran niveles de nicotina y monóxido de carbono más altos (dependientes). Este estudio evaluó el nivel de ansia de los individuos frente a imágenes relacionadas con el producto (cigarrillos y cajetilla de cigarrillos) y si existen diferencias entre inductores visuales y olfativos en relación con el consumo de cigarrillo. Los FD muestran niveles de nicotina y monóxido de carbono más altos. Los participantes mostraron mayor ansia ante las imágenes que presentaban cigarrillos saliendo de la cajetilla. No se hallaron diferencias entre inductores visuales y olfativos en relación con el consumo de cigarrillo. No obstante, la ocurrencia de fumar fue mayor en FD que en FND. Por eso, es importante clasificar el tipo de fumador en futuras investigaciones que pretendan evaluar esta población. 

A dismantling study on imaginal retraining in smokers

Imaginal retraining is a noncomputerized variant of cognitive bias modification, an intervention aimed at reducing craving in substance use disorders and behavioral addictions. We conducted a dismantling study to elucidate which of its multiple components are effective and hence essential ingredients of the training and which are ineffective (and hence perhaps dispensable) in reducing craving. We randomized 187 smokers to one out of six conditions that instructed participants to perform a brief intervention. In four of these, participants were instructed to perform isolated components of the imaginal retraining protocol, and in the two other conditions participants either suppressed or simply observed (control condition) the image of a cigarette. Before and after the intervention, participants were asked to rate their level of craving and how pleasant they found three smoking-related images. We examined within-group changes by means of paired t-tests separately across conditions (trial registration: DRKS00021044). Mental distancing from cigarettes (without a corresponding actual physical movement; non-motor retraining) led to a significant decline in craving (paired t-test), which remained significant when compared to the control condition. The effects of other components of the retraining were less consistent. The present study shows that a single therapeutic "dose" of distinct components involved in imaginal retraining can reduce craving for cigarettes. Future trials should investigate the effectiveness of components of imaginal retraining not yet tested (e.g., mood induction) and whether combinations and repetition of single components strengthen or dilute efficacy.

Effectiveness of Interventions Based on Yogic Breathing Practices (IB-YBP) on Substance Use Disorders-A Systematic Review of the Randomized Control Trials and Quasi-Experimental Trials

Interventions based on Yogic Breathing Practices (IB-YBP) have shown promising results for substance use disorders (SUD). Research in this area is methodologically heterogeneous and only a few, but restricted, systematic reviews are available. The current systematic review aims to assess the effectiveness of IB-YBP for SUD. Materials and Methods: PubMed, Cochrane's Library, EBSCO-Medline, and Google Scholar databases were searched for the randomized- (RCTs) and quasi-randomized trials. Research involving participants with SUD, of either gender or any age, assessing the effectiveness of the IB-YBP either as a standalone intervention or as an adjuvant to standard treatment versus standard pharmacological/non-pharmacological treatment or no-intervention control were included. Studies having participants with co-morbid psychiatric illness and interventions not having IB-YBP as the predominant component were excluded. Results: The initial literature search yielded 396 articles and upon screening, only 14 studies were found eligible for this review. Most studies have researched IB-YBP as an adjunct to the standard treatment for SUD. Evidence for the effectiveness of IB-YBP is mostly available for tobacco and opioid use disorders, though only for short-term outcomes; however, literature is scarce for alcohol- and cocaine-use disorders. This review documented the effectiveness of the IB-YBP for substance use-related outcome parameters such as abstinence, quality of life (QoL), mood, craving, and withdrawal symptoms. Conclusion: IB-YBP may be an effective adjuvant to standard treatment for various SUD. However, more research is required to compare its effectiveness with standard treatment, and assessing its long-term efficacy, for it to be strongly recommended as a treatment strategy.

Spotlight on Compulsive Sexual Behavior Disorder: A Systematic Review of Research on Women

PURPOSE OF REVIEW

World Health Organization recently included compulsive sexual behavior disorder (CSBD) to the upcoming 11th edition of International Classification of Diseases (6C72). Despite the potential benefits of this decision (eg, the acceleration of research in the field will allow the development of effective treatments), previous research focused mainly on men, and as a result, we do not have an accurate clinical picture of compulsive sexual behavior (CSB) among women. Therefore, in this systematic review, we aim to present available knowledge on this topical subject. Literature search was conducted in the guideline of PRISMA methodology. Studies were identified from multiple databases including Academic Search Ultimate, SocINDEX, PsycARTICLES, PsycINFO, PubMed, and MEDLINE. Out of a total of 10,531 articles identified and screened, 58 were included in this review. Included studies covered the following topics: prevalence and etiology of CSB, behavioral and cognitive processes involved, comorbidities, personality traits, psychosocial and interpersonal difficulties, traumatic experiences, and treatments.

RECENT FINDINGS

Available studies indicate that CSB symptom severity is lower in women than in men. Overall, women reported consuming pornography less often than men and exhibit lower rates of feeling urges to these materials. CSB symptoms (including problematic pornography use) have been found to be positively related to trait psychopathy, impulsivity, sensation seeking, attention-deficit/hyperactivity disorder symptoms, obsessive-compulsive disorder, pathological buying, sexual dysfunctions, general psychopathology, child sexual abuse, while negatively related to dispositional mindfulness.

SUMMARY

Conclusions that can be drawn from prior studies are considerably limited. There are no accurate estimates of the CSB prevalence or severity among women, and studies have been mostly conducted on non-clinical populations, which has limited application for women diagnosed with CSBD.

How interindividual differences shape approach-avoidance behavior: Relating self-report and diagnostic measures of interindividual differences to behavioral measurements of approach and avoidance

Responding to stimuli in ambiguous environments is partially governed by approach-avoidance tendencies. Imbalances in these approach-avoidance behaviors are implicated in many mental disorders including anxiety disorders, phobias and substance use disorders. While factors biasing human behavior in approach-avoidance conflicts have been researched in numerous experiments, a much-needed comprehensive overview integrating those findings is missing. Here, we systematically searched the existing literature on individual differences in task-based approach-avoidance behavior and aggregated the current evidence for the effect of self-reported approach/avoidance traits, anxiety and anxiety disorders, specific phobias, depression, aggression, anger and psychopathy, substance use and related disorders, eating disorders and habits, trauma, acute stress and, finally, hormone levels (mainly testosterone, oxytocin). We highlight consistent findings, underrepresented research areas and unexpected results, and detail the amount of controversy between studies. We discuss potential reasons for ambiguous results in some research areas, offer practical advice for future studies and highlight potential variables such as task-related researcher decisions that may influence how interindividual differences and disorders drive automatic approach-avoidance biases in behavioral experiments.

Networked collective intelligence improves dissemination of scientific information regarding smoking risks

Despite substantial investments in public health campaigns, misunderstanding of health-related scientific information is pervasive. This is especially true in the case of tobacco use, where smokers have been found to systematically misperceive scientific information about the negative health effects of smoking, in some cases leading smokers to increase their pro-smoking bias. Here, we extend recent work on 'networked collective intelligence' by testing the hypothesis that allowing smokers and nonsmokers to collaboratively evaluate anti-smoking advertisements in online social networks can improve their ability to accurately assess the negative health effects of tobacco use. Using Amazon's Mechanical Turk, we conducted an online experiment where smokers and nonsmokers (N = 1600) were exposed to anti-smoking advertisements and asked to estimate the negative health effects of tobacco use, either on their own or in the presence of peer influence in a social network. Contrary to popular predictions, we find that both smokers and nonsmokers were surprisingly inaccurate at interpreting anti-smoking messages, and their errors persisted if they continued to interpret these messages on their own. However, smokers and nonsmokers significantly improved in their ability to accurately interpret anti-smoking messages by sharing their opinions in structured online social networks. Specifically, subjects in social networks reduced the error of their risk estimates by over 10 times more than subjects who revised solely based on individual reflection (p < 0.001, 10 experimental trials in total). These results suggest that social media networks may be used to activate social learning that improves the public's ability to accurately interpret vital public health information.

Knowledge about the predictive value of reward conditioned stimuli modulates their interference with cognitive processes

Stimuli conditioned with a substance can generate drug-approach behaviors due to their acquired motivational properties. According to implicit theories of addiction, these stimuli can decrease cognitive control automatically. The present study (n = 49) examined whether reward-associated stimuli can interfere with cognitive processes in the absence of knowledge about stimulus–outcome contingencies. Conditioned stimuli (CS) were paired with high-reward (HR) or low-reward (LR) probabilities of monetary reward using a Pavlovian learning task. Participants were categorized as Aware or Unaware of contingencies using a Bayesian analysis. CS were then used as task-irrelevant distractors in modified flanker and N-back tasks. Results show HR CS can generate increased interference in the flanker task for participants Unaware of contingencies, contributing further evidence for the existence of implicit Pavlovian conditioning. For the N-back task, working memory performance was affected by HR CS, albeit only for Aware participants. These results suggest that CS can interfere implicitly with cognitive processes in a similar way to drug-related stimuli. Such an effect could occur in a stimulus-driven fashion, devoid of top-down goal-directedness. These findings have implications for the conceptualization and study of implicit processes in addiction and highlights the necessity to reconsider the measurement of such phenomena.

Tendencies toward Internet-pornography-use disorder: Differences in men and women regarding attentional biases to pornographic stimuli

BACKGROUND AND AIMS

Several authors consider Internet-pornography-use disorder (IPD) as addictive disorder. One of the mechanisms that has been intensively studied in substance- and non-substance-use disorders is an enhanced attentional bias toward addiction-related cues. Attentional biases are described as cognitive processes of individual's perception affected by the addiction-related cues caused by the conditioned incentive salience of the cue itself. It is assumed in the I-PACE model that in individuals prone to develop IPD symptoms implicit cognitions as well as cue-reactivity and craving arise and increase within the addiction process.

METHODS

To investigate the role of attentional biases in the development of IPD, we investigated a sample of 174 male and female participants. Attentional bias was measured with the Visual Probe Task, in which participants had to react on arrows appearing after pornographic or neutral pictures. In addition, participants had to indicate their sexual arousal induced by pornographic pictures. Furthermore, tendencies toward IPD were measured using the short-Internetsex Addiction Test.

RESULTS

The results of this study showed a relationship between attentional bias and symptom severity of IPD partially mediated by indicators for cue-reactivity and craving. While men and women generally differ in reaction times due to pornographic pictures, a moderated regression analysis revealed that attentional biases occur independently of sex in the context of IPD symptoms.

DISCUSSION

The results support theoretical assumptions of the I-PACE model regarding the incentive salience of addiction-related cues and are consistent with studies addressing cue-reactivity and craving in substance-use disorders.

Optimizing Electrode Montages of Transcranial Direct Current Stimulation for Attentional Bias Modification in Early Abstinent Methamphetamine Users

Introduction: Chronic use of most psychoactive drugs may lead to substance dependence and drug addiction. Drug addiction is a chronically relapsing disorder, and current pharmacological and behavioral therapies are not fully efficient. Attentional bias (AB) is hypothesized to have a causal contribution to substance abuse, addiction development and, maintenance. Transcranial direct current stimulation (tDCS) has been of increasing interest in the past few years as a means for modulating neuroplasticity of the human brain. Although several studies have reported promising therapeutic effects for tDCS in drug abusers, there is no consensus about optimal electrode montages and target brain regions. This study was aimed to compare effectiveness of several electrode montages in modifying AB. Methods and Materials: Ninety early-abstinent methamphetamine users were recruited from several residential drug-rehabilitation centers in Tehran province. They were randomly assigned to six groups with different electrode montages, targeting the left or right dorsolateral prefrontal cortex (DLPFC) as follows: Two conditions with anodal tDCS over the right DLPFC (return electrode placed over the left shoulder or left supraorbital ridge), three conditions with the anode positioned over the left DLPFC (return electrode over the right shoulder, right supraorbital ridge, or contralateral DLPFC), and one sham condition. Active stimulation intensity was 2 mA DC, delivered for 13 min followed by a 20-min rest and another 13 min of stimulation. The probe detection task (PDT) was performed to assess AB. The positive and negative affect scale (PANAS), and the depression anxiety stress scales (DASS) were used to assess baseline affective status before the intervention. Results: Mixed model analysis showed that the left DLPFC/right shoulder and left DLPFC/right DLPFC montages reduced AB toward drug-cues in comparison with sham stimulation. Conclusion: Our findings indicate that anodal stimulation over the left DLPFC reduces AB in methamphetamine users. This study offers promising findings for further studies investigating tDCS as a clinical device to modify AB in drug users.

Anhedonia and Abstinence as Predictors of the Subjective Pleasantness of Positive, Negative, and Smoking-Related Pictures

Introduction

Anhedonia-diminished interest or pleasure in response to rewards-is a dimension implicated in several psychiatric disorders linked to smoking. This laboratory study sought to identify motivational mechanisms linking anhedonia and tobacco addiction by testing the hypothesis that anhedonia, abstinence, and their interaction would predict excesses and deficits in the perceived pleasantness of smoking-related and positive pictures, respectively. We assessed the pleasantness of negative pictures as a secondary outcome.

Methods

After a baseline session involving self-report measures of anhedonia and other factors, 125 regular smokers attended two counterbalanced experimental sessions (overnight abstinent and non-abstinent) at which they rated the pleasantness of positive, smoking-related, negative, and neutral (control) pictures presented via computer. The difference in pleasantness ratings of positive, smoking-related, and negative pictures relative to neutral pictures served as the index of participants' appraisal of the motivational salience of nondrug reward, drug reward, and aversive signals, respectively.

Results

With and without adjusting for sex and depressive symptoms, greater anhedonia significantly or marginally predicted greater pleasantness of smoking (vs. neutral), lower pleasantness of positive (vs. neutral), less unpleasantness of negative (vs. neutral) pictures (|βs| = 0.18 to 0.35, ps = .007 to .07). Anhedonia by abstinence interaction effects on pleasantness ratings of each stimulus category (vs. neutral) were not significant (|βs| ≤ 0.02, ps ≥ .36).

Conclusions

Anhedonia and abstinence additively increase the salience of smoking-related cues in anhedonic smokers. Smoking cessation efforts that attenuate sensitization to smoking stimuli may benefit anhedonic smokers early in quit attempts.

Implications

Taken together, these findings provide tentative evidence that anhedonia is associated with a relative imbalance in the motivational salience of drug relative to nondrug rewards and may be associated with a generalized hypo-reactivity to both positive and negative stimuli. Though some prior smoking research has evidenced this relative imbalance in anhedonia with self-report or a smoking-choice task, we additionally show that this pattern may extend to hyper-affective reactivity to smoking-related stimuli being coincident with hypo-affective reactivity to nondrug-related positive stimuli (ie, may extend to greater pleasantness ratings of smoking pictures being accompanied by lower pleasantness ratings of positive pictures).

Impulsivity and approach tendencies towards cigarette stimuli: Implications for cigarette smoking and cessation behaviors among youth

Impulsivity is associated with smoking, difficulties quitting smoking, and approach tendencies toward cigarette stimuli among adolescents. We examined the effects of impulsivity on (a) the association between approach tendencies and adolescents' smoking status and (b) the effectiveness of Cognitive Bias Modification (CBM), a smoking cessation intervention focused on changing approach tendencies, among adolescent smokers. We conducted a secondary analysis of evidence from 2 previous published studies: Study 1: a cross-sectional study comparing impulsivity and approach tendencies between adolescent smokers (n = 67) and nonsmokers (n = 58); Study 2: a treatment study that randomized 60 adolescent smokers to receive either CBM or sham training. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS) and the Experiential Discounting Task (EDT). We found higher impulsivity, as determined by the BIS but not the EDT, increased adolescents' odds of being smokers. We observed that the interaction between EDT and approach tendencies also significantly predicted smoking status, however post hoc comparisons were not significant. Adolescents with higher BIS scores receiving CBM had increased odds of being abstinent at the end of treatment, but we found no association between EDT and treatment outcome. Our findings suggest that approach-bias modification (a form of CBM) may be more effective in impulsive adolescent smokers. Differences in findings for BIS and EDT highlight the complexity of the construct of impulsivity. Future studies with larger samples are needed to further disentangle the effects of different aspects of impulsivity on smoking behaviors and cessation outcomes among youth. (PsycINFO Database Record

Approach bias modification training and consumption: A review of the literature

Recent theoretical perspectives and empirical evidence have suggested that biased cognitive processing is an important contributor to unhealthy behaviour. Approach bias modification is a novel intervention in which approach biases for appetitive cues are modified. The current review of the literature aimed to evaluate the effectiveness of modifying approach bias for harmful consumption behaviours, including alcohol use, cigarette smoking, and unhealthy eating. Relevant publications were identified through a search of four electronic databases (PsycINFO, Google Scholar, ScienceDirect and Scopus) that were conducted between October and December 2015. Eligibility criteria included the use of a human adult sample, at least one session of avoidance training, and an outcome measure related to the behaviour of interest. The fifteen identified publications (comprising 18 individual studies) were coded on a number of characteristics, including consumption behaviour, participants, task, training and control conditions, number of training sessions and trials, outcome measure, and results. The results generally showed positive effects of approach-avoidance training, including reduced consumption behaviour in the laboratory, lower relapse rates, and improvements in self-reported measures of behaviour. Importantly, all studies (with one exception) that reported favourable consumption outcomes also demonstrated successful reduction of the approach bias for appetitive cues. Thus, the current review concluded that approach bias modification is effective for reducing both approach bias and unhealthy consumption behaviour.

Neuroimaging the Effectiveness of Substance Use Disorder Treatments

Neuroimaging techniques to measure the function and biochemistry of the human brain such as positron emission tomography (PET), proton magnetic resonance spectroscopy ((1)H MRS), and functional magnetic resonance imaging (fMRI), are powerful tools for assessing neurobiological mechanisms underlying the response to treatments in substance use disorders. Here, we review the neuroimaging literature on pharmacological and behavioral treatment in substance use disorder. We focus on neural effects of medications that reduce craving (e.g., naltrexone, bupropion hydrochloride, baclofen, methadone, varenicline) and that improve cognitive control (e.g., modafinil, N-acetylcysteine), of behavioral treatments for substance use disorders (e.g., cognitive bias modification training, virtual reality, motivational interventions) and neuromodulatory interventions such as neurofeedback and transcranial magnetic stimulation. A consistent finding for the effectiveness of therapeutic interventions identifies the improvement of executive control networks and the dampening of limbic activation, highlighting their values as targets for therapeutic interventions in substance use disorders.

Approach bias modification in inpatient psychiatric smokers

Drug-related automatic approach tendencies contribute to the development and maintenance of addictive behavior. The present study investigated whether a nicotine-related approach bias can be modified in smokers undergoing inpatient psychiatric treatment by using a novel training variant of the nicotine Approach-Avoidance-Task (AAT). Additionally, we assessed whether the AAT-training would affect smoking behavior. Inpatient smokers were randomly assigned to either an AAT-training or a sham-training condition. In the AAT-training condition, smokers were indirectly instructed to make avoidance movements in response to nicotine-related pictures and to make approach movements in response to tooth-cleaning pictures. In the sham-training condition, no contingency between picture content und arm movements existed. Trainings were administered in four sessions, accompanied by a brief smoking-cessation intervention. Smoking-related self-report measures and automatic approach biases toward smoking cues were measured before and after training. Three months after training, daily nicotine consumption was obtained. A total of 205 participants were recruited, and data from 139 participants were considered in the final analysis. Prior to the trainings, smokers in both conditions exhibited a stronger approach bias for nicotine-related pictures than for tooth-cleaning pictures. After both trainings, this difference was no longer evident. Although reduced smoking behavior at posttest was observed after both trainings, only the AAT-training led to a larger reduction of nicotine consumption at a three-month follow-up. Our preliminary data partially support the conclusion that the AAT might be a feasible tool to reduce smoking in the long-term in psychiatric patients, albeit its effect on other smoking-related measures remains to be explored.

The addicted brain: cognitive biases in problematic drinkers with mild to borderline intellectual disability

BACKGROUND

Substance use disorders (SUD) are associated with several neurobiological disruptions, including biases in attention and approach/avoidance behaviour. The aims of this study were to compare the strength of cognitive biases between light and problematic drinkers, to explore the role of IQ on the cognitive biases and to study the psychometric qualities of the measures.

METHOD

Participants (N = 130) were divided into four groups based on IQ and severity of alcohol use-related problems: light (n = 28) and problematic drinkers (n = 25) with (sub)average IQ and light (n = 33) and problematic drinkers (n = 44) with mild to borderline intellectual disability (MBID). All participants performed the visual dot probe task and the approach avoidance task to measure the strength of cognitive biases.

RESULTS

In contrast with the hypothesis, no cognitive biases were found in problematic drinkers. Full scale IQ nor level of craving influenced the strength of the cognitive biases in light and problematic drinkers, although IQ did influence task performance (i.e. large intra-individual, trial-to-trial variation in reaction time). The internal consistency of the visual dot probe task was good, whereas the internal consistency of the approach avoidance task was poor.

CONCLUSION

Cognitive biases seem to vary within the group of problematic drinkers as a whole. The psychometric qualities of the measures are problematic, especially in relation to the intra-individual variability in reaction time found in participants with MBID. Until the implications of this variability on the validity of implicit measures and establishing bias scores are more clear, the use of these measures in individuals with MBID calls for scrutiny.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

Prevention of sexually transmitted infections using mobile devices and ubiquitous computing

Background

Advances in the development of information and communication technologies have facilitated social interrelationships, but also sexual contacts without appropriate preventive measures. In this paper, we will focus on situations in which people use applications to meet sexual partners nearby, which could increase their chance of exposure to sexually transmitted infections (STI). How can we encourage users to adopt preventive measures without violating their privacy or infringing on the character of the application?

Methods

To achieve the goal of preventing STI, we have used the design and creation methodology and have developed a prototype software package. This prototype follows the RESTful services principles and has two parts: an Android OS application with emphasis on ubiquitous computing and designed according to General Responsibility Assignment Software Patterns (GRASP), and a server with a web page. To choose the preventive messages, we performed a test in 17 men who have sex with men (MSM).

Results

Our software sends preventive notifications to users when it detects situations such as the activation of particular applications on their smartphones, or their proximity to areas with a high probability of intercourse (hot zones). The underlying idea is the same as that for warning messages on cigarette packets, since users read the message just when they are going to smoke. The messages used have been selected from a list that has been rated by the users themselves. The most popular message is “Enjoy sex and enjoy life. Do not expose yourself to HIV”. The user is unaware of the software, which runs in the background.

Conclusions

Ubiquitous computing may be useful for alerting users with preventive and educational messages. The proposed application is non-intrusive because: 1) the users themselves decide to install it and, therefore, users’ privacy rights are preserved; 2) it sends a message that helps users think about taking appropriate preventive measures; and 3) it works in the background without interfering with users unless a trigger situation is detected. Thus, this type of application could become an important tool in the complex task of STI prevention.

"A cigarette a day keeps the goodies away": smokers show automatic approach tendencies for smoking--but not for food-related stimuli

Smoking leads to the development of automatic tendencies that promote approach behavior toward smoking-related stimuli which in turn may maintain addictive behavior. The present study examined whether automatic approach tendencies toward smoking-related stimuli can be measured by using an adapted version of the Approach-Avoidance Task (AAT). Given that progression of addictive behavior has been associated with a decreased reactivity of the brain reward system for stimuli signaling natural rewards, we also used the AAT to measure approach behavior toward natural rewarding stimuli in smokers. During the AAT, 92 smokers and 51 non-smokers viewed smoking-related vs. non-smoking-related pictures and pictures of natural rewards (i.e. highly palatable food) vs. neutral pictures. They were instructed to ignore image content and to respond to picture orientation by either pulling or pushing a joystick. Within-group comparisons revealed that smokers showed an automatic approach bias exclusively for smoking-related pictures. Contrary to our expectations, there was no difference in smokers’ and non-smokers’ approach bias for nicotine-related stimuli, indicating that non-smokers also showed approach tendencies for this picture category. Yet, in contrast to non-smokers, smokers did not show an approach bias for food-related pictures. Moreover, self-reported smoking attitude could not predict approach-avoidance behavior toward nicotine-related pictures in smokers or non-smokers. Our findings indicate that the AAT is suited for measuring smoking-related approach tendencies in smokers. Furthermore, we provide evidence for a diminished approach tendency toward food-related stimuli in smokers, suggesting a decreased sensitivity to natural rewards in the course of nicotine addiction. Our results indicate that in contrast to similar studies conducted in alcohol, cannabis and heroin users, the AAT might only be partially suited for measuring smoking-related approach tendencies in smokers. Nevertheless, our findings are of special importance for current etiological models and smoking cessation programs aimed at modifying nicotine-related approach tendencies in the context of a nicotine addiction.

Implicit motivational processes underlying smoking in american and dutch adolescents

INTRODUCTION

Research demonstrates that cognitive biases toward drug-related stimuli are correlated with substance use. This study aimed to investigate differences in cognitive biases (i.e., approach bias, attentional bias, and memory associations) between smoking and non-smoking adolescents in the US and the Netherlands. Within the group of smokers, we examined the relative predictive value of the cognitive biases and impulsivity related constructs (including inhibition skills, working memory, and risk taking) on daily smoking and nicotine dependence.

METHOD

A total of 125 American and Dutch adolescent smokers (n = 67) and non-smokers (n = 58) between 13 and 18 years old participated. Participants completed the smoking approach-avoidance task, the classical and emotional Stroop task, brief implicit associations task, balloon analog risk task, the self-ordering pointing task, and a questionnaire assessing level of nicotine dependence and smoking behavior.

RESULTS

The analytical sample consisted of 56 Dutch adolescents (27 smokers and 29 non-smokers) and 37 American adolescents (19 smokers and 18 non-smokers). No differences in cognitive biases between smokers and non-smokers were found. Generally, Dutch adolescents demonstrated an avoidance bias toward both smoking and neutral stimuli whereas the American adolescents did not demonstrate a bias. Within the group of smokers, regression analyses showed that stronger attentional bias and weaker inhibition skills predicted greater nicotine dependence while weak working memory predicted more daily cigarette use.

CONCLUSION

Attentional bias, inhibition skills, and working memory might be important factors explaining smoking in adolescence. Cultural differences in approach-avoidance bias should be considered in future research.

Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature

OBJECTIVE

The limited success of current smoking cessation therapies encourages research into new treatment strategies. Mind-body practices such as yoga and meditation have the potential to aid smoking cessation and become an alternative drug-free treatment option. The aim of this article is to assess the efficacy of yoga and other meditation-based interventions for smoking cessation, to identify the challenges of clinical trials applying mind-body treatments, and to outline directions for future research on these types of therapies to assist in smoking cessation.

METHODS

A systematic review of the scientific literature.

RESULTS

Fourteen clinical trials met the inclusion criteria defined for this review. Each article was reviewed thoroughly, and evaluated for quality, design, and methodology. Although primary outcomes differed between studies, the fourteen articles, most with limitations, reported promising effects supporting further investigation of the use of these practices to improve smoking cessation.

CONCLUSIONS

The literature supports yoga and meditation-based therapies as candidates to assist smoking cessation. However, the small number of studies available and associated methodological problems require more clinical trials with larger sample sizes and carefully monitored interventions to determine rigorously if yoga and meditation are effective treatments.

Automatic approach bias towards smoking cues is present in smokers but not in ex-smokers

RATIONALE

Drug-addicted individuals show automatic approach tendencies towards drug-related cues, i.e., an approach bias (ApB). Nevertheless, little is known about ApB in tobacco smokers and about the presence of ApB after smoking abstinence.

OBJECTIVES

We investigated ApB to smoking cues in heavy tobacco smokers versus never-smokers and studied its relation to smoking characteristics and craving. Second, we compared ApBs of heavy smokers with biases of abstinent heavy smokers.

METHOD

A group of current heavy smokers (n = 24), ex-smokers who were abstinent for at least 5 years (n = 20), and never-smokers (n = 20) took part in the experiment. An indirect smoking approach avoidance task was performed, in which participants were required to respond to pictures of smoking and neutral cues by pulling (approach) or pushing (avoid) on a joystick, according to the content-irrelevant format of the picture (landscape or portrait). Craving scores were examined using the Questionnaire of Smoking Urges.

RESULTS

Heavy smokers showed an ApB for smoking cues compared to ex-smokers and never-smokers, which correlated positively to craving scores. There were no group differences in ApB scores for ex-smokers and never-smokers.

CONCLUSION

These results suggest that ApBs for smoking cues are present in heavy smokers and decrease after long-term successful smoking cessation.

Cannabis intoxication inhibits avoidance action tendencies: a field study in the Amsterdam coffee shops

RATIONALE

Experimental laboratory studies suggest that the approach bias (relatively fast approach responses) toward substance-related materials plays an important role in problematic substance use. How this bias is moderated by intention to use versus recent use remains unknown. Moreover, the relationship between approach bias and other motivational processes (satiation and craving) and executive functioning remains unclear.

OBJECTIVES

The aim of this study was to investigate the cannabis approach bias before and after cannabis use in real-life setting (Amsterdam coffee shops) and to assess the relationship between approach bias, craving, satiation, cannabis use, and response inhibition.

METHODS

Cannabis, tobacco, and neutral approach and avoidance action tendencies were measured with the Approach Avoidance Task and compared between 42 heavy cannabis users with the intention to use and 45 heavy cannabis users shortly after cannabis use. The classical Stroop was used to measure response inhibition. Multiple regression analyses were conducted to investigate relationships between approach bias, satiation, craving, cannabis use, and response inhibition.

RESULTS

In contrast to the hypotheses, heavy cannabis users with the intention to use did not show a cannabis approach bias, whereas intoxicated cannabis users did show an approach bias regardless of image category. This could be attributed to a general slowing of avoidance action tendencies. Moreover, craving was negatively associated with the approach bias, and no relationships were observed between the cannabis approach bias, satiation, prior cannabis use, and response inhibition.

CONCLUSION

Cannabis intoxication in a real-life setting inhibited general avoidance. Expression of the cannabis approach bias appeared not to be modulated by satiation or response inhibition.

Neural mechanisms underlying ecstasy-related attentional bias

Conditioned responses to cues associated with drug taking play a pivotal role in a number of theories of drug addiction. This study examined whether attentional biases towards drug-related cues exist in recreational drug users who predominantly used ecstasy (3,4-methylenedioxymethamphetamine). Experiment 1 compared 30 ecstasy users, 25 cannabis users, and 30 controls in an attentional distraction task in which neutral, evocative, and ecstasy-related pictures were presented within a coloured border, requiring participants to respond as quickly as possible to the border colour. Experiment 2 employed functional magnetic resonance imaging (fMRI) and the attentional distraction task and tested 20 ecstasy users and 20 controls. Experiment 1 revealed significant response speed interference by the ecstasy-related pictures in the ecstasy users only. Experiment 2 revealed increased prefrontal and occipital activity in ecstasy users in all conditions. Activations in response to the ecstasy stimuli in these regions showed an apparent antagonism whereby ecstasy users, relative to controls, showed increased occipital but decreased right prefrontal activation. These results are interpreted to reflect increased visual processing of, and decreased prefrontal control over, the irrelevant but salient ecstasy-related stimuli. These results suggest that right inferior frontal cortex may play an important role in controlling drug-related attentional biases and may thus play an important role in mediating control over drug usage.

Cognitive biases in individuals with mild to borderline intellectual disability and alcohol use-related problems

The primary aim of the present pilot study was to examine cognitive biases in individuals with mild to borderline ID and alcohol use-related problems. Participants (N=57) performed the approach avoidance task, picture rating task and visual dot probe task, which was combined with eye-tracking methodology. They were admitted to a forensic setting and were all abstinent and undergoing treatment at the time of testing. Three groups were formed based on the severity of alcohol use-related problems as measured by the AUDIT. In line with the expectations, no differences were found between participants based on the severity of their alcohol use-related problems. In addition, three groups were formed based on IQ to assess the relationship between IQ and the strength of the cognitive biases. There were also no differences between individuals with mild or borderline ID and individuals with (below) average IQ on any of the variables. It is concluded that computer tasks such as these can be used in individuals with mild to borderline ID. As the results suggest no influence of IQ on the strength of cognitive biases, this study opens up new opportunities for future research on the application of measuring cognitive biases in screening, diagnosing and treating individuals with mild to borderline ID and alcohol use-related problems.

Motivational Mechanisms and Outcome Expectancies Underlying the Approach Bias toward Addictive Substances

Human behavior can be paradoxical, in that actions can be initiated that are seemingly incongruent with an individual’s explicit desires. This is most commonly observed in drug addiction, where maladaptive behavior (i.e., drug seeking) appears to be compulsive, continuing at great personal cost. Approach biases toward addictive substances have been correlated with actual drug-use in a number of studies, suggesting that this measure can, in some cases, index everyday maladaptive tendencies. At present it is unclear whether this bias to drug cues is a Pavlovian conditioned approach response, a habitual response, the result of a Pavlovian-instrumental transfer process, or a goal-directed action in the sense that expectancy of the rewarding effects of drugs controls approach. We consider this question by combining the theoretical framework of associative learning with the available evidence from approach bias research. Although research investigating the relative contributions of these mechanisms to the approach bias is to date relatively limited, we review existing studies and also outline avenues for future research.

Attentional bias for smoking-related information in pregnant women: relationships with smoking experience, smoking attitudes and perceived harm to foetus

According to recent models of drug dependence, attentional bias for drug cues provides an index of vulnerability to drug-taking and relapse. The present study examined attentional bias for smoking-related information in pregnant women and its relationship with smoking experience and attitudes. Participants were 71 pregnant women (35 without smoking experience; 36 with experience of smoking, of whom 16 reported currently smoking). Attentional bias was assessed from the interference index of smoking-related words on a modified Stroop task. The attentional bias for smoking cues was positively associated with smoking experience, and with more favourable general attitudes to smoking (i.e. incentive-related bias). The bias was also greater in women who perceived greater harm of passive smoking to their foetus (i.e. threat-related bias), which was independent of smoking experience. Results indicate that attentional bias for smoking-related cues is independently associated with both incentive-related (reward) and threat-related (aversive) evaluations of cigarette smoking in pregnant women. This work highlights the need for longitudinal research to investigate whether the attentional bias provides a cognitive index of vulnerability for persistent smoking behaviour both during and after pregnancy.

Problematic alcohol use and mild intellectual disability: standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.

Mechanisms of attention to conditioned stimuli predictive of a cigarette outcome

Attention to stimuli associated with a rewarding outcome may be mediated by the incentive motivational properties that the stimulus acquires during conditioning. Other theories of attention state that the prediction error (the discrepancy between the expected and the actual outcome) during conditioning guides attention; once the outcome is fully predicted, attention should be abolished for the conditioned stimulus. The current study examined which of these mechanisms is dominant in conditioning when the outcome is highly rewarding. Allocation of attention to stimuli associated with cigarettes (the rewarding outcome) was tested in 16 smokers, who underwent a classical conditioning paradigm, where abstract visual stimuli were paired with a tobacco outcome. Stimuli were associated with 100% (stimulus A), 50% (stimulus B), or 0% (stimulus C) probability of receiving tobacco. Attention was measured using an eye-tracker device, and the appetitive value of the stimuli was measured with subjective pleasantness ratings during the conditioning process. Dwell time bias (duration of eye gaze) was greatest overall for the A stimulus, and increased over conditioning. Attention to stimulus A was dependent on the ratings of pleasantness that the stimulus evoked, and on the desire to smoke. These findings appear to support the theory that attention for conditioned stimuli is dominated by the incentive motivational qualities of the outcome they predict, and implicate a role for attention in the maintenance of addictive behaviours like smoking.

Differences in "bottom-up" and "top-down" neural activity in current and former cigarette smokers: Evidence for neural substrates which may promote nicotine abstinence through increased cognitive control

Drug-related stimuli, through conditioning, are thought to acquire incentive motivational properties that code possible reward availability and elicit an attentional bias, possibly through increased "bottom-up" neural processing. The processes underlying this attentional bias are considered important in the maintenance of addiction, and crucially, in relapse among substance users attempting to remain abstinent. Equally, impaired "top-down" cognitive control may impair the ability to restrain "bottom-up" pre-potent behaviours, such as drug use, following exposure to drug-related stimuli. Two experiments sought to identify the neural loci of bottom-up/top-down processing during fMRI. Experiment 1 utilised an attentional bias paradigm to examine the behavioural and neural responses to neutral, emotionally evocative and smoking-related cues in control (n=13), ex-smoking (n=10 - abstinent >12months) and smoking (n=13 - mean >6.5years of use) groups. Experiment 2 used a go/no-go paradigm to examine the neural correlates of motor response inhibition and error monitoring in the same sample. The results of Experiment 1 demonstrated that, across conditions, current smokers had significantly less neural activity in cortical but significantly more activity in subcortical areas compared to both controls and ex-smokers. Ex-smokers exhibited more neural activity than both control and smoker groups in prefrontal cortical regions. Similarly, Experiment 2 revealed that smokers had reduced neural activity in prefrontal cortical regions during motor response inhibition compared to controls while ex-smokers demonstrated greater neural activity in prefrontal cortical regions compared to both controls and smokers during error monitoring. The results reveal cortical and subcortical differences between current smokers and controls and a general pattern of increased prefrontal cortical activity in ex-smokers. These findings may suggest that elevated topdown control might be an important characteristic of successful abstinence in individuals formerly dependent on nicotine.

Is smoking-related attentional bias a useful marker for treatment effects?

Theoretical models of nicotine abuse suggest that preferential attention allocation towards smoking-related stimuli plays an important role in the development and maintenance of smoking behavior. However, little is known about the impact of standard treatment programs for nicotine cessation on this effect. In the current study, we investigated smoking-related attentional bias using a visual dot probe task and an emotional Stroop task before and after a standard behavioral group therapy. Smokers (n=39) who received treatment, a smoker control group without treatment (n=20) and a non-smoker control group (n=20) were investigated. Although we found a reduction in attentional bias scores after successful treatment, this effect failed to reach statistical significance. Of note, we observed a low test-retest reliability in low-dependence smokers in both tasks which is a substantial limitation for using these paradigms in longitudinal studies. Additionally, there was no significant correlation between the attentional bias scores from both tasks.

Relation of dietary restraint scores to cognitive biases and reward sensitivity

This study tested the hypotheses that dietary restraint scores are associated with greater reward sensitivity and cognitive bias for food-related cues, which might result in chronic overeating and efforts to curb this tendency through dietary restriction. Participants (N=63) with high versus low scores on the DEBQ-R did not differ on attentional bias for pictorial food-related cues on a visual probe task, or approach tendencies elicited by food cues, as assessed with a stimulus-response compatibility (SRC) task. Restraint was also unrelated to performance on an operant task that assessed how hard participants would work for snacks, or responding during a taste habituation paradigm. Dietary restraint scores were correlated with self-reported appetitive response to food, sensitivity to reward, and sensitivity to punishment. Results provide limited support for the hypothesis that individuals with elevated dietary restraint scores show greater reward sensitivity and cognitive bias for food stimuli, though it is possible that the null findings on the behavioral task resulted because of an approach-avoidance conflict to food cues in which heightened appetitive responses to food are inhibited by food-related anxiety.

The associative basis of cue-elicited drug taking in humans

RATIONALE

Drug cues play an important role in motivating human drug taking, lapse and relapse, but the psychological basis of this effect has not been fully specified.

METHOD

To clarify these mechanisms, the study measured the extent to which pictorial and conditioned tobacco cues enhanced smoking topography in an ad libitum smoking session simultaneously with cue effects on subjective craving, pleasure and anxiety.

RESULTS

Both cue types increased the number of puffs consumed and craving, but pleasure and anxiety responses were dissociated across cue type. Moreover, cue effects on puff number correlated with effects on craving but not pleasure or anxiety. Finally, whereas overall puff number and craving declined across the two blocks of consumption, consistent with burgeoning satiety, cue enhancement of puff number and craving were both unaffected by satiety.

CONCLUSIONS

Overall, the data suggest that cue-elicited drug taking in humans is mediated by an expectancy-based associative learning architecture, which paradoxically is autonomous of the current incentive value of the drug.

A meta-analytic investigation of the relationship between attentional bias and subjective craving in substance abuse

Theoretical models of addiction suggest that attentional bias for substance-related cues should be associated with self-reported craving. The authors evaluated the strength of the association by performing a meta-analysis on 68 independent data sets from which correlation coefficients between subjective craving and attentional bias indices were derived. Additional stratified analyses were conducted to identify any variables that might moderate the association between craving and attentional bias. The primary meta-analysis indicated a significant, albeit weak (r=.19), association between attentional bias and craving. Stratified analyses revealed that the association was larger for illicit drug and caffeine craving than for alcohol and tobacco craving, larger for direct measures of attention (eye movement measures and event-related potential measures) than for indirect behavioral measures of attentional bias, and larger when craving strength was high than when it was low (all ps<.05). The size of the correlation did not differ among patients in treatment and individuals who were not seeking treatment. These results suggest that attentional bias and craving are related phenomena, although the relationship is generally modest and appears to be moderated by various factors. Theoretical implications are discussed.