Lower motivation for rewarded mental effort in tobacco dependence.

Tobacco dependence is characterized by decision-making impairments, which may increase the risk of smoking relapse by lowering the capacity to resist the immediate gratification of nicotine consumption. Because controlling one's desires for immediate rewards is experienced as effortful, aversion to effortful control processes may also influence the prospects of successful smoking cessation. We therefore tested whether persons who smoke, compared with persons who do not smoke, show a lower willingness to engage in goal-directed mental effort. Thirty-seven persons who smoke and 38 persons who do not smoke performed a decision task requiring choices on whether to exert a demanding attention task for monetary rewards. Using state-of-the-art drift-diffusion modeling, we found that persons who smoke showed a stronger starting bias toward effort-free rewards. Taken together, our process model approach allowed us to identify the subcomponents of the decision process underlying the stronger aversion against mental effort in tobacco dependence, which may contribute to altered decision making by lowering the motivation to engage in effortful control processes when trying to suppress the desire for nicotine consumption. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Metacognitive deficits are associated with lower sensitivity to preference reversals in nicotine dependence.

Deficits in impulse control belong to the core profile of nicotine dependence. Smokers might thus benefit from voluntarily self-restricting their access to the immediate temptation of nicotine products (precommitment) in order to avoid impulse control failures. However, little is known about how smokers' willingness to engage in voluntary self-restrictions is determined by metacognitive insight into their general preferences for immediate over delayed rewards. Here, with a series of monetary intertemporal choice tasks, we provide empirical evidence for reduced metacognitive accuracy in smokers relative to non-smokers and show that smokers overestimate the subjective value of delayed rewards relative to their revealed preferences. In line with the metacognitive deficits, smokers were also less sensitive to the risk of preference reversals when deciding whether or not to restrict their access to short-term financial rewards. Taken together, the current findings suggest that deficits not only in impulse control but also in metacognition may hamper smokers' resistance to immediate rewards and capacity to pursue long-term goals.

Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial.

BACKGROUND: Although effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated. METHODS: The study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures. DISCUSSION: This is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00019221 , 11/11/2019.

Web-based Approach Bias Modification in smokers: A randomized-controlled study.

Smoking is associated with automatic approach tendencies towards smoking-related stimuli. Therefore, it has been investigated whether training smoking individuals to consistently avoid smoking-related stimuli exerts positive effects on smoking behavior (Approach-Bias Modification [AppBM]). A web-based pilot study provided preliminary evidence for the effectiveness of AppBM in smokers; however, interpretability was constrained by several limitations. The aim of the present study was to replicate and extend previous findings. A web-based three group parallel (1:1:1) randomized-controlled study with adult smokers (N = 149) was conducted (DRKS00011901). Upon completion of a baseline assessment, participants were randomized to either six sessions of AppBM or Sham training or a waitlist control group. In both trainings, participants were presented smoking-related and neutral pictures. While all smoking-related pictures were associated with pushing and all neutral pictures with pulling in AppBM training, the contingency was 50:50 in Sham training. Participants were re-assessed directly and six months after training. Primary outcome was daily cigarette consumption at follow-up. At follow-up, no significant group differences emerged, although AppBM training significantly reduced daily cigarette consumption directly after training. No consistent change of bias through AppBM training emerged. This study does not provide support for the long-term effectiveness of AppBM training as a stand-alone training in smoking. PRE-REGISTRATION: German Clinical Trials Register (DRKS00011901).

Approach-avoidance modification as an add-on in smoking cessation: A randomized-controlled study.

Biases in information processing are attributed an important role in the maintenance of tobacco dependence. As these biases are not sufficiently taken into account in current treatments, the aim of the present study was to investigate whether clinical outcome can be improved by combining treatment-as-usual (TAU) with Approach-Avoidance Modification Training (AAMT). A two group parallel (1:1) randomized-controlled single-blind study with adult smokers (N = 105) was conducted (DRKS00011406). Participants received three sessions of TAU and either six sessions of AAMT or Sham training. During AAMT, participants were trained to implicitly avoid all smoking-related and to approach all smoking-unrelated pictures, while the contingency was 50:50 in Sham training. Participants were assessed after the intervention and 6 months later. Primary outcome was daily cigarette consumption at follow-up. Participants receiving TAU + AAMT did not show a significantly greater reduction of daily cigarette consumption at follow-up compared to TAU + Sham (per-protocol: 95% CI: -2.56-4.89, p = .608; intention-to-treat: 95% CI: -3.11-2.96, p = .968). Using an implicit AAMT (vs. Sham) as an add-on to TAU did not improve clinical outcome. However, no consistent evidence for a change of bias was found. It is important for future research to explore the effectiveness of optimized training versions (e.g., explicit instructions). PRE-REGISTRATION: German Clinical Trials Register (DRKS00011406).

The approach-avoidance task as an online intervention in cigarette smoking: a pilot study.

BACKGROUND AND OBJECTIVES: Dual-process models posit that addictive behaviors are characterized by strong automatic processes that can be assessed with implicit measures. The present study investigated the potential of a cognitive bias modification paradigm, the Approach-Avoidance Task (AAT), for retraining automatic behavioral tendencies in cigarette smoking. METHODS: The study was set up as an online intervention. After completing an online survey, 257 smokers were randomly allocated either to one of two experimental conditions (AAT) or a waitlist control group. Participants responded to different pictures by pushing or pulling the computer mouse, depending on the format of the picture. Pictures in portrait format depicted smoking-related items and were associated with pushing, pictures in landscape format depicted neutral items and were associated with pulling. One version of the AAT provided individual feedback after each trial whereas the standard version did not. After four weeks, participants were re-assessed in an online survey. RESULTS: Analyses revealed that the standard AAT, in particular, led to a significant reduction in cigarette consumption, cigarette dependence, and compulsive drive; no effect was found in the control group. LIMITATIONS: Interpretability of the study is constrained by the fact that no active control condition was applied. CONCLUSIONS: Notwithstanding the limitations, our findings indicate that the AAT might be a feasible instrument to reduce tobacco dependence and can be applied as an online intervention. Future studies should investigate whether the effects of behavior therapy can be augmented when combined with retraining interventions.