title: Counterbalancing in smoking cue research: a critical analysis.
abstract: BACKGROUND
  Cue exposure research has been used to examine key issues in smoking research, such as predicting relapse, testing new medications, investigating the neurobiology of nicotine dependence, and examining reactivity among smokers with comorbid psychopathologies. Determining the order that cues are presented is one of the most critical steps in the design of these investigations. It is widely assumed that cue exposure studies should counterbalance the order in which smoking and control (neutral) cues are presented. This article examines the premises underlying the use of counterbalancing in experimental research, and it evaluates the degree to which counterbalancing is appropriate in smoking cue exposure studies.
  
  
  METHODS
  We reviewed the available literature on the use of counterbalancing techniques in human smoking cue exposure research.
  
  
  RESULTS
  Many studies counterbalancing order of cues have not provided critical analyses to determine whether this approach was appropriate. Studies that have reported relevant data, however, suggest that order of cue presentation interacts with type of cue (smoking vs. control), which raises concerns about the utility of counterbalancing. Primarily, this concern arises from potential carryover effects, in which exposure to smoking cues affects subsequent responding to neutral cues.
  
  
  CONCLUSIONS
  Cue type by order of cue interactions may compromise the utility of counterbalancing. Unfortunately, there is no obvious alternative that is optimal across studies. Strengths and limitations of several alternative designs are considered, and key questions are identified to advance understanding of the optimal conditions for conducting smoking cue exposure studies.
authors.affiliation: Department of Psychology, 3137 Sennott Square, University of Pittsburgh, Pittsburgh, PA 15260, USA. sayette@pitt.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Sayette
authors.forename: Kasey M
authors.initials: KM
authors.lastname: Griffin
authors.forename: W Michael
authors.initials: WM
authors.lastname: Sayers
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D003463:Cues; D006801:Humans; D009042:Motivation; D012107:Research Design; D055502:Secondary Prevention; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*