title: Cue exposure and response prevention with heavy smokers: a laboratory-based randomised placebo-controlled trial examining the effects of D-cycloserine on cue reactivity and attentional bias.
abstract: BACKGROUND
  Treatments based on exposure/response prevention (Exp/RP) produce only modest benefits in substance dependence disorders. However, a new strategy, which has shown promise in animal models of addiction involves combining Exp/RP with extinction-enhancing pharmacological treatments. A prototype of the latter is D-cycloserine (DCS), a partial agonist at the glycine site of the NMDA receptor.
  
  
  METHODS
  In a laboratory-based randomised, double-blind, placebo-controlled trial with non-treatment-seeking heavy smokers (n = 32), we examined the efficacy of Exp/RP combined with DCS (125 mg). Two sessions of Exp/RP were carried out during which cue reactivity was monitored. Effects on attentional bias and/or subjective craving and smoking behaviour were also evaluated after at least 48 h and 2 weeks following session 2 of Exp/RP.
  
  
  RESULTS
  Within- and between-session reductions in cue reactivity were observed in both treatment groups, although the DCS group did not show an enhanced reduction by the end of session 2. However, a subtle effect of DCS on the emotionality subscale of the Tobacco Craving Questionnaire was observed, with a trend towards a sustained reduction in this aspect of craving at 2-week follow-up.
  
  
  CONCLUSIONS
  Our findings suggest that two sessions of Exp/RP combined with DCS does not enhance the reduction in episodic cue reactivity in non-treatment seeking smokers. A trend towards a greater sustained reduction in the emotionality scale of the TCQ in the DCS group suggests that further detailed study of the effects of combined Exp/RP-DCS on different aspects of craving is warranted, especially in smokers with a current intention to quit.
authors.affiliation: Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK. sunjeevk@hotmail.com
authors.forename: Sunjeev K
authors.initials: SK
authors.lastname: Kamboj
authors.forename: Alyssa
authors.initials: A
authors.lastname: Joye
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Das
authors.forename: Andrew J W
authors.initials: AJ
authors.lastname: Gibson
authors.forename: Celia J A
authors.initials: CJ
authors.lastname: Morgan
authors.forename: H Valerie
authors.initials: HV
authors.lastname: Curran
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects*; D003463:Cues; D003523:Cycloserine / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005108:Extinction, Psychological / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D003523:Cycloserine
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