Decline in cue-provoked craving during cue exposure therapy for smoking cessation.
BACKGROUND
Based on the principles of Pavlovian learning and extinction, cue exposure therapy (CET) involves repeated exposure to substance-associated cues to extinguish conditioned cravings and reduce the likelihood of relapse. The efficacy of CET is predicated on successful extinction, yet the process of extinction in CET trials has rarely been demonstrated. This study explored the extinction process using a cue-reactivity paradigm in smokers undergoing multiple CET sessions as part of a comprehensive smoking cessation treatment.


METHODS
The sample comprised 76 moderately dependent, treatment-seeking smokers who completed at least 4 CET sessions and 6 counseling sessions. The CET and counseling sessions were scheduled twice weekly, and participants began using transdermal nicotine replacement therapy on their quit day, which occurred prior to initiation of CET. Each CET session consisted of presentation of 140 images on a computer screen, with self-reported craving as the primary measure of cue reactivity.


RESULTS
Mixed-model analyses revealed a progressive decline in cue-provoked craving both within and across 6 sessions of CET. Moderator analyses showed that the decline in craving was greatest among those who displayed initial cue reactivity.


CONCLUSIONS
These data are consistent with the premise that CET can produce extinction of laboratory-based cue-provoked smoking cravings and highlight important individual differences that may influence extinction. Implications for conducting cue exposure research and interventions are discussed.
Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
Marina
M
Unrod
David J
DJ
Drobes
Paul R
PR
Stasiewicz
Joseph W
JW
Ditre
Bryan
B
Heckman
Ralph R
RR
Miller
Steven K
SK
Sutton
Thomas H
TH
Brandon
D000328:Adult; D003463:Cues; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000523:psychology; D016896:Treatment Outcome