title: The approach-avoidance task as an online intervention in cigarette smoking: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany. Electronic address: c.wittekind@uke.uni-hamburg.de.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Wittekind
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Feist
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Brooke C
authors.initials: BC
authors.lastname: Schneider
authors.affiliation: University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.affiliation: University Hamburg, Department of Psychology and Psychotherapy, Von-Melle-Park 5, 20246 Hamburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Fritzsche
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001362:Avoidance Learning; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D010865:Pilot Projects; D011930:Reaction Time / Q000502:physiology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Approach-avoidance task; Cessation; Cognitive bias modification; Retraining; Smoking