title: Lack of attentional retraining effects in cigarette smokers attempting cessation: a proof of concept double-blind randomised controlled trial.
abstract: BACKGROUND
  Observational studies have shown that attentional bias for smoking-related cues is associated with increased craving and relapse. Laboratory experiments have shown that manipulating attentional bias may change craving. Interventions to reduce attentional bias could reduce relapse in smokers seeking to quit. We report a clinical trial of attentional retraining in treatment-seeking smokers.
  
  
  METHODS
  This was a double-blind randomised controlled trial that took place in UK smoking cessation clinics. Smokers interested in quitting were randomised to five weekly sessions of attentional retraining (N=60) or placebo training (N = 58) using a modified visual probe task from one week prior to quit day. Both groups received 21 mg nicotine patches (from quit day onwards) and behavioural support. Primary outcomes included change in attentional bias reaction times four weeks after quit day on the visual probe task and craving measured weekly using the Mood and Physical Symptoms Scale. Secondary outcomes were changes in withdrawal symptoms, time to first lapse and prolonged abstinence.
  
  
  RESULTS
  No attentional bias towards smoking cues was found in the sample at baseline (mean difference = 3 ms, 95% CI = -2, 9). Post-training bias was not significantly lower in the retraining group compared with the placebo group (mean difference = -9 ms, 95% CI = -20, 2). There was no difference between groups in change in craving (p = 0.89) and prolonged abstinence at four weeks (risk ratio = 1.00, 95% CI = 0.70, 1.43).
  
  
  CONCLUSIONS
  Taken with one other trial, there appears to be no effect from clinic-based attentional retraining using the visual probe task. Attentional retraining conducted out of clinic may prove more effective.
  
  
  BACKGROUND
  UK Clinical Trials ISRCTN 54375405.
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK. Electronic address: rachna.begh@phc.ox.ac.uk.
authors.forename: Rachna
authors.initials: R
authors.lastname: Begh
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol BS8 2BN, UK.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Munafò
authors.affiliation: Department of Psychology, University of Pittsburgh, Sennott Square, 3rd Floor, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.
authors.forename: Saul
authors.initials: S
authors.lastname: Shiffman
authors.affiliation: School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS 7001, Australia.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Ferguson
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Nichols
authors.affiliation: School of Health Studies, University of Bradford, Bradford BD7 1DP, UK.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Mohammed
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Holder
authors.affiliation: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge CB2 1TN, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutton
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
mesh_terms: D000328:Adult; D001288:Attention; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D066249:Craving; D003463:Cues; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011930:Reaction Time; D016540:Smoking Cessation; D013997:Time Factors; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Attentional bias; Attentional retraining; Cigarette smoking; Craving; Smoking cessation