The best available treatments do not prevent the majority of smokers from relapsing within a year of cessation. While background craving subsides with extended abstinence, smoking cue-induced craving can increase with abstinence and precipitate smoking relapse. It has been well documented that in vivo and in vitro smoking cue exposure in the laboratory sensitizes smokers to cigarettes (i.e., increases their cravings). To date, cue exposure has not involved the repetitive imaginal exposure that would normally be experienced when a smoker is actually smoking. Decades of research examining the overlap between perception and mental imagery, suggests that mentally simulating smoking a cigarette in a manner analogous to actually smoking should lead to habituation or a decrease in a smoker's motivation to smoke and hedonic response to a cigarette. In other words, performing the mental imagery that would accompany smoking should evoke the same response as actually smoking - habituation to cigarettes. Using a validated human laboratory model of smoking relapse, the proposed study will break new ground by determining whether repetitive mental simulation of smoking can engender habituation thereby reducing cravings, the reinforcing value of smoking, cigarette consumption, and the hedonic response to cigarette smoking (liking). These hypotheses will be tested in smokers (n=60) ages 18-55 years old using a 2 (Cue: Smoking, Neutral) x 2 (Imagery: Repetitive, Limited) within-subjects design. The order of the four conditions will be counterbalanced. We will explore whether repetitive imagery diminishes the impact of smoking cue exposure on heart rate and skin conductance (two physiological indices of cue-reactivity) and smoking intensity (CO boost). Whether affective mechanisms account, in part, for the effects of repetitive imagery on the outcomes will also be explored. By exploiting the overlap between perception and mental imagery, the proposed study will uncover a unique, counterintuitive and portable approach to immediately manage cue-induced craving without the contextual dependency of cue exposure therapy, the drug state dependency of medication, the cognitive expense of craving suppression and the cue avoidance of mainstay treatment strategies that may potentiate craving. If the hypotheses are supported, these findings would suggest that cognitive strategies that directly engage cue-induced craving through repetitive smoking imagery may be more effective than long- standing strategies. Identification of novel strategies that can be easily implemented after cue exposure to alter craving and smoking behavior may decrease the likelihood of smoking lapse and relapse.
The best available treatments do not prevent the majority of smokers from relapsing within a year of cessation. While background craving subsides with extended abstinence, smoking cue-induced craving increases with abstinence and can precipitate smoking relapse. Investigation of novel cognitive approaches to reduce smoking cue associated craving and alter smoking behavior, may ultimately decrease the likelihood of smoking relapse.
|Audrain-McGovern, Janet; Strasser, Andrew A; Wileyto, E Paul (2016) Can repetitive mental simulation of smoking engender habituation? Exp Clin Psychopharmacol 24:415-422|