Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study

Abstract

Background: This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers. Methods: Sixty adolescent smokers received four weeks of Cognitive Behavioral Therapy (CBT) for smoking cessation, with CBM (90% avoidance/10% approach for smoking stimuli and 10% avoidance/90% approach for neutral stimuli) or sham (50% avoidance/50% approach for smoking and neutral stimuli) training in the Netherlands (n = 42) and the United States (n = 18). Results: While we did not observe changes in action tendencies related to CBM, adolescents with higher smoking approach biases at baseline had greater decreases in approach biases at follow-up, compared to adolescents with smoking avoidance biases, regardless of treatment condition (p = 0.01). Intent-to-treat (ITT) analyses showed that CBM, when compared with sham trended toward higher end-of-treatment, biochemically-confirmed, seven-day point prevalence abstinence, (17.2% vs. 3.2%, p = 0.071). ITT analysis also showed that regardless of treatment condition, cotinine level (p = 0.045) and average number of cigarette smoked (p ≤ 0.001) significantly decreased over the course of treatment. Conclusions: The findings from this pilot study suggests that re-training approach biases toward cigarettes shows promise for smoking cessation among adolescent smokers. Future research should utilize larger samples and increased distinction between CBM and sham conditions, and examine mechanisms underlying the CBM approach.

• Adolescents
• approach-avoidance task
• attentional bias
• cognitive bias modification
• intervention
• smoking

Acknowledgements

We would like to thank Anne-Sophie Schürmann, Mirtemaaij van Schooten, Rianne Zomer, Xia Stevens, Marion Velten, Roos Knijnenburg and Wenda Frederiks for their assistance in the study.

Funding

This work was funded by a bi-national grant, jointly awarded to the two senior authors (SKS: National Institute on Drug Abuse supplement to R01DA01596 and P50 DA009241. RW: ZONMW grant: 60-60600-97-305). ES is supported by a grant from the Dutch National Science Foundation (VENI 451-10-029).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Supplementary material available online

Data preparation and Supplementary Table 1.

Notes

¹We also conducted survival analysis (time to first lapse) and found no significant differences between the treatment condition in time to first lapse during treatment (Wald χ²= 0.12, p = 0.73).