Extinction Updating in Reconsolidation
| Status: | Completed |
|---|---|
| Conditions: | Smoking Cessation, Smoking Cessation, Psychiatric, Tobacco Consumers |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | December 2013 |
| End Date: | September 2015 |
Reducing Smoking Cue Reactivity and Behavior Via Retrieval-Extinction Mechanism
Smoking occurs in approximately 21% of the US population, is responsible for an annual
mortality rate of approximately 438,000 citizens, and has an associated healthcare economic
burden of $167 billion. Although pharmacotherapies have improved cessation outcome, the vast
majority of individuals making quit attempts relapse within 5-10 days of cessation. The
hypotheses to be examined in this study may have potentially important implications for
smoking cessation treatment and will, therefore, target the single greatest
addiction-related cause of morbidity and mortality.This study will investigate a novel
behavioral strategy for altering important memory processes that underlie human
smoking-related nicotine addiction. This strategy used in this study employs established cue
exposure procedures to putatively update smoking-related memory with information that will
suppress responding to smoking cues. The goal here is to alter existing nicotine-related
memory directly rather than rely exclusively on the establishment of an inhibitory
extinction process, via traditional cue exposure therapy, which is known to be vulnerable to
spontaneous recovery, renewal and reinstatement. Positive findings would represent a
significant advance in exposure-based therapy for addiction and could lead to a treatment
that uniquely targets the problem of cue-elicited craving and reactivity, thereby addressing
a major obstacle to successful smoking cessation.
mortality rate of approximately 438,000 citizens, and has an associated healthcare economic
burden of $167 billion. Although pharmacotherapies have improved cessation outcome, the vast
majority of individuals making quit attempts relapse within 5-10 days of cessation. The
hypotheses to be examined in this study may have potentially important implications for
smoking cessation treatment and will, therefore, target the single greatest
addiction-related cause of morbidity and mortality.This study will investigate a novel
behavioral strategy for altering important memory processes that underlie human
smoking-related nicotine addiction. This strategy used in this study employs established cue
exposure procedures to putatively update smoking-related memory with information that will
suppress responding to smoking cues. The goal here is to alter existing nicotine-related
memory directly rather than rely exclusively on the establishment of an inhibitory
extinction process, via traditional cue exposure therapy, which is known to be vulnerable to
spontaneous recovery, renewal and reinstatement. Positive findings would represent a
significant advance in exposure-based therapy for addiction and could lead to a treatment
that uniquely targets the problem of cue-elicited craving and reactivity, thereby addressing
a major obstacle to successful smoking cessation.
We propose to examine the effects of two sessions of retrieval-extinction (R-E) training in
smokers who are making a quit attempt. Retrieval will be initiated by a brief (5-min.) video
with smoking-related content and the extinction will consist of protracted (1 hr.) exposure
to smoking cues. A control group receiving the same treatment except that the retrieval
video will have nonsmoking/neutral content will serve to demonstrate that retrieval is a key
feature of R-E training. Effects of training on smoking craving and cue reactivity will be
assessed 1-day, 2-weeks and 4-weeks post-training, whereas training effects on indices of
smoking behavior/cessation will be preliminarily assessed 2-weeks and 4-weeks post-training.
It is expected that the R-E training will result in significant and enduring reductions in
craving and reactivity to both novel and familiar smoking cues and have a favorable impact
on smoking. Positive findings from this study could lead to a safe and effective behavioral
intervention that will help smokers overcome the threat to cessation posed by cue-elicited
craving and reactivity, and thereby reduce the burden levied against society by this most
costly addiction. Additionally, this intervention could be modified to treat addiction to
other substances.
smokers who are making a quit attempt. Retrieval will be initiated by a brief (5-min.) video
with smoking-related content and the extinction will consist of protracted (1 hr.) exposure
to smoking cues. A control group receiving the same treatment except that the retrieval
video will have nonsmoking/neutral content will serve to demonstrate that retrieval is a key
feature of R-E training. Effects of training on smoking craving and cue reactivity will be
assessed 1-day, 2-weeks and 4-weeks post-training, whereas training effects on indices of
smoking behavior/cessation will be preliminarily assessed 2-weeks and 4-weeks post-training.
It is expected that the R-E training will result in significant and enduring reductions in
craving and reactivity to both novel and familiar smoking cues and have a favorable impact
on smoking. Positive findings from this study could lead to a safe and effective behavioral
intervention that will help smokers overcome the threat to cessation posed by cue-elicited
craving and reactivity, and thereby reduce the burden levied against society by this most
costly addiction. Additionally, this intervention could be modified to treat addiction to
other substances.
Inclusion Criteria:
- Participants must be able to provide informed consent and function at an intellectual
level sufficient to allow accurate completion of all assessment instruments.
- Participants must meet DSM-IV criteria for current nicotine dependence and be a daily
cigarette smoker of 10+ cigarettes/day for a minimum duration of three years.
- Participants must live within a 50-mile radius of the research facility and have
reliable transportation.
- Participants must be willing to make a quit attempt beginning the night before the
three consecutive daily laboratory sessions (i.e., two retrieval-extinction training
sessions and the test session performed 24-hours after the second
retrieval-extinction training session).
- Participants must be willing to (a) be overnight smoking abstinent (CO verified)
prior to the baseline smoking cue reactivity assessment, and (b) make a cessation
attempt and be smoking abstinent (CO verified) over the three day period that
corresponds to the two retrieval-extinction training sessions and the test session
performed 24-hours after the second retrieval-extinction training session.
- Participants must be willing to submit to a breathalyzer (alcohol) assessment and
urine drug screen (for benzodiazepines, methamphetamine, cocaine, marijuana and
opiates) and produce a negative test result on (a) the day of the baseline smoking
cue reactivity assessment, and (b) each of the three consecutive days that correspond
to the two retrieval-extinction training sessions and the test session performed
24-hours after the second retrieval-extinction training session.
- Participants must consent to random assignment to the R-E vs. NR-E conditions.
- Participants must not use smokeless tobacco.
- Participants must be willing to forego any other medication or behavioral treatment
for smoking cessation during their enrollment in this study (with the exception of a
referral, upon request, to the SC Quitline). Treatment referral will be provided at
the end of the study.
Exclusion Criteria:
- Participants with current/active (untreated) psychotic disorder, current major
depressive disorder (severe), bipolar affective disorder or a severe anxiety disorder
as these conditions would likely interfere with their ability to fulfill the
requirements for successful participation (e.g., provide accurate interview data,
complete study assessments, attend scheduled laboratory visits, etc.).
- Participants meeting DSM-IV criteria for substance dependence (other than nicotine)
within the past 60 days.
- Participants who are unwilling or unable to maintain abstinence from alcohol and
other drugs of abuse (benzodiazepines, methamphetamine, cocaine, marijuana and
opiates) in order to comply with Inclusion Criterion f above.
- Participants currently taking ß-blockers, anti-arrhythmic agents, psychostimulants or
any other agents known to interfere with heart rate, skin conductance or blood
pressure responses.
- Current use of any pharmacotherapy or psychotherapy for smoking cessation.
- Pregnant women (because pregnancy can influence responding during study procedures).
We found this trial at
1
site
171 Ashley Avenue
Charleston, South Carolina 29425
Charleston, South Carolina 29425
843-792-1414
Medical University of South Carolina The Medical University of South Carolina (MUSC) has grown from...
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