Nicotine craving and cue exposure therapy by using virtual environments.

Smokers who are exposed to cues associated with smoking show cardiovascular reactivity and an increase in smoking urges as compared to when they are presented with neutral cues. Cue exposure therapy (CET), which refers to the repeated exposure to drug-related cues in order to extinguish this learned association, has increasingly been proposed as a potential treatment of addictive behaviors, including tobacco smoking. The result of our pilot study suggests that a cue elicited using a virtual environment (VE) is more effective than other cue exposure devices. The VE was composed of craving environments (virtual bar) and objects (an alcoholic drink, a packet of cigarettes, a lighter, an ashtray, a glass of beer, and advertising posters) that are likely to trigger craving, a smoking avatar, and an audio environment that included the noisy sound and music of a restaurant. Sixteen late-adolescent males who smoked at least 10 cigarettes a day were recruited to participate in the VE-CET study. The CET virtual bar program consisted of six sessions, and the participants were exposed repeatedly to each session using different questions and procedures. Although the effects of CET did not yield significant reductions in all of the dependent variables, the craving for cigarettes was gradually decreased during the course of the sessions. This tendency was closely related to the reduction in the smoking count between the morning before the experiment and the start of the experiment. Based on these preliminary results, it appears that VE-CET maybe a useful tool to use in treatment programs to help reduce craving in those who are nicotine dependent.     

The efficacy of cue exposure with response prevention in extinguishing drug and alcohol cue reactivity

It has been suggested that drug cue‐elicited urges and psychophysiological reactions are the results of Pavlovian conditioning processes and that it should be possible to extinguish these responses with cue exposure with response prevention. It has already been shown that subjective cue‐elicited urges can be extinguished, but it is unclear whether this is also true for cue‐elicited psychophysiological arousal. This was tested in the present study in a heterogeneous sample of drug and alcohol dependent patients. It was found that cue‐elicited urges can indeed be extinguished. However, such a clear pattern of extinguished cue reactivity was not found for the psychophysiological measures. Furthermore, the extinction of drug urges was not specific for cue exposure treatment. It is concluded that cue‐elicited psychophysiological arousal does not underlie subjective cue reactivity and may not reflect Pavlovian conditioned drug responding. Copyright © 2006 John Wiley & Sons, Ltd.     

Psychological tests as indicators of excessive exposure to carbon disulfide

Twelve psychological tests including a standardized questionnaire were administered to 20 male viscose rayon workers with long-term exposure to carbon disulfide and to 152 nonexposed men. With the method of multiple discriminant analysis the number of tests was reduced from 12 to 5 and the number of variables from 30 to 7. The variable setting of the obtained discriminant function contained measures of different types of psychomotor performances, emotional behaviour and subjective symptoms. Sensitivity and specificity of the tests and the criteria for a detected effected were evaluated a posteriori. In general, the sensitivity of the methods was better than its specificity. Sufficient specificity could be obtained when a higher probability level for belonging to the exposed group was applied as the criterion, but even then, the application of other, reference diagnostic methods seems necessary to separate the false positive cases.     

Renewal of cue-elicited urge to smoke: implications for cue exposure treatment

The effects of cue exposure therapy are limited, because renewal after extinction is an important source of relapse. In this study, 33 smokers were exposed to a cue predicting smoking availability and a cue predicting smoking unavailability in one context (acquisition context A). Following extinction in another context (extinction context B), a test for renewal took place in the original acquisition context A (i.e. ABA renewal). Urge to smoke was measured using a Visual Analogue Scale. Renewal of differential conditioned urge responding occurred when participants were tested in the acquisition context, while differential urge responding remained extinguished when tested in the extinction context. This experiment provides evidence that ABA renewal occurred in smokers. Clinical implications are discussed.     

Rapid smoking,cue exposure and support in the modification of smoking

Forty-nine dependent smokers were assigned to one of three treatment conditions: rapid smoking, cue exposure or simple support. There were no differences between treatments in the proportion who stopped smoking or the average reduction in smoking at the end of treatment or at 1 yr follow-up. The overall proportion who stopped was 22% at the end of treatment and 14% at 1 yr follow-up. Time of the first cigarette of the day (before tea or coffee) and percentage reduction in consumption whilst trying to cut down unaided, predicted abstinence at 1 yr follow-up. These results do not support claims made for the effectiveness of rapid smoking.     

Effects of cue prominence and palatability on the drinking behavior of obese and normal humans.

This study examines the effects of cue salience and palatability (water temperature) on the water drinking of obese and normal subjects. Obese subjects drink more than do normal subjects when the water cue is prominent but do not do so when this cue is remote. Palatability does not differentially affect the drinking behavior of obese and normal subjects. These results support the extension to nonfood stimuli of the hypothesis of the hyperreactivity of the obese to prominent cues.     

A placebo-controlled randomized trial of D-cycloserine augmentation of cue exposure therapy for smoking cessation

Recent studies underscore the importance of studying d-cycloserine (DCS) augmentation under conditions of adequate cue exposure treatment (CET) and protection from reconditioning experiences. In this randomized trial, we evaluated the efficacy of DCS for augmenting CET for smoking cessation under these conditions.

Sixty-two smokers attained at least 18 hours abstinence following 4 weeks of smoking cessation treatment and were randomly assigned to receive a single dose of DCS (n=30) or placebo (n=32) prior to each of two sessions of CET. Mechanistic outcomes were self-reported cravings and physiologic reactivity to smoking cues. The primary clinical outcome was 6-week, biochemically-verified, continuous tobacco abstinence.

DCS, relative to placebo, augmentation of CET resulted in lower self-reported craving to smoking pictorial and in vivo cues (d = 0.8 to 1.21) in a relevant subsample of participants who were reactive to cues and free from smoking-related reconditioning experiences. Select craving outcomes were correlated with smoking abstinence, and DCS augmentation was associated with a trend toward a higher continuous abstinence rate (33% vs. 13% for placebo augmentation).

DCS augmentation of CET can significantly reduce cue-induced craving, supporting the therapeutic potential of DCS augmentation when applied under appropriate conditions for adequate extinction learning.     

Food cue exposure and body image satisfaction: the moderating role of BMI and dietary restraint

Effects of cue exposure to high and low-caloric food on body image satisfaction and the moderating role of body mass index (BMI) and restraint were investigated in 77 lean unrestrained, lean restrained and overweight restrained females. Body (BS) and weight satisfaction (WS) were assessed before and after the cue exposure. Lean restrained participants were significantly less satisfied with their weight after cue exposure to high-caloric foods in comparison to cue exposure to low-caloric foods, whereas no such effect was present in overweight restrained and lean unrestrained participants. Low-caloric food cues did not influence WS. Food cues had a nonsignificant trend effect on BS. Yet, only lean unrestrained participants experienced significantly more BS in response to food cue exposure.     

The importance of cue familiarity and cue distinctiveness in prospective memory

Abstract

Both retrospective cued-memory tasks and event-based prospective memory tasks require that cue and target information be associated, and that aspects of that association be reinstated for successful remembering. These functional similarities between retrospective memory and prospective memory were the bases for the hypothesis that the familiarity and the distinctiveness of the target event (cue) would influence prospective memory performance. Experiment 1, focusing on target familiarity, found a nominal advantage in prospective memory with unfamiliar target events. Experiment 2 showed a significant benefit for unfamiliar target events, as well as for target events that were distinctive relative to the local context. Additionally, prospective memory performance did not reliably correlate with explicit retrospective memory tasks (recall and recognition), but did correlate with an indirect retrospective memory task (word fragment completion). This pattern suggests and helps specify the general view that prospective memory processes may be similar to those involved in both direct and indirect tests of retrospective memory.     

The role of temporal delay and repeated prospective memory cue exposure on the deactivation of completed intentions

Previous studies have shown that completed prospective memory (PM) intentions entail aftereffects in terms of ongoing-task-performance decrements in trials containing repeated PM cues which previously served as PM cues triggering the intended action. Previous research reported that PM aftereffects decrease over time, thus revealing a specific time course of PM aftereffects. In the present study, we tested two accounts for this pattern, assuming either that the decline of aftereffects is related to the temporal distance to PM task completion or may be a result of the repeated exposure of repeated PM cues in the ongoing task. In three experiments, we manipulated both the temporal distance to PM task completion and the frequency of repeated PM cues and demonstrated that aftereffects of completed intentions declined with repeated exposure of formerly relevant PM cues. In addition, effects of repeated exposure were not only limited to the repetition of specific PM-cue exemplars but also generalized to other semantically related PM cues within the PM-cue category. Together, findings show that decreased aftereffects of completed intentions are not related to the temporal duration of the subsequent test block, but crucially depend on the repeated exposure of the previously relevant PM cues.     

Combined perceptual or motor-related expectancies modulated by type of cue

The interaction of two expectancies was examined. These were either two perceptual or two response-related expectancies. Perceptual expectancies were induced by combining spatial cuing with feature cuing on a trial-by-trial basis. Cues consisted either of two integrated parts, such as two arrows, or two separated pieces, such as an arrow and a word. Spatial-cuing effects were reduced on trials with invalid feature cues, as compared with valid ones. However, the interaction of spatial cuing and feature cuing was modulated by the type of cue used to induce expectancies. With integrated cues, spatial-cuing effects were reduced about twice as much as with separated cues. The same effect of type of cue was found in Experiment 2, although finger cuing was combined with hand cuing. With integrated cues, finger-cuing effects were much smaller on trials with invalid hand cues, as compared with valid ones. With separated cues, however, finger-cuing effects were additive to hand-cuing effects. The similarity of the results within perceptual- and motor-cuing tasks suggests that a general principle governs the combination of expectancies, such as that outlined in the framework of the proposed adjusted expectancy model.     

Effects of food deprivation upon cue utilization as measured by novelty-incentive

A series of three experiments was done to test the hypothesis that high levels of food deprivation would adversely affect cue utilization from a complex stimulus goal as tested by its novelty-incentive value when that goal was later opposed to food for hungry subjects in a T-maze. It was found that the hunger drive level under which the male rats had originally experienced the complex stimulus goal determined its later incentive value, whether the original experience was in a latent learning type II situation (Experiment I, 20 subjects), a drive-shift situation (Experiment II, 40 subjects), or a free exploration situation (Experiment III, 30 subjects). In each experiment, having first experienced the complex goal under low levels of deprivation significantly decreased the frequency of choices of that goal in a later test relative to the performance of the more deprived animals. The data was interpreted as indicating that utilization of cues, in the sense of input and possibly retention of information, was hindered by the higher levels of deprivation.     

Separating cue relevance from cue importance within models of judgment and decision making

Many investigations concerned with human decision making have centered their attention on the issues of cue integration and cue importance. Unfortunately, an equally important issue—that of cue relevance—has been either neglected or equated with the importance issue. Two experiments tested the ability of information integration theory (N. H. Anderson, 1981, Foundations of information integration theory, New York: Academic Press) to disentangle cue relevance and cue importance formally as well as empirically. The decision environment was divided into two components: aspects of the information present during a decision (information context) and aspects of the situation surrounding a decision (situation context). It was hypothesized that variations in information context would affect cue importance while changes in situation context would affect cue relevance. Furthermore, it was hypothesized that the weight parameter (w) of information integration theory would reflect the information context manipulations but not situation context manipulations. Results supported previous findings showing the influence of information context on w. As predicted situation context did not affect w; however, it did affect the variability of the responses to a cue's values. The relationship between perceived variability and situation context suggests that the scale dispersion parameter σ of information integration theory may be used as a measure of relevance (K. L. Norman, 1980, Organizational Behavior and Human Performance, 25, 289–310).     

Sources of exposure to smoking and drinking friends among adolescents: a behavioral-genetic evaluation

Substance-using friends expose adolescents to models of, and opportunities for, substance use that may lead to its initiation or reinforce existing use. Using genetically informative data from the National Longitudinal Study of Adolescent Health (P. S. Bearman, J. Jones, & J. R. Udry, 1998), the authors examined whether adolescents' exposure to friends' tobacco smoking and alcohol drinking was better explained by family-social or genetic influences. To conduct analyses, the authors constructed substance use exposure scores for adolescent siblings from the responses of siblings' nominated friends to self-reported smoking and drinking items. Using behavioral-genetic analyses of these substance use exposure scores, the authors estimated that 64% of the variance in adolescents' exposure to friends who smoke and drink could be explained by genetic influences, whereas shared environmental influences were zero. These results provide evidence of active, evocative, or both types of gene-environment correlations. Genetic factors can influence the formation of friendships with substance-using peers, thereby contributing to adolescents' exposure to substance use behaviors.