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.     

Transdermal nicotine during cue reactivity in adult smokers with and without anxiety disorders

Transdermal nicotine almost doubles tobacco cessation rates; however, little is known about what happens to smokers during the quit process when they are wearing the nicotine patch and are confronted with high-risk smoking triggers. This is particularly important for smokers with psychological disorders who disproportionately represent today's smokers and have more trouble quitting. Using a mixed between- and within-subjects design, smokers with anxiety disorders (n = 61) and smokers without any current Axis I disorders (n = 38) received transdermal nicotine (21 mg) or a placebo patch over two assessment days separated by 48 hr. Urge to smoke was evaluated during a 5-hr patch absorption period (reflecting general smoking deprivation) and during imaginal exposure to theoretically high-risk triggers containing smoking cues, anxiety cues, both, or neutral cues. No differences were observed between smokers with and without anxiety disorders. Significant Patch × Time and Patch × Cue Content interactions were found. Both patch conditions experienced an increase in urge during the deprivation period, but postabsorption urge was significantly higher in the placebo condition, suggesting that transdermal nicotine attenuated the degree to which urge to smoke increased over time. During the cue reactivity trials, when participants received the nicotine patch, they experienced significantly lower urge in response to both smoking-only and neutral cues, but not when anxiety cues were present (alone or in combination with smoking cues). These data suggest that transdermal nicotine alleviates urge only under certain circumstances and that adjunctive interventions are likely necessary to address smoking urges in response to spikes in distress among smokers trying to quit. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The DRD4 VNTR polymorphism influences reactivity to smoking cues

Recent research has indicated that craving for tobacco can be reliably elicited by exposure to smoking cues, suggesting that cue-elicited craving for tobacco may be a useful phenotype for research on genetic factors related to nicotine dependence. Given the potential role of dopamine in cue-elicited craving, the authors examined whether the DRD4 VNTR polymorphism is associated with cue-elicited craving for tobacco. Participants who were homozygous or heterozygous for the 7 repeat (or longer) allele were classified as DRD4 L, and all other participants were classified as DRD4 S. Participants were exposed to smoking cues before smoking either high-nicotine cigarettes or control cigarettes. Analyses suggested that participants in the L group demonstrated significantly greater craving, more arousal, less positive affect, and more attention to the smoking cues than did the participants in the S group.     

用药动作线索诱发海洛因戒断者的镜像神经活动:一项fMRI研究

相关线索能够诱发药物依赖者的心理渴求,而健康人不会对相关线索产生心理渴求。15名海洛因成瘾者和12名没有任何物质滥用的健康被试参与实验,收集了他们在观看相关线索与对照线索时的脑神经活动。结果发现,药物线索能够诱发戒断者更多脑区的活动,包括扣带回和楔前叶。两组被试在对照动作线索刺激诱发作用下,其颞叶、顶叶均出现了较为一致的活动。在用药动作线索诱发作用下,戒断组双侧颞中回、双侧顶下小叶、左侧顶上小叶和右侧额下回显示出显著活动,并且与对照动作线索激活脑区一致;健康组被试除枕叶-颞叶联合区外,没有出现显著的脑区活动。以上结果表明,用药动作线索诱发了海洛因戒断者颞中回、顶下小叶、额下回等镜像神经系统的活动,这些脑区对不同类型的相关线索十分敏感,它们可能通过对用药动作的心理模拟,参与了用药动作线索的快速自动化加工。     

不同药物相关线索反应下感觉-运动脑区的激活及作用

药物相关线索反应不仅表现在心理渴求, 也表现在强迫性用药行为上。相关线索下, 除包括奖赏环路在内的边缘系统被激活外, 感觉-运动脑区也被激活, 引发自动化动作图式的表达, 这对相关线索反应及复吸行为具有特殊的意义。是否所有相关线索都会激活感觉-运动脑区, 目前, 还不清楚, 而这对临床治疗具有重要意义。本研究采用磁共振扫描, 生理测试等方法探索了不同类型相关线索下, 海洛因成瘾戒断者的大脑激活状况, 试图了解他们在不同线索刺激下的大脑反应。采用组内实验设计, 测量29名海洛因成瘾者相关线索反应下的血氧水平。结果发现, 相比对照线索, 所有药物相关线索, 包括药物、用药工具、用药动作线索都更多激活扣带回、海马、舌回、梭回等与奖赏机制相关的脑区; 而不同类型的药物相关线索之间的比较则显示, 用药工具和用药动作线索更多激活了双侧颞中回、双侧顶下小叶、左侧顶上小叶和右侧额下回等感觉-运动脑区。用药动作线索比单纯药物和用药工具线索, 激活了更为广泛的动作脑区。由此, 我们认为药物相关线索导致成瘾者大脑中奖赏和感觉-动作两套系统被激活, 包含用药工具、用药动作在内的相关线索会激活更多的感觉-运动脑区。     

Effects of nicotine deprivation on alcohol-related information processing and drinking behavior

This study examined the influence of smoking cues and nicotine deprivation on responses to alcohol among hazardous drinkers. Fifty-six daily smoking, hazardous drinkers were exposed to either smoking cues or control cues after either 6 hr of nicotine deprivation or no deprivation. Urges to drink alcohol, alcohol-related cognitive processing, and alcohol consumption were assessed after cue exposure. Results indicated that nicotine deprivation increased urges to drink, the accessibility of alcohol outcome expectancies, and the volume of alcohol consumed. There was little influence of the smoking cue manipulation on these processes. Implications for understanding the mechanisms underlying alcohol-tobacco interactions are discussed.     

Effects of cognitive load on neural and behavioral responses to smoking-cue distractors

Smoking cessation failures are frequently thought to reflect poor top-down regulatory control over behavior. Previous studies have suggested that smoking cues occupy limited working memory resources, an effect that may contribute to difficulty achieving abstinence. Few studies have evaluated the effects of cognitive load on the ability to actively maintain information in the face of distracting smoking cues. For the present study, we adapted an fMRI probed recall task under low and high cognitive load with three distractor conditions: control, neutral images, or smoking-related images. Consistent with a limited-resource model of cue reactivity, we predicted that the performance of daily smokers (n = 17) would be most impaired when high load was paired with smoking distractors. The results demonstrated a main effect of load, with decreased accuracy under high, as compared to low, cognitive load. Surprisingly, an interaction revealed that the effect of load was weakest in the smoking cue distractor condition. Along with this behavioral effect, we observed significantly greater activation of the right inferior frontal gyrus (rIFG) in the low-load condition than in the high-load condition for trials containing smoking cue distractors. Furthermore, load-related changes in rIFG activation partially mediated the effects of load on task accuracy in the smoking-cue distractor condition. These findings are discussed in the context of prevailing cognitive and cue reactivity theories. These results suggest that high cognitive load does not necessarily make smokers more susceptible to interference from smoking-related stimuli, and that elevated load may even have a buffering effect in the presence of smoking cues under certain conditions.     

Using emotional cues in a discrimination learning task: Effects of trait emotional intelligence and affective state

Individuals may differ in their ability to learn the significance of emotional cues within a specific context. If so, trait emotional intelligence (EI) may be associated with faster cue learning. This study (N = 180) tested whether trait EI predicts faster learning of a critical cue for discriminating “terrorists” from “non-terrorists”, using virtual-reality heads as stimuli. The critical cue was either facial emotion (positive or negative), or a neutral feature (hat size). Cognitive ability and subjective state were also assessed. Participants were faster to learn with an emotive cue. Surprisingly, high trait EI was correlated with poorer performance, especially early in learning. Subjective distress was also associated with impaired learning to emotive cues.     

Effects of nicotine deprivation on craving response covariation in smokers

Most models of craving propose that when cravings are strong, diverse responses--thought to index an underlying craving state--covary. Previous studies provided weak support for this hypothesis. The authors tested whether nicotine deprivation affects degree of covariation across multiple measures related to craving. Heavy and light smokers (N = 127) were exposed to smoking cues while either nicotine deprived or nondeprived. Measures included urge ratings, affective valence, a behavioral choice task assessing perceived reinforcement value of smoking, and smoking-related judgment tasks. Results indicated higher correlations in the nicotine-deprived than in nondeprived group. The measures principally responsible for this effect loaded onto a single common Craving factor for nicotine-deprived but not nondeprived smokers. These findings suggest that, under certain conditions, measures of craving-related processes covary.     

Auditory emotional cues enhance visual perception

Recent studies show that emotional stimuli impair performance to subsequently presented neutral stimuli. Here we show a cross-modal perceptual enhancement caused by emotional cues. Auditory cue words were followed by a visually presented neutral target word. Two-alternative forced-choice identification of the visual target was improved by emotional cues as compared to neutral cues. When the cue was presented visually we replicated the emotion-induced impairment found in other studies. Our results suggest emotional stimuli have a twofold effect on perception. They impair perception by reflexively attracting attention at the expense of competing stimuli. However, emotional stimuli also induce a nonspecific perceptual enhancement that carries over onto other stimuli when competition is reduced, for example, by presenting stimuli in different modalities.     

Modulation of auditory spatial attention by visual emotional cues: differential effects of attentional engagement and disengagement for pleasant and unpleasant cues

Previous research has demonstrated that threatening, compared to neutral pictures, can bias attention towards non-emotional auditory targets. Here we investigated which subcomponents of attention contributed to the influence of emotional visual stimuli on auditory spatial attention. Participants indicated the location of an auditory target, after brief (250 ms) presentation of a spatially non-predictive peripheral visual cue. Responses to targets were faster at the location of the preceding visual cue, compared to at the opposite location (cue validity effect). The cue validity effect was larger for targets following pleasant and unpleasant cues compared to neutral cues, for right-sided targets. For unpleasant cues, the crossmodal cue validity effect was driven by delayed attentional disengagement, and for pleasant cues, it was driven by enhanced engagement. We conclude that both pleasant and unpleasant visual cues influence the distribution of attention across modalities and that the associated attentional mechanisms depend on the valence of the visual cue.     

Extinction of drug cue reactivity in methamphetamine-dependent individuals

Conditioned responses to drug-related environmental cues (such as craving) play a critical role in relapse to drug use. Animal models demonstrate that repeated exposure to drug-associated cues in the absence of drug administration leads to the extinction of conditioned responses, but the few existing clinical trials focused on extinction of conditioned responses to drug-related cues in drug-dependent individuals show equivocal results. The current study examined drug-related cue reactivity and response extinction in a laboratory setting in methamphetamine-dependent individuals. Methamphetamine cue-elicited craving was extinguished during two sessions of repeated (3) within-session exposures to multi-modal (picture, video, and in-vivo) cues, with no evidence of spontaneous recovery between sessions. A trend was noted for a greater attenuation of response in participants with longer (4-7 day) inter-session intervals. These results indicate that extinction of drug cue conditioned responding occurs in methamphetamine-dependent individuals, offering promise for the development of extinction- based treatment strategies.     

Psychophysiological reactivity to sleep-related emotional stimuli in primary insomnia

The present study examined psychophysiological reactivity to emotional stimuli related and non-related to sleep in people with primary insomnia (PPI) and in good sleepers (GS). Twenty-one PPI and 18 GS were presented with five blocks of neutral, negative, positive, sleep-related negative and sleep-related positive pictures. During the presentation of the pictures, facial electromyography (EMG) of the corrugator and the zygomatic muscles, heart rate (HR) and cardiac vagal tone (CVT) were recorded. Subjective ratings of the stimuli were also collected. We found that only PPI exhibited greater inhibition of the corrugator activity in response to sleep-related positive stimuli compared to the other blocks of stimuli. Furthermore, PPI rated the sleep-related negative stimuli as more unpleasant and arousing and showed higher CVT in response to all stimuli as compared to GS. Results were interpreted as indicating that PPI exhibit craving for sleep-related positive stimuli, and also hyper-arousability in response to sleep-related negative stimuli, as compared to GS. Our results suggest that psychological treatment of insomnia could benefit by the inclusion of strategies dealing with emotional processes linked with sleep processes.     

The role of spatial frequency in cued shifts of attention between global and local forms

It has been suggested that shifts of attention between global and local forms might be based on selection between, or differential activation of, low- and high-spatial-frequency channels. In the present study, pretrial cues indicated which level (global or local) was likely to contain the target on each trial. There was a response time (RT) advantage for validly cued trials and an RT cost for invalidly cued trials relative to a neutral cue baseline. This cuing effect was the same for broadband stimuli and for contrast-balanced stimuli in which low spatial frequencies were eliminated. Thus, cued attentional shifts between global and local forms occur even when selection cannot be based on spatial frequency.     

Attentional shifts to emotionally charged cues: Behavioural and erp data

Abstract

When information activated in memory involves emotional associations, the ability to shift attention away from an emotional cue is impaired compared to an emotionally neutral cue. The purpose of the present study was to investigate how emotional stimuli modulate attentional processes, and how this is reflected in localised brain electrical activity. Eight emotion and eight neutral words served as cues in a covert attention spatial orienting task. The cues were either valid or invalid indicators of which hemifield the target would be presented to. In the remaining trials, no cue was presented prior to the target. Twenty subjects were instructed to manually respond to the target as fast as possible. Event-related potentials (ERPs) showed an enhanced P3 component to the emotion words. The ERPs to the target showed enhanced P1 and P3 components on invalid trials, with emotional cues. There were faster reaction times (RTs) to validly cued targets, but only when the emotion words served as cues. The results demonstrated that the emotional cues elicited sustained focused attention, facilitating an engage mechanism of spatial orienting.     

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.     

Cue-exposure therapy to decrease alcohol craving in virtual environment.

During abstinence from alcohol, craving is elicited by the cues and contexts previously associated with alcohol, which contribute to relapse. To prevent the craving and relapse experienced by alcoholics, cue-exposure therapy (CET) has been used to extinguish the association between alcohol and alcohol-related cues and contexts. This study applied CET, using a virtual reality (VR) system, to eight members of an Alcoholics Anonymous group for eight sessions. Cues and contexts most likely to elicit an urge to drink were selected through a preliminary survey in order to compose VR-CET scenarios: a glass, a bottle, food, and a bar were judged to be the most tempting for people in alcohol dependence and abstinence. Using these cues and contexts, a Japanese-style pub and a western bar were created. Each session was administered for 30 minutes by a psychiatrist and included an introduction, immersion, VR navigation, interviews about feelings, and self-report questionnaires about cravings. The eight sessions consisted of initial and closing sessions and person-, object-, and situation-focused sessions. As a result, a reduction in cue-elicited craving after VR-CET was reported. A mean score of 15.75 (SD = 10.91) on the Alcohol Urge Questionnaire in the first session decreased to 11.50 (SD = 5.76) in the final session. This study suggests that using virtual reality can enhance the effectiveness of CET.     

不同相关线索下海洛因成瘾者的反应差异及反应抑制特征：来自ERP的证据

采用ERP技术, 探究海洛因成瘾者在不同相关线索下的脑电反应及其与冲动性的关系。实验采用组间实验设计和双选择Oddball范式, 要求海洛因成瘾组和健康对照组被试对标准刺激与偏差刺激分别做不同的按键反应, 记录他们的EEG数据。结果发现：相比对照组被试, 海洛因成瘾者在观看药物相关线索时诱发的N2波幅更小, P3波幅更大; 在成瘾组内, 相比用药工具线索, 用药动作线索诱发了更小的N2波幅和更大的P3波幅。这表明海洛因成瘾者对药物相关线索存在反应抑制缺陷, 且不同的药物相关线索会激发海洛因成瘾者不同程度的反应抑制缺陷, 用药动作线索比用药工具线索更大程度地影响成瘾者的反应抑制能力, 反映出更高的动作冲动性。     

Cue-exposure vs self-control in the treatment of binge eating: a pilot study.

From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS-US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. The present authors treated six obese bulimics with cue exposure and response prevention. Six other patients learned to avoid or escape the binge-related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the 1 yr follow-up. In contrast to the 100% binge-free subjects treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the subjects.     

Women Inmate Substance Abusers’ Reactivity to Visual Alcohol, Cigarette, Marijuana, and Crack-Cocaine Cues: Approach and Avoidance as Separate Dimensions of Reactivity

Despite the growing recognition for multidimensional assessments of cue-elicited craving, few studies have attempted to measure multiple response domains associated with craving. The present study evaluated the Ambivalence Model of Craving (Breiner et al. Alcohol Research and Health 23:197–206, 1999; Stritzke et al. 2007) using a unique cue reactivity methodology designed to capture both the desire to use (approach inclination) and desire to not consume (avoidance inclination) in a clinical sample of incarcerated female substance abusers. Participants were 155 incarcerated women who were participating in or waiting to begin participation in a nine-month drug treatment program. Results indicated that all four substance cue-types (alcohol, cigarette, marijuana, and crack cocaine) had good reliability and showed high specificity. Also, the validity of measuring approach and avoidance as separate dimensions was supported, as demonstrated by meaningful clinical distinctions between groups evincing different reactivity patterns and incremental prediction of avoidance inclinations on measures of stages of change readiness. Taken together, results continue to highlight the importance of measuring both approach and avoidance inclinations in the study of cue-elicited craving.