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This study aims to examine the modification of the hypothesized imbalance between goal-directed and habitual behavior and its neural correlates in smokers. Two interventions will be used as add-on trainings to a smoking cessation program.
In this study, the investigators aim to assess the imbalance between goal-directed and habitual behavior, its neural basis and how it can be differentially modified in treatment-seeking smokers, using two training interventions. The first intervention is cognitive remediation treatment (CRT), also known as cognitive enhancement therapy, focusing on improving inhibitory control and executive functions. The second intervention, a computer-based habit-modifying training focusing on implicit drug seeking ("implicit computer-based habit-modifying training", ICHT) uses a conditioning approach through implicit priming and contextual modulation. Indicators of the imbalance will be examined with respect to reward devaluation, cue reactivity and a pavlovian instrumental transfer (PIT) paradigm. The investigators hypothesize that both interventions change the balance between goal-directed and habitual behavior but by different mechanisms. Whereas CRT should directly increase cognitive control, in contrast, ICHT should affect the early processing and the emotional valence of smoking and smoking cues.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| standard smoking cessation program (SCP) | Active Comparator | standard smoking cessation program |
|
| SCP + CRT | Experimental | SCP plus cognitive remediation treatment (CRT) |
|
| SCP + ICHT | Experimental | SCP plus an implicit computer-based habit-modifying training (ICHT) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| standard smoking cessation program (SCP) | Behavioral | Each subject will receive standard SCP as group treatment once a week (1 hour) over six weeks. This group therapy is based on behavioural therapy and a psycho-educational approach (for more details see Batra & Buchkremer 2004), and will be carried out by a qualified therapist. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in imbalance between goal-directed and habitual behavior | measured by reward devaluation procedure (Hogarth & Chase 2011) | 2 time points: before and after 6 weeks SCP |
| Change in implicit smoking-related associations | smoking-related implicit association task (Wiers et al. 2016). | 3 time points: before and after 6 weeks SCP plus after 3 months |
| Change in attentional bias to smoking cues | smoking-related dot-probe task (Vollstädt-Klein et al. 2009). | 3 time points: before and after 6 weeks SCP plus after 3 months |
| Change in smoking urges | questionnaire of smoking urges (QSU, Müller et al. 2001)); self-report questionnaire; two subscales: "intention and desire to smoke / anticipation of pleasure from smoking" (range 11 - 77) and "anticipation of relief from negative affect and nicotine withdrawal / urgent and overwhelming desire to smoke" (range 10 - 70) high values represent high craving | 3 time points: before and after 6 weeks SCP plus after 3 months |
| Change in working memory capacity | Spatial Working Memory task from the Cambridge Automated Neuropsychological Test Automated Battery (Robbins et al. 1994) | 3 time points: before and after 6 weeks SCP plus after 3 months |
| Change in planning ability | One Touch Stockings of Cambridge task from the Cambridge Automated Neuropsychological Test Automated Battery (Robbins et al. 1994) | 3 time points: before and after 6 weeks SCP plus after 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| nicotine consumption | self-report | 3 months follow-up |
| Change in neural PIT effect | PIT phase of a choice task (adapted from Hogarth & Chase 2011) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sabine Vollstädt-Klein, Prof. Dr. | Central Institute of Mental Health, Mannheim | Principal Investigator |
| Herta Flor, Prof. Dr. | Central Institute of Mental Health, Mannheim | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Klinik für Abhängiges Verhalten, Zentralinstitut für Seelische Gesundheit | Mannheim | Baden-Wurttemberg | 68159 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36698210 | Derived | Karl D, Wieland A, Shevchenko Y, Grundinger N, Machunze N, Gerhardt S, Flor H, Vollstadt-Klein S. Using computer-based habit versus chess-based cognitive remediation training as add-on therapy to modify the imbalance between habitual behavior and cognitive control in tobacco use disorder: protocol of a randomized controlled, fMRI study. BMC Psychol. 2023 Jan 25;11(1):24. doi: 10.1186/s40359-023-01055-z. |
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| ID | Term |
|---|---|
| D014029 | Tobacco Use Disorder |
| D016739 | Behavior, Addictive |
| D016540 | Smoking Cessation |
| D012008 | Recurrence |
| ID | Term |
|---|---|
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D003192 | Compulsive Behavior |
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|
| Cognitive remediation treatment (CRT) | Behavioral | Cognitive remediation treatment (CRT) employing a chess-based battery of tasks two times per week over six weeks as a group treatment in our outpatient clinic (60 min duration per session). |
|
| Implicit computer-based habit-modifying training (ICHT) | Behavioral | Implicit computer-based habit-modifying training (ICHT), applied twice a week for six weeks. In this training, the participants perform a two-part training. First, a subliminal presentation (20 ms) of negative valenced primes before smoking-cues in context and secondly, a subliminal presentation of positive valenced primes before potentially reinforcing events. |
|
| Change in cognitive flexibility | Internal-External Set Shifting task from the Cambridge Automated Neuropsychological Test Automated Battery (Robbins et al. 1994) | 3 time points: before and after 6 weeks SCP plus after 3 months |
| 2 time points: before and after 6 weeks SCP |
| Change in neural cue reactivity | fMRI cue-reactivity task (Vollstädt-Klein et al. 2011) | 2 time points: before and after 6 weeks SCP |
| D007175 | Impulsive Behavior |
| D001519 | Behavior |
| D015438 | Health Behavior |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |