AAT + tDCS to reduce cue-induced craving and smoking behavior

摘要 暴露在与吸烟有关的线索中会显著增加自我报告的渴望和紧随其后的 抽烟。这种线索反应性(CR)是吸烟者戒烟的一个经常被报道的障碍。与方法不同 减少禁欲引起的渴望，这种渴望随着尼古丁的出现而非常成功 替代疗法(NRT)和药物疗法尚未被证明能减少与吸烟相关的疾病 对暗示的反应。过去减少吸烟者CR的行为方法，最常见的是戒烟训练 通过线索暴露治疗(CET)，也一直失败。回顾过去的CET研究发现 这一失败在很大程度上是由于几个方法上的缺陷，包括：(1)仅 近端暗示(例如，香烟、烟灰缸)，(2)被动地暴露于这些有限的 提示，以及(3)仅实现有限的新学习。我们丰富的过去线索工作使我们具有独一无二的资格 通过设计和测试结合当代大学英语四级考试的新方法来弥补这些缺陷 减少CR和减轻吸烟者这种无处不在的复发风险的技术和技术。 我们提出了三种提高大学英语四级考试成绩的方法。首先，使用我们现在经过充分测试的个性化方法 吸烟提示和呈现许多近端、环境和人的提示相结合，我们的 建议的线索曝光将更好地捕捉和瞄准最有可能触发吸烟者的线索丰富的情况 最强的CR。其次，吸烟者不会反复被动地接触暗示，而是参与其中 在对他们个人吸烟刺激的方法偏见的积极再培训中，使用 接近/回避任务(AAT)，一种激活背外侧前额叶皮质(DlPFC)的方法， 大脑中的一个区域，既与对渴望的认知控制有关，也与药物奖励系统失活有关。 第三，为了加强新的学习，吸烟者将接受非侵入性的经颅直流电大脑 刺激(即，tDCs)dlPFC。尽管我们建议每种方法，AAT和TDCS，都应该 独立地将吸烟者的CR降低到他们最显著的暗示，为AAT提供同步的tDC (AAT+tDCs)可通过更好地增加dlPFC的皮质兴奋性而协同减弱CR。至 评估这一点，在个性化多线索过程中，对AAT和tDCs进行2x2主动和假控制测试 暴露将被用来检查训练前在几个与吸烟有关的指标上的变化 线索反应性(线索诱发的渴望、线索引发的吸烟地形和注意偏向测量 事件相关电位和反应时间)，以及每天吸烟的变化以及离职前的信心和戒烟意图 训练后1周、1个月随访。这项工作的目标是开发一种有效的治疗方法 更好地为吸烟者做好准备，当他们试图戒烟时面对暗示。

Abstract Exposure to smoking-related cues robustly increases self-report craving and immediate subsequent smoking. This cue-reactivity (CR) is an often-reported obstacle to quitting among smokers. Unlike methods to diminish abstinence-induced craving, which have been highly successful with the advent of nicotine replacement therapies (NRTs), pharmacotherapies have not been shown to diminish smoking-related reactivity to cues. Past behavioral methods to reduce smokers’ CR, most commonly extinction training through cue-exposure treatment (CET), have also consistently failed. Review of past CET studies reveals that this failure is largely due to several methodological shortcomings including: (1) presenting only proximal cues (e.g., cigarettes, ashtrays), (2) conducting passive unreinforced exposure to these limited cues, and (3) achieving only limited new learning. Our extensive past cue work makes us uniquely qualified to remedy these flaws by designing and testing novel CET methodology incorporating contemporary techniques and technology to reduce CR and relieve smokers of this ubiquitous source of relapse risk. We propose three methods to improve CET. First, using our now well-tested methods for personalizing smoking cues and presenting numerous proximal, environment, and people cues in combination, our proposed cue exposure will better capture and target the cue-rich situations most likely to trigger smokers’ strongest CR. Second, rather than repeated passive unreinforced exposure to cues, smokers will engage in active re-training of approach biases toward their personal smoking stimuli using an Approach/Avoidance Task (AAT), a method shown to activate the dorsolateral prefrontal cortex (dlPFC), a brain region associated with both cognitive control over craving and deactivation of drug reward systems. Third, to enhance new learning, smokers will undergo non-invasive transcranial direct current brain stimulation (i.e., tDCS) of the dlPFC. Although we propose that each method, AAT and tDCS, should independently reduce smokers’ CR to their most salient cues, providing AAT with simultaneous tDCS (AAT+tDCS) should synergistically attenuate CR by better increasing cortical excitability in the dlPFC. To assess this, a 2 x 2 active and sham-controlled test of AAT and tDCS during personalized multi-cue exposures will be used to examine pre-post training changes across several measures of smoking-related cue reactivity (cue-induced craving, cue-provoked smoking topography, and attentional bias measures of ERPs and reaction time), as well as changes in daily smoking and confidence and intent to quit pre-post training and at 1 week and 1-month follow up. The goal of this work is to develop an efficacious treatment adjunct that better prepares smokers to confront cues when they try to remain quit.