(PQA3) Smartphone delivered attentional bias modification training for smokers

描述（由申请人提供）：70%以上接受一线治疗的吸烟者在6个月内复发。因此，需要替代和补充戒烟疗法。鉴于在治疗焦虑和酒精障碍方面取得的成功，注意力偏差矫正（ABM）——一种计算机提供的干预手段——已被提议用于治疗尼古丁依赖。ABM减少了对吸烟线索的注意偏差（AB），这种注意偏差是随着时间的推移而发展起来的，通过条件反射过程，吸烟线索成为强烈的动机显著性。对吸烟者进行ABM的尝试，但收效甚微。迄今为止，我们已经确定了吸烟ABM方法的三个弱点：(1)现有的吸烟ABM研究仅依赖于单一的实验室培训课程，缺乏对该技术影响与AB和吸烟行为相关的神经生物学机制的潜力的现实和可概括的评估；(2)没有已发表的吸烟ABM研究评估了ABM对多种环境下发生的AB、多种模式下的AB以及长期改变AB的普遍性；(3)之前没有研究考察ABM对一线戒烟治疗的潜在附加益处。本应用程序的目的是确定智能手机内置ABM的可行性，以减少AB到吸烟线索，并在短期和长期内改变吸烟行为。参与者将是250名寻求治疗的吸烟者，他们将在完成ABM（远离吸烟线索和转向中性线索）或每天进行2周的假训练后接受8周的NRT。本研究的第一个目的是确定家庭酒精饮料对AB的影响，第二个目的是确定家庭酒精饮料对吸烟行为的影响。这个项目的意义在于一种新的非药物干预，使寻求治疗的吸烟者的AB和吸烟行为正常化，可以作为一线戒烟治疗的辅助手段。该项目的创新之处在于：1)我们将率先使用智能手机进行多时段的家庭戒烟训练，这将最大限度地发挥戒烟对吸烟者自然环境的影响；2)我们将率先评估ABM与一线戒烟治疗（NRT）联合使用的影响；3)我们将是第一个直接评估ABM对使用多种方式测量的AB的泛化性的研究，包括使用ERP方法的中枢神经系统变化指标，其高空间分辨率非常适合检查RT无法复制的早期注意过程；4)通过使用多个会话，我们将能够评估AB随时间变化的轨迹，以确定ABM训练的最佳次数。我们预计，通过确定一种创新的低成本干预措施，改变寻求治疗的吸烟者的AB和吸烟行为，我们的研究将对戒烟治疗产生积极影响，这将为未来的戒烟临床试验提供一条有希望的新途径。

DESCRIPTION (provided by applicant): More than 70% of smokers who receive first-line therapies relapse within 6 months. Thus, alternative and complementary smoking-cessation therapies are needed. Given its success in treating anxiety and alcohol disorders, Attentional bias modification (ABM), a computer-delivered intervention, has been proposed to treat nicotine dependence. ABM reduces the attentional bias (AB) towards smoking cues that develops over time as a result of conditioning processes through which smoking cues become strongly motivationally salient. ABM with smokers has been attempted, but with limited success. We have identified three weaknesses with the smoking ABM approaches to date: (1) Existing smoking ABM studies have relied on only a single laboratory training session, falling short of a realistic and generalizable assessment of the technique's potential to influence neurobiological mechanisms associated with AB and smoking behavior; (2) No published smoking ABM study has evaluated the generalizability of ABM to AB experienced in multiple environments, to AB across multiple modalities, and to alter AB in the long-term; (3) No previous study has examined the potential additive benefits of ABM on first-line smoking cessation therapy. The objective of this application is to determine the feasibility of smartphone-delivered, in-home ABM to reduce AB to smoking cues and to modify smoking behavior in the short- and long-term. Participants will be 250 treatment-seeking smokers, who will receive 8 weeks of NRT after completing either ABM (AB away from smoking cues and toward neutral cues) or sham training daily for 2 weeks. The first aim of this study is to identify the impact of in- home ABM on AB and the second aim is to identify the impact of in-home ABM on smoking behavior. The significance of this project is a new non-pharmacological intervention that normalizes AB and smoking behavior in treatment-seeking smokers that can be used as an adjunct to first-line cessation therapies. The innovations of this project are as follows: 1) we will be the first to administer multiple-session n-home ABM training using smartphones which offers the potential of maximizing ABM's effects to smokers' naturalistic environments; 2) we will be the first to evaluate the impact of ABM in conjunction with a first-line smoking cessation therapy (NRT); 3) we will be the first study to directly assess the generalizability of ABM on AB measured using multiple modalities, including central nervous system indicators of changes using ERP methodology, which its high spatial resolution is ideal for examining early attentional processes that RT cannot duplicate and 4) by using multiple sessions, we will be able to assess trajectories of change in AB over time to determine the optimum number of ABM training sessions. We anticipate that our study will have a positive impact on smoking cessation treatment by identifying an innovative low-cost intervention that alters AB and smoking behavior in treatment-seeking smokers, which would suggest a promising new avenue for future smoking cessation clinical trials.