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Original Investigation
February 1, 2017

Effect of a Brief Memory Updating Intervention on Smoking BehaviorA Randomized Clinical Trial

Author Affiliations
  • 1Department of Health Sciences and Research, Medical University of South Carolina, Charleston
  • 2Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
  • 3Hollings Cancer Center, Medical University of South Carolina, Charleston
  • 4Department of Public Health Sciences, Medical University of South Carolina, Charleston
  • 5Department of Neuroscience, Medical University of South Carolina, Charleston
  • 6Mental Health Service Line, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
JAMA Psychiatry. Published online February 1, 2017. doi:10.1001/jamapsychiatry.2016.3148
Key Points

Question  Can protracted extinction training following brief cue-elicited memory retrieval attenuate smoking-related craving and behavior?

Findings  In this randomized clinical trial, retrieval-extinction training substantially attenuated the craving response to both familiar and novel smoking cues 1 month after treatment relative to extinction training alone. Although no between-group differences were observed for physiological responses, cotinine level, number of days abstinent, relapse, and lapse, between-group differences were observed for number of cigarettes smoked per day during follow-up, and a marginal difference was observed for a 60% smoking reduction at follow-up.

Meaning  A brief behavioral intervention that targets smoking-related memory processes can attenuate smoking-related craving and behavior, thereby suggesting the possibility that it might aid cessation.

Abstract

Importance  Recent research on addiction-related memory processes suggests that protracted extinction training following brief cue-elicited memory retrieval (ie, retrieval-extinction [R-E] training) can attenuate/eradicate the ability of cues to elicit learned behaviors. One study reported that cue-elicited craving among detoxified heroin addicts was substantially attenuated following R-E training and through 6-month follow-up.

Objective  To build on these impressive findings by examining whether R-E training could attenuate smoking-related craving and behavior.

Design, Setting, and Participants  This prospective, mixed-design, human laboratory randomized clinical trial took place between December 2013 and September 2015. Participants were recruited in Charleston, South Carolina. Study sessions took place at the Medical University of South Carolina. The participants were 168 screened volunteer smokers, of whom 88 were randomized; 72 of these 88 participants (81.8%) attended all the follow-up sessions through 1 month. The primary eligibility criteria were current nicotine dependence (DSM criteria), smoking 10 or more cigarettes per day, and a willingness to attempt smoking cessation.

Interventions  Participants were randomly assigned to receive either smoking-related memory retrieval followed by extinction training (the R-E group) or nonsmoking-related retrieval followed by extinction training (the NR-E group).

Main Outcomes and Measures  Primary outcomes were cue-elicited craving and physiological responding to familiar and novel cues in the R-E group vs the NR-E group over a 1-month follow-up period. Secondary outcomes were smoking-related behaviors.

Results  A total of 44 participants were randomly assigned to the R-E group (mean age, 48.3 years; 72.7% male); a total of 44 participants were randomly assigned to the NR-E group, with 43 attending at least 1 training session (mean age, 46.7 years; 55.8% male). The mean craving response to both familiar and novel smoking cues was significantly lower for participants in the R-E group than for participants in the NR-E group at 1-month follow-up (for both cue types: t1225 = 2.1, P = .04, d = 0.44, and Δ = 0.47 [95% CI, 0.04-0.90]). The mean numbers of cigarettes smoked per day at 2 weeks and 1-month were significantly lower for the R-E group than for the NR-E group (treatment main effect: F1,68 = 5.4, P = .02, d = 0.50, and Δ = 2.4 [95% CI, 0.4-4.5]). Significant differences in physiological responses, urine cotinine level, number of days abstinent, lapse, and relapse were not observed between groups (all between P = .06 and .75).

Conclusions and Relevance  Retrieval-extinction training substantially attenuated craving to both familiar and novel smoking cues and reduced the number of cigarettes smoked per day by participants 1 month after treatment relative to extinction training alone. Between-group differences were not observed for physiological responses, cotinine level, number of days abstinent, relapse, or lapse. In summary, R-E training is a brief behavioral treatment that targets smoking-related memories and has the potential to enhance relapse prevention.

Trial Registration  clinicaltrials.gov Identifier: NCT02154685

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