Department of Health Outcomes and Behavior, Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
Nicotine Tob Res. 2014 Mar;16(3):306-15. doi: 10.1093/ntr/ntt145. Epub 2013 Sep 28.
Based on the principles of Pavlovian learning and extinction, cue exposure therapy (CET) involves repeated exposure to substance-associated cues to extinguish conditioned cravings and reduce the likelihood of relapse. The efficacy of CET is predicated on successful extinction, yet the process of extinction in CET trials has rarely been demonstrated. This study explored the extinction process using a cue-reactivity paradigm in smokers undergoing multiple CET sessions as part of a comprehensive smoking cessation treatment.
The sample comprised 76 moderately dependent, treatment-seeking smokers who completed at least 4 CET sessions and 6 counseling sessions. The CET and counseling sessions were scheduled twice weekly, and participants began using transdermal nicotine replacement therapy on their quit day, which occurred prior to initiation of CET. Each CET session consisted of presentation of 140 images on a computer screen, with self-reported craving as the primary measure of cue reactivity.
Mixed-model analyses revealed a progressive decline in cue-provoked craving both within and across 6 sessions of CET. Moderator analyses showed that the decline in craving was greatest among those who displayed initial cue reactivity.
These data are consistent with the premise that CET can produce extinction of laboratory-based cue-provoked smoking cravings and highlight important individual differences that may influence extinction. Implications for conducting cue exposure research and interventions are discussed.
基于巴甫洛夫学习和消退的原理，线索暴露疗法（CET）涉及到反复暴露于物质相关线索，以消除条件性渴望并降低复发的可能性。CET 的疗效取决于成功的消退，但 CET 试验中的消退过程很少得到证明。本研究通过对正在接受多次 CET 治疗的吸烟者进行线索反应性范式，探索了这一消退过程，作为综合戒烟治疗的一部分。
该样本包括 76 名中度依赖、寻求治疗的吸烟者，他们至少完成了 4 次 CET 治疗和 6 次咨询。CET 和咨询治疗每两周进行一次，参与者在开始 CET 治疗前的戒烟日开始使用经皮尼古丁替代疗法。每次 CET 治疗包括在电脑屏幕上呈现 140 张图片，以自我报告的渴望作为线索反应的主要测量指标。
混合模型分析显示，在 CET 的 6 个疗程中，无论是在一个疗程内还是在多个疗程内，线索引起的渴望都呈逐渐下降趋势。调节分析表明，在那些最初表现出线索反应的人中，渴望的下降幅度最大。
这些数据与 CET 可以产生实验室基于线索引起的吸烟渴望的消退这一前提一致，并强调了可能影响消退的重要个体差异。讨论了进行线索暴露研究和干预的影响。
