Department of Addictive Behaviour and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, 21 20, PO Box 12, 68072, Mannheim, Germany.
Institute of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
BMC Psychol. 2023 Jan 25;11(1):24. doi: 10.1186/s40359-023-01055-z.
Although the vast majority of smokers are aware of the enormous preventable health hazards caused by smoking, only a small percentage of smokers manage to remain abstinent in the long term. One possible explanation for this discrepancy lies in the inflexibility of addictive behavior and associated disadvantageous decision-making. According to a dual-process theory of decision-making, two distinct decision systems can be identified. One slow deliberate system based on desirable expectations of outcome value described as goal-directed behavior and a fast reflexive system based on habitual instrumental behavior and driven by reinforcement experienced in the past. In the course of addiction development, an imbalance occurs between habitual behavior and goal-directed. The present study aims to investigate the modifiability of the balance between habitual and goal-directed behavior at the neurobiological and behavioral level in smokers using two different novel add-on therapies. We hypothesize that both interventions change the balance between goal-directed and habitual behavior, but by different mechanisms. Whereas a cognitive remediation treatment should directly improve cognitive control, in contrast an implicit priming task should affect the early processing and the emotional valence of smoking and smoking cues.
We will conduct a randomized controlled study in treatment-seeking individuals with tobacco use disorder applying either chess-based cognitive remediation training (N = 30) or implicit computer-based habit-modifying training (N = 30) as add on therapy compared to the standard smoking cessation group therapy (N = 30) only. We will address neurobiological and neuropsychological correlates associated with craving, reward devaluation, cue reactivity and attentional bias. In addition, various effects of treatment and prediction of treatment outcome will be examined using behavioral and neural measures.
The present study will apply different examination methods such as functional magnetic resonance imaging, neuropsychological tests, and self-report before and after the interventions. This allows the identification of intervention-specific mechanisms and therefore potential neurobiology-based specific treatment targets for individuals with Tobacco Use Disorder.
Registered at clinicaltrials.gov/ct2/show/NCT03764969 (05 December 2018).
尽管绝大多数吸烟者都意识到吸烟会带来巨大的可预防健康危害，但只有一小部分吸烟者能够长期保持不吸烟。这种差异的一个可能解释在于成瘾行为的不灵活性和相关的不利决策。根据决策的双过程理论，可以识别出两种不同的决策系统。一个是缓慢的深思熟虑的系统，基于对结果价值的期望，被描述为目标导向行为，另一个是快速的反射系统，基于习惯性的工具行为，由过去的强化驱动。在成瘾发展过程中，习惯行为和目标导向之间会出现不平衡。本研究旨在使用两种不同的新附加疗法，在吸烟者的神经生物学和行为水平上研究习惯性和目标导向行为之间平衡的可变性。我们假设这两种干预措施都可以改变目标导向和习惯性行为之间的平衡，但机制不同。虽然认知矫正治疗应该直接改善认知控制，但相反，内隐启动任务应该影响吸烟和吸烟线索的早期处理和情绪效价。
我们将在寻求治疗的烟草使用障碍患者中进行一项随机对照研究，将基于象棋的认知矫正训练（n=30）或基于计算机的内隐习惯修正训练（n=30）作为附加治疗与仅接受标准戒烟组治疗（n=30）进行比较。我们将解决与渴望、奖励贬值、线索反应和注意力偏差相关的神经生物学和神经心理学相关性。此外，还将使用行为和神经测量来检查治疗的各种效果和治疗结果的预测。
本研究将应用不同的检查方法，如功能性磁共振成像、神经心理学测试和干预前后的自我报告。这允许识别干预特异性机制，因此为烟草使用障碍个体提供潜在的基于神经生物学的特定治疗靶点。
在 clinicaltrials.gov/ct2/show/NCT03764969（2018 年 12 月 5 日）注册。
