“Push it!” or “Hold it!”? A comparison of nicotine-avoidance training and nicotine-inhibition training in smokers motivated to quit

Rationale Recently, experimental paradigms have been developed to strengthen automatic avoidance or inhibitory responses for smoking cues. However, these procedures have not yet been directly compared regarding their effectiveness and mechanisms of action. Objective This study compared the effects of avoidance vs. inhibitory training as an add-on to a brief smoking cessation intervention. The standard Approach-Avoidance-Task (AAT) was adapted for both training types and control conditions. Methods One hundred twenty-four smokers attended behavioral counseling for smoking cessation and were thereafter randomized to one of four training conditions: avoidance-AAT, sham-avoidance-AAT, inhibition-AAT, sham-inhibition-AAT. During a 2-week training period including five training sessions, smokers in the avoidance-AAT trained to implicitly avoid all smoking-related cues, while smokers in the inhibition-AAT trained to implicitly inhibit behavioral response to smoking cues. During sham training, no such contingencies appeared. Self-report and behavioral data were assessed before and after training. Cigarette smoking and nicotine dependence were also assessed at 4- and 12-week follow-ups. Results At posttest, avoidance training was more effective in reducing daily smoking than inhibition training. However, this difference was no longer evident in follow-up assessments. All training conditions improved other smoking- and health-related outcomes. Neither training changed smoking-related approach biases or associations, but approach biases for smoking-unrelated pictures increased and Stroop interference decreased in all conditions. Smoking devaluation was also comparable in all groups. Conclusions Avoidance training might be slightly more effective in reducing smoking than inhibitory training. Overall, however, all four training types yielded equivalent therapy and training effects. Hence, a clear preference for one type of training remains premature.

Attentional bias modification for chocolate: Sham-n training as a new control group

Although attentional bias modification has been shown effective in several appetitive domains, results have been mixed. A major contributor seems to be the choice of control condition. The aim of the present study was to compare attentional bias modification for chocolate against a new control condition, sham-n (neutral or no-contingency) training. Using a modified dot probe protocol, participants (N = 192; 17–30 years) were randomly trained to attend to chocolate pictures, avoid chocolate pictures, or received sham-n training. In the attend and avoid conditions, stimulus pairs consisted of one chocolate and one non-chocolate picture, and probes replaced most often (90/10) chocolate or non-chocolate pictures, respectively. In the sham-n training condition, stimulus pairs consisted of two chocolate or two non-chocolate pictures, and probes replaced pictures within pairs with equal frequency (50/50). Attentional bias for chocolate increased following attend training, decreased following avoidance training, and did not change following sham-n training. The findings clearly demonstrate that both attend and avoidance training alter (in opposite direction) attentional bias for chocolate, whereas sham-n training is inert. This makes sham-n training particularly promising for use in clinical samples who tend to show strong initial biases.

Evaluating the role of Approach-Avoidance Training on action-tendencies in individuals with skin-picking disorder: A preliminary randomized experiment

Background and aimsPathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response.MethodForty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli).ResultsResults of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups.DiscussionOur preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.