Low Reward Sensitivity and Behavioral Activation Therapy for Smoking Cessation

University Of Tx Md Anderson Can Ctr, Houston TX

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Abstract

DESCRIPTION (provided by applicant): The adverse health risks of smoking increase significantly with duration and amount smoked per day (i.e., dependence) 2, and it is precisely these heavier and more nicotine dependent smokers that are most refractory to treatment. While current smoking cessation therapies have produced several positive outcomes, no magic bullet has emerged, nor does it seem likely that will be the case. Our research has recently identified a subgroup of smokers with low intrinsic reward sensitivity (IRS-) who are at increased risk of relapse when attempting to quit smoking compared to those with a normal intrinsic reward sensitivity (IRS+). Compared to the IRS+ smokers who exhibited normal responses to intrinsically pleasant stimuli, the IRS- smokers were characterized by blunted brain responses to intrinsically pleasant stimuli and by enhanced responses to cigarette cues. The increased risk for relapse among these IRS- smokers may reflect a sensitivity to the reinforcement enhancing properties of nicotine such that these smokers may rely upon nicotine to experience pleasure from intrinsically rewarding activities. Perhaps a treatment integrating strategies targeted at systematically increasing the motivational value and enjoyment of an individual's environment, such as behavioral activation strategies (BATS), in addition to standard smoking cessation strategies, will result in increased cessation rates in IRS- smokers attempting to quit. In fact, a recent study illustrated that a newly adapted treatment strategy, the objective of this proposal is to evaluate the efficacy of BATS versus standard cessation treatment in IRS- smokers. Reward sensitivity grouping will be determined at baseline using a previously derived algorithm for classifying smokers based on their differential LPP responses to visual cues for natural rewards and smoking. We will randomly assign smokers from each group to receive either standard smoking cessation counseling or BATS (matched for treatment time), in addition to the nicotine patch (NRT). We hypothesize that BATS plus NRT, relative to standard cessation treatment plus NRT, will result in substantially higher abstinence rates in IRS- smokers compared to IRS+ smokers. We predict that the BATS plus NRT effect on abstinence rates in the IRS- smokers will be mediated by self-reported and behavioral measures of several constructs related to the desire for and enjoyment of natural rewards, such as anhedonia, reward valuation, and overall levels of participation in and the enjoyment of rewarding activities. More specifically, we hypothesize that decreased levels of anhedonia, increased levels of reward valuation, and increased levels of environmental reward in IRS- smokers will mediate the effect of BATS plus NRT on abstinence.