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Retraining Automatic Action Tendencies for Smoking Using Mobile Phone-Based Approach-Avoidance Bias Training: A Study Protocol for a Randomized Controlled Study


Retraining Automatic Action Tendencies for Smoking Using Mobile Phone-Based Approach-Avoidance Bias Training: A Study Protocol for a Randomized Controlled Study

Alla Machulska et al. Trials.


Background: Automatic tendencies to approach drug-related cues have been linked to the development and maintainance of harmful drug-taking behavior. Recent studies have demonstrated that these automatic approach tendencies can be targeted directly by means of cognitive bias modification (CBM). Moreover, changing those approach tendencies may enhance treatment outcomes. However, training and therapy effects tend to be rather small and adherence to the training might be impaired by time-consuming multiple laboratory training sessions. Here, we present a protocol for a randomized controlled design to improve CBM training efficiency and facilitate access to the training by providing mobile-phone-based training sessions at home to current smokers motivated to quit smoking.

Methods: Participants (n = 100) are current smokers who smoke at least six cigarettes per day for at least 6 months and are willing to quit smoking. All participants attend a brief behavioral smoking cessation intervention (TAU) and are randomly assigned either to an experimental (TAU + training) or a control group. Participants in the experimental condition are given access to a training application (app) aimed at retraining automatic approach biases for smoking cues. Participants are instructed to perform the app training outside the laboratory context on a daily basis for 14 consecutive days. Participants in the control group do not receive the training. Primary outcome measures are changes in smoking-related approach biases and reductions in daily nicotine consumption as assessed at baseline, post-training and at 6-week follow up. Secondary outcome measures include approach biases for alternative stimuli or smoking stimuli to which participants were not exposed during training, attentional and association biases, biochemical outcomes, and self-reported smoking behavior, also measured at three different time points (baseline, post-training, and follow up). After completion of the study, smokers in the control condition will receive access to the training app.

Discussion: This randomized controlled trial is the first to test the effectiveness of an app-based CBM intervention as an adjunct to a brief smoking cessation intervention in smokers motivated to quit smoking. The results of this study can inform future research in the optimization and advancement of CBM treatment for addiction.

Trial registration: Current Controlled Trials, ISRCTN15690771. Registered on 20 November 2018.

Keywords: Approach bias; Cigarette smoking; Cognitive bias modification; Nicotine addiction; Randomized controlled trial; Smartphone apps.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential competing interest.


Fig. 1
Fig. 1
Consolidated standards of reporting trials (CONSORT) flow diagram. APP-AAT, application-based training-Approach-Avoidance Task
Fig. 2
Fig. 2
Schedule of enrollment, assessments and interventions (SPIRIT)

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    1. World Health Organization . WHO global report: mortality attributable to Tobacco. Geneva: WHO Press; 2013.
    1. Schmitz N, Kruse J, Kugler J. Disabilities, quality of life, and mental disorders associated with smoking and nicotine dependence. Am J Psychiatr. 1999;160:1670–1676. doi: 10.1176/appi.ajp.160.9.1670. - DOI - PubMed
    1. Rezaei S, Sari AA, Arab M, Majdzadeh R, Poorasl AM. Economic burden of smoking: a systematic review of direct and indirect costs. Med J Islam Repub Iran. 2016;30:397. - PMC - PubMed
    1. Pabst A, Kraus L, Gomes de Matos E, Piontek D. Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 2012. Sucht. 2013;50:321–331. doi: 10.1024/0939-5911.a000275. - DOI
    1. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99:29–38. doi: 10.1111/j.1360-0443.2004.00540.x. - DOI - PubMed

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