Abstract
Introduction: Imaginal retraining is a self-help technique that adapts the principles of approach bias modification to the imagination. Imaginal retraining has been shown to reduce craving and addictive behaviours in 3 randomized controlled trials (RCTs) on problematic alcohol consumption, overweight, and tobacco use. To date, there have been no studies evaluating the long-term efficacy of the intervention. The aim of the present study was to generate first hypotheses on the long-term efficacy of imaginal retraining in smokers in a controlled 1-year follow-up study. Materials and Methods: We recontacted the 345 participants who had taken part in an RCT on imaginal retraining for smokers 1 year later. The survey was carried out online and assessed craving for tobacco (primary outcome), smoking behaviour, well-being, and subjective appraisal. Individuals who applied the technique at least once during the previous year were categorized as the training group, whereas participants who never performed the training were categorized as the no-training group. Data were analysed using linear mixed models (LMMs). The study was preregistered as DRKS00021044. Results: The completion rate was 45.5%. Less than 40% used the intervention at least once in the previous 12 months. LMM analyses showed a significant reduction in craving for tobacco for the training compared to the no-training group after 1 year. No significant group differences emerged in smoking behaviour, depressive symptoms, or quality of life. Subjective appraisal of the intervention was favorable, similar to the initial study. Conclusion: The present study provides preliminary support for the long-term efficacy of imaginal retraining on craving for tobacco but not on smoking behaviour, highlighting the importance of multimodal treatment concepts in smoking cessation that target a variety of maintaining factors. Future studies need to investigate the long-term efficacy of the intervention in prospective RCTs that test alternative ways of conveying the technique to improve adherence.
References
1.
Lang
JC
, Abrams
DM
, De Sterck
H
. The influence of societal individualism on a century of tobacco use: modelling the prevalence of smoking
. BMC Public Health
. 2015
;15
(1
):1280
–13
. .2.
World Health Organization
. World health statistics 2020: monitoring health for the SDGs, sustainable development goals
. Geneva
: World Health Organization
; 2020
.3.
World Health Organization
. Tobacco-free generations. Protecting children from tobacco in the WHO European Region
. Copenhagen
: WHO Regional Office for Europe
; 2017
.4.
Reitsma
MB
, Fullman
N
, Ng
M
, Salama
JS
, Abajobir
A
, Abate
KH
, Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the global burden of disease study 2015
. Lancet
. 2017
;389
(10082
):1885
–906
. .5.
Peters
R
, Ee
N
, Peters
J
, Beckett
N
, Booth
A
, Rockwood
K
, Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction
. Ther Adv Chronic Dis
. 2019
;10
:2040622319880392
. .6.
Kotz
D
, Böckmann
M
, Kastaun
S
. The use of tobacco, e-cigarettes, and methods to quit smoking in Germany – a representative study using 6 waves of data over 12 months (the DEBRA study)
. Dtsch Arztebl Int
. 2018
;115
(14
):235
–42
.7.
Hughes
JR
, Keely
J
, Naud
S
. Shape of the relapse curve and long-term abstinence among untreated smokers
. Addiction
. 2004 Jan
;99
(1
):29
–38
. .8.
Boyle
RG
, Stanton
CA
, Sharma
E
, Tang
Z
. Examining quit attempts and successful quitting after recent cigarette tax increases
. Prev Med
. 2019
;118
:226
.9.
Zhou
X
, Nonnemaker
J
, Sherrill
B
, Gilsenan
AW
, Coste
F
, West
R
. Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study
. Addict Behav
. 2009 Apr
;34
(4
):365
–73
. .10.
Ebert
DD
, Mortier
P
, Kaehlke
F
, Bruffaerts
R
, Baumeister
H
, Auerbach
RP
, Barriers of mental health treatment utilization among first-year college students: first cross-national results from the WHO World Mental Health International College Student Initiative
. Int J Methods Psychiatr Res
. 2019
;28
(2
):e1782
. .11.
Chan
S
, Li
L
, Torous
J
, Gratzer
D
, Yellowlees
PM
. Review and implementation of self-help and automated tools in mental health care
. Psychiatr Clin North Am
. 2019
;42
(4
):597
–609
. .12.
Bennett
SD
, Cuijpers
P
, Ebert
DD
, McKenzie Smith
M
, Coughtrey
AE
, Heyman
I
, Practitioner review: unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis
. J Child Psychol Psychiatry
. 2019
;60
(8
):828
–47
. .13.
Rosenthal
L
, Carroll-Scott
A
, Earnshaw
VA
, Sackey
N
, O’Malley
SS
, Santilli
A
, Targeting cessation: understanding barriers and motivations to quitting among urban adult daily tobacco smokers
. Addict Behav
. 2013
;38
(3
):1639
–42
. .14.
Wiers
RW
, Cox
WM
, Field
M
, Fadardi
JS
, Palfai
TP
, Schoenmakers
T
, The search for new ways to change implicit alcohol-related cognitions in heavy drinkers
. Alcohol Clin Exp Res
. 2006 Feb
;30
(2
):320
–31
. .15.
American Psychiatric Association
. Diagnostic and statistical manual of mental disorders
. 5th ed. Washington
: American Psychiatric Association
; 2013
.16.
Berlin
I
, Singleton
EG
, Heishman
SJ
. Predicting smoking relapse with a multidimensional versus a single-item tobacco craving measure
. Drug Alcohol Depend
. 2013
;132
(3
):513
–20
. .17.
Shadel
WG
, Martino
SC
, Setodji
C
, Cervone
D
, Witkiewitz
K
, Beckjord
EB
, Lapse-induced surges in craving influence relapse in adult smokers: an experimental investigation
. Health Psychol
. 2011
;30
(5
):588
. .18.
Wiers
RW
, Rinck
M
, Kordts
R
, Houben
K
, Strack
F
. Retraining automatic action-tendencies to approach alcohol in hazardous drinkers
. Addiction
. 2010 Feb
;105
(2
):279
–87
. .19.
Wiers
RW
, Eberl
C
, Rinck
M
, Becker
ES
, Lindenmeyer
J
. Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome
. Psychol Sci
. 2011 Apr
;22
(4
):490
–7
. .20.
Wiers
RW
, Houben
K
, Fadardi
JS
, van Beek
P
, Rhemtulla
M
, Cox
WM
. Alcohol cognitive bias modification training for problem drinkers over the web
. Addict Behav
. 2015 Jan
;40
:21
–6
. .21.
Wiers
CE
, Kühn
S
, Javadi
AH
, Korucuoglu
O
, Wiers
RW
, Walter
H
, Automatic approach bias towards smoking cues is present in smokers but not in ex-smokers
. Psychopharmacology
. 2013
;229
:187
–97
. .22.
Detandt
S
, Bazan
A
, Quertemont
E
, Verbanck
P
. Smoking addiction: the shift from head to hands: approach bias towards smoking-related cues in low-dependent versus dependent smokers
. J Psychopharmacol
. 2017
;31
(7
):819
–29
. .23.
Wiers
CE
, Stelzel
C
, Gladwin
TE
, Park
SQ
, Pawelczack
S
, Gawron
CK
, Effects of cognitive bias modification training on neural alcohol cue reactivity in alcohol dependence
. Am J Psychiatry
. 2015
;172
(4
):335
–43
. .24.
Jasinska
AJ
, Stein
EA
, Kaiser
J
, Naumer
MJ
, Yalachkov
Y
. Factors modulating neural reactivity to drug cues in addiction: a survey of human neuroimaging studies
. Neurosci Biobehav Rev
. 2014
;38
:1
–16
. .25.
Machulska
A
, Zlomuzica
A
, Rinck
M
, Assion
HJ
, Margraf
J
. Approach bias modification in inpatient psychiatric smokers
. J Psychiatr Res
. 2016
;76
:44
–51
. .26.
Baird
SO
, Rinck
M
, Rosenfield
D
, Davis
ML
, Fisher
JR
, Becker
ES
, Reducing approach bias to achieve smoking cessation: a pilot randomized placebo-controlled trial
. Cogn Ther Res
. 2017
;41
(4
):662
. .27.
Wittekind
CE
, Feist
A
, Schneider
BC
, Moritz
S
, Fritzsche
A
. The approach-avoidance task as an online intervention in cigarette smoking: a pilot study
. J Behav Ther Exp Psychiatry
. 2015
;46
:115
. .28.
Wittekind
CE
, Lüdecke
D
, Cludius
B
. Web-based approach bias modification in smokers: a randomized-controlled study
. Behav Res Ther
. 2019
;116
:52
–60
. .29.
Kong
G
, Larsen
H
, Cavallo
DA
, Becker
D
, Cousijn
J
, Salemink
E
, Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study
. Am J Drug Alcohol Abuse
. 2015
;41
(5
):425
–32
. .30.
Mühlig
S
, Paulick
J
, Lindenmeyer
J
, Rinck
M
, Cina
R
, Wiers
RW
. Applying the “cognitive bias modification” concept to smoking cessation – a systematic review
. Sucht
. 2016
;62
(6
):333
–54
. .31.
Cristea
IA
, Kok
RN
, Cuijpers
P
. The effectiveness of cognitive bias modification interventions for substance addictions: a meta-analysis
. van den Bos R, editor. PLoS One
. 2016 Sep
;11
(9
):e0162226
.32.
Wen
S
, Larsen
H
, Boffo
M
, Grasman
RPPP
, Pronk
T
, van Wijngaarden
JBG
, Combining web-based attentional bias modification and approach bias modification as a self-help smoking intervention for adult smokers seeking online help: double-blind randomized controlled trial
. JMIR Ment Health
. 2020
;7
(5
):e16342
. .33.
Boendermaker
WJ
, Boffo
M
, Wiers
RW
. Exploring elements of fun to motivate youth to do cognitive bias modification
. Games Health J
. 2015 Dec
;4
(6
):434
–43
. .34.
Moritz
S
, Paulus
AM
, Hottenrott
B
, Weierstall
R
, Gallinat
J
, Kühn
S
. Imaginal retraining reduces alcohol craving in problem drinkers: a randomized controlled trial
. J Behav Ther Exp Psychiatry
. 2019
;64
:158
–66
. .35.
Duckworth
A
. Grit: the power of passion and perseverance
. New York, NY
: Scribner
; 2016
.36.
Moritz
S
, Göritz
AS
, Schmotz
S
, Weierstall-Pust
R
, Gehlenborg
J
, Gallinat
J
, Imaginal retraining decreases craving for high calorie food in overweight and obese women. a randomized controlled trial
. Transl Psychiatry
. 2019
;9
:319
. .37.
Moritz
S
, Göritz
AS
, Kraj
M
, Gehlenborg
J
, Hottenrott
B
, Tonn
P
, Imaginal retraining reduces cigarette smoking: a randomized controlled study
. Eur Addict Res
. 2020
;26
:355
–64
. .38.
Etter
JF
, Le Houezec
J
, Perneger
TV
. A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale
. Neuropsychopharmacology
. 2003 Feb
;28
(2
):359
–70
. .39.
Etter
JF
, Le Houezec
J
, Huguelet
P
, Etter
M
. Testing the cigarette dependence scale in 4 samples of daily smokers: psychiatric clinics, smoking cessation clinics, a smoking cessation website and in the general population
. Addict Behav
. 2009 May
;34
(5
):446
–50
. .40.
Etter
JF
. Comparing the validity of the cigarette dependence scale and the Fagerström test for nicotine dependence
. Drug Alcohol Depend
. 2008 May
;95
(1–2
):152
–9
. .41.
Heatherton
TF
, Kozlowski
LT
, Frecker
RC
, Fagerström
KO
. The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire
. Br J Addict
. 1991 Sep
;86
(9
):1119
–27
.42.
Pomerleau
CS
, Carton
SM
, Lutzke
ML
, Flessland
KA
, Pomerleau
OF
. Reliability of the Fagerstrom tolerance questionnaire and the Fagerstrom test for nicotine dependence
. Addict Behav
. 1994 Jan
;19
(1
):33
–9
. .43.
Beck
AT
, Steer
RA
, Brown
GK
. Beck depression inventory
. 2nd ed. San Antonio, TX
: The Psychological Corporation
; 1996
.44.
Kühner
C
, Bürger
C
, Keller
F
, Hautzinger
M
. [Reliability and validity of the revised beck depression inventory (BDI-II). Findings from German-speaking samples]
. Nervenarzt
. 2007
;78
(6
):651
–6
. German.45.
Skevington
SM
, Lotfy
M
, O’Connell
KA
. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group
. Qual Life Res
. 2004
;13
:299
–310
.46.
Schmidt
J
, Wittmann
WW
. ZUF-8 fragebogen zur messung der patientenzufriedenheit
. In: Brähler
E
, Schumacher
J
, Strauß
B
, editors. Diagnostische verfahren in der psychotherapie
. Göttingen
: Hogrefe
; 2002
. p. 392
–6
.47.
Kriz
D
, Nübling
R
, Steffanowski
A
, Rieger
J
, Schmidt
J
. Patientenzufriedenheit: psychometrische reanalyse des ZUF-8. DRV schriftenBand 77
. Berlin
: DRV Bund
; 2008
. p. 84
–5
.48.
Schmidt
J
, Lamprecht
F
, Wittmann
WW
. [Satisfaction with inpatient management. Development of a questionnaire and initial validity studies]
. Brähler E, Schumacher J, Strauß B, editors. Psychother Psychosom Med Psychol
. 1989
;39
:248
–55
. German.49.
Hasler
G
, Klaghofer
R
, Buddeberg
C
. Der Fragebogen zur Erfassung der Veränderungs-bereitschaft (FEVER). Testung der deutschen Version der University of Rhode Island Change Assessment scale (URICA)
. Psychother Psychosom Med Psychol
. 2003
;53
(9/10
):406
–11
.50.
DiClemente
CC
, Prochaska
JO
. Towards a comprehensive, transtheoretical model of change: stages of change and addictive behaviors
. In: Miller
WR
, Heather
N
, editors. Applied clinical psychology treating addictive behaviors
. Plenum Press
; 1998
. p. 3
–24
.51.
Boffo
M
, Zerhouni
O
, Gronau
QF
, van Beek
RJJ
, Nikolaou
K
, Marsman
M
, Cognitive bias modification for behavior change in alcohol and smoking addiction: bayesian meta-analysis of individual participant data
. Neuropsychol Rev
. 2019 Jan
;29
(1
):52
–78
. .52.
West
R
. Tobacco smoking: health impact, prevalence, correlates and interventions
. Psychol Health
. 2017
;32
(8
):1018
–36
. .53.
Bagga
D
, Cecchetto
C
, Aigner
CS
, Tiraspolski
I
, Koschutnig
K
, Fischmeister
FPS
, Metabolic dynamics in the prefrontal cortex during a working memory task in young adult smokers
. Eur Addict Res
. 2021 Jun 2
:1–11. Epub ahead of print
. .54.
Boendermaker
WJ
, Sanchez Maceiras
S
, Boffo
M
, Wiers
RW
. Attentional bias modification with serious game elements: evaluating the shots game
. JMIR Serious Games
. 2016 Dec
;4
(2
):e20
. .55.
Sharpe
T
, Alsahlanee
A
, Ward
KD
, Doyle
F
. Systematic review of clinician-reported barriers to provision of smoking cessation interventions in hospital inpatient settings
. J Smok Cessat
. 2018
;13
(4
):233
–43
. .56.
McHugh
RK
, Votaw
VR
, Fulciniti
F
, Connery
HS
, Griffin
ML
, Monti
PM
, Perceived barriers to smoking cessation among adults with substance use disorders
. J Subst Abuse Treat
. 2017
;74
:48
–53
. .57.
Eberl
C
, Wiers
RW
, Pawelczack
S
, Rinck
M
, Becker
ES
, Lindenmeyer
J
. Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?
Dev Cogn Neurosci
. 2013 Apr
;4
:38
–51
. .58.
Sharbanee
JM
, Hu
L
, Stritzke
WG
, Wiers
RW
, Rinck
M
, MacLeod
C
. The effect of approach/avoidance training on alcohol consumption is mediated by change in alcohol action tendency
. PLoS One
. 2014
;9
:e85855
. .© 2021 S. Karger AG, Basel
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