A double-blind randomized controlled trial evaluating the efficacy of attentional retraining on attentional bias and craving in smokers attempting cessation

Background: Smokers show attentional bias, meaning they attend preferentially to cigarettes and related cues. Attentional bias may contribute to craving and failure to stop smoking. Modified visual probe tasks have been used in laboratory studies to manipulate attentional biases for smoking cues, although these procedures have not been applied in smoking cessation programmes. We conducted the first trial to examine the efficacy of multiple sessions of attentional retraining (AR) on attentional bias, craving, and abstinence in smokers attempting cessation. Methods: Adult cigarette smokers (N=118) were randomized to a modified visual probe task with AR or placebo training (PT). Training began 1 week prior to quit day and was delivered weekly for 5 sessions. Both groups received 21mg transdermal nicotine patches for 8-12 weeks and withdrawal-orientated behavioural support for 7 sessions. Primary outcomes included the difference in attentional bias reaction time measured at baseline and 4-weeks post-quit. Urge to smoke was measured weekly using the Mood and Physical Symptoms Scale (MPSS). The secondary outcome, prolonged abstinence, was measured and biochemically validated at each session. Results: The sample smoked a mean of 20.8 (SD=9.2) cigarettes/ day and mean FTND=5.5 (SD=2.3). Post-training bias scores were lower in the intervention than control group (mean difference=-7.9ms), though this did not reach statistical significance (p=0.19). After adjusting for baseline bias scores, no significant main effects or interactions were found by group/abstinence status (ps>0.17). Mixed-effects linear regression analyses indicated that from quit-day to 4-weeks, craving was lower in abstinent smokers who received AR than PT but this was not statistically significant (b=-0.25, 95% CI=-1.41, 0.91, p=0.67). There was no significant difference in the proportion of smokers achieving prolonged abstinence at 4-weeks (RR=0.97, 95% CI=0.67, 1.40). Conclusions: Multiple sessions of AR using a modified visual probe task had no effect on attentional bias, craving and abstinence outcomes. The findings call into question the clinical value of AR procedures for treatment-seeking smokers.