Attentional bias training and cue reactivity in cigarette smokers.

Aims  Attentional bias for drug-related cues has been associated with drug maintenance and relapse. We investigated whether attentional bias for smoking-related stimuli could be altered using a modified visual probe task in cigarette smokers. We also sought to determine whether changes in attentional bias were associated with changes in subsequent craving and cue reactivity. Participants  Male and female (n = 54) current smokers (≥5 cigarettes per day), aged between 18 and 40 years, were recruited from staff and students of the University of Bristol, and from the general population. Design  Participants attended a single test session and completed an attentional training procedure in which they were either trained to attend to smoking-related pictorial stimuli (attend group) or to neutral pictorial stimuli (avoid group). Group allocation was randomized. Measurements  Following attentional training, participants underwent a smoking cue exposure procedure in which they were exposed to smoking-related stimuli. Subjective measures of mood and craving were taken at baseline and before and after cue exposure. Participants then smoked a cigarette and smoking topography was measured. Findings  Attentional training increased attentional bias among participants in the attend group, and decreased attentional bias among those in the avoid group. There were also differences between the attend and avoid groups in post-training changes in craving during exposure to in vivo smoking cues, reflecting greater increases in craving in the attend group, although these effects were observed in males only. Conclusions  These data are the first to show alterations in attentional bias for smoking-related stimuli following a modified visual probe training procedure. Furthermore, post-training group differences in subjective craving suggest potential clinical utility of training procedures, although these effects may operate only in males. Future research should investigate whether multiple training sessions enhance post-training reductions in craving and cue reactivity, and the longer-term persistence of training effects.