Craving on the move: targeting smoking memories with a novel 3MDR-smoking cessation protocol

Abstract

Introduction: Improved effectiveness and treatment adherence is needed in smoking cessation (SC) therapies. Another important challenge is to disrupt maladaptive drug-related memories. To achieve these goals, we developed a novel treatment strategy on the basis of motion-assisted memory desensitization and reprocessing (3MDR).

Methods: In this study, the added effect of a distractor task following memory recall during a newly designed 3-day SC version of 3MDR (3MDR-SC) protocol on reducing smoking cue-elicited craving was investigated in abstinent chronic smokers. Chronic smokers were randomly allocated to an active 3MDR-SC group (receiving 3MDR-SC with a working memory distractor task) (n = 42) or a control 3MDR-SC group (receiving 3MDR-SC with a non-distracting task) (n = 39). Smoking cue-induced craving and physiological measures were assessed at baseline (T0) and 1 day after the intervention (T4), and smoking behavior was measured at T0 and 2-week (FU1) and 3-month (FU2) follow-up.

Results: Significant decreases in cue-induced craving from T0 to T4 and daily cigarette use from T0 to FU1 and FU2 were observed but not differ between the two experimental groups. Cue-induced changes in heart-rate variability and skin conductance, which did not differ from T0 to T4, and relapse at FU2 were also not different between groups. Dropout rate during intervention was 2.5%.

Conclusions: The 3-day 3MDR-SC intervention resulted in a reduction in cue-induced craving and smoking behavior and showed very good treatment adherence. There was no added effect of the distractor task on 3MDR-SC efficacy. Further studies, including a treatment as usual control, are needed to confirm 3MDR-SC as an effective SC therapy.

Keywords: EMDR; craving; cue exposure; memory reconsolidation; smoking; smoking cessation; tobacco use disorder; working memory.

Figure 1

3MDR-SC system setup. Shown are the projection screens (1), projectors (2), safety line (3) for safety harness (4), treadmill (5), safety handrails (6), emergency stop button (7), computer with D-Flow 3MDR software (8), and fume hood (9).

Figure 2

The effect of active 3MDR-SC on cue-induced craving and cue-reactivity. Shown is the mean (+ SD) difference in QSU-brief sum score after cue exposure for all items (A) and reward- and relief-related craving items (B) (n = 75) and of the mean (± SD) RMSSD (C) and mean SCL (D) during the blocks relaxation (R), video (V), picture (P), and handling (H) blocks of the nicotine cue-exposure task (n = 81) at session T0 and T4 in the active 3MDR-SC (red) and control 3MDR-SC (blue) groups. * session, main effect of session of p < 0.05. ** session, main effect of session of p < 0.001. ** block, main effect of block of p < 0.001. R, relaxation; V, video; P, picture; H, handling. Of the HRV data, 10.6% of data points were missing (n = 69), and of the skin conductance data, 6.9% of the data points were missing (n = 45).

Figure 3

The effect of active 3MDR-SC on nicotine dependence severity and daily cigarette use at follow-up. Shown is the mean (± SD) FTND sum score (A) and mean self-reported smoked cigarettes (B) at session T0, FU1, and FU2 in the active 3MDR-SC group (red) and the control 3MDR-SC (blue) group (n = 71). **, main effect of time of p < 0.001.

Figure 4

The effect of active 3MDR-SC on craving for smoking-related personalized pictures directly following treatment and on craving following memory recall of smoking-related cues during treatment. Shown is (A) the mean (+ SD) craving rating at session T0 and T4 for the self-chosen pictures that were selected and not-selected during treatment (n = 76) and (B) mean (± SD) craving at session T1, T2, and T3 at baseline (b) after memory recall by cigarette (c) or personal picture (P1,2) and after the (non-)distractor task (T) (n = 76) in the active 3MD group (red) or the control 3MDR-SC group (blue). * session by phase by group, session by treatment phase by group interaction effect of p < 0.05. * session by group, session by group interaction effect of p < 0.05. ** session by picture type, session by picture type interaction effect of p < 0.001. ** session, main effect of session of p < 0.001. ** picture type, main effect of picture type of p < 0.001. B, baseline; C, puffed cigarette; T, (non-)distractor task; P1, first personalized picture; P2, second personalized picture.