Effects of episodic future thinking on reinforcement pathology during smoking cessation treatment among individuals with substance use disorders

Abstract

Rationale Reinforcer pathology (RP) is a theoretical model based on two processes: delay discounting (DD) and drug demand. Given that RP has been shown to have a predictive value on smoking behaviors, several studies have explored which interventions can reduce RP. Consistent with the RP framework, episodic future thinking (EFT) has shown effects on treatment outcomes and RP processes. The vast majority of studies that assess the effects of EFT on RP consist of experimental studies, and no previous research has tested these effects in a clinical sample of smokers. Objectives The primary aim of this study was to assess the effects of EFT on RP throughout the course of a smoking cessation intervention in smokers with substance use disorders (SUDs). Methods Participants were randomized to cognitive behavior therapy (CBT) + EFT (n = 39) or CBT + EFT + contingency management (n = 33). Cotinine, frequency of EFT practices, cigarette purchase task (CPT), and DD were evaluated in treatment sessions. Mixed-effects model repeated measures analysis was used to explore DD and CPT in-treatment changes as a function of EFT practices and cotinine levels. Results Greater practice of the EFT component significantly reduced cigarette demand (p < .020) as well as DD (p = .003). Additionally, a greater reduction in cotinine levels coupled with greater EFT practice led to a greater decrease in cigarette demand (p < .014). Conclusions EFT reduced the two facets of RP in treatment-seeking smokers with SUDs.

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes.

“…EFT event timeframes into the future differed across studies and ranged from 1 day (e.g., Snider et al, 2016) to 10 years (Nan & Qin, 2019) for the shortest delay and between 3 months (García-Pérez et al, 2022) and 25 years for future delays (Snider et al, 2021). The most common control condition was episodic recent thinking (ERT), in which individuals recall various time points in the past ( n = 11 studies; 69%).…”

Effects of content and valence of episodic future thinking on delay discounting and alcohol demand.

“…Recent meta-analyses show EFT could effectively reduce DD, although inconsistent results are reported (Rösch et al, 2021; Ye et al, 2021). Specifically, research has demonstrated EFT can reduce DD among individuals using substances (e.g., Bulley & Gullo, 2017; Forster et al, 2021; García-Pérez et al, 2022; Mellis et al, 2019; Patel & Amlung, 2020; Snider et al, 2016; Sofis et al, 2020; Stein et al, 2016, 2018). Similar effects have been found on alcohol demand (Bulley & Gullo, 2017; Meshesha et al, 2020; Patel & Amlung, 2020; Snider et al, 2016).…”

Episodic future thinking for the prevention and treatment of health risk behaviors

“…Con respecto al número de prácticas necesarias, la evidencia más reciente sugiere que una mayor práctica del PEF tiene un mayor impacto sobre el DD, tanto en consumidores de sustancias (García-Pérez et al, 2022;Mellis et al, 2019), como en personas con obesidad (Mansouri et al, 2020), aumentando el efecto sobre el DD a medida que aumentan el número de sesiones. Con relación al formato de aplicación, el PEF se ha implementado mayoritariamente en un formato cara a cara, aunque recientemente se ha evaluado su factibilidad en formato online (Sofis et al, 2020;Sze et al, 2015).…”

“…Por otro lado, aunque el PEF ha sido llevado a cabo principalmente de forma aislada, algunos estudios lo han combinado con otros tratamientos (p.ej., terapia cognitivo conductual, manejo de contingencias) obteniendo excelentes resultados (García-Pérez et al, 2022).…”