Imaginal Retraining Reduces Cigarette Smoking: A Randomized Controlled Study

Abstract

Objectives: Smoking is a highly prevalent addictive behavior with severe and life-shortening health consequences. This is the first study to evaluate the efficacy of a newly developed imaginal variant of approach bias modification (ABM) (i.e., imaginal retraining) for the reduction of craving for tobacco and actual smoking behavior. Methods: We randomized 345 smokers to imaginal retraining (self-help manual) or a control group (either active control or wait-list control). Assessments were carried out online. The treatment interval was 6 weeks. Craving for tobacco represented the primary outcome. The study was registered as DRKS00016860. Results: Retention was 79.7% with no difference between groups. The intention-to-treat (ITT) analyses were significant for the primary outcome (Visual Analogue Scale on craving for tobacco) as well as subjective reduction of smoking (45.5 vs. 26.4%) in favor of imaginal retraining. In the treatment group, 47.6% performed the exercises at least once. This sub

A dismantling study on imaginal retraining in smokers

“…Results suggest that some prior practice of the technique may indeed foster effectiveness. In the current (full) protocol of imaginal retraining, we suggest that participants use smartphone timers to remind them to perform the technique as there is increasing support that frequent practice augments the outcome 21 , 23 . Future studies may also adopt a more balanced factorial design.…”

“…A formal diagnosis of tobacco dependence or fulfillment of any threshold criteria was not mandatory. For further details on recruitment, mode of assessment, and the initial technique, see the original study 21 .…”

“…The food or beverage is then brought toward the user and is consumed in a somewhat exaggerated way to increase the feeling of relish. The effectiveness of imaginal retraining has been demonstrated in smokers 21 , people with alcohol use disorder 22 , and overweight individuals who crave high-calorie food 23 . A possible disadvantage of the original CBM technique is that the procedure can be boring for some individuals 24 and requires certain technical devices, which makes routine implementation more difficult.…”

A dismantling study on imaginal retraining in overweight or obese women

“…Imaginal retraining is a non-computerized technique taking the limitations mentioned before into account, merging imaginal and behavioural components. Previous studies have demonstrated the efficacy of imaginal retraining across a variety of addictive behaviours, such as excessive high-calorie food consumption [ 21 ], problem drinking [ 27 ] and cigarette smoking [ 28 ]. Imaginal retraining transfers the classical AAT into one’s own imagination.…”

“…Consequently, a benefit of dismantling effective mechanisms would be to design simpler and briefer interventions. Moreover, previous imaginal retraining interventions were usually implemented for the duration of 1 month [ 21 , 27 , 28 ]. A question of interest is therefore whether a single implementation of the imaginal retraining technique could already have a significant and relevant effect on reducing craving and appraisal for high-calorie food.…”