Influence of affective manipulations on cigarette craving: a meta-analysis

Abstract

Background and Aims Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators. Methods We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single vs. multi-item craving assessment, and affect induction method were tested as moderators of affective cue-induced craving. Results NA manipulations produced a medium effect (g = .47; CI = .31 – .63) on craving, but no main effects were found for PA manipulations (g = .05; CI = −.09 – .20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (p’s < .02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA. Conclusions Laboratory studies indicate that negative affect, but not positive affect, is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke.

Commentary on Heckmanet al. (2013): Negative affect increases craving-Questions about the relationship of affect, craving and smoking

“…Heckman and colleagues [1] have done the field a service by carefully analyzing the relationship between affect induced in laboratory cue-reactivity (CR) settings and subsequent craving. Their finding that negative affect (NA) is associated with increased craving adds important information to our understanding of the interrelationships among affect, craving and smoking.…”

“…Although craving is a good proximal predictor of smoking [2,3] the relationship is not perfect [4], so craving cannot necessarily be used as a proxy for smoking. Heckman et al [1] describe CR studies as 'laboratory analogues of drug-seeking', yet CR studies seldom measure drug-seeking or drug use. Indeed, CR studies have been criticized for focusing on craving as a sole outcome, to the exclusion of smoking [5].…”

“…As Heckman et al [1] note, affective experience itself is complex, and not completely captured by an NA scale. According to the circumplex model of affect [9], the nature of NA is moderated by the accompanying level of arousal.…”

“…Heckman et al [1] also raise another crucial issue about inferences from CR data. Although CR data are meant as laboratory models of the real-world dynamics of craving and smoking, there is no evidence that they accurately model real-world experience and behavior.…”

“…In summary, Heckman et al's [1] meta-analysis gives us new insight into the relationship between experimentally induced affect and laboratory-assessed craving. At the same time, their paper raises many issues that could be fruitfully explored regarding the broader questions of how affect is best conceptualized and assessed, how craving relates to smoking and how these relationships are best assessed and understood.…”