A Puff Topography Biofeedback Paradigm to Reduce Stress-Precipitated Smoking Reinforcement - PROJECT SUMMARY/ABSTRACT Smokers with emotional distress are particularly vulnerable to smoking reinforcement due to various biopsychological factors that contribute to deficits in emotion regulation and heightened reward processing, which undermine cessation efforts. The timing and intensity of one's puffing (i.e., puff topography) can titrate or maximize the cigarette's rewarding effect. Our group has identified puff topography as a core driver of smoking reinforcement, especially in emotionally distressed smokers. Although largely considered a behavioral phenotype of smoking reinforcement, inherent in puffing behavior are corresponding changes in cardiorespiratory parameters (e.g., cardiac vagal control, CVC) that may promote self-regulation and reduce craving. In our integrated psychophysiological model of emotional distress and smoking, we proposed that in smokers, impaired CVC not only implicates physiological homeostasis, but also influences addiction-relevant processes, including impaired higher-order cognitive processes needed for self-regulation and psychological functioning (e.g., reduced anxiety and stress).Yet, under certain time-sensitive contexts (e.g., stress), emotionally distressed smokers may puff in a way that enhances CVC, resulting in acute self-regulatory benefits, and in turn paradoxically amplifies the reinforcing value of each puff. Thus, a bio-behavioral intervention that could modify puff topography and CVC has the strong potential to reduce the reinforcing value of cigarettes in high-risk emotionally distressed smokers. Grounded in our biobehavioral framework, we designed a highly innovative bio-behavioral paradigm, called Puff Topography Biofeedback Training (PTBT) to directly target putative bio-behavioral underpinnings of smoking reinforcement (i.e., puffing topography and CVC). PTBT leverages in vivo monitoring of respiratory parameters (i.e., biofeedback) that occurs during smoking so that puffing is constrained to a pace that is designed to minimize CVC in order to attenuate acute self-regulatory, emotional, and craving reduction associated with smoking reinforcement. In this R1, we propose a between-subjects experimental test of PTBT and its ability to modify puff topography and CVC during stress-precipitated smoking, and in turn, reduce acute smoking reinforcement. Emotionally distressed daily smokers (N=88, 50% female) will be randomized to PTBT or Control; which are matched for time and attentional demand. Participants will complete two smoking trials on two successive days using either PTBT/Control. The first smoking trial (Visit 1) will allow participants to gain familiarity with the task. The second smoking trial (Visit 2) will be completed following acute laboratory stress induction (stress-precipitated smoking trial). The primary study aims are to test the effect of PTBT vs. Control, in terms of: acute changes in stress- precipitated smoking reinforcement (tobacco demand; cigarette reward; satisfaction) and changes in mechanisms (puff duration, CVC). The results of this high pre-intervention study could inform the subsequent development of a novel intervention strategy for improving quit outcomes in a treatment-resistant population.
