"Cue Labeling as a Tool to Regulate Craving During Abstinence from Smoking”. - PROJECT SUMMARY / ABSTRACT As the leading preventable cause of death, tobacco smoking causes nearly 8 million deaths globally each year. Nearly 70% of U.S. adults who smoke want to quit, but only 7.5% manage to quit for 6 months or more. Cigarette craving, induced or exacerbated by exposure to smoking-related cues, is a major factor in lapses in abstinence. The goal of this project is to evaluate whether a cognitive technique for reducing negative affect, called Affect Labeling, can be adapted into a new strategy for reducing craving in people who smoke. Affect Labeling refers to the act of naming an emotional experience or an emotion-inducing stimulus. Affect Labeling reduces self-reported distress and activity in the amygdala, a key brain region linked to emotional experience and response. Given that negative affect and craving may share neural and psychological underpinnings, interventions that downregulate negative affect (e.g., Affect Labeling) may be effective in downregulating craving. To examine this possibility, the Cue Labeling task was developed as a tool to regulate craving and tested on 47 adults (Pittsburgh study) and 19 emerging adults (LA study) who smoked daily. The objective of this proposal is to analyze these two datasets, in order to: 1) Examine the overlap in the neural substrates of cue-elicited negative affect and craving; 2) Examine the effect of Cue Labeling on self-report and neural markers of craving; 3) Identify the neural mechanism of Cue Labeling; and 4) Compare the neural pathways of Cue Labeling and Cue Reappraisal, another cognitive technique for regulating craving. Participants completed the Cue Labeling and Cue Reappraisal tasks during fMRI after overnight abstinence from smoking. In the Cue Labeling task, participants viewed either neutral picture cues (e.g., a man holding a cup) or cigarette picture cues (e.g., a man holding a cigarette), and they selected one of two words (labeling condition) or one of two pictures (matching condition) that fit the cue. In the Reappraisal task, participants reinterpreted a cigarette cue in a way that made it less enticing, or they passively viewed neutral, negative, or cigarette cues. During Cue Labeling, participants in the Pittsburgh study provided ratings of their craving following each cue. During Reappraisal, all participants provided craving ratings following each cue. Primary analyses of activation will focus on data extracted from pre-defined ROIs in the salience network and other regions associated with craving, such as the striatum. Positive findings would provide the first evidence that Affect Labeling can be adapted for regulating craving. If confirmed in trials, the potential clinical impact of this finding could parallel that of Affect Labeling. In the same way that Affect Labeling has been identified as a method for enhancing exposure therapy for phobia, this project may identify Cue Labeling as a method for enhancing standard therapies for addiction. Part of the appeal of the Labeling technique is its simplicity and low cognitive demand, important advantages in substance use disorder and particularly during withdrawal, when cognitive function may be compromised.
