The approach-avoidance task as an online intervention in cigarette smoking: a pilot study

BACKGROUND AND OBJECTIVES: Dual-process models posit that addictive behaviors are characterized by strong automatic processes that can be assessed with implicit measures. The present study investigated the potential of a cognitive bias modification paradigm, the Approach-Avoidance Task (AAT), for retraining automatic behavioral tendencies in cigarette smoking.

METHODS: The study was set up as an online intervention. After completing an online survey, 257 smokers were randomly allocated either to one of two experimental conditions (AAT) or a waitlist control group. Participants responded to different pictures by pushing or pulling the computer mouse, depending on the format of the picture. Pictures in portrait format depicted smoking-related items and were associated with pushing, pictures in landscape format depicted neutral items and were associated with pulling. One version of the AAT provided individual feedback after each trial whereas the standard version did not. After four weeks, participants were re-assessed in an online survey.

RESULTS: Analyses revealed that the standard AAT, in particular, led to a significant reduction in cigarette consumption, cigarette dependence, and compulsive drive; no effect was found in the control group.

LIMITATIONS: Interpretability of the study is constrained by the fact that no active control condition was applied.

CONCLUSIONS: Notwithstanding the limitations, our findings indicate that the AAT might be a feasible instrument to reduce tobacco dependence and can be applied as an online intervention. Future studies should investigate whether the effects of behavior therapy can be augmented when combined with retraining interventions.