Theory-based strategies to enhance interventions for smoking: Relevance to a digital intervention

Knowledge concerning the neuropharmacological, cognitive, and behavioral processes that lead to and sustain addictive smoking is often not translated sufficiently to inform the development and assessment of smoking interventions. This article briefly reviews evidence suggesting that smoking is maintained by habitual-automatic processes, compromised cognitive control, incentive sensitization, anhedonia, erosion of non-smoking reward evaluation, and withdrawal symptoms that are aversive and further erode cognitive control. We then sketch a novel smoking behavior modification treatment targeting these processes - an extended-use, digitally-assisted smoking interruption system. In theory, this intervention would gradually disrupt habitual smoking, foster cognitive control, counter the strong incentive effects of smoking, reduce withdrawal and anhedonia, and enhance the relative value of nonsmoking behavioral options. The intervention we propose is tractable but admittedly notional; our goal, however, is to stimulate innovation in the design of smoking cessation treatments by more intensive efforts to explore the therapeutic implications of basic cognitive, neuroscience, and behavioral research and theory.