A novel imagery-based retrieval-extinction training for intervention in nicotine addiction

Retrieval-extinction training based on the theory of memory reconsolidation has promising intervention effects for addiction. However, the conventional conditioned stimuli used in retrieval-extinction training have limitations in lack of contextual and selective activation of memories, which limits intervention efficacy and clinical translation. Therefore, we developed a novel imagery-based retrieval-extinction training (I-RE) and examined its effects on nicotine addiction.

This study included 57 nicotine-dependent individuals randomly assigned to either the experimental (n = 29) or control (n = 28) group. Participants were exposed to a 5-min imagery script cue, followed by a 10-min rest period and 60-min extinction training session. Short- and long-term (1 week, 1 month, 3 months, 6 months, 12 months) intervention effects were assessed via the smoking imagery vividness score, smoking craving, and daily cigarette consumption. Electroencephalogram (EEG) data were collected pre- and post-intervention.

Regarding short-term effects, smoking imagery vividness score [pre- vs. post-intervention: p < 0.001; pre- vs. 1-day follow-up (FU): p = 0.003] and craving significantly decreased (pre- vs. post-intervention: p < 0.001; pre- vs. 1-day FU: p < 0.001). Decreased imagery vividness score mediated decreased smoking craving induced by smoking-related I-RE. Moreover, the significant correlation observed between these variables at pre-intervention disappeared at post-intervention. For effects on EEG microstate, a significant decrease was observed in microstate C duration induced by the smoking-related imagery script cue reactivity task post-intervention (p < 0.001). This mediated a decreased smoking craving induced by smoking-related I-RE. Degree of decrease in duration was positively correlated with addict imagery ability (p = 0.035). Consistently, the microstate C occurrence rate significantly decreased during the memory reconsolidation phase (p < 0.001). Regarding long-term effects, the smoking imagery vividness score (1-week FU: p = 0.004; 1-month FU: p < 0.001), smoking craving (1-week FU: p < 0.001; 1-month FU: p < 0.001), and daily cigarette consumption (1-week FU: p < 0.001; 1-month FU: p < 0.001) significantly decreased at 1-week and 1-month FU. Furthermore, decreased smoking craving mediated decreased Daily cigarette consumption in the experimental group. The significant correlation observed between the imagery vividness score and craving at pre-intervention disappeared at the 1-week and 1-month FU.

This novel I-RE demonstrated significant effects on nicotine addiction for 1 month after a single intervention session, suggesting that it is a promising treatment tool.

Chinese Clinical Trial Registry identifier: ChiCTR2200064469.