Long-term outcomes of approach-bias-modification for smoking cessation: A six-month and four-year follow-up study

Approach-Bias-Modification (ApBM) targets maladaptive approach tendencies toward substance-related cues through repeated training of avoidance movements. Recently, this rationale has been applied to nicotine use. However, evidence regarding its long-term effectiveness remains scarce. Therefore, the present study included follow-up assessments at six months and four years, drawing on participants from two randomized controlled trials evaluating ApBM as an adjunct to a brief smoking cessation intervention in individuals motivated to quit smoking. Primary outcomes were self-reported point abstinence and daily cigarette consumption. In addition, demographic, smoking- and training-related variables were examined as potential predictors or moderators of training outcomes. Participants randomized to ApBM (n = 87) showed significantly higher abstinence rates at the four-year follow-up than those receiving sham training with no stimulus-response contingency (n = 91; 60% vs. 37%; OR = 2.221, 95% CI = [1.068; 4.764]; p = .035). No group differences emerged at earlier time points. Daily cigarette consumption decreased by approximately 50% during the intervention phase and remained lower than at baseline over the four years, independent of training condition. Exploratory analyses suggested that age and its interaction with training condition, positive training evaluation, and bias change predicted smoking reduction. This study provides the longest follow-up to date in ApBM research and suggests that ApBM as an adjunct to brief cessation support yields long-term benefits in smoking abstinence.