# Multimodal Assessment of Smoking cue Reactivity During a Smoking Cue Exposure Task

## TL;DR

This study explores how smoking cues affect brain activity and heart rate in smokers and non-smokers, using a multimodal approach to better understand cue reactivity in substance use disorders.

## Contribution

The study introduces a multimodal method combining EEG and HRV to assess cue reactivity in a naturalistic smoking exposure task.

## Key findings

- Smokers showed increased beta power during smoking cue exposure compared to controls.
- Beta power correlated inversely with maximum craving in smokers.
- HRV correlated negatively with smoking urges in smokers post-exposure.

## Abstract

Background. Cue-reactivity as a characteristic symptom of substance use disorders (SUD) is highly context dependent. Paradigms with high context validity need to be established for the investigation of underlying neurobiological mechanisms. While craving can be assessed by self-report as one aspect of cue-reactivity (CR), the assessment of biological measures such as the autonomous response and EEG promises a holistic perspective including CR at an automatized level. In a multimodal approach, smoking cue exposure (CE) effects on heart rate variability (HRV), EEG frequency power, and craving as well as their interrelation were assessed. This pilot study focused on the validity of CR measurements in a naturalistic CE paradigm. Methods. EEG frequency power, HRV, and craving were assessed during resting state (RS) and smoking CE in smokers (n = 14) and nonsmoking controls (n = 10) to investigate the psychophysiological and subjective reactions to CE. Results. Increased beta power was found only in smokers during CE compared to the control condition. There was an inverse correlation of beta power and maximum craving. Likewise, HRV correlated negatively with maximum smoking urges in smokers immediately after the measurements, without differentiation between CE and control condition. Conclusion. The increased beta power in smokers during CE is discussed as increased inhibitory control related to reduced craving in smokers. Furthermore, increased craving during CE seems to be associated to decreased vagal activity. The multimodal measurements during the CE showed ecological validity to be fundamental for CE assessment in clinical populations to evaluate its predictive value.