The effects of approach bias modification on smoking cue-reactivity in individuals who smoke: A randomized controlled fMRI study

TL;DR

This study tested if approach bias modification (ApBM) reduces brain reactivity to smoking cues and improves smoking cessation, but found no significant benefits.

Contribution

The study is the first to investigate ApBM's neural mechanisms and clinical outcomes in smoking cessation using fMRI.

Findings

ApBM did not reduce smoking cue-reactivity in reward-related brain regions.

ApBM did not enhance abstinence rates compared to control conditions.

Increased cue-reactivity in the precuneus after ApBM was linked to higher long-term abstinence probability.

Abstract

Approach bias modification (ApBM), a computerized training designed to retrain involuntary approach action tendencies toward drug-related cues, has been shown to reduce relapse rates when added to treatment-as-usual (TAU) in alcohol use disorder. A potential working mechanism involves reduced neural drug cue-reactivity in reward-related brain regions. In smoking cessation, however, the efficacy and neural mechanisms of ApBM remain unclear. In this randomized-controlled trial, individuals with chronic, moderate-to-heavy tobacco dependence (N = 117, Mage = 41.5, 45.3% female) received a one-day smoking cessation intervention (TAU) and were subsequently randomized to complete seven sessions of ApBM (TAU+ApBM), Sham control training (TAU+Sham), or no training (TAU-only). Neural reactivity toward smoking-related versus neutral stimuli (smoking cue-reactivity) was assessed using functional magnetic resonance imaging (fMRI) before and after intervention. Abstinence was the primary clinical outcome. Results showed no significant group×time interactions on cue-reactivity, and ApBM did not enhance abstinence rates. In the precuneus (sensorimotor region), increased cue-reactivity following ApBM was associated with higher long-term abstinence probability, while the control groups showed the opposite descriptive pattern. In conclusion, ApBM did not reduce smoking cue-reactivity in reward-related regions, consistent with the lack of beneficial effects on clinical outcomes. Alternative neural target processes (e.g., sensorimotor-related) and respective training procedures should be explored.

The online version contains supplementary material available at 10.1038/s41598-026-45748-y.

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