Approach Bias and Tobacco Craving as Mechanisms of the Effect of Approach Bias Retraining on Smoking Cessation

Introduction: Approach bias, the automatic tendency to advance toward, rather than move away from appetitive cues, has been associated with greater tobacco cravings, dependence, and likelihood of smoking relapse. Approach bias retraining (ABR) has emerged as one way to reduce approach bias and promote avoidance of smoking cues. Yet, additional research is needed to identify the mechanisms that may help explain the effect of ABR on smoking cessation. Aims and Methods: The current study uses data collected as part of a randomized controlled trial to test two unique mechanisms of action ([1] approach bias and [2] tobacco craving) for the efficacy of standard smoking cessation treatment (ST) augmented by ABR on smoking abstinence. Participants were 96 adult daily smokers (M-age = 43.1, SD = 10.7) motivated to quit smoking. Results: Results showed that lower approach bias and lower cravings at a treatment session were significantly related to the next session smoking abstinence (p's < .018). Furthermore, deviations in approach bias partially mediated the effect of ABR on smoking abstinence (ab = -12.17, 95% CI: [-29.67, -0.53]). However, deviations in tobacco craving did not mediate this relation (ab = .40, 95% CI: [-0.27, 1.34]). Conclusions: The current findings add to the extant literature by identifying approach bias as a mechanism of action of the effect of ABR on smoking abstinence during smoking cessation treatment. Implications: The current study adds to the best of our knowledge on the effectiveness of ABR as a part of smoking cessation treatment. Results indicate that reductions in approach bias partially mediate the effect of ABR on smoking abstinence. These findings are consistent with previous research on alcohol-dependent adults and underline the potential of ABR to reduce approach bias and promote smoking cessation among smokers. Such findings could inform the development of future research exploring more targeted and effective smoking cessation interventions, ultimately improving outcomes for individuals attempting to quit smoking.