Attentional bias modification in smokers trying to quit: A longitudinal study about the effects of number of sessions ☆ Fernanda Machado Lopes, Ph.D. ⁎, Augusto Viana Pires, Lisiane Bizarro, Ph.D. Department of Psychology, Laboratory of Experimental Psychology, Neurosciences and Behavior, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcellos 2600, Porto Alegre-RS, Brazil, 90035-003 abstract article info Article history: Received 13 October 2013 Received in revised form 27 January 2014 Accepted 3 March 2014 Keywords: Smoking Attentional bias modification Smoking cessation program Treatment Cognitive–Behavioral therapy Attentional bias modification (ABM) to avoid smoking-related cues is a potentially new intervention in addition to existing therapy to stop smoking. We examined immediate and long-term changes in attentional bias and treatment outcomes from multiple ABM sessions in 67 smokers trying to quit. After assessing attentional bias baseline, participants were randomly allocated to one of three training groups: three sessions of ABM (avoid 3); two sessions of placebo-ABM and one session of ABM (avoid 1); and three sessions of placebo-ABM (avoid 0). At baseline, all groups had similar positive attentional bias, which became negative at 24 h post-training. After 1 month, avoid 1 and avoid 3 still exhibited negative attentional biases. Only avoid 3 maintained this effect at 6-month, but not at 12-month assessments. ABM produced a long-lasting automatic and maintained avoidance to smoking-related cues which depended on number of sessions; however its effects on treatment outcomes are uncertain. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Evidence suggests that implicit cognitive mechanisms such as attentional bias and cues reactivity influence the decision and behavior of drug use, playing an important role in maintaining this addiction (Field & Cox, 2008). The cues reactivity refers to the variety of responses (physiological or behavioral) that are observed when drug addicts, former addicts or frequent users are exposed to some stimuli that were previously associated with the drug effects (Rooke, Hine, & Thorsteins- son, 2008). Drug-related stimuli produce responses associated with its effects, including craving, excitement and difficulty sustaining absti- nence (Robbins & Ehrman, 2004). Although cognitive–behavioral therapy is effective for smoking cessation (Focchi & Braun, 2005), it is aimed at explicit processes (e.g. motivation for treatment, relapse prevention), and not implicit automatic processes. Thus, investigation of new techniques focused on implicit cognition as complementary to traditional interventions is preeminent (Schoenmakers et al., 2010). Attentional bias modification (ABM) has been widely studied as an implicit training strategy to reduce cue reactivity in anxiety disorders (Amir, Beard, Burns, & Bomyea, 2009; MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002; Schmidt, Richey, Buckner, & Timpano, 2009) and a few studies in addiction (Attwood, O'Sullivan, Leonards, Mackintosh, & Munafo, 2008; Field, Duka, Tyler, & Schoenmakers, 2009; Field & Eastwood, 2005; Schoenmakers et al., 2010). Since individuals affected by emotional disorders such as anxiety, depres- sion, and addiction have increased attention toward events (words or images) related to their pathologies (Amir et al., 2009; Peuker, Lopes, & Bizarro, 2009), ABM could be a novel and promising approach with a potential clinical utility as an additional intervention. Attentional bias is the tendency for a person to drive or maintain attention to stimuli due to the value attributed to them. Theoretical models suggest that attentional bias results from repeated pairing of smoking cues with direct effects of nicotine, leading to a sensitized reaction to smoking- related cues which become salient (Field & Cox, 2008; Franken, 2003; Lopes, Peuker, & Bizarro, 2008; Robinson & Berridge, 1993). Smoking- related stimuli tend to capture the attention of smokers, and this is considered relevant to drug seeking and smoking cessation outcomes (Waters, Shiffman, Bradley, & Mogg, 2003). Smokers have positive bias for a cigarette compared to nonsmokers (Bradley, Field, Mogg, & De Houver, 2004; Lopes et al., 2008; Moog, Bradley, Field, & De Houwer, 2003) when deprived of nicotine (Field, Mogg, Zetteler, & Bradley, 2004) and even when motivated to quit smoking (Waters et al., 2003). On the other hand, former smokers showed long-lasting negative attentional bias, i.e. an avoidance to smoking-related cues, which might be a successful outcome of a smoking cessation attempt (Peuker & Bizarro, 2013). Thus, strategies that help to reduce and/or make this bias negative may contribute to a higher success rate in smoking cessation treatment. The visual-probe task is one of the most widely used tasks to investigate attentional bias (MacLeod, Mathews, & Tata, 1986), and a modified version is employed in ABM (MacLeod et al., 2002) which Journal of Substance Abuse Treatment 47 (2014) 50–57 ☆ Support: The research was supported by a grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil - CNPq 401035/2007-7. ⁎ Corresponding author. Tel.: +55 51 33085363; fax: +55 51 93322233. E-mail addresses: femlopes23@gmail.com (F.M. Lopes), augusto.pires@ufrgs.br (A.V. Pires), lisiane.bizarro@gmail.com (L. Bizarro). 0740-5472/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsat.2014.03.002 Contents lists available at ScienceDirect Journal of Substance Abuse Treatment