Extended treatment for cigarette smoking cessation: a randomized control trial

AIM

To test the potential benefit of extending cognitive-behavioral therapy (CBT) relative to not extending CBT on long-term abstinence from smoking.

DESIGN

Two-group parallel randomized controlled trial. Patients were randomized to receive non-extended CBT (n = 111) or extended CBT (n = 112) following a 26-week open-label treatment.

SETTING

Community clinic in the United States.

PARTICIPANTS

A total of 219 smokers (mean age: 43 years; mean cigarettes/day: 18).

INTERVENTION

All participants received 10 weeks of combined CBT + bupropion sustained release (bupropion SR) + nicotine patch and were continued on CBT and either no medications if abstinent, continued bupropion + nicotine replacement therapy (NRT) if increased craving or depression scores, or varenicline if still smoking at 10 weeks. Half the participants were randomized at 26 weeks to extended CBT (E-CBT) to week 48 and half to non-extended CBT (no additional CBT sessions).

MEASUREMENTS

The primary outcome was expired CO-confirmed, 7-day point-prevalence (PP) at 52- and 104-week follow-up. Analyses were based on intention-to-treat.

FINDINGS

PP abstinence rates at the 52-week follow-up were comparable across non-extended CBT (40%) and E-CBT (39%) groups [odds ratio (OR) = 0.99; 95% confidence interval (CI) = 0.55, 1.78]. A similar pattern was observed across non-extended CBT (39%) and E-CBT (33%) groups at the 104-week follow-up (OR = 0.79; 95% CI= 0.44, 1.40).

CONCLUSION

Prolonging cognitive-behavioral therapy from 26 to 48 weeks does not appear to improve long-term abstinence from smoking.

I can time with a little help from my friends: effect of social enrichment on timing processes in Pigeons (Columba livia)

There is evidence that impulsive decision-making is associated with errors in timing. However, there has been little attempt to identify the putative mechanism responsible for impulsive animals' timing errors. One means of manipulating impulsivity in non-human animals is providing different levels of access to conspecifics. These preclinical models have revealed that social isolation increases impulsive responding across a wide range of tasks. The goal of the present study was to determine whether social isolation modulates time perception in pigeons by inducing more variability or a bias to underestimate the passage of time in temporal judgments. A temporal bisection task was used to characterize time perception. One group of pigeons performed the bisection following social enrichment, and the remaining half of the pigeons were tested following social isolation. Results revealed pigeons in the social isolation condition categorized a temporal stimulus sample as "long" at shorter durations than pigeons in the social enrichment condition. These data highlight the mechanism(s) thought to underlie timing-based interventions aimed at reducing impulsivity in humans. Future work should consider whether impulsivity is produced by misperceptions of time or a reduced threshold for a response.

Alcohol cues impair learning inhibitory signals in beer drinkers

BACKGROUND

Models of drug addiction emphasize the reciprocal influence of incentive-motivational properties of drug-related cues and poor impulse control resulting in drug use. Recent studies have shown that alcohol-related cues can impair response inhibition. What is unknown is whether these cues also disrupt learning of inhibitory associations.

METHODS

Participants performed a conditioned inhibition (CI) task and were required to learn that a neutral image was a conditioned inhibitor when presented in the context of either an alcohol image intended to draw their attention away from the to-be-trained inhibitor, or a control condition in which the alcohol image was absent. After training, subjects in each condition rated the likelihood that the neutral image would signal the outcome. Eye tracking was used to verify that attention to the neutral image was in fact reduced when the alcohol image was present.

RESULTS

Compared with controls those trained in the alcohol image condition reported a greater likelihood that the presence of the inhibitor would be followed by the outcome and thus were less able to acquire CI. Measures of eye tracking verified that attention to the alcohol cue was associated with this maladaptive behavior.

CONCLUSIONS

When alcohol cues are present, there is a reduced ability to learn that such information is irrelevant to an outcome, and this impairs ones' ability to inhibit perseveration of a response. This has implications for persistence of a drinking episode.

Drivers who self-estimate lower blood alcohol concentrations are riskier drivers after drinking

RATIONALE

Alcohol increases the tendency for risky driving in some individuals but not others. Little is known about the factors underlying this individual difference. Studies find that those who underestimate their blood alcohol concentration (BAC) following a dose of alcohol tend to be more impulsive and report greater willingness to drive after drinking than those who estimate their BACs to be greater than their actual BAC. BAC underestimation could contribute to risky driving behavior following alcohol as such drivers might perceive little impairment in their driving ability and thus no need for caution.

OBJECTIVES

This study was designed to test the relationship between drivers' BAC estimations following a dose of alcohol or a placebo and the degree of risky driving they displayed during a simulated driving test.

METHODS

Forty adult drivers performed a simulated driving test and estimated their blood alcohol concentration after receiving a dose of alcohol (0.65 g/kg for men and 0.56 g/kg for women) or a placebo.

RESULTS

Alcohol increased risk-taking and impaired driving skill. Those who estimated their BAC to be lower were the riskiest drivers following both alcohol and placebo.

CONCLUSIONS

The tendency to estimate lower BACs could support a series of high-risk decisions, regardless of one's actual BAC. This could include the decision to drive after drinking.

Who are the real bird brains? Qualitative differences in behavioral flexibility between dogs (Canis familiaris) and pigeons (Columba livia)

Pigeons given a simultaneous spatial discrimination reversal, in which a single reversal occurs at the midpoint of each session, consistently show anticipation prior to the reversal as well as perseveration after the reversal, suggesting that they use a less effective cue (time or trial number into the session) than what would be optimal to maximize reinforcement (local feedback from the most recent trials). In contrast, rats (Rattus norvegicus) and humans show near-optimal reversal learning on this task. To determine whether this is a general characteristic of mammals, in the present research, pigeons (Columba livia) and dogs (Canis familiaris) were tested with a simultaneous spatial discrimination mid-session reversal. Overall, dogs performed the task more poorly than pigeons. Interestingly, both pigeons and dogs employed what resembled a timing strategy. However, dogs showed greater perseverative errors, suggesting that they may have relatively poorer working memory and inhibitory control with this task. The greater efficiency shown by pigeons with this task suggests they are better able to time and use the feedback from their preceding choice as the basis of their future choice, highlighting what may be a qualitative difference between the species.

Simulated driving performance under alcohol: Effects on driver-risk versus driver-skill

BACKGROUND

Those who place their vehicles closer to others on the roadway are said to have high risk acceptance, and this contributes to motor vehicle crashes. However, the effect of alcohol on this risky driving behavior is understudied. Behavioral mechanisms that contribute to risky driving are also not well understood. Further, whether increased risk-taking behavior in a driver co-occurs with pronounced impairment in the driver's skill is unknown.

METHODS

The study examined the effect of alcohol on driver risk and skill and whether riskier drivers were also those who showed high skill impairment. The relationship between driving behavior and inhibitory control was also tested. Participants completed two driving simulations. In the first drive test, risky driving was encouraged and in the second test, skill-based performance was emphasized. The cued go/no-go task provided a measure inhibitory control. Tests were completed under a 0.65g/kg alcohol and 0.0g/kg (placebo) dose of alcohol.

RESULTS

Alcohol impaired a measure of driving skill and increased driver risk taking. It was also found that riskier drivers were not necessarily those who showed the greatest impairments in skill. Poorer inhibitory control was associated with greater driver risk in the sober state.

CONCLUSIONS

Alcohol-induced risk-taking behaviors can be dissociable from impairing effects on driver skill and poor inhibitory control is selectively related to risky driving. As such, a distinction between driver risk and driver skill needs to be made in the investigation of problems concerning DUI-related accidents and fatalities in future research.

Impulsivity affects suboptimal gambling-like choice by pigeons

Pigeons prefer a low-probability, high-payoff but suboptimal alternative over a reliable low-payoff optimal alternative (i.e., one that results in more food). This finding is analogous to suboptimal human monetary gambling because in both cases there appears to be an overemphasis of the occurrence of the winning event (a jackpot) and an underemphasis of losing events. In the present research we found that pigeons chose suboptimally to the degree that they were impulsive as indexed by the steeper slope of the hyperbolic delay-discounting function (i.e., the shorter the delay they would accept in a smaller-sooner/larger-later procedure). These correlational findings have implications for the mechanisms underlying suboptimal choice by humans (e.g., problem gamblers) and they suggest that high baseline levels of impulsivity can enhance acquisition of a gambling habit.

The evolution of self-control

Cognition presents evolutionary research with one of its greatest challenges. Cognitive evolution has been explained at the proximate level by shifts in absolute and relative brain volume and at the ultimate level by differences in social and dietary complexity. However, no study has integrated the experimental and phylogenetic approach at the scale required to rigorously test these explanations. Instead, previous research has largely relied on various measures of brain size as proxies for cognitive abilities. We experimentally evaluated these major evolutionary explanations by quantitatively comparing the cognitive performance of 567 individuals representing 36 species on two problem-solving tasks measuring self-control. Phylogenetic analysis revealed that absolute brain volume best predicted performance across species and accounted for considerably more variance than brain volume controlling for body mass. This result corroborates recent advances in evolutionary neurobiology and illustrates the cognitive consequences of cortical reorganization through increases in brain volume. Within primates, dietary breadth but not social group size was a strong predictor of species differences in self-control. Our results implicate robust evolutionary relationships between dietary breadth, absolute brain volume, and self-control. These findings provide a significant first step toward quantifying the primate cognitive phenome and explaining the process of cognitive evolution.

Six-term transitive inference with pigeons: successive-pair training followed by mixed-pair training

In nonhuman animals, the transitive inference (TI) task typically involves training a series of four simultaneous discriminations involving, for example, arbitrary colors in which choice of one stimulus in each pair is reinforced [+] and choice of the other color is nonreinforced [-]. This can be represented as A+B-, B+C-, C+D-, D+E- and can be conceptualized as a series of linear relationships: A > B > C > D > E. After training, animals are tested on the untrained non-endpoint pair, BD. Preference for B over D is taken as evidence of TI and occurs because B is greater than D in the implied series. In the present study we trained pigeons using a novel training procedure-a hybrid of successive pair training (training one pair at a time) and mixed-pair training (training all pairs at once)-designed to overcome some of the limitations of earlier procedures. Using this hybrid procedure, we trained five premise pairs (A+B-, B+C-, C+D-, D+E-, and E+F-) which allowed us to test three untrained non-endpoint pairs (BD, CE, and BE). A significant TI effect was found for most subjects on at least two out of three test pairs. Different theories of TI are discussed. The results suggest that this hybrid training is an efficient procedure for establishing mixed-pair acquisition and a TI effect.

Suboptimal choice by pigeons may result from the diminishing effect of nonreinforcement

Pigeons prefer an alternative that provides them with a stimulus 20% of the time that predicts 10 pellets of food and a different stimulus 80% of the time that predicts 0 pellets, over an alternative that provides them with a stimulus that always predicts 3 pellets of food, even though the preferred alternative provides them with considerably less food. It appears that the stimulus that predicts 10 pellets acts as a strong conditioned reinforcer, despite the fact that the stimulus that predicts 0 pellets occurs 4 times as often. In the present research, we tested the hypothesis that early in training conditioned inhibition develops to the 0-pellet stimulus, but later in training it dissipates. We trained pigeons with a hue as the 10-pellet stimulus and a vertical line as the 0-pellet stimulus. To assess the inhibitory value of the vertical line, we compared responding to the 10-pellet hue with responding to the compound of the 10-pellet hue and the vertical line early in training and once again late in training, using both a within-subject design (Experiment 1) and a between-groups design (Experiment 2). We found that there was a significant reduction in inhibition between the early test (when pigeons chose optimally) and late test (when choice was suboptimal). Thus, the increase in suboptimal choice may result from the decline in inhibition to the 0-pellet stimulus. Implications for human gambling behavior are considered.

Do Pigeons Gamble? I Wouldn’t Bet Against It

Human gambling generally involves suboptimal choice because the expected return is usually less than the investment. We have found that animals, too, choose suboptimally under similar choice conditions. Pigeons, like human gamblers, show an impaired ability to objectively assess overall probabilities and amounts of reinforcement when a rare, high-value outcome (analogous to a jackpot in human gambling) is presented in the context of more frequently occurring losses. More specifically, pigeons prefer a low-probability, high-reward outcome over a guaranteed low-reward outcome with a higher overall value. Furthermore, manipulations assumed to increase impulsivity (pigeons maintained at higher levels of motivation for food and pigeons housed in individual cages) result in increased suboptimal choice. They do so presumably because they function to increase attraction to the signal for the low-probability, high-reward outcomes rather than consider the more global probability of reinforcement associated with each alternative.

Pigeons show near-optimal win-stay/lose-shift performance on a simultaneous-discrimination, midsession reversal task with short intertrial intervals

Discrimination reversal tasks have been used as a measure of species flexibility in dealing with changes in reinforcement contingency. The simultaneous-discrimination, midsession reversal task is one in which one stimulus (S1) is correct for the first 40 trials of an 80-trial session and the other stimulus (S2) is correct for the remaining trials. After many sessions of training with this task, pigeons show a curious pattern of choices. They begin to respond to S2 well before the reversal point (they make anticipatory errors) and they continue to respond to S1 well after the reversal (they make perseverative errors). That is, they appear to be using the passage of time or number of trials into the session as a cue to reverse. We tested the hypothesis that these errors resulted in part from a memory deficit (the inability to remember over the intertrial interval, ITI, both the choice on the preceding trial and the outcome of that choice) by manipulating the duration of the ITI (1.5, 5, and 10 s). We found support for the hypothesis as pigeons with a short 1.5-s ITI showed close to optimal win-stay/lose-shift accuracy.