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Stone BM, Hammersley JJ, Rabinovich NE, Gilbert DG. Effects of nicotine patches on early and late attentional bias to smoking cues: We may know less than we think. Exp Clin Psychopharmacol 2024:2024-50461-001. [PMID: 38330343 DOI: 10.1037/pha0000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
In contrast to overnight deprivation versus satiety studies, a small number of placebo-controlled studies have failed to find that nicotine administration reduces attentional bias (AB) to smoking cues. To assess the reliability of this failure and to address the duration and salience of AB in smokers versus never-smokers, we used a longer-than-typical (i.e., 3,000 ms) smoking cue-presentation time in a placebo-controlled trial of smokers and never-smokers. We aimed to assess whether a nicotine patch (i.e., active vs. placebo) attenuates continuously assessed eye gaze-measured AB to smoking cues across 3,000 ms in 32 habitual, overnight-deprived smokers and smoker-nonsmoker differences compared to 32 never-smokers. We presented a series of picture pairs (i.e., one smoking-related and one affectively neutral control picture) simultaneously to assess AB. Participants attended a 14 mg nicotine patch and a placebo patch session in a randomized order. The habitual smokers were 12-18 hr nicotine-deprived during both sessions. Smokers demonstrated a stronger AB toward smoking cues than never-smokers across the entire 3,000 ms cue-presentation time. Nicotine did not significantly reduce the AB to smoking cues but the AB was strongly and positively related to deprivation-associated cravings in smokers. Patch-delivered nicotine did not reduce AB to smoking cues presented for up to 3,000 ms, even though smoker-nonsmoker differences in bias remained. Assessments of longer cue presentations and more subtle cues may provide nuance not currently captured by existing studies, because of potential demand effects in designs that contrast overnight versus sated state effects on AB. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Bryant M Stone
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | | | - Norka E Rabinovich
- Department of Psychology, School of Psychological & Behavioral Sciences, Southern Illinois University
| | - David G Gilbert
- Department of Psychology, School of Psychological & Behavioral Sciences, Southern Illinois University
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2
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Diggs HA, Rabinovich NE, Gilbert DG. Facilitated extinction of conditioned fear responses by delta 9-tetrahyrdrocannabidol in humans: a pilot study. Hum Psychopharmacol 2022; 37:e2853. [PMID: 35983959 DOI: 10.1002/hup.2853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to determine whether acute delta 9-tetrahyrdrocannabidol (THC) administration would facilitate fear extinction in young occasional cannabis users, given that animal models indicate THC facilitates extinction learning, and recent studies indicate THC administration may also enhance threat memory extinction in humans. METHODS On each of the 2 days, 24+ hour THC-deprived participants were conditioned to fear visual stimuli in a delay conditioning and extinction paradigm. Both CS+ and CS- were faces of negative emotional valence, with the CS+ paired with mild electric shock. Throughout both conditioning and extinction paradigms, EEG was measured to quantify event-related potentials for these learning processes. Following conditioning, individuals, in a randomized and counter-balanced order, smoked either an active THC cigarette (26.25 mg/2.7% THC) or a placebo marijuana cigarette (0.002% THC) on 1 day and the opposite cigarette on the second day. After smoking, CS+ and CS- were presented without shock, resulting in extinction of conditioned fear. RESULTS Relative to placebo, THC facilitated extinction of the conditioned response to the CS+, as reflected by reductions in late positive potential amplitude during extinction learning. CONCLUSIONS The results indicate that acute THC administration may facilitate extinction of the conditioned fear response in humans.
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Affiliation(s)
- Herman A Diggs
- School of Psychological and Behavioral Sciences, Southern Illinois University Carbondale, Carbondale, Illinois, USA.,Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, Illinois, USA
| | - Norka E Rabinovich
- School of Psychological and Behavioral Sciences, Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | - David G Gilbert
- School of Psychological and Behavioral Sciences, Southern Illinois University Carbondale, Carbondale, Illinois, USA.,Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, Illinois, USA
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Gunn MP, Rabinovich NE, Martens KM, Lindt JD, Gilbert DG. Effects of Cannabis-Delivered THC on mood and negative attentional bias in the context of positive vs. neutral Alternatives-a pilot study. Hum Psychopharmacol 2022; 37:e2844. [PMID: 35451099 DOI: 10.1002/hup.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess: (1) the acute effects of smoked marijuana (MJ) on negative attentional bias (NAB), (2) moderation of these effects by positive versus neutral alternatives, and (3) the associations of tetrahydrocannabinol (THC)-induced changes in NAB with changes in affect. METHODS Fourteen MJ users (1-4 uses/wk) smoked a THC cigarette on 1 day and a placebo cigarette on the other counterbalanced day. After smoking, participants freely gazed back and forth at a series of two side-by-side pictures pairs presented for 3000 ms (one negative, while the other was either positive or neutral) while eye gaze was tracked. RESULTS The effects of THC relative to placebo varied across time such that THC increased NAB during the early temporal component of threatening picture viewing, 333-858 ms after dual-picture onset, regardless of alternative picture valance. However, contrary to the attentional bias-causes affect hypothesis, during the early viewing phase THC-enhanced positive affect (PA) correlated positively with THC-induced NAB. In contrast, during the late phase (891-3000 ms) THC-enhanced PA did not correlate significantly with NAB, though THC-induced negative affect (NA) change did correlate positively with THC-induced change in NAB in the positive alternative condition. CONCLUSIONS We replicated findings of others showing that THC can enhance NAB during the early stages of threatening picture viewing. We extended previous results by demonstrating the THC-induced NAB is associated with increased PA during initial threat viewing, but with increased NA during later processing if positive alternatives are present.
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Affiliation(s)
- Matthew P Gunn
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
| | - Norka E Rabinovich
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
| | - Kris M Martens
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA.,Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - John D Lindt
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
| | - David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, Illinois, USA
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Whitton AE, Rabinovich NE, Lindt JD, Pergadia ML, Pizzagalli DA, Gilbert DG. Genetic and Depressive Traits Moderate the Reward-Enhancing Effects of Acute Nicotine in Young Light Smokers. Nicotine Tob Res 2021; 23:1779-1786. [PMID: 33844007 DOI: 10.1093/ntr/ntab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/11/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Rates of light smoking have increased in recent years and are associated with adverse health outcomes. Reducing light smoking is a challenge because it is unclear why some but not others, progress to heavier smoking. Nicotine has profound effects on brain reward systems and individual differences in nicotine's reward-enhancing effects may drive variability in smoking trajectories. Therefore, we examined whether a genetic risk factor and personality traits known to moderate reward processing, also moderate the reward-enhancing effects of nicotine. METHODS Light smokers (n = 116) performed a Probabilistic Reward Task to assess reward responsiveness after receiving nicotine or placebo (order counterbalanced). Individuals were classified as nicotine dependence 'risk' allele carriers (rs16969968 A-allele carriers) or non-carriers (non-A-allele carriers), and self-reported negative affective traits were also measured. RESULTS Across the sample, reward responsiveness was greater following nicotine compared to placebo (p = 0.045). For Caucasian A-allele carriers but not non-A-allele carriers, nicotine enhanced reward responsiveness compared to placebo for those who received placebo first (p = 0.010). Furthermore, for A-allele carriers but not non-A-allele carriers who received nicotine first, the enhanced reward responsiveness in the nicotine condition carried over to the placebo condition (p < 0.001). Depressive traits also moderated the reward-enhancing effects of nicotine (p = 0.010) and were associated with blunted reward responsiveness following placebo but enhanced reward responsiveness following nicotine. CONCLUSION These findings suggest that individual differences in a genetic risk factor and depressive traits alter nicotine's effect on reward responsiveness in light smokers and may be important factors underpinning variability in smoking trajectories in this growing population. IMPLICATIONS Individuals carrying genetic risk factors associated with nicotine dependence(rs16969968 A-allele carriers) and those with higher levels of depressive personality traits, showmore pronounced increases in reward learning following acute nicotine exposure. These findingssuggest that genetic and personality factors may drive individual differences in smoking trajectoriesin young light smokers by altering the degree to which nicotine enhances reward processing. CLINICAL TRIAL REGISTRATION NCT02129387 (pre-registered hypothesis: www.clinicaltrials.gov).
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Affiliation(s)
- Alexis E Whitton
- McLean Hospital & Harvard Medical School, Boston, MA, USA.,Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Norka E Rabinovich
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - John D Lindt
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Michele L Pergadia
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
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Coppens R, Rabinovich NE, Kanneganti R, Diggs HA, Wiggs K, Healey T, Huggenvik J, Rose GM, Gilbert DG. APOE genotype influences P3b amplitude and response to smoking abstinence in young adults. Psychopharmacology (Berl) 2021; 238:1171-1181. [PMID: 33506304 DOI: 10.1007/s00213-021-05763-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE There is strong evidence that nicotine can enhance cognitive functions and growing evidence that this effect may be larger in young healthy APOE ε4 carriers. However, the moderating effects of the APOE ε4 allele on cognitive impairments caused by nicotine deprivation in chronic smokers have not yet been studied with brain indices. OBJECTIVE We sought to determine whether young female carriers of the APOE ε4 allele, relative to noncarriers, would exhibit larger abstinence-induced decreases in P3b amplitude during a two-stimulus auditory oddball task. METHODS We compared parietal P3bs in female chronic smokers with either APOE ε3/ε3 (n = 54) or ε3/ε4 (n = 20) genotype under nicotine-sated conditions and after 12-17-h nicotine deprivation. RESULTS Nicotine deprivation significantly reduced P3b amplitudes in APOE ε4 carriers, but not in APOE-ε3/ε3 individuals, such that the difference seen prior to nicotine deprivation was eliminated. CONCLUSIONS The results suggest that subjects with the APOE ε4 allele are more sensitive to nicotine, which could influence smoking patterns, the risk for nicotine dependence, and the cognitive effects of nicotine use in these individuals.
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Affiliation(s)
- Ryan Coppens
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
- Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Norka E Rabinovich
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | | | - Herman A Diggs
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
- Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Kristin Wiggs
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Travis Healey
- Department of Physiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jodi Huggenvik
- Department of Physiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gregory M Rose
- Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, IL, USA
- Department of Physiology, Southern Illinois University School of Medicine, Springfield, IL, USA
- Department of Anatomy, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA.
- Center for Integrated Research in Cognitive & Neural Sciences, Southern Illinois University, Carbondale, IL, USA.
- School of Psychological and Behavioral Sciences, Southern Illinois University, Mail Code 6502, Carbondale, IL, 62901, USA.
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Gilbert DG, Rabinovich NE, Gilbert-Matuskowitz EA, Klein KP, Pergadia ML. Smoking abstinence symptoms across 67 days compared with randomized controls-Moderation by nicotine replacement therapy, bupropion, and negative-affect traits. Exp Clin Psychopharmacol 2019; 27:536-551. [PMID: 30920255 PMCID: PMC9559614 DOI: 10.1037/pha0000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate knowledge of negative affect (NA)-related smoking abstinence symptoms (SAS) severity and duration and their moderation by pharmacotherapy and NA-related personality traits is critical for efficacious treatments given that elevated state and trait NA are predictors of relapse. However, SAS severity, duration, and moderation are not well characterized. To date, the longest randomized controlled trial (RCT) of NA-related SAS using randomized delayed-quit smoking controls only examined symptoms across 45 days, despite clinical evidence that SAS may last longer. The present RCT assessed SAS across 67 days in dependent smokers (N = 95) who were randomized either to quit or to delay quitting for the course of the trial. The quit group was further randomized to receive either nicotine replacement therapy (NRT), bupropion (BUP), or placebo. Abstinence-related increases in anger-irritability, depressive, anxiety, and general NA symptoms did not resolve relative to the delayed quit group (DQG) levels across the 67 days in any of the 3 quit groups, though craving fell to below DQG and prequit levels. While NRT attenuated Day 3 SAS relative to BUP and placebo, BUP and NRT generally did not reduce SAS. High scores on trait measures of NA/neuroticism predicted greater increases in and duration of NA-related SAS, potentially indicating that smoking abstinence unmasks affective symptoms. Positive affect was not impacted by abstinence or treatment. The results support the views that (a) prequit baseline values are not a valid index of NA SAS recovery, and (b) on average, NA-related SAS take longer than 67 days to resolve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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7
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Zuo Y, Rabinovich NE, Gilbert DG. Negative affect subtypes and craving differentially predict long-term cessation success among smokers achieving initial abstinence. Psychopharmacology (Berl) 2017; 234:761-771. [PMID: 28028602 PMCID: PMC5309162 DOI: 10.1007/s00213-016-4509-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to examine the associations of individual trajectories of three types of negative affect (NA: anxiety, depression, and anger) and craving during a 44-day period of incentivized smoking abstinence period with cessation outcome at 3 months and at 1 year. METHODS Adult smokers (N = 140) completed questionnaire assessments of NA and craving during pre-quit baseline sessions and 15 postquit sessions over the 45 days of biochemically verified abstinence while on nicotine or placebo patch treatment. Growth curve and logistic regression analyses were used to examine the associations of trajectory parameters of the individual NA states and craving with the abstinence outcomes at 3 months and 1 year postquit. RESULTS Greater declines in anxiety, depression, and anger symptoms over the first 44 days of smoking cessation were predictive of higher odds of abstinence at both 3 months and 1 year. Moreover, the greater declines in anxiety and anger remained as significant predictors of abstinence at both time points, independent of the predictive ability of the trajectory profiles of craving. CONCLUSIONS The findings suggest that slower dissipation of NA, especially anxiety and anger, represents a greater risk for relapse to smoking beyond that predicted by craving during early abstinence. Thus, temporal profiles of the affective symptoms convey unique motivational significance in relapse. Reduction in NA during early abstinence may be a valid target for interventions to increase long-term cessation success rates particularly among individuals with refractory affective symptoms.
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Affiliation(s)
- Yantao Zuo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA;
| | - Norka E. Rabinovich
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901-6502; mail:
| | - David G. Gilbert
- Department of Psychology, Southern Illinois University, Mailcode 6502, Carbondale, IL 62901, USA. Phone: 1-618-453-3527; Fax: 1-618-453-3563;
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8
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Zhu J, Coppens RP, Rabinovich NE, Gilbert DG. Effects of bupropion sustained release on task-related EEG alpha activity in smokers: Individual differences in drug response. Exp Clin Psychopharmacol 2017; 25:41-49. [PMID: 28150971 PMCID: PMC5310829 DOI: 10.1037/pha0000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying bupropion's efficacy as an antidepressant and a smoking cessation aid are far from being fully characterized. The present study is the first to examine the effects of bupropion on visuospatial task-related parietal EEG alpha power asymmetry-an asymmetry that has previously been found to be associated with severity of depressive symptoms (i.e., the more depressive symptoms, the greater alpha power in the right vs. left parietal area [Henriques & Davidson, 1997; Rabe, Debener, Brocke, & Beauducel, 2005]). Participants, all of whom were smokers and none of whom were clinically depressed, were randomly assigned to the Placebo group (n = 79) or Bupropion group (n = 31) in a double-blind study. EEG during the performance of the visuospatial task was collected before and after 14 days on placebo or bupropion sustained-release capsules. Relative to the Placebo group, the Bupropion group (especially, the Bupropion subgroup who had a positive right versus left parietal alpha power asymmetry at pretreatment) had a reduction in the parietal alpha asymmetry (driven largely by a decrease in right parietal alpha power). These findings support the hypothesis that bupropion can induce changes in parietal EEG asymmetry that have been shown in previous literature to be associated with a reduction in depressive states and traits. (PsycINFO Database Record
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Affiliation(s)
- Jian Zhu
- Department of Psychology, Southern Illinois University Carbondale
| | - Ryan P Coppens
- Department of Psychology, Southern Illinois University Carbondale
| | | | - David G Gilbert
- Department of Psychology, Southern Illinois University Carbondale
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Hammersley JJ, Gilbert DG, Rzetelny A, Rabinovich NE. Moderation of nicotine effects on covert orienting of attention tasks by poor placebo performance and cue validity. Pharmacol Biochem Behav 2016; 149:9-16. [PMID: 27461547 DOI: 10.1016/j.pbb.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND RATIONALE Given baseline-dependent effects of nicotine on other forms of attention, there is reason to believe that inconsistent findings for the effects of nicotine on attentional orienting may be partly due to individual differences in baseline (abstinence state) functioning. Individuals with low baseline attention may benefit more from nicotine replacement. METHOD The effects of nicotine as a function of baseline performance (bottom, middle, and top third of mean reaction times during placebo) were assessed in 52 habitual abstinent smokers (26 females/26 males) utilizing an arrow-cued covert orienting of attention task. RESULTS Compared to a placebo patch, a 14mg nicotine patch produced faster overall reaction times (RTs). In addition, individuals with slower RTs during the placebo condition benefitted more from nicotine on cued trials than did those who had shorter (faster) RTs during placebo. Nicotine also enhanced the validity effect (shorter RTs to validly vs. invalidly cued targets), but this nicotine benefit did not differ as a function of overall placebo-baseline performance. CONCLUSIONS These findings support the view that nicotine enhances cued spatial attentional orienting in individuals who have slower RTs during placebo (nicotine-free) conditions; however, baseline-dependent effects may not generalize to all aspects of spatial attention. These findings are consistent with findings indicating that nicotine's effects vary as a function of task parameters rather than simple RT speeding or cognitive enhancement.
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Affiliation(s)
- Jonathan J Hammersley
- Southern Illinois University at Carbondale, Department of Psychology, Carbondale, IL 62901-6502, USA.
| | - David G Gilbert
- Southern Illinois University at Carbondale, Department of Psychology, Carbondale, IL 62901-6502, USA.
| | - Adam Rzetelny
- Southern Illinois University at Carbondale, Department of Psychology, Carbondale, IL 62901-6502, USA.
| | - Norka E Rabinovich
- Southern Illinois University at Carbondale, Department of Psychology, Carbondale, IL 62901-6502, USA.
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Hammersley JJ, Rzetelny A, Gilbert DG, Rabinovich NE, Small SL, Huggenvik JI. Effects of nicotine on emotional distraction of attentional orienting: evidence of possible moderation by dopamine type 2 receptor genotype. Pharmacol Biochem Behav 2013; 105:199-204. [PMID: 23474369 DOI: 10.1016/j.pbb.2013.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/20/2013] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Growing evidence suggests that attentional bias to, and distraction by, emotional stimuli may moderate affective states and motivation for nicotine and other drug use. METHODS The present study assessed the effects of nicotine and dopamine receptor genotype on distraction by emotional pictures, during a modified spatial attention task, in 46 overnight-deprived smokers. RESULTS Relative to placebo, 14mg nicotine patch produced shorter overall reaction times (RTs) and individuals with two dopamine type 2 receptor (DRD2) A2 alleles exhibited the greatest RT benefit from nicotine following emotionally negative pictures after the longest cue-target delay (800ms), but benefitted least from nicotine following positive pictures after the shortest delay (400ms). In contrast, at the shortest delay, A1 carriers did not benefit from nicotine following emotionally negative pictures but did following positive ones. CONCLUSIONS These genetic differences in the effects of nicotine on attention immediately following emotionally positive versus negative stimuli may reflect differential excitatory and inhibitory transmitter processes related to approach (reward) and avoidance (punishment) sensitivities of dopamine-related neural networks that support positive and negative affect.
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Affiliation(s)
- Jonathan J Hammersley
- Southern Illinois University at Carbondale, Department of Psychology, Carbondale, IL, 62901-6502, USA.
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11
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Zuo Y, Gilbert DG, Rabinovich NE, Riise H, Needham R, Huggenvik JI. DRD2-related TaqIA polymorphism modulates motivation to smoke. Nicotine Tob Res 2009; 11:1321-9. [PMID: 19819938 DOI: 10.1093/ntr/ntp141] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION TaqIA polymorphism, a genetic variant associated with the expression level of dopamine D2 receptors in the brain, has been linked to various aspects of smoking behavior, including smoking prevalence, affective withdrawal symptoms, and smoking cessation outcome. However, its involvement in motivation to smoke cigarettes has not been elucidated. METHODS The present study examined the possible differences in self-reported reasons to smoke and craving for smoking in 160 smokers participating in a clinical trial. RESULTS Individuals with at least one A1 allele of the TaqIA polymorphism were more likely to report smoking for stimulating effects and to reduce negative affect compared with those lacking an A1 allele. The association of the A1 genotype with a higher probability and stronger motive to smoker to enhance cognitive functioning was evident in female but not in male smokers. Female A1 carriers also expected a greater likelihood of smoking for pleasure than those without an A1 allele. A1 subjects reported stronger craving for cigarettes during early days and the last phase of a 6-week abstinence period. DISCUSSION These results support the idea that dopaminergic transmission plays an important role in the neurobiological basis of reasons for smoking and that the TaqIA variant is one of the genetic factors underlying individual differences in these aspects. These findings also have implications for improving treatment strategies to help individuals quit smoking by controlling their motivation to continue cigarette consumption.
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Affiliation(s)
- Yantao Zuo
- Department of Psychology, Southern Illinois University-Carbondale, IL, USA
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12
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Gilbert DG, Zuo Y, Rabinovich NE, Riise H, Needham R, Huggenvik JI. Neurotransmission-related genetic polymorphisms, negative affectivity traits, and gender predict tobacco abstinence symptoms across 44 days with and without nicotine patch. J Abnorm Psychol 2009; 118:322-34. [PMID: 19413407 DOI: 10.1037/a0015382] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Genetic and personality trait moderators of tobacco abstinence-symptom trajectories were assessed in a highly controlled study. Based on evidence suggesting their importance in stress reactivity and smoking, moderators studied were serotonin transporter gene (5-HTTLPR) and dopamine D2 receptor gene (DRD2) polymorphisms and personality traits related to negative affect (NA). Smokers were randomly assigned to quit smoking with nicotine or placebo patches. Financial incentives resulted in 80% verified abstinence across the 44-day study. Individuals with 1 or 2 short alleles of 5-HTTLPR (S carriers) experienced larger increases in NA symptoms than did those without a short allele. Nicotine replacement therapy (NRT) alleviated anxiety only in S carriers. NRT reduced NA to a greater extent in DRD2 A1 carriers than in A2A2 individuals during the 1st 2 weeks of treatment (when on the 21-mg patch); however, A1 carriers experienced a renewal of NA symptoms when switched to the 7-mg patch and when off the patch, while A2A2 individuals continued to benefit from NRT. The results suggest that the effects of genotype and treatment may vary across different durations of abstinence, treatment doses, and genotypes.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901-6502, USA.
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13
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Carlson JM, Gilbert DG, Riise H, Rabinovich NE, Sugai C, Froeliger B. Serotonin transporter genotype and depressive symptoms moderate effects of nicotine on spatial working memory. Exp Clin Psychopharmacol 2009; 17:173-80. [PMID: 19586232 DOI: 10.1037/a0016384] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smokers may use nicotine to self-medicate for situation-specific or person-specific cognitive or affective deficits. Although evidence suggests that nicotine replacement therapy (NRT), relative to placebo, enhances spatial working memory (SWM) in smoking-abstinent smokers with schizophrenia, the extent to which NRT may be helpful in attenuating abstinence-related SWM in other groups with deficits in SWM is unknown. Depressive symptoms are associated with both tobacco smoking and deficits in SWM. Previous studies have found that smoking abstinence increases depressive affect and depression-related hemispheric asymmetries in brain activation. Although the serotonin neurotransmitter system is closely associated with depression and the effects of nicotine, the authors are not aware of any studies that have evaluated the possible role of individual differences in serotonin transporter (5-HTT) genotype and depressive symptoms as moderators of the effects of NRT on SWM. Thus, the current study assessed the effects of NRT (nicotine patch) on SWM in relation to: (1) depressive traits and (2) 5-HTT genotype. Smoking-deprived habitual smokers (N = 64) completed the dot recall test of SWM during counterbalanced and double-blind nicotine and placebo testing sessions. There was a marginal overall effect of NRT on SWM. More importantly, NRT enhanced SWM in 5-HTT short allele carriers, relative to those with two long alleles, and this enhancement in short-allele carriers was greater for individuals with higher levels of depressive symptoms.
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Affiliation(s)
- Joshua M Carlson
- Department of Psychology, Southern Illinois University-Carbondale, USA.
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14
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Rzetelny A, Gilbert DG, Hammersley J, Radtke R, Rabinovich NE, Small SL. Nicotine decreases attentional bias to negative-affect-related Stroop words among smokers. Nicotine Tob Res 2008; 10:1029-36. [PMID: 18584466 DOI: 10.1080/14622200802097514] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study examined the hypothesis that nicotine is associated with reduced attentional bias to affective and smoking-related stimuli in a modified Stroop task. A total of 56 habitual smokers were each tested on 4 days with 14 mg nicotine patches and placebo patches, counterbalanced, as a within-subjects factor in a double-blind design. A modified Stroop using negative-affect words, smoking words, color words, and neutral words was presented via computer in blocked format. As predicted, nicotine, relative to placebo, was associated with decreased attentional bias to negative words. Nicotine speeded performance during smoking-word and color-word blocks to the same degree as during neutral words and thus appeared to also have a nonspecific performance-enhancing effect. In an exploratory analysis, nicotine-attention effects occurred only in the initial presentation of pairs of blocked word pages. Nicotine also was associated with improved mood. The results are discussed in terms of affect-attention and smoking literatures.
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Affiliation(s)
- Adam Rzetelny
- M.A.Southern Illinois University at Carbondale, Carbondale, IL, USA.
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15
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Gilbert DG, Carlson JM, Riise H, Rabinovich NE, Sugai C, Froeliger B. Effects of nicotine and depressive traits on affective priming of lateralized emotional word identification. Exp Clin Psychopharmacol 2008; 16:293-300. [PMID: 18729683 PMCID: PMC3461268 DOI: 10.1037/a0012871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Based on evidence suggesting that depressive traits, emotional information processing, and the effects of nicotine may be mediated by lateralized brain mechanisms, analyses assessed the influence of depressive traits and nicotine patch on emotional priming of lateralized emotional word identification in 61 habitual smokers. Consistent with hypotheses, nicotine as compared to placebo patch enhanced right visual field (RVF) emotional word identification while decreasing performance of emotional word identification in the left visual field (LVF). Nicotine also enhanced positive affect and decreased negative affect. Consistent with the Heller model of depression, scoring high in depressive traits was associated with a general decrease in LVF emotional word identification. Additionally, this general LVF deficit was especially pronounced for positive word identification in individuals scoring high in trait depression. Positive primes facilitated positive target identification in the RVF and negative primes facilitated negative target identification in the LVF. Thus, nicotine promoted a LVF word-identification deficit similar to that observed in those with depressive traits. However, nicotine also enhanced RVF processing and reduced negative affect, whereas it enhanced positive affect.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale. IL 62901, USA.
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16
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Abstract
The authors tested the hypothesis that the effects of nicotine on affect are moderated by the presence or absence of emotionally positive and negative stimuli and by attentional choice to avoid attending to emotionally negative stimuli. Thirty-two habitual smokers were assigned to tasks allowing attentional freedom to look back and forth at 2 simultaneously presented pictures, whereas another 32 habitual smokers viewed single pictures without attentional choice. Picture contents in both tasks were 1 of 4 combinations: emotionally negative + neutral, negative + positive, positive + neutral, or neutral + neutral. Participants wore a nicotine patch on 1 day and placebo patch on another day. Nicotine reduced anxiety most when negative pictures were presented in combination with neutral pictures, but it had no effect on anxiety when negative pictures were presented in combination with positive pictures and when negative pictures were not presented. In contrast, nicotine only reduced depressive affect when the participant had attentional choice between positive and negative pictures. Nicotine also enhanced positive affect and reduced negative affect as measured by the Positive and Negative Affect Schedule, but these effects were not moderated by task manipulations. Overall, the findings support the view that nicotine's ability to reduce specific negative affects is moderated by emotional context and attentional freedom. Nicotine tended to enhance eye-gaze orientation to emotional pictures versus neutral pictures in women, but it had no significant effect on eye-gaze in men.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901-6502, USA.
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17
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Gilbert DG, Sugai C, Zuo Y, Rabinovich NE, McClernon FJ, Froeliger B. Brain indices of nicotine's effects on attentional bias to smoking and emotional pictures and to task-relevant targets. Nicotine Tob Res 2007; 9:351-63. [PMID: 17365767 DOI: 10.1080/14622200701188810] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aversive and smoking-related stimuli are related to smoking urges and relapse and can be potent distractors of selective attention. It has been suggested that the beneficial effect of nicotine replacement therapy may be mediated partly by the ability of nicotine to reduce distraction by such stimuli and thereby to facilitate attention to task-relevant stimuli. The present study tested the hypothesis that nicotine reduces distraction by aversive and smoking-related stimuli as indexed by the parietal P3b brain response to a task-relevant target digit. We assessed the effect of nicotine on distraction by emotionally negative, positive, neutral, and smoking-related pictures immediately preceding target digits during a rapid visual information processing task in 16 smokers in a double-blind, counterbalanced, within-subjects design. The study included two experimental sessions. After overnight smoking deprivation (12+ hr), active nicotine patches were applied to participants during one of the sessions and placebo patches were applied during the other session. Nicotine enhanced P3b responses associated with target digits immediately subsequent to negative emotional pictures bilaterally and subsequent to smoking-related pictures only in the right hemisphere. No effects of nicotine were observed for P3bs subsequent to positive and neutral distractor pictures. Another measure of attention, contingent negative variation amplitude in anticipation of the target digits also was increased by nicotine, especially in the left hemisphere and at posterior sites. Together, these findings suggest that nicotine reduces the distraction by emotionally negative and smoking-related stimuli and promotes attention to task-related stimuli by modulating somewhat lateralized and task-specific neural networks.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901-6502, USA.
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18
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Gilbert DG, Izetelny A, Radtke R, Hammersley J, Rabinovich NE, Jameson TR, Huggenvik JI. Dopamine receptor (DRD2) genotype‐dependent effects of nicotine on attention and distraction during rapid visual information processing. Nicotine Tob Res 2005; 7:361-79. [PMID: 16085504 DOI: 10.1080/14622200500125245] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The effects of nicotine, distractor type, and dopamine type-2 receptor (DRD2) genotype on rapid visual information processing (RVIP) task performance were assessed in habitual smokers. Four RVIP tasks differed in terms of distractor location (central vs. peripheral) and distractor type (numeric vs. emotional). Each participant performed each of the tasks on two different days, once while wearing an active nicotine patch and once while wearing a placebo patch. Overall, the nicotine patch produced more accurate detection of and faster reaction times to target sequences; however, these effects varied with distractor type and genotype. Nicotine speeded reaction time more with left-visual-field (LVF) than right-visual-field (RVF) emotional distractors but speeded reaction time more with RVF than LVF numeric distractors, especially when the distractor digit matched the target sequence in terms of numeric oddness or evenness. Nicotine tended to facilitate performance more in individuals with at least one A1 allele than in homozygous A2A2 individuals, especially with numeric distractors presented to the left hemisphere. Nicotine tended to reduce distraction by negative stimuli more than other types of stimuli. Few gender differences were observed. The overall pattern of results was consistent with the view that nicotine modulates selective attention or subsequent information processing in a manner that depends partly on the emotional versus numeric nature of task distractors, DRD2 genotype, and the brain hemisphere that initially processes the distractors (visual field of distractor).
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University, Carbondale, IL 62901-6502, USA.
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Gilbert DG, Sugai C, Zuo Y, Eau Claire N, McClernon FJ, Rabinovich NE, Markus T, Asgaard G, Radtke R. Effects of nicotine on brain responses to emotional pictures. Nicotine Tob Res 2004; 6:985-96. [PMID: 15801571 DOI: 10.1080/14622200412331324947] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Given that nicotine reduces negative affect, one would expect nicotine to have different effects on brain responses to emotionally negative stimuli than it does on responses to emotionally neutral or positive stimuli. However, no studies have assessed this possibility. The present study assessed the effects of nicotine patch versus placebo patch on brain event-related potential (ERP) responses to emotion-inducing negative, positive, and neutral color pictures in 16 smokers in a double-blind, counterbalanced, within-subjects design. The study included four experimental sessions. After overnight smoking deprivation (12 hr or more), active nicotine patches were applied to participants during one of the first two sessions and during one of the last two sessions. Placebo patches were applied during the other two sessions. Nicotine reduced frontal ERP processing voltage negativity (from 144-488 ms poststimulus onset) evoked by viewing emotionally negative pictures to a greater extent than it did when emotionally neutral pictures were viewed, whereas it had no effect on processing negativity evoked by positive pictures. Nicotine also enhanced P390 amplitudes evoked by emotionally negative pictures more than it did when emotionally neutral and positive pictures were viewed. Across picture types, nicotine (relative to placebo) reduced N300 amplitude (more at anterior and dorsal sites) and increased P390 amplitude. Overall, nicotine influenced ERPs to emotionally neutral and positive pictures less than it did to negative pictures.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University at Carbondale, IL 62901-6502, USA.
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Gilbert DG, Zuo Y, Browning RA, Shaw TM, Rabinovich NE, Gilbert-Johnson AM, Plath L. Platelet monoamine oxidase B activity changes across 31 days of smoking abstinence. Nicotine Tob Res 2003; 5:813-9. [PMID: 14668065 DOI: 10.1080/14622200310001614575] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although recent studies demonstrate that tobacco cigarette smoke substantially inhibits both central nervous system and blood platelet monoamine oxidase (MAO) activity, little is known about the time course of MAO increases after smoking cessation. Therefore, changes in platelet MAO-B activity and mood were assessed before and at multiple times after quitting smoking. Quitting smoking was associated with a significant (22%) increase in MAO activity by day 3 and with a maximum increase (about 50%) by day 10 that was maintained through day 31 of abstinence. However, abstinence-related increases in depressive mood peaked at day 2 of abstinence, a week more rapidly than the peak increase in MAO-B activity. Neither mood nor MAO-B activity returned to baseline or smoking control levels across the 31-day abstinence period. The asynchrony of increased negative affect and MAO-B activity during the first few days of abstinence may reflect any of several possibilities. First, the duration of the platelet life cycle may not reflect central MAO-B or MAO-A activity. Second, MAO-B may not contribute to or index mood changes during the first days of abstinence though it may contribute to protracted abstinence-induced negative affect. These findings are discussed in terms of the hypothesis that platelet MAO activity reflects central nervous system MAO changes that promote increased depressive affect resulting from smoking abstinence.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University at Carbondale, Carbondale, IL 62901-6502, USA.
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Gilbert DG, McClernon FJ, Rabinovich NE, Plath LC, Masson CL, Anderson AE, Sly KF. Mood disturbance fails to resolve across 31 days of cigarette abstinence in women. J Consult Clin Psychol 2002. [PMID: 11860040 DOI: 10.1037//0022-006x.70.1.142] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smoking abstinence responses were characterized in 96 female smokers. Participants completed subjective state measures twice per week for 5 weeks and were then randomly assigned to a group required to abstain for 31 days or a control group that continued to smoke. Financial incentives for biochemically verified abstinence resulted in an 81% completion rate. Abstinence-related increases in depression, tension, anger, irritability, and appetite showed little tendency to return to prequit levels and remained significantly elevated above smoke-group levels. In contrast to psychological components of anxiety, physical components decreased to smoke group levels by the 2nd week of abstinence. Trait depression and neuroticism predicted larger increased abstinence-associated negative affect. The Big Five personality dimensions predicted variance not associated with depressive traits.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University at Carbondale, 62901-6502, USA.
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Gilbert DG, McClernon FJ, Rabinovich NE, Plath LC, Masson CL, Anderson AE, Sly KF. Mood disturbance fails to resolve across 31 days of cigarette abstinence in women. J Consult Clin Psychol 2002; 70:142-52. [PMID: 11860040 DOI: 10.1037/0022-006x.70.1.142] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Smoking abstinence responses were characterized in 96 female smokers. Participants completed subjective state measures twice per week for 5 weeks and were then randomly assigned to a group required to abstain for 31 days or a control group that continued to smoke. Financial incentives for biochemically verified abstinence resulted in an 81% completion rate. Abstinence-related increases in depression, tension, anger, irritability, and appetite showed little tendency to return to prequit levels and remained significantly elevated above smoke-group levels. In contrast to psychological components of anxiety, physical components decreased to smoke group levels by the 2nd week of abstinence. Trait depression and neuroticism predicted larger increased abstinence-associated negative affect. The Big Five personality dimensions predicted variance not associated with depressive traits.
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Affiliation(s)
- David G Gilbert
- Department of Psychology, Southern Illinois University at Carbondale, 62901-6502, USA.
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Gilbert DG, McClernon FJ, Rabinovich NE, Dibb WD, Plath LC, Hiyane S, Jensen RA, Meliska CJ, Estes SL, Gehlbach BA. EEG, physiology, and task-related mood fail to resolve across 31 days of smoking abstinence: relations to depressive traits, nicotine exposure, and dependence. Exp Clin Psychopharmacol 1999; 7:427-43. [PMID: 10609977 DOI: 10.1037/1064-1297.7.4.427] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Changes in task-related mood and physiology associated with 31 days of smoking abstinence were assessed in smokers, 34 of whom were randomly assigned to a quit group and 22 to a continuing-to-smoke control group. A large financial incentive for smoking abstinence resulted in very low participant attrition. Individuals were tested during prequit baselines and at 3, 10, 17, and 31 days of abstinence. Abstinence was associated with decreases in heart rate and serum cortisol, a slowing of electroencephalogram (EEG) activity, and task-dependent and trait-depression-dependent hemispheric EEG asymmetries. Differences between the quit group and the smoking group showed no tendency to resolve across the 31 days of abstinence. Trait depression and neuroticism correlated with increases in left-relative-to-right frontal EEG slow-wave (low alpha) activity at both 3 and 31 days of abstinence. In contrast, prequit nicotine intake and Fagerström Tolerance scores correlated with alpha asymmetry and with greater EEG slowing only at Day 3. Thus, the effects of smoking abstinence appear to last for at least several months.
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Affiliation(s)
- D G Gilbert
- Department of Psychology, Southern Illinois University at Carbondale, 62901, USA.
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Iurevich VM, Rabinovich NE. [A new Soviet apparatus for the control of depth of anesthesia]. Med Prom SSSR 1966; 20:57-62. [PMID: 6000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Efuni SN, Trusov VS, Rabinovich NE. [The use of a pointer indicator for the purpose of determining the depth of anesthesia]. Khirurgiia (Mosk) 1965; 41:27-9. [PMID: 5879125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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