Facilitated Extinction Training to Improve Pharmacotherapy for Smoking Cessation: A Pilot Feasibility Trial

• Published in: Nicotine & tobacco research 2018-09, Vol.20 (10), p.1189-1197
• Main Authors: Brandon, Thomas H., Unrod, Marina, Drobes, David J., Sutton, Steven K., Hawk, Larry W., Simmons, Vani N., Brandon, Karen O., Roetzheim, Richard G., Meltzer, Lauren R., Miller, Ralph R., Cahill, Shawn P.
• Format: Article
• Language: English
• Subjects: Adult; Counseling - methods; Extinction, Psychological - drug effects; Extinction, Psychological - physiology; Feasibility Studies; Female; Humans; Male; Middle Aged; Original Investigations; Pilot Projects; Smoking Cessation - methods; Smoking Cessation - psychology; Smoking Cessation Agents - pharmacology; Smoking Cessation Agents - therapeutic use; Tobacco Smoking - psychology; Tobacco Smoking - therapy; Varenicline - therapeutic use
• ISSN: 1462-2203; 1469-994X
• DOI: 10.1093/ntr/ntx203

Abstract Introduction Varenicline reduces smoking satisfaction during the pre-cessation run-in period, which may contribute to extinction of cravings and smoking behavior. Research indicates that efficacy is enhanced when the run-in period is increased from 1 to 4 weeks, providing a longer extinction opportunity. We hypothesized that efficacy could be further enhanced by harnessing basic and applied research on extinction. We developed a pre-cessation extinction-facilitating intervention and tested its feasibility in a pilot trial. Methods The facilitated extinction (FE) intervention comprised brief counseling and workbook-recommending strategies to maximize extinction processes during the run-in, including instructions to smoke at a normal rate across contexts and cues, and use of an extinction cue to enhance generalization. Participants were randomly assigned to one of three varenicline interventions: standard (1-week run-in), extended (4-week run-in), and extended + FE. Interventions were delivered prior to the target quit date (TQD). Assessments were conducted in weeks 1 and 4 pre-TQD and 1 and 3 months post-TQD, with focus on feasibility indices. Results Recruitment and retention goals were met (N = 58). Treatment satisfaction was high across groups. The majority of FE participants adhered to instructions and maintained their usual smoking rate during the run-in period. Greater decreases in craving and smoking satisfaction were observed among participants in both extended groups versus the standard group (p < .005). Conclusions Feasibility was demonstrated. Participants adhered to the FE intervention, thereby optimizing the number and variety of extinction trials. Findings support testing the novel FE smoking cessation intervention in a fully powered trial. Implications This study expands the research on the clinical benefits of extending the pre-cessation run-in period of varenicline. It introduces the hypothesis that further benefit might be achieved by translating basic behavioral research, as well as cue-exposure research and therapy for other disorders, to improve the extinction and generalization processes thought to underlie much of varenicline’s effect. A FE intervention was developed and found acceptable to smokers and feasible to implement in a research setting. The study sets the stage for a subsequent randomized controlled trial.