High-Level Construal for Smoking Cessation

Not currently recruiting at 1 trial location

Overseen By Dasa Zeithamova, Ph.D.

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Oregon

Must be taking: Nicotine replacement

Disqualifiers: Metal implants, Claustrophobia, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different mental strategies can help people quit smoking by focusing on the brain's pathways involved in these processes. Participants will receive messages encouraging them to manage cravings (down-regulation of craving for cigarettes), envision a smoke-free future (high-level construal), and reflect on their core values (up-regulation of goal energization). The trial seeks individuals who smoke at least 10 cigarettes a day, have unsuccessfully tried to quit, and face financial challenges. Participants must be willing to use nicotine replacement therapies like patches or gum. The study aims to find effective ways to support smoking cessation in real-life settings. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could lead to new methods for quitting smoking.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you are required to use nicotine replacement therapy (NRT) like patches or gum during the study.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the treatments in this study are generally safe and well-tolerated.

For the "down-regulation of craving for cigarettes" treatment, studies have found that techniques like cognitive reappraisal, which involves rethinking cravings, can help reduce smoking. Participants usually receive these methods well, experiencing fewer cravings over time.

The "high-level construal" approach involves considering the long-term benefits of quitting smoking. Early research suggests that focusing on future benefits can aid in quitting attempts. This method is safe because it uses mental exercises instead of medications.

Lastly, the "up-regulation of goal energization" method uses messages that encourage focus on core values and goals. Research indicates that setting clear goals can increase motivation to quit smoking. This method is safe, as it involves self-reflection and goal-setting.

Overall, these methods are non-invasive and focus on psychological strategies, making them safe options for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores new psychological methods to help people quit smoking, focusing on mental strategies rather than medications. Unlike standard treatments like nicotine replacement therapy or prescription medications, this trial examines the power of changing thoughts and behaviors. The trial's methods include teaching people to manage cravings by thinking about health consequences, envisioning a smoke-free future, and tapping into personal values that motivate quitting. These innovative approaches aim to provide smokers with mental tools that can make quitting more achievable and sustainable.

What evidence suggests that this trial's treatments could be effective for smoking cessation?

Research shows that changing thoughts about smoking can help manage cravings. In this trial, participants in the "Effortful down-regulation of craving for cigarettes" arm will receive messages encouraging them to rethink smoking's negative effects. Studies have found that this can change brain activity to help control cravings. Meanwhile, participants in the "High-level construal" arm will focus on the long-term benefits of quitting smoking, which can increase motivation to quit. Additionally, the "Up-regulation of goal energization" arm will encourage participants to consider their core values and how quitting aligns with them, potentially increasing their likelihood of attempting to quit. Overall, these mental strategies and future-focused thinking have shown promise in helping people reduce smoking. ^{6 7 8 9 10}

Who Is on the Research Team?

Elliot T Berkman, Ph.D.

Principal Investigator

University of Oregon

Are You a Good Fit for This Trial?

Adult smokers aged 25-55, living with low income (below 200% of the federal poverty line), who have tried and failed to quit smoking. They must be willing to use nicotine replacement therapy provided or their own throughout the study. Pregnant women, individuals with metal implants, electronic medical devices, or those weighing over 550 lbs are excluded.

Inclusion Criteria

Income-to-needs ratio (INR) is less than 2.0, meaning that their household income adjusted for household size is below 200% of the federal poverty line

You smoke cigarettes regularly, at least 10 cigarettes per day for at least 1 year.

Low-SES

Exclusion Criteria

People in this population are likely to have some comorbid psychiatric, substance use, and/or other health disorders that might pose a challenge to retention and intervention compliance. Such comorbidities are inherent to the population of interest (persistent smokers) so they will not be exclusionary criteria; instead, we will gather information about psychiatric, substance use, and medical comorbidities on intake so that we can monitor and report any associations with attrition, compliance, and effects of the experimental conditions

Weight ˃ 550 lbs.

I am pregnant or might be pregnant.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

Baseline Assessment

Participants complete a multimodal battery assessing neural, behavioral, and self-report indices before randomization

1 week

1 visit (in-person)

Treatment

Participants receive text messages and complete biweekly online booster sessions for affect regulation and smoking cessation

8 weeks

Biweekly online sessions

Follow-up

Participants are monitored for changes in smoking behavior and neural activity post-treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Down-regulation of craving for cigarettes
• High-level construal
• Treatment-as-usual control
• Up-regulation of goal energization

Trial Overview The trial is testing whether changing how people think about their goals (high-level construal) can help them regulate emotions and quit smoking more effectively than traditional methods like reducing cravings directly. Participants' brain activity will be monitored to see if this new approach works differently from standard treatments.

How Is the Trial Designed?

Group I: Up-regulation of goal energization Experimental Treatment 1 Intervention

Participants will be sent messages that encourage them to consider the core values that drive their desire to quit smoking.

Group II: High-level construal Experimental Treatment 1 Intervention

Participants will be sent messages asking them to imagine what their lives will look like in the future if they succeed ("What would quitting mean to you and your family's future?"; Yeager et al., 2014).

Group III: Effortful down-regulation of craving for cigarettes Experimental Treatment 1 Intervention

Participants will be sent messages that encourage inhibitory control of cravings for cigarettes (e.g., using cognitive reappraisal or attentional control) and that provide strategies to do so (e.g., "When you feel an urge to smoke, think about the health consequences").

Down-regulation of craving for cigarettes is already approved in United States, Canada, European Union for the following indications:

Approved in United States as Chantix for:

• Smoking cessation
• Dry eye disease (for Tyrvaya nasal spray)

Approved in Canada as Champix for:

• Smoking cessation

Approved in European Union as Champix for:

• Smoking cessation

Who Is Running the Clinical Trial?

University of Oregon

Lead Sponsor

Trials

91

Recruited

46,700+

Ohio State University

Collaborator

Trials

891

Recruited

2,659,000+

Published Research Related to This Trial

Varenicline, a medication for smoking cessation, works by targeting both the reinforcing effects of nicotine and its ability to enhance the appeal of environmental cues, which can influence smoking behavior.

The effectiveness of Varenicline may vary among smokers, particularly benefiting those who are more sensitive to nicotine's effects on their environment, suggesting a personalized approach to treatment could be advantageous.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varenicline Targets the Reinforcing-Enhancing Effect of Nicotine on Its Associated Salient Cue During Nicotine Self-administration in the Rat. Garcia-Rivas, V., Fiancette, JF., Cannella, N., et al.[2020]

Varenicline, a medication for smoking cessation, not only reduces withdrawal symptoms and nicotine reinforcement but also blunts brain responses to smoking cues, which helps decrease cravings.

In a study involving nicotine-dependent smokers, varenicline significantly reduced activity in brain regions associated with craving when exposed to smoking cues, indicating a new mechanism that likely enhances its effectiveness in helping people quit smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of varenicline on smoking cue–triggered neural and craving responses. Franklin, T., Wang, Z., Suh, JJ., et al.[2022]

Varenicline is the most effective medication for smoking cessation, achieving cessation rates of 25-35% after one year, despite high recidivism rates among smokers.

The study found that varenicline reduces anticipatory reward processing in smokers, which may help decrease the desire to smoke by altering brain circuits related to reward, thus contributing to its effectiveness as a treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reward Anticipation Is Differentially Modulated by Varenicline and Nicotine in Smokers. Fedota, JR., Sutherland, MT., Salmeron, BJ., et al.[2019]

In a study involving 47 treatment-seeking heavy drinkers, varenicline did not reduce alcohol cue-induced craving compared to a placebo, indicating it may not be effective in blunting cravings in this context.

However, the study found that higher levels of craving measured during the cue reactivity tests were predictive of increased alcohol use in real-world settings, highlighting the importance of craving as a potential indicator of drinking behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Alcohol Cue Reactivity on Subsequent Treatment Outcomes Among Treatment-Seeking Individuals with Alcohol Use Disorder: A Multisite Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Varenicline. Miranda, R., O'Malley, SS., Treloar Padovano, H., et al.[2021]

In a study of 17 non-treatment seeking adult smokers, extended pre-treatment with varenicline for 21 days significantly reduced the number of cigarettes smoked per day and smoking urges, particularly during the later days of treatment.

The findings suggest that a longer duration of varenicline pre-treatment may enhance its effectiveness in promoting smoking cessation, as reductions in smoking behavior and cravings were observed only after the typical one-week adjustment period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of 21 days of varenicline versus placebo on smoking behaviors and urges among non-treatment seeking smokers. Ashare, RL., Tang, KZ., Mesaros, AC., et al.[2021]

Varenicline effectively inhibits nicotine-enhanced brain stimulation reward (BSR), supporting its role as a smoking cessation aid, as shown through experiments with varying doses of nicotine and varenicline.

The mechanism of action for varenicline's effects is primarily through the activation of alpha4beta2 nicotinic receptors, while alpha7 receptors do not appear to play a significant role in this process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varenicline attenuates nicotine-enhanced brain-stimulation reward by activation of alpha4beta2 nicotinic receptors in rats. Spiller, K., Xi, ZX., Li, X., et al.[2021]

Varenicline, an FDA-approved smoking cessation aid, has been shown to effectively signal reward-seeking behavior in rats, indicating its potential to help with smoking cessation by mimicking nicotine's effects at specific brain receptors.

The study demonstrated that the effects of varenicline are primarily mediated through its partial agonist activity at alpha4beta2 nicotinic acetylcholine receptors, suggesting that targeting these receptors could enhance the development of new smoking cessation therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varenicline serves as the training stimulus in the drug-discriminated goal-tracking task with rats: initial evaluation of potential neuropharmacological processes. Thompson, BM., Tracy, ME., Huynh, YW., et al.[2023]

In a study involving 8 cigarette smokers, acute administration of varenicline (0.5, 1, and 2 mg) did not significantly alter smoking or eating behavior, suggesting it may not have immediate behavioral effects.

In contrast, methylphenidate, used as a positive control, increased smoking behavior and decreased caloric intake, highlighting the need for further research on the long-term effects of varenicline on smoking and eating behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The influence of acute varenicline administration on smoking and eating behavior in humans. Stoops, WW., Vansickel, AR., Glaser, PE., et al.[2015]

Varenicline, a recently approved smoking cessation drug, has been shown to significantly increase abstinence rates compared to placebo and other treatments like bupropion SR and nicotine patches, with rates tripling compared to placebo.

In addition to improving abstinence, varenicline effectively reduces cravings and withdrawal symptoms, supporting its mechanism as a partial agonist that diminishes the rewarding effects of smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Varenicline in the treatment of tobacco dependence. Fagerström, K., Hughes, J.[2021]

Citations

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Randomized trial of mindfulness- and reappraisal-based ... Cognitive reappraisal of craving involves thinking about the negative consequences of smoking (i.e., bad breath, spending money, risk of cancer, etc.).

2. psycnet.apa.org psycnet.apa.org/record/2022-33159-001

Neurofunctional alterations of cognitive down-regulation of ... In this study, 78 subjects (37 TUD & 42 NS) underwent functional magnetic resonance imaging while performing a down-regulation of craving task.

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Regulation of craving and underlying resting-state neural ... This laboratory study examined associations between regulation of craving (ROC) efficacy and smoking lapse, utilized functional connectivity multivariate ...

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Construal Level as a Novel Pathway for Affect Regulation ... In the down-regulation of craving condition, participants will be sent messages that encourage inhibitory control of cravings for cigarettes (e.g., using ...

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Emotion regulation in heavy smokers These results suggest that heavy smokers are capable to regulate emotion via deliberate reappraisal and smokers' cigarette craving is associated with emotional ...

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The Effects of Immediate vs Gradual Reduction in Nicotine ... The significantly lower cravings were observed in the immediate vs. gradual nicotine reduction group, and led to faster reduction in the number of CPD.

7. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK555596/

Interventions for Smoking Cessation and Treatments ... - NCBI For more than a decade, national surveillance data on smoking cessation have revealed a similar pattern, with modest improvement—two-thirds of adult cigarette ...

8. mayoclinic.org mayoclinic.org/diseases-conditions/nicotine-dependence/in-depth/nicotine-craving/art-20045454

Quitting smoking: 10 ways to resist tobacco cravings The urge to use tobacco and nicotine products can wear you down when you're trying to quit. Use these tips to lessen and resist cravings.

9. sciencedirect.com sciencedirect.com/science/article/pii/S2589004224023150

Personalized and adaptive interventions for smoking ... This article explores mechanisms of efficacy and limitations of established cessation therapies, identifies emerging products expanding the range of ...

10. nature.com nature.com/articles/npp201353

Effect on Brain Nicotinic Acetylcholine Receptor Density Smoking reduction and cessation with commonly used treatments (and pill placebo) lead to decreased α 4 β 2 * nAChR densities across brain regions.