Generalized and Domain-Specific Episodic Thinking for Smoking Cessation

Virginia Polytechnic Institute and State University

Status: Not yet enrolling

Conditions: Cigarette Smoking Behavior

Treatments: Behavioral: Domain-specific episodic thinking; Behavioral: Episodic Future Thinking (EFT); Behavioral: Episodic Recent Thinking (ERT); Behavioral: Generalized episodic thinking

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT07158749

1R21CA294049 (U.S. NIH Grant/Contract)

24-1183

Details and patient eligibility

About

Cigarette smoking remains common, particularly in rural areas, despite ample evidence that smoking causes cancer and respiratory disease. Successful smoking cessation yields the majority of its health benefits (e.g., avoidance of lung cancer) after years of sustained behavioral change; however, people who smoke cigarettes tend to show elevated rates of delay discounting (i.e., devaluation of delayed outcomes) and a bias for immediate gratification. The overall goal of this project is to develop different versions of an episodic future thinking intervention (i.e., visualization of the future) and test their feasibility and efficacy for smoking cessation in rural and urban populations.

Full description

Cigarette smoking causes more than a dozen cancers, including cancers of the head and neck, colon, bladder, and lung. Although quitting smoking drastically reduces the risk of cancer mortality, rates of cessation are low, particularly in rural areas and other communities. Current evidence-based treatments for smoking cessation have made progress, but substantial room for innovation remains and novel strategies are needed. Successful smoking cessation may be considered, in part, an intertemporal choice between continuing to smoke and achieving the delayed health benefits associated with quitting (e.g., avoidance of lung cancer). Thus, quitting requires one's behavior to be sufficiently motivated by future outcomes. Unfortunately, robust cross-sectional and longitudinal evidence indicates that people who smoke cigarettes show elevated delay discounting, or a bias for immediate gratification. Prior research shows that delay discounting predicts treatment failure and relapse in smoking cessation. These findings suggest that delay discounting often prevents successful quitting because the health benefits of cessation (e.g., avoiding cancer) are too delayed to motivate sustained behavioral change. Thus, delay discounting is a therapeutic target in smoking cessation, where interventions that increase valuation of future outcomes may facilitate quitting. Episodic future thinking (EFT) is one such scalable intervention that is designed to shift time perspective and reduce bias for immediate gratification by promoting vivid and frequent visualization of a broad range of personally significant future events (e.g., weddings, birthdays, spending time with loved ones). In laboratory studies, research has shown that this form of generalized EFT in cigarette smokers reduces delay discounting and motivation to smoke (i.e., cigarette consumption, craving, and valuation). Moreover, strong preliminary evidence suggests that cancer-related EFT, a novel form of the intervention that involves visualizing the future experience of smoking-related lung cancer, may be more efficacious for reducing urges to smoke than the generalized form. The proposed trial will adapt both forms of EFT (generalized and cancer-related) for clinical use in smoking cessation. Remote intervention delivery and outcomes assessment (breath carbon monoxide and number of cigarettes smoked per day) will be used to minimize clinical burden and increase intervention reach and access, including in rural populations who often lack access to evidence-based treatments for smoking cessation. In an eight-week proof-of-concept trial, participants will be prompted to engage in EFT or control episodic thinking multiple times per day and during acute craving episodes. Specific Aims 1 and 2 will examine the feasibility and efficacy, respectively, of generalized and cancer-related EFT to reduce smoking. An Exploratory Aim will investigate the potential moderating role of income, education, sex, and other characteristics (e.g., baseline delay discounting, cigarettes/day) in the effects of EFT on smoking outcomes.

Enrollment: 134 estimated patients

Sex: All

Ages: 21+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• smoked cigarettes daily for the last 30 days;
• salivary cotinine > 30 ng/mL, consistent with tobacco use;
• plan to quit smoking in the next 30 days

Exclusion criteria

• prior diagnosis with a smoking-related illness (e.g., respiratory disease);
• past 30-day use any smoking cessation treatment;
• anxiety or mood disorders; and
• medical contraindications for use of nicotine replacement therapy (e.g. pregnancy).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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134 participants in 4 patient groups, including a placebo group

Generalized episodic future thinking (EFT)

Experimental group

Description:

The Generalized EFT group will identify positive events that may occur at 6 future time points (1 month to 5 years). These may include a broad range of personally significant milestones (e.g., weddings, birthdays) or other events that participants are looking forward to (e.g., spending time with loved ones). Participants will also generate vivid text descriptions, or cues (transcribed in their own words), to prompt EFT in the natural environment. These cues, including emotional impacts, will be elicited using standardized questions: Who are you with? What are you doing? Where are you? How are you feeling? Participants will be prompted to engage in Generalized EFT in the natural environment.

Treatment:

Behavioral: Generalized episodic thinking

Behavioral: Episodic Future Thinking (EFT)

Domain-specific episodic future thinking (EFT)

Experimental group

Description:

The Domain-Specific EFT group will complete an identical interview as the Generalized EFT group to identify positive future events, with one exception. Following initial cue generation, participants will be provided with descriptions of lung cancer symptoms (e.g., painful breathing; extreme fatigue; coughing up blood, phlegm, or mucus) and will be asked to visualize and include details related to this experience and their emotional impact in their revised cues. Thus, cancer-related symptoms occur in the context of otherwise positive, personally significant events to further highlight the impact of the diagnosis and to be consistent with Generalized EFT. Participants will be prompted to engage in Domain-Specific EFT in the natural environment.

Treatment:

Behavioral: Episodic Future Thinking (EFT)

Behavioral: Domain-specific episodic thinking

Generalized episodic recent thinking (ERT)

Placebo Comparator group

Description:

The Generalized ERT interview will be identical to the one described for Generalized EFT, except participants will describe positive events they experienced in the last week. Participants will be prompted to engage in Generalized ERT in the natural environment.

Treatment:

Behavioral: Generalized episodic thinking

Behavioral: Episodic Recent Thinking (ERT)

Domain-specific episodic recent thinking (ERT)

Active Comparator group

Description:

The Domain-Specific ERT interview will be identical to the one described for Domain-Specific EFT, except participants will describe positive events they experienced in the last week and will subsequently add detail as though they were experiencing symptoms of lung cancer. Participants will be prompted to engage in Domain-Specific ERT in the natural environment.

Treatment:

Behavioral: Episodic Recent Thinking (ERT)

Behavioral: Domain-specific episodic thinking