Cognitive avoidance and aversive cues related to tobacco in male smokers

Background: Treatment using aversive conditioning has been suggested for smoking cessation. The efficacy of this method is thought to be associated with cognitive avoidance. We compare differences in avoidance traits and patterns of associated brain activation in response to cues that induce cravings versus aversion between smokers and non-smokers.

Methods: Fifteen smokers and fifteen non-smokers completed cue reactivity tasks while undergoing functional magnetic resonance imaging (fMRI) to examine brain responses to craving-inducing cues (Cr) and aversion-inducing cues (Av). Participant avoidant traits were also assessed.

Results: Activation of the left frontal subcallosal gyrus in response to Cr was greater in smokers than in non-smokers. Smokers showed less activation in the right temporal lobe in response to Av than did non-smokers. Brain activation in response to Cr in the left frontal subcallosal gyrus was positively correlated with Fagerstrom Test for Nicotine Dependence (FTND) scores in smokers. Brain activation in response to Av in the right temporal lobe was negatively correlated with the Korean Version of the Cognitive Avoidance Questionnaire (KCAQ) scores in non-smokers.

Conclusions: Cognitive avoidance in smokers during aversive stimulation might result in sustaining addictive behaviors. On the other hand, non-smokers may be able to emotionally confront the adverse effects of smoking.