Impulsive and reflective processes in chronic tobacco dependence

Motka, Franziska (2025): Impulsive and reflective processes in chronic tobacco dependence: empirical research on assessment and modification. Dissertation, LMU München: Fakultät für Psychologie und Pädagogik

Abstract

Tobacco smoking remains a major public health concern, with substantial economic costs. Although evidence-based treatments are available, relapse rates remain high. Dual-process models explain the development and maintenance of tobacco dependence by an imbalance between strong impulsive processes (e.g., appetitive responses toward smoking-related stimuli, such as involuntary approach tendencies) and weak reflective processes (e.g., deficits in inhibitory control). From a neurobiological perspective, the Incentive-Sensitization Theory (IST) posits that appetitive responses are driven by the incentive sensitization of the mesocorticolimbic reward circuit (including, e.g., amygdala, striatum), which attributes incentive-motivational value to drug-related cues. Computerized training interventions targeting these processes have shown promise in reducing alcohol relapse rates and unhealthy eating behaviors. However, evidence on assessing and modifying these processes in tobacco dependence is limited and inconsistent, possibly due to methodological shortcomings, such as small sample sizes and poor measurement reliability. This dissertation aimed to address previous limitations and methodological shortcomings to advance the field by pursuing two objectives. The first objective was to test key assumptions of dual-process models and the IST in chronic tobacco dependence within two cross-sectional studies. Study I assessed responses toward smoking-related stimuli in a large sample of chronically smoking individuals (N = 362) employing a multi-method approach, including self-report, cognitive-behavioral (reaction time tasks), psychophysiological (facial electromyography), and neural (functional magnetic resonance imaging) measures. Study II compared a smoking sample (N = 122) to healthy controls (N = 69), investigating general and smoking-specific inhibitory deficits using Go/No-Go Tasks. Results suggest that chronic tobacco dependence is associated with both deficits in reflective processes (i.e., inhibitory control) and strong impulsive processes toward smoking-related stimuli. However, contrary to the assumptions of the IST, these impulsive processes appeared to reflect automatized, habitual action patterns rather than appetitive responses (e.g., approach tendencies) driven by the incentive-motivational value of these stimuli. Nevertheless, incentive-driven appetitive responses appeared to emerge when individuals experience heightened craving. The second objective was to examine the efficacy and working mechanisms of training interventions targeting dysfunctional impulsive and reflective processes in two randomized-controlled trials. Study III investigated the effects of Approach Bias Modification (ApBM) as an add-on to regular smoking cessation treatment (TAU) on neural reactivity toward smoking-related versus neutral stimuli (smoking cue-reactivity). Contrary to findings in alcohol research, TAU+ApBM did not significantly reduce smoking cue-reactivity in reward-related brain regions compared to control conditions. Study IV evaluated the efficacy and working mechanisms of general and smoking-specific Go/No-Go Task-based inhibitory control training as a stand-alone intervention for smoking reduction. Results suggest that Go/No-Go training may yield short-term reductions in tobacco dependence and craving, though its long-term efficacy and underlying mechanisms remain uncertain. In sum, this dissertation provides novel insights into impulsive and reflective processes in chronic tobacco dependence and their targeted modification. The findings challenge the IST assumption that chronic smoking is primarily driven by incentive-motivated appetitive responses toward smoking-related stimuli, instead highlighting the significant role of automatized, habitual action patterns. This has important implications for training interventions, suggesting that disrupting habit-driven impulsive processes may be a promising target. The results also underscore the role of inhibitory deficits and provide empirical support for Go/No-Go Task-based inhibitory control training. Key directions for future research include a more detailed investigation of habitual response patterns toward smoking-related stimuli, the use of ecologically valid methods to capture the dynamic nature of impulsive processes in real-life settings, and further research on the efficacy and underlying mechanisms of inhibitory control training in smoking cessation.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 100 Philosophie und Psychologie ; 100 Philosophie und Psychologie > 150 Psychologie
• Fakultäten: Fakultät für Psychologie und Pädagogik
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 20. Oktober 2025
• 1. Bericht­erstatter:in: Wittekind, Charlotte