Effects of episodic future thinking on reinforcement pathology during smoking cessation treatment among individuals with substance use disorders

Rationale Reinforcer pathology (RP) is a theoretical model based on two processes: delay discounting (DD) and drug demand. Given that RP has been shown to have a predictive value on smoking behaviors, several studies have explored which interventions can reduce RP. Consistent with the RP framework, episodic future thinking (EFT) has shown effects on treatment outcomes and RP processes. The vast majority of studies that assess the effects of EFT on RP consist of experimental studies, and no previous research has tested these effects in a clinical sample of smokers. Objectives The primary aim of this study was to assess the effects of EFT on RP throughout the course of a smoking cessation intervention in smokers with substance use disorders (SUDs). Methods Participants were randomized to cognitive behavior therapy (CBT) + EFT (n = 39) or CBT + EFT + contingency management (n = 33). Cotinine, frequency of EFT practices, cigarette purchase task (CPT), and DD were evaluated in treatment sessions. Mixed-effects model repeated measures analysis was used to explore DD and CPT in-treatment changes as a function of EFT practices and cotinine levels. Results Greater practice of the EFT component significantly reduced cigarette demand (p < .020) as well as DD (p = .003). Additionally, a greater reduction in cotinine levels coupled with greater EFT practice led to a greater decrease in cigarette demand (p < .014). Conclusions EFT reduced the two facets of RP in treatment-seeking smokers with SUDs.

The effect of episodic future thinking on delay discounting

<p>Delay discounting refers to the fact that rewards lose their value if they are delayed. Excessive delay discounting is associated with various health-related problems such as over-eating and substance abuse. One phenomenon shown to reduce delay discounting is Episodic Future Thinking (EFT; imagining personal future events). Across multiple experiments and a meta-analysis, the current thesis examined the reliability of the effect of EFT on delay discounting and also sought to clarify the components of EFT that are necessary to reduce delay discounting. Experiment 1 replicated the EFT effect using a common titrating-amount procedure, and the meta-analysis based on 40 independent studies confirmed that EFT has a reliable, medium-sized effect on delay discounting. The meta-analysis also assessed the robustness of the EFT effect across various methodological features and participant characteristics. A multiple meta-regression revealed that the between-study variability in the size of the EFT effect was accounted for by study design and type of discounting measure. Within-subjects design studies had significantly smaller effect sizes than between-subjects design studies. Studies that used k as a discounting rate measure had significantly smaller effect sizes than studies that used area under the discounting curve or other atheoretical discounting measures. The size of the EFT effect was robust across different participant characteristics and ages, suggesting that EFT may be utilized as an effective intervention for a variety of age groups and impulsive behaviors. Experiments 2A, 2B and 2C assessed the suitability of an alternative and briefer delay discounting procedure (in which participants simply report their indifference points) for subsequent EFT experiments. The report indifference points procedure produced a high percentage of invalid data, a finding that was replicated across all three experiments. We therefore continued to use the well-established titrating-amount procedure in subsequent studies. Experiment 3A found that episodic past thinking (imagining personal past events) and semantic future thinking (estimating what a person could buy with the larger, delayed amount) had no effect on discounting, indicating that both episodic thinking and future thinking are necessary components of the EFT effect. Experiment 3A results also indicated that financial relevance alone is not sufficient to reducing discounting. Experiment 3B found that the future events also need to be personally relevant to reduce discounting, and that participants perceived EFT to reduce their discounting by primarily making the larger, delayed reward more valuable. We also showed that demand characteristics, where participants change their behavior to conform to the researcher’s expectations, are an unlikely explanation for the EFT effects found in Experiments 3A and 3B. Further research is warranted to form a better understanding of the mechanism(s) through which EFT reduces delay discounting.</p>

The effect of episodic future thinking on delay discounting

<p>Delay discounting refers to the fact that rewards lose their value if they are delayed. Excessive delay discounting is associated with various health-related problems such as over-eating and substance abuse. One phenomenon shown to reduce delay discounting is Episodic Future Thinking (EFT; imagining personal future events). Across multiple experiments and a meta-analysis, the current thesis examined the reliability of the effect of EFT on delay discounting and also sought to clarify the components of EFT that are necessary to reduce delay discounting. Experiment 1 replicated the EFT effect using a common titrating-amount procedure, and the meta-analysis based on 40 independent studies confirmed that EFT has a reliable, medium-sized effect on delay discounting. The meta-analysis also assessed the robustness of the EFT effect across various methodological features and participant characteristics. A multiple meta-regression revealed that the between-study variability in the size of the EFT effect was accounted for by study design and type of discounting measure. Within-subjects design studies had significantly smaller effect sizes than between-subjects design studies. Studies that used k as a discounting rate measure had significantly smaller effect sizes than studies that used area under the discounting curve or other atheoretical discounting measures. The size of the EFT effect was robust across different participant characteristics and ages, suggesting that EFT may be utilized as an effective intervention for a variety of age groups and impulsive behaviors. Experiments 2A, 2B and 2C assessed the suitability of an alternative and briefer delay discounting procedure (in which participants simply report their indifference points) for subsequent EFT experiments. The report indifference points procedure produced a high percentage of invalid data, a finding that was replicated across all three experiments. We therefore continued to use the well-established titrating-amount procedure in subsequent studies. Experiment 3A found that episodic past thinking (imagining personal past events) and semantic future thinking (estimating what a person could buy with the larger, delayed amount) had no effect on discounting, indicating that both episodic thinking and future thinking are necessary components of the EFT effect. Experiment 3A results also indicated that financial relevance alone is not sufficient to reducing discounting. Experiment 3B found that the future events also need to be personally relevant to reduce discounting, and that participants perceived EFT to reduce their discounting by primarily making the larger, delayed reward more valuable. We also showed that demand characteristics, where participants change their behavior to conform to the researcher’s expectations, are an unlikely explanation for the EFT effects found in Experiments 3A and 3B. Further research is warranted to form a better understanding of the mechanism(s) through which EFT reduces delay discounting.</p>

The Influence of Episodic Future Thinking and Graphic Warning Labels on Delay Discounting and Cigarette Demand

Delay discounting and operant demand are two behavioral economic constructs that tend to covary, by degree, with cigarette smoking status. Given historically robust associations between adverse health outcomes of smoking, a strong preference for immediate reinforcement (measured with delay discounting), and excessive motivation to smoke cigarettes (measured with operant demand), researchers have made numerous attempts to attenuate the extent to which behaviors corresponding to these constructs acutely appear in smokers. One approach is episodic future thinking, which can reportedly increase the impact of future events on present decision making as well as reduce the reinforcing value of cigarettes. Graphic cigarette pack warning labels may also reduce smoking by increased future orientation. Experiment 1 evaluated the combined effects of episodic future thinking and graphic warning labels on delay discounting; Experiment 2 evaluated solely the effects of episodic future thinking on delay discounting and operant demand. We observed no statistically significant effects of episodic future thinking when combined with graphic warning labels or when assessed on its own. These results serve as a call for further research on the boundary conditions of experimental techniques reported to alter behaviors associated with cigarette smoking.

EXPRESS: A meta-analysis of the effects of episodic future thinking on delay discounting

Delay discounting (DD) refers to the phenomenon in which the subjective value of future rewards is reduced over time. There are individual differences in the DD rate, and increased discounting has been observed in those with various psychiatric disorders. Episodic future thinking (EFT) is the act of vividly imagining events that may happen in the future. Studies have shown that EFT could reduce DD, although inconsistent results have been reported. The aim of this meta-analysis was to clarify the efficacy with which EFT reduces DD and to identify potential moderators. Forty-seven studies (including 63 contrasts) were included in the final analysis. EFT was found to significantly reduce DD (Hedges’ g =0.52). Moderator analysis showed that positive EFT (g=0.64) was more effective in reducing DD than EFT with the valence not specifically mentioned (g=0.28), and EFT with neutral or negative valence (g=-0.03). In addition, several factors related to the control task and DD task were related to the efficacy of EFT to reduce DD. These findings have implications for using EFT to reduce DD in the future.