Contexts enhance ratings of craving and psychophysiological responses of cue-reactivity in tobacco use disorder

Introduction Confrontation with smoking-related cues can provoke craving and relapse, even after long periods of abstinence. The context of these cues might be important for the elicitation of craving. In this study we examined the effects of social, physical and consumptive contexts on cue-reactivity in smokers using ratings and physiological measures. Method A total of 22 smokers (12 male, 10 female) with tobacco use disorder (TUD) assessed using a cue-reactivity picture perception paradigm in a laboratory setting. Pictures of smoking in different physical and social contexts and of different phases of the smoking ritual were used. Ratings of cigarette craving, valence and arousal as well as startle reflex modulation, skin conductance responses and heart rate were assessed. Results We observed an increased startle modulation in the bar versus control context and a stronger heart rate deceleration in the social versus neutral context. Social smoking induced more craving than neutral context, and cues from the beginning of the smoking ritual induced more craving than in the terminal phase. Social smoking context was rated as more arousing than neutral context, and cigarettes of the terminal phase of the smoking ritual were rated as least pleasant. Conclusions The results indicate that physical, social and consumptive contexts differentially affect cue-reactivity in TUD. Implications Cues in contexts lead to more pronounced indicators of craving than cues alone. Thus, contexts should be included in both, the assessment and treatment of TUD. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The present study was supported by a grant from the Deutsche Forschungsgemeinschaft (TRR 265 Project ID-402170461, C01 SVK/HF) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee II of the University of Heidelberg gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors