Cue labeling reduces cigarette craving and associated neural activity

Cigarette craving, triggered by smoking-related cues, significantly contributes to resumption of smoking after cessation. This study investigated whether affect labeling, the cognitive technique of using words to regulate emotions, could be adapted to regulate cue-induced craving. Fifty adults who smoked cigarettes daily (24 women, ages 20-65) completed a novel Cue Labeling Task during fMRI. In this task, participants viewed cigarette-cue images under three conditions: cue matching (craving elicitation), cue labeling (experimental condition), and gender labeling (control). In a fourth condition, neutral matching (baseline), they matched neutral images with one another. Participants rated their cigarette craving in each condition. Relative to cue matching, cue labeling elicited lower craving (p < 0.05, Hedges' g = -0.11) and lower activation in the precuneus (Z = -4.5, p_corrected < 0.001), a region associated with craving in prior research and in the present study (β = 0.43, p < 0.05). Age moderated these effects. In the older (but not younger) subsample (Johnson-Neyman age cutoff of 46.7 years), craving during cue labeling was lower than cue matching (p < 0.05, g = -0.29) and similar to neutral matching (p > 0.5). Greater age was also associated with lower precuneus activity during cue labeling versus cue matching (Z = -3.8, p_corrected < 0.001). Gender labeling did not significantly alter craving compared to cue matching (p > 0.05, g = -0.13); and, although it led to lower precuneus activity (Z = -5.5, p_corrected < 0.001), activity in this region was lower during cue labeling than cue matching (Z = -3.9, p_corrected < 0.01). These findings suggest that cue labeling, a simple and scalable self-regulation strategy, may reduce cigarette craving and related neural activity, particularly among older midlife adults with nicotine addiction.