A systematic review and meta-analysis of electroencephalographic evidence and applied methods to cue-reactivity and cue exposure. Part I: ERP

This systematic review synthesizes empirical evidence on differences in processing addiction-related target and control cues in individuals with and without addictive behaviors, using event-related potentials (ERP). A pre-registered search (PROSPERO: CRD42024500485) of PubMed and Web of Science identified experimental electroencephalography studies on cue reactivity. Study quality was assessed with the Newcastle-Ottawa Scale. Thirty-one studies were included. For the late positive potential (LPP), 23 studies (n = 1160 with addictive behavior) compared target and control cues, and 14 compared addiction to control group (n = 4453 with addictive behavior, n = 359 control participants). For the P300, five studies (n = 269 with addictive behavior) compared target and control cues. Methodological parameters across studies were presented. Meta-analyses showed that individuals with addictive behavior exhibit higher LPP amplitudes when processing target cues compared to control participants with a large effect size (k = 14, Hedge's g = 0.955 [0.357, 1.552], z = 3.13, p =.002). Within addiction groups, target cues elicited higher LPP amplitudes with a medium effect size (k = 23, Hedge's g = 0.633 [0.633, 0.908], z = 4.506, p <.001). For the P300, target cues elicited higher amplitudes with a small effect size (k = 5, Hedge's g = 0.265 [0.094, 0.436], z = 3.032, p =.002). Despite consistent effects, methodological heterogeneity limits firm conclusions. Standardized designs are needed to strengthen comparability and reliability. Overall, findings support heightened neural reactivity to addiction-related cues, underscoring the value of ERP markers and the need for improved methodological rigor.