Abstract Background and aims Appetitive responses, such as approach biases, are thought to play a crucial role in smoking. This study aimed to compare responses toward smoking‐related stimuli with responses in control conditions (e.g. non‐approach or neutral stimuli) using a multi‐method approach. By examining associations between response measures and with smoking‐related variables, the study sought to extend understanding of their role in abstinence‐motivated, non‐deprived individuals with chronic tobacco dependence. Design and setting Cross‐sectional study conducted at a university laboratory and magnetic resonance imaging (MRI) scanner in Munich, Germany. Participants 362 chronically smoking individuals (51.38% female; data collection: November 2019–March 2023) with moderate‐to‐severe tobacco dependence, enrolled in a smoking cessation study, allowed ad libitum smoking prior to assessment. Measurements Responses toward smoking‐related stimuli were assessed using cognitive‐behavioral (reaction‐time‐based approach biases), psychophysiological (electromyography: corrugator supercilii, zygomaticus major and orbicularis oculi for acoustic startle reflex) and neural (functional MRI: regions relevant to smoking cue‐reactivity) measures. Smoking‐related variables were cigarettes per day, tobacco dependence severity and craving. Split‐half reliabilities were estimated for all measures. Findings Participants exhibited a statistically significantly attenuated acoustic startle reflex toward smoking‐related versus neutral stimuli ( P < 0.001, Rosenthal's r = 0.39), while no statistically significant differences emerged for other psychophysiological or cognitive‐behavioral measures. Neural measures showed statistically significantly heightened reactivity toward smoking‐related versus neutral stimuli in sensory and motor regions (e.g. precuneus; P < 0.001, Rosenthal's r = 0.44) but reduced activity in reward‐related regions (e.g. striatum; P = 0.021, Cohen's d = 0.22). Higher craving was statistically significantly associated with stronger appetitive responses on some measures from all assessment methods ( P s ≤ 0.041), whereas greater tobacco dependence and smoking behavior were linked to reduced neural reactivity toward smoking‐related stimuli ( P s ≤ 0.036). No statistically significant associations emerged between measures from different methods (factor loadings ≤ 0.145, P s ≥ 0.076). Differences scores between conditions (rel. = −0.351 to 0.837) were generally less reliable than their individual components (rel. = 0.619 to 0.964; excluding one exception) Conclusions Appetitive responses toward smoking‐related stimuli may play a limited role in abstinence‐motivated, non‐deprived individuals with chronic tobacco dependence, whereas habitual motor responses could be more crucial.
Motka et al. (Sun,) studied this question.