In the editorial, the researchers from Turning Point and Monash Addiction Research Centre provide a commentary on a recent trial from Ludwig Maximilian University of Munich, which tested whether adding ApBM to standard smoking cessation treatment could boost 6‑month quit rates.

Unlike the strong relapse‑prevention effects seen across multiple alcohol ApBM trials, this study didn’t find any evidence that it was effective for people with tobacco use disorder.

However, Prof Manning and Dr Garfield suggest that this null finding may not be the death knell for tobacco approach bias modification research.

The editorial highlights several reasons why ApBM may still hold promise for smoking cessation:

• Longer training schedules may be needed to shift deeply ingrained smoking cues.
• Quality of engagement matters. The supervised sessions in many alcohol trials may have boosted focus and adherence compared to unsupervised at‑home training used in this tobacco study.
• Using personalised, meaningful images (including participants’ own photos) in the ApBM training task has shown early promise in alcohol trials by strengthening motivation and reinforcing positive goals.
• ApBM programs that are co‑designed with people who smoke ensure that the images and content used in the training reflect real‑world tobacco products, contexts, and quit goals. This is a critical factor in engagement and acceptability.

Where to next?

The study from Ludwig Maximilian University of Munich offers valuable insights into why recent ApBM positive findings for alcohol haven’t yet shown consistent effects for tobacco.

Due to the differences in trial design and emerging evidence supporting personalised and gamified approaches, Prof Manning and Dr Garfield argue that further research is needed.

Their research team has recently completed a trial piloting a personalised and gamified ApBM app for Victorians who want to quit smoking, to add to the evidence base in this promising area of research, and will soon analyse the data. This study is funded by the Victorian Medical Research Acceleration Fund (VMRAF) and Eastern Health.

Read the editorial to explore the full discussion and future directions for tobacco ApBM research: Smoking Cessation Treatment: Still Seeking a New Approach?

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