If you name it, you can tame it

A 2022 study by the U.S. Centers for Disease Control and Prevention revealed that 67.7% of adults who smoked said they wanted to quit smoking, and 53.5% said they had tried to quit in the past year. Yet less than one in 10 adults who smoke cigarettes succeed in quitting each year.

Research led by UC Irvine has revealed a new technique that can reduce the subjective experience of craving cigarettes and the brain activity associated with it.

In announcing the team’s publication about their discovery in the journal Neuropsychopharmacology on LinkedIn, lead author and UC Irvine assistant research psychologist Golnaz Tabibnia wrote: “Name it to tame it! Putting feelings into words has long been known to calm emotions. Our latest paper shows that putting what we crave into words can help calm cravings.”

The technique, called “cue labeling,” is the subject of this episode of The UC Irvine Podcast. Tabibnia will explain why it’s so hard for people to quit smoking, what cue labeling is and how it can help. She’s a neuroscientist who conducts her research in the Department of Psychology in the School of Social Ecology, and this study was supported in part by funding from the National Institutes of Health and the National Institute on Drug Abuse.

“Confliction & Catharsis,” the music for this episode, was provided by Asher Fulero via the audio library in YouTube Studio.

To get the latest episodes of The UC Irvine Podcast delivered automatically, subscribe at Apple Podcasts or Spotify.

TRANSCRIPT

Cara Capuano/The UC Irvine Podcast:

From the University of California, Irvine, I’m Cara Capuano. Thank you for listening to The UC Irvine Podcast. Our guest today is Golnaz Tabibnia, an assistant research psychologist in UC Irvine’s School of Social Ecology. Golnaz, thank you for joining us today.

Golnaz Tabibnia:

Oh, I’m so happy to be here. Thank you for inviting me.

Capuano:

You’re the lead author on research published in the Springer Nature Journal, Neuropsychopharmacology, that reveals a new way to fight cigarette cravings. Before we get to the specific details of your discovery, what inspired you to investigate this topic?

Tabibnia:

Well, the short answer is that my research findings took me there. So, my research has mainly focused on emotions and emotion regulation from a neuroscience perspective.

Specifically, the goal of my work has been to use insights from the brain to improve the mental strategies we have for emotion regulation or to develop new strategies. Then later in my career, I was struck by some research, including my own, showing how emotions and cravings – and how we regulate them – share common mechanisms in the brain. So, I became very interested in the idea that if the cognitive technique or like a mental strategy works for emotion regulation, then it might also work for craving regulation.

So, really that was the inspiration behind this latest study. We took an established emotion regulation technique, which is basically putting feelings into words, and adapted it for craving regulation.

Capuano:

Can you give us a little bit more on that emotion regulation technique that you’re referring to? I’m a little confused.

Tabibnia:

So, in the academic literature, it’s called “affect labeling.” By “affect,” we mean emotion. So, it’s just the act of putting a name to a feeling or to putting a name to something that triggers a feeling.

I’ll take a step back for a second. This line of work is actually a great example of how we can use insights from neuroscience to develop a novel mental strategy for emotion regulation. So, going back to when I in graduate school, evidence was emerging about how the language parts of the brain may be connected to and may influence the amygdala. The amygdala is the part of the brain best known for its involvement in emotions, particularly fear.

To cut a long story short, across multiple different studies, it was found that putting feelings into words activates a specific part of the prefrontal cortex and reduces emotional response – whether that emotional response was measured through amygdala activity or through self-report or through physiological arousal, like how much the skin sweats – putting feelings into words reduced emotional response.

So, I got very interested in exploring the clinical implications of this effect, this like “language/ emotion interaction.” It seemed very relevant to therapy. And I did some work showing how incorporating language in a specific way into a behavior-based therapy for fear and anxiety – called “exposure therapy” – might improve treatment outcome. And there were follow-up clinical trials done on that work and, eventually, affect labeling was recommended by anxiety experts as a technique to add on to standard exposure therapy to maximize the therapy’s outcome.

When my later work and other people’s work showed that emotions and cravings may be processed and regulated in very similar ways in the brain, I got interested in the question of whether labeling could also be effective for regulating craving.

Capuano:

Thank you for that background. Studies show that each year about half of the US adults who smoke attempt to quit, yet fewer than 10% can sustain that behavior and stay away from cigarettes for six months or longer. Why is it so hard for folks to quit smoking?

Tabibnia:

Well, as a neuroscientist, I like to take a neuroscience perspective on it, and I would say that that’s because nicotine and other addictive substances co-opt the same circuits we have in the brain that compel us to do things that are important for survival, like seek food or water or have sex or anything else that might help us pass on our genes.

I’m talking about the neurochemical dopamine here. Dopamine neurons in the reward circuits of the brain are particularly responsive when we have a surprisingly good experience or when we’re anticipating a pleasant experience. And interestingly, dopamine is also important for initiating movement. Patients with Parkinson’s disease, some listeners might know, have a loss of dopamine neurons, and they have difficulty initiating movement. So, the very brain chemical that makes us want something that previously felt good, whether it’s food or a drug, is also involved in getting us to move.

So, wanting and moving towards the thing we want are intertwined.  And this whole system is evolution’s brilliant way of getting us to repeat actions that we had positive experience with in the past. And nicotine and other addictive substances activate the dopamine system a lot more strongly than everyday survival cues like food or water. That’s why the desire can feel so strong. But our brains are also equipped with the capacity to overcome these non-adaptive desires, but in some cases, it might require some help and training.

Capuano:

And you’re going to tell us about (Tabibnia laughs) one of those possible opportunities. What are some of the traditional methods that people employ to try to quit smoking before we get into your intervention?

Tabibnia:

Okay. So, this is not exactly my area of expertise since I’m not a clinician, but I can say that other mental strategies that people might use while trying to regulate their craving include mindfulness or mindfulness-based techniques, which is basically paying attention to the sensation of craving – just noticing what it feels like without trying to change it.

For example, we can just observe how our craving can go up, but then it comes back down like a wave in the ocean, and we can go up and down with the wave rather than trying to fight the wave.

Another technique is cognitive reappraisal, which is reframing how we think of the desired object in a way that is less enticing. So, for example, instead of focusing on how good it’s going to feel to use the substance, we might focus on the harmful consequences of using it.

So, both of these techniques can take a bit of practice, but they can be very helpful.

Capuano:

So now let’s finally talk about your suggested technique, which call “cue labeling.” How would you describe what cue labeling is?

Tabibnia:

Cue labeling, in a nutshell, refers to the act of putting a name to the thing that we are craving. The idea behind cue labeling, and behind affect labeling for that matter, is that when we encounter something evocative out in the world – say a cigarette if we smoke or a spider if we’re afraid of spiders – we can take the edge off it a little by processing it in a linguistic way rather than a purely perceptual way or an instinctive way.

Part of the idea is that this sort of cognitive processing may be taking us out of autopilot mode or reactive mode and helping us bring more awareness and maybe more control over the experience.

Capuano:

How do you examine that in a laboratory?

Tabibnia:

We examined it in the same way that we have examined affect labeling in the past – and I’ll get into that in a second – but, the difference between what we did in this case and with affect labeling is that here we’ve recruited people who were motivated to quit smoking, and we asked them to abstain from smoking overnight, and then come into the laboratory and perform our cue labeling task while lying down in an MRI scanner.

And so, while they’re in the scanner, we ask them to view a series of cigarette pictures – either it was pictures of cigarettes or pictures of people smoking cigarettes. We call these “cigarette cues,” although some people call them “tilt triggers,” because they tend to trigger people to want to smoke. And we asked our participants to perform various tasks with each picture. So, in some conditions, they were selecting one of two labels that fits the picture, that was our cue labeling task, and then we had some control conditions as well.

Capuano:

How do you test the effectiveness of the cue labeling technique? Like, how do you know if it’s working?

Tabibnia:

Well, we had two outcome measures. One is self-report, and the other is how the brain is responding. And we have some idea of what parts of the brain are related to craving, and so if we see reduction in activity in those regions, we can conclude that maybe craving is being reduced both subjectively by how people say they’re feeling, but also in terms of how the brain is responding.

And one way we can be sure – or at least increase our confidence that this brain activity is in fact related to craving – is whether the activity is correlated with the self-report measure of craving, and whether the activity in that region is correlated with activity in other craving-related regions. And so, we did all of those things to confirm that both subjective craving went down, which is the self-report, and the neural correlates of craving went down.

Capuano:

Why does naming a craving help reduce its intensity? What’s actually happening in the brain?

Tabibnia:

So, what seems to be happening in the brain during cue labeling is really interesting. I told you earlier that in affect labeling, the emotion labels activate a part of the prefrontal cortex that eventually leads to quieting down of the amygdala response. Now, a less talked about thing that’s also happening that particularly piqued our interest in terms of the implications for craving is that affect labeling also seems to reduce activity in this midline part of the brain in the medial parietal cortex that is associated with thinking about ourselves.

So, this brain region is a key part of what we call the “default mode network.” So, the default mode network is active when we’re quote “not doing anything.” Of course, we’re never not doing anything, right? When we’re lying there and sitting – when we’re not engaged in anything effortful – our brains default to thinking about ourselves, to thinking about the people in our lives, and our past, and our future.

And unfortunately, too often, these thoughts are not happy thoughts. They tend to be the nagging negative thoughts that we can’t let go of. And indeed, overactivation in the default mode network is associated with unhappiness and mental health issues. And you see heightened activation in this medial parietal hub of the default network during early abstinence from smoking, and in response to smoking cues, those smoking triggers. So, affect labeling not only reduces activity in the amygdala, it also reduces activity in the medial parietal cortex. So, in other words, affect labeling reduces activity in a part of the brain that is associated with both craving and negative affect.

There’s something about those emotionally charged labels that seem to be especially effective at reducing activity in this brain region that’s associated with obsessive mental looping or mental chatter that plagues many of us. Maybe what labeling is doing is interrupting that chatter.

I should say though that this labeling effect is not just a distraction effect. There’s something special about the evocative labels that is particularly effective. So neutral labels, in a number of studies, have not been as effective as emotional labels in reducing emotional response. And that’s basically what we found in the cue labeling study as well. The hot labels – so, words like smoke, puck, puff, pack, that refer to the aspects of the photos that make people crave – were more effective than neutral labels like man or woman in reducing activity in the medial parietal cortex. So, we’re pretty confident that this medial parietal activity was involved in craving and that cue labeling brought the activity down.

Capuano:

Is the practice of cue labeling available for people to try without special training?

Tabibnia:

Yes, we think so. In our study, we found that very little training was needed. Our participants were not highly educated and were mostly lower socioeconomic status, but everyone understood the instructions for the task without problem, and they seemed to find it a lot easier to do than a more standard emotion regulation task that we also tested, which was the cognitive reappraisal task I mentioned earlier, which is reframing something in a way that is less arousing. So, affect labeling or cue labeling tends to be easier than reappraisal.

Capuano:

Were there any findings that surprised you from the study?

Tabibnia:

Yes. We were surprised to find that cue labeling was helpful particularly for participants who were older midlife and older. In our study, that meant participants aged 47 to 65 – we didn’t recruit participants who were older than 65.

So, we don’t have a clear understanding of why that might be. Our first thought was that, well, age is correlated with cumulative cigarettes that a person might have smoked in their lifetime, but lifetime exposure, as best estimated by self-report, didn’t change the effect of labeling on craving or on brain activity.

We also thought that, well, maybe older adults are more motivated to quit, and perhaps that might be because of health reasons. But that’s not likely either because all participants reported a strong desire to quit, so it wasn’t unique to the older participants.

Whatever the explanation for this surprising finding, it’s an exciting one. We know that quitting smoking becomes harder after age 45, which means we need simple, accessible tools to help older adults stop smoking. In our study, we found that for people over 46, cue labeling brought craving levels back down to baseline, and the size of that effect was meaningful from a clinical standpoint. And the best part is that cue labeling is quick, free, and has no side effects. So compared to other approaches like cognitive reappraisal – that rethinking or reframing – cue labeling might have an advantage.

Reappraisal takes training and mental effort, and that matters because as we get older, we tend to have less cognitive reserve – basically, less mental bandwidth available. And age-related cognitive changes, as well as nicotine withdrawal itself, can make effortful strategies like reappraisal harder to use effectively. Cue labeling, on the other hand, is much simpler and less demanding. So, for older people who smoke or people going through withdrawal, it could be a more practical and effective option. Now, that said, we still need clinical trials that directly compare these techniques head-to-head before we can say so definitively. And that’s something we’re working on next.

Capuano:

When you were announcing this publication, you said on LinkedIn, quote, “Our latest paper shows that putting what we crave into words can help calm cravings.” Would that cue labeling technique work then for other cravings beyond cigarette smoking?

Tabibnia:

I love this question. We haven’t tested it yet, but this is something that I think is really worthwhile to pursue. There’s evidence suggesting that behavioral addictions, like gambling or gaming, have a similar underlying brain mechanism as addiction to substances. So, I would predict that cue labeling would show similar effects in those groups.

Capuano:

This research is so distinctive because it involves this collaborative team of researchers from all over the United States: UCLA up the road in Los Angeles, but we’ve got Vanderbilt in Nashville, Tennessee, the University of Pittsburgh and Carnegie Mellon, both in Pittsburgh, Pennsylvania. How did this wide-ranging multidisciplinary effort come about?

Tabibnia:

This is a sweet story I love to tell. Well, mostly sweet – there was a bit of a rollercoaster for a few years, but it has a happy ending.

So, my collaborators and I actually designed the study together and collected the data over 15 years ago when I was an assistant professor at Carnegie Mellon University in Pittsburgh. And most of my co-authors were also in Pittsburgh at the time, or at UCLA, where I had done my postdoc, and I had actually started designing the project at that time during my postdoc. But as we were in the midst of data analysis at Carnegie Mellon, life happened. And I unexpectedly had to take a step back from my career and ended up going on a hiatus for many years to care for a sick family member, who thankfully eventually turned a corner and is doing great now.

So, things worked out, and when I was ready to reenter academia, which is not very easy to do after a long hiatus, I was supported by fabulous mentors who helped show me the way. And at the first opportunity I had, I applied for funding through the National Institute of Health to go back to this data set and analyze it.

There are several things that were exciting about this. First, it was pretty amazing that after 15 years, this research was still relevant and my anonymous peers who evaluated the proposal thought it’s worthwhile to do. Also exciting was that getting this project funded provided a very sweet opportunity to reconnect with old friends and colleagues, some of whom had moved to other universities, which Is why you see this diversity of affiliations. And a highlight is that two of the co-authors who were students at the time are now assistant professors at the University of Pittsburgh doing impressive work, which has been really delightful to witness.

Capuano:

That is fantastic, and it’s a beautiful illustration of the giant web of academia that just spreads all over. So, we have to ask it: what are you working on now? What’s next in this study?

Tabibnia:

Okay. So, we are now analyzing the same data set further to see how cue labeling compares to other techniques, because as it happens, we also have data on the other techniques that I mentioned, including cognitive reappraisal and this technique that’s based on mindfulness. We think that there might be some similarities among all these techniques, but also some differences, and we want to tease those apart.

We have other projects going on as well that I’m very excited about. I mean (laughs), that’s a topic for another podcast, but just briefly, we are super interested in the following general question, which is: when people understand the brain mechanism involved in emotion regulation and in craving regulation, will that help them better regulate their emotions and craving? In other words, does understanding the machinery help us operate the machine better? We’ve received pilot funding to run a few studies on this project, and the results so far have been really interesting, so that’s another project that we’re excited to pursue.

Capuano:

What haven’t we discussed today that maybe you wanted to share in this conversation?

Tabibnia:

Well, I wanted to make sure I emphasize the fact that there’s really no single strategy that’s going to be a silver bullet for everyone. Our hope for cue labeling is that it can be an additional tool in a person’s toolbox – or a clinician’s toolbox – to help people overcome craving when they need to. Some substance-use clinicians already use this technique and find it useful. Now, our study provides empirical evidence for it, and it helps explain the brain mechanism behind it.

Capuano:

What’s the one thing you want a listener to remember from your research and your findings on cravings?

Tabibnia:

It would be that negative emotions and cravings are processed in some similar ways in the brain. So, if there’s a strategy that works for us in one domain, say for regulating emotions, then it might be worth exploring whether we can tweak it into a strategy for regulating the other, say regulating craving. And there are many different tools available for mentally regulating our emotions and cravings, and some are more effective for some people than others. And it’s worth exploring different techniques and finding the one that works best for us.

Capuano:

Like you said, there’s not one silver bullet and there’s not one technique, and those are both excellent pieces of advice to remember. Thank you so much for joining us today, Golnaz.

Tabibnia:

Thank you. This was a pleasure, Cara. Thank you for inviting me.

Capuano:

Golnaz Tabibnia is an assistant research psychologist in UC Irvine’s School of Social Ecology. I’m Cara Capuano. Thank you for listening to our conversation. For the latest UC Irvine News, please visit news.uci.edu. The UC Irvine Podcast is a production of Strategic Communications and Public Affairs at the University of California, Irvine. Please subscribe wherever you listen to podcasts.