tDCS and Cognitive Training Intervention for Chronic Smokers With Schizophrenia

Adults with severe mental illness (SMI) are three times more likely to smoke than non-SMI
adults, consuming 35-44% of all cigarettes in the U.S.; and, the highest rates of
tobacco-related illnesses and death are among smokers with schizophrenia. Unfortunately, not
only are patients with schizophrenia less likely to receive smoking treatments, but cessation
medications are only modestly effective in helping this subset of smokers quit. Therefore, it
is vital to discover new treatment adjuncts that specifically aid this high-risk subset of
smokers to achieve successful abstinence. Toward that end, the investigators propose a novel
non-pharmacologic technique that directly targets both cognitive impairment, an avenue
considerable past research suggests may be particularly effective to exploit in smokers with
schizophrenia, and reactivity to prepotent stimuli, shown to be enhanced in smokers with
schizophrenia. Combining a subset of cognitive enhancement therapy known as Cognitive
Remediation (CR), with another safe and effective technique, Transcranial Direct Current
Stimulation (tDCS), the investigators propose a new cognitive training method aimed at
enabling smokers with schizophrenia to gain greater control over smoking and stimuli-induced
reactivity (e.g., craving). Recent studies have found significant tDCS-induced cognitive
enhancement, as well as reduction in both cue-induced craving and smoking behavior among
healthy smokers. This combined with knowledge of the cognitive deficits that exist among
individuals with schizophrenia, and clear evidence of a relationship between cognitive
function and smoking treatment success, provides the rationale for testing novel CR + tDCS to
target underlying mechanisms of smoking among individuals with schizophrenia. Specifically,
the proposed study will examine the extent to which targeted cognitive enhancement with CR +
tDCS, leads to changes in cognitive control, cue-provoked craving, reaction time and ERP
measures of attentional bias; as well as the impact of these changes on smoking behavior and
intention and confidence to quit among 80 smokers with schizophrenia. The goal of this study
is to inform the development of new non-medication, noninvasive, therapeutic techniques to
specifically target smoking among patients with schizophrenia. The long term goal is to
establish an effective treatment adjunct to help smokers with schizophrenia successfully
achieve abstinence.

Inclusion Criteria:

- Currently meets DSM-5 criteria for Schizophrenia, Schizoaffective Disorder,
Schizophreniform Disorder, or Delusional Disorder.

- Ability to provide written informed consent

- Smoke ≥ 7 cigarettes per day

- Expired breath CO ≥ 10 ppm at screening

- Stable medication regimen for ≥ 4 weeks (If on more than one psychotropic medication,
main antipsychotic will be considered for stability)

Exclusion Criteria:

- Epilepsy or Current Seizure Disorder

- Alcohol or Substance Dependence past 3 months (caffeine allowed, nicotine is part of
inclusion criteria).

- Pregnant or lactating

- Psychiatric hospitalization in past 3 months

- Suicidal and/or aggressive behavior past 3 months

- Implanted cardiac or brain medical devices

- Latex allergy

- Scalp irritation or recent shaving of scalp

- Use of other smoking cessation medication

- History of head trauma

- History of ECT