Preliminary studies suggest an extinction-based smoking cessation treatment 
using reduced nicotine content (RNC) cigarettes decreases self-report craving 
for cigarettes prior to quitting and may be an effective smoking cessation 
treatment. The aims of this study was to evaluate the effect of an 
extinction-based smoking cessation treatment on brain responses to smoking cues 
using blood-oxygen level-dependent (BOLD) functional magnetic resonance imaging 
(fMRI). Sixteen (n = 16) dependent smokers were scanned using BOLD fMRI at 
baseline, following 2-4 weeks of smoking RNC cigarettes while wearing a 21-mg 
nicotine patch, and 2-4 weeks following quitting smoking. During scanning, 
participants viewed smoking-related pictures (e.g. lit cigarette) and pictures 
of people engaged in everyday activities (e.g. using a stapler). Event-related 
BOLD responses to smoking and control cues were analyzed in regions of interest 
(ROIs) known to subserve reward, attention, motivation and emotion. The 
extinction-based treatment simultaneously attenuated responses to smoking cues 
in amygdala while potentiating responses to control cues. Exploratory analysis 
indicated that this pattern was also observed in the thalamus of future 
abstinent but not relapsing smokers. The results of this preliminary study 
suggest that an extinction-based treatment for smoking cessation alters brain 
responses to smoking and control cues in amygdala--a region previously 
associated with drug cue reactivity and extinction.