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Zhang M, Ying J, Song G, Fung DSS, Smith H. Web-Based Cognitive Bias Modification Interventions for Psychiatric Disorders: Scoping Review. JMIR Ment Health 2019; 6:e11841. [PMID: 31651410 PMCID: PMC6915808 DOI: 10.2196/11841] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 06/06/2019] [Accepted: 08/26/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. OBJECTIVE This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. METHODS Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: ("attention bias" OR "cognitive bias" OR "approach bias" OR "avoidance bias" OR "interpretative bias") AND ("Internet" OR "Web" OR "Online"). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. RESULTS Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. CONCLUSIONS This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10427.
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel S S Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Zhang M, Heng S, Song G, Fung DS, Smith HE. Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study. JMIR Mhealth Uhealth 2019; 7:e15871. [PMID: 31584003 PMCID: PMC6797967 DOI: 10.2196/15871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 01/04/2023] Open
Abstract
Background Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. Methods The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. Results Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. Conclusions The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm.
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Sandor Heng
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen E Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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A Pilot Study of Smartphone-Based Memory Bias Modification and Its Effect on Memory Bias and Depressive symptoms in an Unselected Population. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10042-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Memory bias modification (MBM) is a relatively new approach at targeting biased processing—a central cognitive factor causing and maintaining depression. In this pilot study we aimed to develop a smartphone-based autobiographical memory training, a novel form of MBM. A total of 153 unselected participants were randomly allocated to one of three experimental training conditions (positive, negative or sham memory training) conducted over a period of three days. Autobiographical memory bias and depressive scores were assessed pre- and post-training, whilst recent event recall and explicit self-referent memory bias were assessed post-training. Positive memory bias significantly increased in the positive training condition, however memory bias did not significantly differ post-training between the three conditions. Participants who received positive training recalled a positive autobiographical event more frequently compared to the other conditions. No significant difference between conditions was found in the other outcomes, including symptoms. The novel smartphone-based MBM intervention seems apt to affect autobiographical memory of emotional material. Future research should explore its possible (therapeutic) application.
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104
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Variations in the Visual Probe Paradigms for Attention Bias Modification for Substance Use Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183389. [PMID: 31547477 PMCID: PMC6765878 DOI: 10.3390/ijerph16183389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 12/20/2022]
Abstract
Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders—that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified for opioid use disorders, three for cannabis use disorders and four for stimulant use disorders. As evident from the synthesis, there is great variability in the paradigm adopted, with most articles including only information about the nature of the stimulus, the number of trials, the timings for the fixation cross and the timings for the stimulus set. Future research examining attentional biases among individuals with substance use disorders should take into consideration the paradigms that are commonly used and evaluate the optimal stimulus and stimulus-onset asynchrony timings.
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105
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Zhang M, Ying J, Amron SB, Mahreen Z, Song G, Fung DSS, Smith HE. A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study. JMIR Mhealth Uhealth 2019; 7:e15465. [PMID: 31586359 PMCID: PMC6779068 DOI: 10.2196/15465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. Objective This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. Methods A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. Results Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels. Conclusions Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. International Registered Report Identifier (IRRID) RR2-10.2196/11822
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Affiliation(s)
- Melvyn Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Syidda B Amron
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Zaakira Mahreen
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel S S Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Elizabeth Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Groefsema MM, Mies GW, Cousijn J, Engels RCME, Sescousse G, Luijten M. Brain responses and approach bias to social alcohol cues and their association with drinking in a social setting in young adult males. Eur J Neurosci 2019; 51:1491-1503. [PMID: 31498505 PMCID: PMC7155040 DOI: 10.1111/ejn.14574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022]
Abstract
Alcohol is mainly consumed in social settings, in which people often adapt their drinking behaviour to that of others, also called imitation of drinking. Yet, it remains unclear what drives this drinking in a social setting. In this study, we expected to see stronger brain and behavioural responses to social compared to non-social alcohol cues, and these responses to be associated with drinking in a social setting. The sample consisted of 153 beer-drinking males, aged 18-25 years. Brain responses to social alcohol cues were measured during an alcohol cue-exposure task performed in an fMRI scanner. Behavioural responses to social alcohol cues were measured using a stimulus-response compatibility task, providing an index of approach bias towards these cues. Drinking in a social setting was measured in a laboratory mimicking a bar environment. Specific brain responses to social alcohol cues were observed in the bilateral superior temporal sulcus and the left inferior parietal lobe. There was no approach bias towards social alcohol cues specifically; however, we did find an approach bias towards alcohol (versus soda) cues in general. Brain responses and approach bias towards social alcohol cues were unrelated and not associated with actual drinking. Thus, we found no support for a relation between drinking in a social setting on the one hand, and brain cue-reactivity or behavioural approach biases to social alcohol cues on the other hand. This suggests that, in contrast to our hypothesis, drinking in a social setting may not be driven by brain or behavioural responses to social alcohol cues.
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Affiliation(s)
- Martine M Groefsema
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Gabry W Mies
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Janna Cousijn
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Guillaume Sescousse
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS, UMR5292, PSYR2 Team, Lyon, France.,CH Le Vinatier, Service Universitaire d'Addictologie, Bron, France
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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107
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Moritz S, Paulus AM, Hottenrott B, Weierstall R, Gallinat J, Kühn S. Imaginal retraining reduces alcohol craving in problem drinkers: A randomized controlled trial. J Behav Ther Exp Psychiatry 2019; 64:158-166. [PMID: 31071483 DOI: 10.1016/j.jbtep.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Retraining, a psychological intervention derived from the approach-avoidance paradigm, has yielded mixed results for the treatment of alcohol use disorder as well as other forms of addiction. The present study investigated the efficacy of an imaginal variant of retraining that allowed greater personalization of the content. METHODS Within the framework of a randomized controlled trial (RCT), 84 individuals with self-reported alcohol-related problems were recruited over the Internet and allocated to either imaginal retraining (treatment manual dispatched as a pdf-file via email) or a wait-list control group (with care-as-usual). The intervention period was four weeks. Alcohol craving, as measured with a visual analogue scale (VAS), served as the primary outcome. Other emotional (e.g. self-esteem) and drinking-related variables served as secondary outcomes. RESULTS Both per-protocol (PP) and intention-to-treat (ITT) analyses showed that imaginal retraining led to a significant reduction in alcohol craving compared to the control group at a large effect size. Self-esteem improved in the retraining condition relative to controls in the PP and one of the ITT analyses; 75% of the individuals in the treatment group reported less alcohol consumption in the treatment period, whereas drinking behavior remained essentially unchanged in the control group (p < .001) (the trial was registered at the German Clinical Trials Register, DRKS00015319). LIMITATIONS Whether the effects of imaginal retraining are sustained over time needs to be established. Attrition was significantly higher in the retraining group (40.5%) than in the control group (16.7%). Designs with an active control condition are needed as well as dismantling studies to explore which of the treatment's multiple components best predicts improvement. Future studies should verify participants' alcohol consumption levels using objective measures. CONCLUSION Imaginal retraining led to significant effects on the reduction of alcohol craving.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Alia Marie Paulus
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Weierstall
- MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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108
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Forscher PS, Lai CK, Axt JR, Ebersole CR, Herman M, Devine PG, Nosek BA. A meta-analysis of procedures to change implicit measures. J Pers Soc Psychol 2019; 117:522-559. [PMID: 31192631 PMCID: PMC6687518 DOI: 10.1037/pspa0000160] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Using a novel technique known as network meta-analysis, we synthesized evidence from 492 studies (87,418 participants) to investigate the effectiveness of procedures in changing implicit measures, which we define as response biases on implicit tasks. We also evaluated these procedures' effects on explicit and behavioral measures. We found that implicit measures can be changed, but effects are often relatively weak (|ds| < .30). Most studies focused on producing short-term changes with brief, single-session manipulations. Procedures that associate sets of concepts, invoke goals or motivations, or tax mental resources changed implicit measures the most, whereas procedures that induced threat, affirmation, or specific moods/emotions changed implicit measures the least. Bias tests suggested that implicit effects could be inflated relative to their true population values. Procedures changed explicit measures less consistently and to a smaller degree than implicit measures and generally produced trivial changes in behavior. Finally, changes in implicit measures did not mediate changes in explicit measures or behavior. Our findings suggest that changes in implicit measures are possible, but those changes do not necessarily translate into changes in explicit measures or behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Calvin K. Lai
- Dept. of Psychological & Brain Sciences, Washington University in St. Louis
| | - Jordan R. Axt
- Center for Advanced Hindsight, Duke University, Washington University in St. Louis
| | | | | | | | - Brian A. Nosek
- Dept. of Psychology, University of Virginia
- Center for Open Science, Charlottesville, VA
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109
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Manning V, Garfield JBB, Mroz K, Campbell SC, Piercy H, Staiger PK, Lum JAG, Lubman DI, Verdejo-Garcia A. Feasibility and acceptability of approach bias modification during methamphetamine withdrawal and related methamphetamine use outcomes. J Subst Abuse Treat 2019; 106:12-18. [PMID: 31540606 DOI: 10.1016/j.jsat.2019.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/27/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Approach bias modification (ApBM), a computerised cognitive training task which aims to reduce automatic, impulsive responding to drug-related cues, has been found to reduce alcohol consumption among individuals seeking treatment for their drinking. However, this approach has not been trialled in patients with methamphetamine use disorder (MUD), where altered impulsivity and reward processing are well-established. As such, this study aimed to examine the feasibility and acceptability of four consecutive days of ApBM training during a residential admission for methamphetamine withdrawal. Abstinence rates were examined 2-weeks and 3-months post-discharge. In terms of uptake, 52 of the 99 eligible patients approached agreed to participate and 47 of these 52 commenced training. Uptake and training completion rates (62%) were lower than those achieved in similar trials of ApBM for residential alcohol withdrawal, suggesting there are challenges to its delivery in this setting. This is likely due to the severity of acute methamphetamine withdrawal syndrome and associated behavioural characteristics. However, participants' ratings of the task and reports of post-session craving suggest acceptability was high. Abstinence rates were 61% at 2 weeks and 54% at 3-months, which compare favourably with the abstinence rates observed in a previous large treatment outcome study. The evidence of acceptability and apparent effectiveness suggest future trials of ApBM with MUD patients are warranted. However, ApBM may be more feasible in certain settings or among particular sub-groups where patients are more clinically stable and therefore more likely to complete the training (e.g., residential rehabilitation, after acute withdrawal has subsided).
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Joshua B B Garfield
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Katherine Mroz
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Samuel C Campbell
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
| | - Jarrad A G Lum
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia.
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences & Turner Institute for Brain and Mental Health, Monash University, Australia.
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110
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Karoly HC, Schacht JP, Jacobus J, Meredith LR, Taylor CT, Tapert SF, Gray KM, Squeglia LM. Preliminary evidence that computerized approach avoidance training is not associated with changes in fMRI cannabis cue reactivity in non-treatment-seeking adolescent cannabis users. Drug Alcohol Depend 2019; 200:145-152. [PMID: 31132681 PMCID: PMC6635134 DOI: 10.1016/j.drugalcdep.2019.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive Bias Modification (CBM) has garnered interest as a potential addiction treatment. CBM interventions such as Approach Avoidance Training (AAT) are designed to alter automatic tendencies to approach drugs or drug-related cues. In our previous work, the cannabis AAT (CAAT) reduced cannabis approach bias, which was related to reduced cannabis use, among 80 non-treatment-seeking cannabis-using youth (Jacobus et al., 2018). In this preliminary examination, a subsample of these youth underwent neuroimaging to explore CAAT's effect on cannabis cue-related neural activation. METHODS Sub-study participants were 41 cannabis-using youth ages 17-21 (mean age = 18.83; 47.5% female). Participants completed a cannabis cue-reactivity task during a functional MRI scan pre- and post CAAT-training or CAAT-sham to examine CAAT-related neural changes. RESULTS Thirty-seven youth completed all six CAAT (n = 19) or CAAT-sham (n = 18) training sessions and had usable neuroimaging data. The group*time interaction on cannabis approach bias reached trend-level significance (p = .055). Change in approach bias slopes from pre-to post-treatment was positive for CAAT-sham (increased approach bias) and negative for CAAT-training (change to avoidance bias), consistent with the larger study. No significant changes emerged for cannabis cue-induced activation following CAAT-training or CAAT-sham in whole brain or region of interest analyses. However, active CAAT-training was associated with small-to-medium decreases in amygdala (Cohen's dz = 0.36) and medial prefrontal cortex (Cohen's dz = 0.48) activation to cannabis cues. CONCLUSIONS Despite reducing cannabis use in the larger sample, CAAT-training did not alter neural cannabis cue-reactivity in the sub-study compared to CAAT-sham. More research is needed to understand neural mechanisms underlying AAT-related changes in substance use.
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Affiliation(s)
- Hollis C. Karoly
- University of Colorado Boulder, Institute of Cognitive Science, Boulder, CO, USA,Corresponding author: Hollis C. Karoly, Institute of Cognitive Science University of Colorado Boulder, Phone: 480-206-8533,
| | - Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Joanna Jacobus
- Department of Psychiatry,University of California San Diego, La Jolla, CA, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Charles T. Taylor
- Department of Psychiatry,University of California San Diego, La Jolla, CA, USA
| | - Susan F. Tapert
- Department of Psychiatry,University of California San Diego, La Jolla, CA, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, USA
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111
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Müller UWD, Witteman CLM, Spijker J, Alpers GW. All's Bad That Ends Bad: There Is a Peak-End Memory Bias in Anxiety. Front Psychol 2019; 10:1272. [PMID: 31249540 PMCID: PMC6582762 DOI: 10.3389/fpsyg.2019.01272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
The peak-end memory bias has been well documented for the retrospective evaluation of pain. It describes that the retrospective evaluation of pain is largely based on the discomfort experienced at the most intense point (peak) and at the end of the episode. This is notable because it means that longer episodes with a better ending can be remembered as less aversive than shorter ones; this is even if the former had the same peak in painfulness and an overall longer duration of pain. Until now, this bias has not been studied in the domain of anxiety despite the high relevance of variable levels of anxiety in the treatment of anxiety disorders. Therefore, we set out to replicate the original studies but with an induction of variable levels of anxiety. Of 64 women, half watched a clip from a horror movie which ended at the most frightening moment. The other half watched an extended version of this clip with a moderately frightening ending. Afterward, all participants were asked to rate the global anxiety which was elicited by the video. When the film ended at the most frightening moment, participants retrospectively reported more anxiety than participants who watched the extended version. This is the first study to document that the peak-end bias can be found in the domain of anxiety. These findings require replication and extension to a treatment context to evaluate its implications for exposure therapy.
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Affiliation(s)
- Ulrich W D Müller
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Cilia L M Witteman
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
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Manning V, Mroz K, Garfield JBB, Staiger PK, Hall K, Lubman DI, Verdejo-Garcia A. Combining approach bias modification with working memory training during inpatient alcohol withdrawal: an open-label pilot trial of feasibility and acceptability. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:24. [PMID: 31171005 PMCID: PMC6555735 DOI: 10.1186/s13011-019-0209-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
Background According to contemporary neurocognitive models, addiction is maintained by the biasing of information-processing and decision-making systems towards relatively automatic, impulsive, reward-seeking responses to drug-related stimuli, and away from more controlled, deliberative, “reflective” states of processing that could result in decisions to delay or avoid drug use. Cognitive training programs aimed at either countering “impulsive” processing or enhancing “reflective” processing alone have shown promise. However, there has been no attempt to simultaneously target both aspects of processing with a combined training program. We aimed to test the feasibility and acceptability of a novel ‘dual-training’ program targeting both processes during residential alcohol withdrawal, and to measure abstinence rates following discharge. Methods Thirty-seven patients undergoing alcohol withdrawal at a residential unit participated in this open-label pilot feasibility study. We tested a 4-session program of dual cognitive training targeting both impulsive (approach bias) and reflective (working memory) aspects of processing. Descriptive statistics were used to examine feasibility (training uptake and completion rates) and acceptability (withdrawal from the study; participants’ ratings of the tasks). Alcohol abstinence rates were examined 2-weeks post-discharge. Results Seven participants withdrew after commencing training. Twenty-six (70%) completed the 4-session training protocol, and four completed 3 sessions before discharging. Among participants who provided ratings, nearly all (93%) rated the training as interesting. Most (87%) indicated that they felt it had improved their attention. However, most did not feel it had decreased their craving for alcohol. At 2-weeks post-discharge, 16 (53%) participants reported abstaining from alcohol. For comparison, an earlier pilot trial in the same setting found a 68% abstinence rate with approach bias training alone, and 47% abstinence in a non-training control group. Conclusions Dual training during residential alcohol detoxification appears to be both acceptable and feasible, suggesting that future research is warranted to test its effectiveness at reducing likelihood of relapse.
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia. .,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia.
| | - Katherine Mroz
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Joshua B B Garfield
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Locked bag, Geelong, 2200, Australia.,Centre for Drug use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Locked bag, Geelong, 2200, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Locked bag, Geelong, 2200, Australia.,Centre for Drug use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Locked bag, Geelong, 2200, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, 18 Innovation Walk, Clayton Campus, Wellington Road, Monash University, Melbourne, Victoria, 3800, Australia
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Claus ED, Klimaj SD, Chavez R, Martinez AD, Clark VP. A Randomized Trial of Combined tDCS Over Right Inferior Frontal Cortex and Cognitive Bias Modification: Null Effects on Drinking and Alcohol Approach Bias. Alcohol Clin Exp Res 2019; 43:1591-1599. [PMID: 31081924 DOI: 10.1111/acer.14111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/07/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Deriving novel treatments for alcohol use disorders (AUDs) is of critical importance, as existing treatments are only modestly effective for reducing drinking. Two promising strategies for treating AUDs include cognitive bias modification (CBM) and transcranial direct current stimulation (tDCS). While each strategy has shown positive results in reducing drinking or alcohol-related constructs (e.g., craving), initial tests of the combination of CBM and tDCS have shown mixed results. The present study investigated the degree to which combining CBM and tDCS (2.0 mA anodal current over F10) could reduce alcohol approach biases and alcohol consumption. METHODS Seventy-nine at-risk drinkers were randomized to 1 of 4 conditions in a 2 × 2 factorial design: verum CBM/verum tDCS, verum CBM/sham tDCS, sham CBM/verum tDCS, or sham CBM/sham tDCS. Participants completed a baseline assessment of alcohol approach bias and drinking quantity/frequency (i.e., drinks per drinking day [DDD] and percent heavy drinking days [PHDD]), 4 sessions of combined CBM and tDCS, and follow-up assessments of approach bias and alcohol consumption. RESULTS Results indicated that while participants did demonstrate significant alcohol approach biases at baseline, neither CBM, tDCS, nor the interaction reduced the bias at the follow-up. In addition, there was evidence of a trend toward reducing DDD from baseline to the 1-week/1-month follow-ups, but there was no significant effect of the intervention on either DDD or PHDD. CONCLUSIONS These results partially replicated null results presented in similar CBM/tDCS trials and suggest that this combination, at least with anodal stimulation over dorsolateral or inferior frontal sites, may have limited utility to reduce drinking.
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Affiliation(s)
- Eric D Claus
- The Mind Research Network, Albuquerque, New Mexico
| | | | - Roberta Chavez
- Center on Alcoholism, Substance Abuse, and Addiction, University of New Mexico, Albuquerque, New Mexico
| | - Amber D Martinez
- Center on Alcoholism, Substance Abuse, and Addiction, University of New Mexico, Albuquerque, New Mexico
| | - Vincent P Clark
- The Mind Research Network, Albuquerque, New Mexico.,Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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114
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Brockmeyer T, Friederich HC, Küppers C, Chowdhury S, Harms L, Simmonds J, Gordon G, Potterton R, Schmidt U. Approach bias modification training in bulimia nervosa and binge-eating disorder: A pilot randomized controlled trial. Int J Eat Disord 2019; 52:520-529. [PMID: 30689229 DOI: 10.1002/eat.23024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Bulimia nervosa (BN) and binge-eating disorder (BED) are associated with poorly controlled approach behavior toward food resulting in binge eating. Approach bias modification (ABM) may reduce these automatic action tendencies (i.e., approach bias) toward food and may thus decrease binge eating and related symptoms. METHOD A total of 56 patients with BN/BED participated in this double-blind, randomized controlled trial (RCT) comparing real and sham ABM. The real ABM condition adopted an implicit learning paradigm in which participants were trained to show avoidance behavior in response to food cues. Participants in the sham condition used a similar task but were not trained to avoid food cues. Both conditions comprised 10 training sessions within 4 weeks. RESULTS Participants in both groups experienced significant reductions in binge eating, eating disorder symptoms, trait food craving, and food cue reactivity. Real ABM tended to result in greater reductions in eating disorder symptoms than sham ABM. Food intake, approach bias, and attention bias toward food did not change. DISCUSSION This is the first RCT on ABM in eating disorders. The findings provide limited support for the efficacy of ABM in BN/BED and pose questions regarding its active ingredients and its usefulness as a stand-alone treatment for eating disorders.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Carolyn Küppers
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sharmain Chowdhury
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Louisa Harms
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jess Simmonds
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gemma Gordon
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Potterton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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115
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Sheynin J, Myers CE, Ghafar F, Morris AN, Morley KC, Haber PS, Moustafa AA. A pilot study of escape, avoidance, and approach behaviors in treated alcohol-dependent males. J Clin Exp Neuropsychol 2019; 41:601-614. [PMID: 31023142 DOI: 10.1080/13803395.2019.1595530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol-dependent individuals are often reported to use behavioral strategies both to escape from and avoid negative affective states, and also to approach positive affective states. However, there has been little examination of how these individuals acquire and express these types of behaviors. In this study, male adults meeting the International Classification of Diseases-10th Revision (ICD-10) criteria for alcohol dependence recruited from an outpatient treatment clinic and healthy male controls were given a computer-based task to assess learning and performance of escape, avoidance, and approach behaviors. In this task, participants control a spaceship and can either gain points by shooting an enemy spaceship or hide in safe areas to escape or avoid on-screen aversive events. We found that patients with alcohol dependence exhibited greater escape and approach behaviors, tended to show greater avoidance behavior, and achieved higher total score on the computer task than healthy controls. This is the first demonstration of such behavioral differences in this population, supporting the overactivation of both positive and negative reinforcement systems in alcohol dependence, and suggesting that such behavioral biases are not limited to alcohol-related cues. The contribution of this work to behavioral assessment and therapeutic approaches, as well as possible future directions, are discussed.
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Affiliation(s)
- Jony Sheynin
- a Veterans Affairs Ann Arbor Healthcare System , Ann Arbor , MI , USA.,b Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | - Catherine E Myers
- c Department of Veterans Affairs , New Jersey Health Care System , East Orange , NJ , USA.,d Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School , Rutgers University , Newark , NJ , USA
| | - Farahnaz Ghafar
- e School of Social Sciences and Psychology , Western Sydney University , Sydney , NSW , Australia
| | - Alejandro N Morris
- e School of Social Sciences and Psychology , Western Sydney University , Sydney , NSW , Australia
| | - Kirsten C Morley
- f NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, Central Clinical School , The University of Sydney , Sydney , NSW , Australia
| | - Paul S Haber
- f NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, Central Clinical School , The University of Sydney , Sydney , NSW , Australia
| | - Ahmed A Moustafa
- e School of Social Sciences and Psychology , Western Sydney University , Sydney , NSW , Australia.,g The MARCS Institute for Brain, Behaviour and Development , Western Sydney University , Sydney , Australia
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116
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„Cognitive bias modification“ als mögliche Add-on-Therapie bei Depression. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0354-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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117
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Vollstädt-Klein S, Mildner P, Bumb JM, Karl D, Ueberle C, Shevchenko Y, Kiefer F, Effelsberg W. The training game SALIENCE for the therapy of alcohol use disorder. Health Informatics J 2019; 26:499-512. [PMID: 30958081 DOI: 10.1177/1460458219839612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The feasibility study was aimed to develop a web-based gaming tool for the therapy of alcohol use disorder to offer patients a cue-exposure-based extinction and decision training, enhanced with virtual reality. To increase the training effect, patients playfully experience situations that resemble critical real-life situations. For implementing the game, a combination of HTML5 and JavaScript was used. The application comes with an administrator interface, to allow editing the game content. Initially, we included 21 patients (Group 1), 18 suffering from alcohol use disorder and 3 using cannabis (18/3 male/female, mean age 39 ± 13 years). Considering the iterative process of a feasibility study, we developed the game design as suggested by participants of Group 1 and additionally included 11 novel participants (Group 2) (11 suffering from an alcohol use disorder, 7/4 male/female, mean age 46 ± 14 years). Basically, the game was very well received. Usability ratings were generally high, even in patients with little computer experience. Both groups rated the application as realistic, and would generally be willing to play it on a daily basis. Given that SALIENCE is inexpensive, easily available, and engaging, it might be a reasonable add-on intervention to the standard treatment of alcohol use disorder.
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Affiliation(s)
- Sabine Vollstädt-Klein
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | | | - Jan Malte Bumb
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Damian Karl
- Central Institute of Mental Health Medical Faculty Mannheim/University of Mannheim, Heidelberg University, Germany
| | | | - Yury Shevchenko
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Falk Kiefer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
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118
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Hahn AM, Simons RM, Simons JS, Wiers RW, Welker LE. Can cognitive bias modification simultaneously target two behaviors? Approach bias retraining for alcohol and condom use. Clin Psychol Sci 2019; 7:1078-1093. [PMID: 31890350 DOI: 10.1177/2167702619834570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study tested the effectiveness of a cognitive bias modification (CBM) intervention to simultaneously reduce approach biases toward alcohol and increase approach biases toward condoms among high-risk young adults. Participants (N = 102) were randomly assigned to either a training condition or a sham-training condition. Participants in the training condition were trained to make avoidance movements away from alcohol stimuli and approach movements toward condom stimuli over four training sessions. Approach biases and behavior were assessed at pretest, posttest, and 3-month follow-up. Approach biases changed for both stimulus categories in accordance with training condition. Condom behavior and attitudes also changed as a function of training condition, such that participants in the training condition reported fewer instances of condom nonuse and a more positive attitudes toward condoms at a three-month follow-up. Participants in both conditions had significant reductions in alcohol consumption following the intervention and did not differ by training condition.
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Affiliation(s)
- Austin M Hahn
- Department of Psychology, University of South Dakota
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119
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Blakemore SJ. Editorial. Dev Cogn Neurosci 2019; 36:100617. [PMID: 30685234 PMCID: PMC6969215 DOI: 10.1016/j.dcn.2019.100617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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120
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Lindgren KP, Hendershot CS, Ramirez JJ, Bernat E, Rangel-Gomez M, Peterson KP, Murphy JG. A dual process perspective on advances in cognitive science and alcohol use disorder. Clin Psychol Rev 2019; 69:83-96. [PMID: 29680185 PMCID: PMC6181791 DOI: 10.1016/j.cpr.2018.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
There is a tremendous global and national (US) burden associated with alcohol misuse and alcohol use disorder (AUD). Further, of the mental health disorders, AUD has the widest treatment gap. Thus, there is a critical need for improved understanding of the etiology, maintenance, and treatment of AUD. The application of cognitive science to the study of AUD has a longstanding history of attempting to meet this need. In this selective review, we identified and focused on four domains of recent (i.e., in the last decade) applications of cognitive science to the study of AUD: implicit cognitive biases, executive function, behavioral economic approaches to alcohol decision making, and functional connectivity neuroimaging. We highlighted advances within these four domains and considered them in the context of dual process models of addiction, which focus on the contribution and interplay of two complementary neurocognitive systems (impulsive and control systems). Findings across the domains were generally consistent with dual process models. They also suggest the need for further model refinements, including integrating behavioral economic approaches and findings from functional connectivity neuroimaging studies. Research evaluating candidate interventions associated with these domains is emergent but promising, suggesting important directions for future research.
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Affiliation(s)
- Kristen P Lindgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Christian S Hendershot
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jason J Ramirez
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Edward Bernat
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Kirsten P Peterson
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - James G Murphy
- Department of Psychology, University of Memphis, Memphis, TN, USA
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121
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Approach bias retraining to augment smoking cessation: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2019; 14:100340. [PMID: 30899837 PMCID: PMC6406622 DOI: 10.1016/j.conctc.2019.100340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 11/23/2022] Open
Abstract
Heavy users and addicted individuals have shown to develop an approach action tendency - or approach bias - toward stimuli related to the substance of interest. Emerging evidence points to approach bias retraining (ABR) as an effective aid for the treatment of addictive behaviors. The current study seeks to extend this work by testing, in a pilot study, whether standard smoking cessation treatment involving cognitive-behavioral therapy (CBT) and nicotine replacement therapy can be augmented by ABR. To this end, we will randomly assign 100 adult smokers to either ABR-augmented treatment or placebo-augmented treatment and compare the two conditions on short-term and long-term abstinence rates. The hope is that the findings of this study can inform treatment development for adult smokers.
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122
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Swinkels LMJ, Gramser H, Becker ES, Rinck M. Self-Approach Tendencies: Relations With Explicit and Implicit Self-Evaluations. Front Psychol 2019; 10:309. [PMID: 30846951 PMCID: PMC6394373 DOI: 10.3389/fpsyg.2019.00309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/31/2019] [Indexed: 11/15/2022] Open
Abstract
We used a newly developed Self-Approach-Avoidance Task (Self-AAT) to measure self-approach tendencies in female students. In this task, participants use a joystick to pull portraits of themselves and of others closer or to push them away. In the three studies, we found a significant self-approach tendency: participants were faster to pull mirror-imaged portraits of themselves closer than to push them away. This approach tendency was reduced for non-mirrored self-portraits, and absent for control pictures showing unknown males, unknown females, or empty backgrounds. Moreover, in two out of the three studies, the self-approach tendency was weakly related to explicit self-valuations measured with the Rosenberg Self-Esteem Scale (RSES), and in one out of two studies, it was related to implicit self-evaluations measured with the Implicit Association Task (IAT). Implications and potential applications of the findings are discussed.
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Affiliation(s)
- Lieke M J Swinkels
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Hidde Gramser
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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123
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Garnett C, Crane D, West R, Brown J, Michie S. The development of Drink Less: an alcohol reduction smartphone app for excessive drinkers. Transl Behav Med 2019; 9:296-307. [PMID: 29733406 PMCID: PMC6417151 DOI: 10.1093/tbm/iby043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Excessive alcohol consumption poses a serious problem for public health. Digital behavior change interventions have the potential to help users reduce their drinking. In accordance with Open Science principles, this paper describes the development of a smartphone app to help individuals who drink excessively to reduce their alcohol consumption. Following the UK Medical Research Council's guidance and the Multiphase Optimization Strategy, development consisted of two phases: (i) selection of intervention components and (ii) design and development work to implement the chosen components into modules to be evaluated further for inclusion in the app. Phase 1 involved a scoping literature review, expert consensus study and content analysis of existing alcohol apps. Findings were integrated within a broad model of behavior change (Capability, Opportunity, Motivation-Behavior). Phase 2 involved a highly iterative process and used the "Person-Based" approach to promote engagement. From Phase 1, five intervention components were selected: (i) Normative Feedback, (ii) Cognitive Bias Re-training, (iii) Self-monitoring and Feedback, (iv) Action Planning, and (v) Identity Change. Phase 2 indicated that each of these components presented different challenges for implementation as app modules; all required multiple iterations and design changes to arrive at versions that would be suitable for inclusion in a subsequent evaluation study. The development of the Drink Less app involved a thorough process of component identification with a scoping literature review, expert consensus, and review of other apps. Translation of the components into app modules required a highly iterative process involving user testing and design modification.
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Affiliation(s)
- Claire Garnett
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - David Crane
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Robert West
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Jamie Brown
- Research Department of Behavioural Science and Health, UCL, London, UK
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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124
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Approach-avoidance modification as an add-on in smoking cessation: A randomized-controlled study. Behav Res Ther 2019; 114:35-43. [DOI: 10.1016/j.brat.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
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125
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Becker ES, Barth A, Smits JAJ, Beisel S, Lindenmeyer J, Rinck M. Positivity-approach training for depressive symptoms: A randomized controlled trial. J Affect Disord 2019; 245:297-304. [PMID: 30439675 DOI: 10.1016/j.jad.2018.11.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/19/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is highly comorbid and depressive symptoms are very common. Symptom severity adversely affects treatment outcome and later health status. Established interventions for depression leave ample room for improvement. Short interventions that target specific vulnerabilities emerge as plausible augmentation strategies. In this study, we tested the efficacy of a computerized general positivity-approach training and its effect on depressive symptoms. METHODS Patients (N = 240) with various diagnoses of mental disorders who received treatment-as-usual in an inpatient setting were randomly assigned to also receive either 4 sessions of a positivity-approach training or 4 sessions of sham training. Depression severity was assessed at baseline and post-treatment. Training data were analyzed for a subset of 111 patients. RESULTS Depressive symptoms were reduced more after positivity-approach training than after sham training. Initial depression symptom severity moderated the intervention effects, such that approach tendencies and depression symptoms were only affected positively among patients with higher levels of initial depression symptom severity. CONCLUSIONS The findings provide preliminary support for positivity-approach training as an add-on treatment option for depressive symptoms.
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Affiliation(s)
- Eni S Becker
- Behavioural Science Institute, Radboud University, The Netherlands.
| | - Anja Barth
- Behavioural Science Institute, Radboud University, The Netherlands
| | | | | | | | - Mike Rinck
- Behavioural Science Institute, Radboud University, The Netherlands.
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Karoly HC, Schacht JP, Meredith LR, Jacobus J, Tapert SF, Gray KM, Squeglia LM. Investigating a novel fMRI cannabis cue reactivity task in youth. Addict Behav 2019; 89:20-28. [PMID: 30243035 DOI: 10.1016/j.addbeh.2018.09.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/24/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Adult and adolescent studies suggest increased motivational responses to cannabis cues among regular cannabis users. However, functional magnetic resonance imaging (fMRI) studies have not explored neural activation in response to visual cannabis cues among adolescents in the United States. Gaining a better understanding of the neural circuits related to cue-elicited craving during adolescence may shed light on the neural basis for the development of problematic cannabis use that could ultimately be targeted for interventions. METHODS 41 non-treatment-seeking youth (ages 17-21; mean age = 18.83; 46.3% female) who reported regular cannabis use underwent fMRI scanning involving a visual cannabis cue task and completed self-report and biological measures. Whole-brain activation was examined for cannabis cues compared to non-cannabis cues, and for active versus passive cannabis cues. Associations between self-reported substance use and task activation were examined. RESULTS Cannabis images were identifiable to adolescents and were rated as more rewarding than matched non-cannabis images (p < .05). Greater activation was found for the cannabis cues compared to non-cannabis cues in bilateral posterior cingulate, cuneus, fusiform, precuneus, inferior temporal and parahippocampal gyri, as well as left thalamus, medial frontal and superior frontal gyri. Cue-elicited activation was not significantly associated with self-reported cannabis use (ps > 0.05). No differences were observed for the active versus passive cue contrast. CONCLUSIONS Cannabis-using youth show more activation to cannabis cues than non-cannabis cues in brain regions underlying incentive salience, reward, and visual attention. This task could be useful for future studies examining neural underpinnings of reward processes in adolescent cannabis users.
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Wittekind CE, Bierbrodt J, Lüdecke D, Feist A, Hand I, Moritz S. Cognitive bias modification in problem and pathological gambling using a web-based approach-avoidance task: A pilot trial. Psychiatry Res 2019; 272:171-181. [PMID: 30583260 DOI: 10.1016/j.psychres.2018.12.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023]
Abstract
There is evidence that training addicted participants to implicitly avoid disorder-related stimuli by using a training version of the Approach-Avoidance Task (AAT) results in reduced substance consumption (i.e., Approach Bias Modification [AppBM]). The aim of the present web-based study was to investigate the feasibility and effectiveness of AppBM in reducing gambling-related symptoms. A self-selected sample of participants with problem/pathological slot-machine gambling completed an online survey and received either AppBM or Sham training (final N = 131). Attrition during study participation was high (66%). In both conditions slot-machine related and neutral pictures were presented. Within the AppBM condition all slot-machine related pictures had to be pushed and all neutral pictures had to be pulled, whereas in the Sham condition the contingency was 50:50. Eight weeks after baseline, participants were re-assessed. Both groups showed a similar reduction in gambling-related symptoms. Findings are at odds with the hypothesis claiming that only contingency trainings yield beneficial effects. However, it cannot be ruled out that effects result from other factors unrelated to training such as expectancy effects. We think this study holds valuable information how to conduct larger trials in the future and may prove helpful to improve training and its delivery.
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Affiliation(s)
- Charlotte E Wittekind
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, Hamburg 20246, Germany.
| | - Julia Bierbrodt
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, Hamburg 20246, Germany
| | - Daniel Lüdecke
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Institute of Medical Sociology, Martinistraße 52, Hamburg 20246, Germany
| | - Ansgar Feist
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, Hamburg 20246, Germany
| | - Iver Hand
- MVZ Falkenried, Falkenried 7, Hamburg 20251, Germany
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, Hamburg 20246, Germany
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128
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Krishna A, Eder AB. The influence of pre-training evaluative responses on approach-avoidance training outcomes. Cogn Emot 2019; 33:1410-1423. [PMID: 30663944 DOI: 10.1080/02699931.2019.1568230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Approach-avoidance training (AAT) has been shown to be effective in both clinical and laboratory research. However, some studies have failed to show the effects of AAT. Therefore, finding moderators of the AAT effect is a priority for further research. We investigate the moderating effect of pre-training evaluative responses towards familiar AAT targets. In particular, we test predictions: (a) that congruent responses (i.e. approach to positive targets and avoidance of negative targets) increase liking, whereas incongruent responses decrease liking; (b) that training is more effective when it can strengthen existing positivity or negativity; and (c) that ambivalence increases AAT effects. Two experiments (total N = 132) implemented an AAT with local soft-drink brands after measuring initial positive/negative explicit evaluative components and implicit liking towards the brands. Results show no reliable evidence for training effects on consumption or rating of drinks, but participants showed more implicit liking of approached drinks than avoided drinks. Furthermore, the magnitude of implicit liking measured pre-training was positively related to the size of the training effect. Ambivalence had no direct effect on the training outcomes. These results partially support the congruency prediction and underline the importance of implicit liking prior to AAT as a moderator for AAT effects.
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Affiliation(s)
- Anand Krishna
- a Department of Psychology, University of Würzburg , Würzburg , Germany
| | - Andreas B Eder
- a Department of Psychology, University of Würzburg , Würzburg , Germany
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129
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Boffo M, Zerhouni O, Gronau QF, van Beek RJJ, Nikolaou K, Marsman M, Wiers RW. Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data. Neuropsychol Rev 2019; 29:52-78. [PMID: 30644025 PMCID: PMC6499757 DOI: 10.1007/s11065-018-9386-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/18/2018] [Indexed: 01/20/2023]
Abstract
Cognitive Bias Modification (CBM) refers to a family of interventions targeting substance-related cognitive biases, which have been found to play a role in the maintenance of addictive behaviors. In this study, we conducted a Bayesian meta-analysis of individual patient data from studies investigating the effects of CBM as a behavior change intervention for the treatment of alcohol and tobacco use disorders, in individuals aware of the behavior change goal of the studies. Main outcomes included reduction in the targeted cognitive biases after the intervention and in substance use or relapse rate at the short-to-long term follow-up. Additional moderators, both at the study-level (type of addiction and CBM training) and at the participant-level (amount of completed training trials, severity of substance use), were progressively included in a series of hierarchical mixed-effects models. We included 14 studies involving 2435 participants. CBM appeared to have a small effect on cognitive bias (0.23, 95% credible interval = 0.06–0.41) and relapse rate (−0.27, 95% credible interval = −0.68 – 0.22), but not on reduction of substance use. Increased training practice showed a paradoxical moderation effect on relapse, with a relatively lower chance of relapse in the control condition with increased practice, compared to the training condition. All effects were associated with extremely wide 95% credible intervals, which indicate the absence of enough evidence in favor or against a reliable effect of CBM on cognitive bias and relapse rate in alcohol and tobacco use disorders. Besides the need for a larger body of evidence, research on the topic would benefit from a stronger adherence to the current methodological standards in randomized controlled trial design and the systematic investigation of shared protocols of CBM.
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Affiliation(s)
- Marilisa Boffo
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018, Amsterdam, WS, Netherlands.
| | - Oulmann Zerhouni
- Department of Psychology, University Paris Nanterre, Paris, France
| | - Quentin F Gronau
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018, Amsterdam, WS, Netherlands
| | - Ruben J J van Beek
- Trimbos Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | | | - Maarten Marsman
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018, Amsterdam, WS, Netherlands
| | - Reinout W Wiers
- Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018, Amsterdam, WS, Netherlands.
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130
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Langbridge JE, Jones RD, Canales JJ. A Neurophysiological and Behavioral Assessment of Interventions Targeting Attention Bias and Sense of Control in Binge Drinking. Front Hum Neurosci 2019; 12:538. [PMID: 30687051 PMCID: PMC6337047 DOI: 10.3389/fnhum.2018.00538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/24/2018] [Indexed: 11/13/2022] Open
Abstract
Attention bias modification (ABM) can decrease the selective visual attention paid to alcohol-related cues but has not been found to reliably reduce alcohol craving. Here, a cognitive intervention to decrease craving by increasing sense of control (Shamloo and Cox, 2014) was used as a complement. We investigated the effects of two such interventions administered singly or in combination. Participants were 41 binge drinkers (BDs) and 10 non-binge drinkers (NBDs). BDs received either ABM, sense of control training, both interventions, or no intervention, and were compared with NBDs who received no intervention. Groups were assessed on alcohol attention bias change including both reaction times and cue-elicited ERPs (visual dot-probe task), alcohol craving change, and alcohol consumption. BDs exhibited higher attention bias scores than NBDs. ABM had no effect on BDs' behavioral or electrophysiological markers of attention bias. Sense of control training did not increase personal sense of control but protected against decreased task accuracy and against increased craving. BDs receiving the combined intervention consumed less alcohol in a bogus taste test than participants receiving no intervention. Taken together, the results suggest that ABM procedure may reduce alcohol consumption if combined with sense of control training.
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Affiliation(s)
- Jessica E. Langbridge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Richard D. Jones
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Juan J. Canales
- Division of Psychology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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131
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Batschelet HM, Stein M, Tschuemperlin RM, Soravia LM, Moggi F. Alcohol-Specific Computerized Interventions to Alter Cognitive Biases: A Systematic Review of Effects on Experimental Tasks, Drinking Behavior, and Neuronal Activation. Front Psychiatry 2019; 10:871. [PMID: 31998146 PMCID: PMC6970199 DOI: 10.3389/fpsyt.2019.00871] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/05/2019] [Indexed: 12/26/2022] Open
Abstract
Background: In patients with alcohol use disorder, novel interventions to increase abstinence have attracted growing attention. Interventions aimed at modifying cognitive biases linked to alcohol use [i.e. cognitive bias modification (CBM)] may serve as an add-on to standard therapy. This systematic review thoroughly aggregates existing data on the effects of three alcohol-specific computerized interventions, namely attentional bias modification (AtBM), approach bias modification (ApBM), and inhibition training (IT). In doing so, each CBM's effects on experimental tasks assessing the relevant biases, drinking behavior, and neurophysiology are summarized. Also, the influence of drinking behavior severity and motivation to change drinking behavior are discussed. Methods: A literature search was conducted in four databases for original research articles published between 2000 and May 2019. Studies were eligible if investigating the effects of alcohol-specific computerized interventions (AtBM, ApBM, IT) on drinking behavior, bias change, and/or neurophysiology. Forty eligible articles were classified as being either a non-clinical experimental lab study (ELS) or clinical randomized-controlled trial (RCT) and summarized. Results: While AtBM seems to influence attentional bias, its effects on drinking behavior are inconsistent. As for ApBM, the best effects on drinking behavior are obtained in clinical samples. Effects of ApBM on approach bias are mixed. Interestingly, those clinical RCTs which investigated ApBM effects on bias change as well as on drinking outcome, reported consistent effects in both measures (i.e. either effects on bias and drinking or no effects). Studies on IT are limited to non-clinical samples and show inconsistent effects on drinking behavior. Considering ITs effects on implicit semantic associations, most studies do not support the conceptualization of IT as a form of memory bias modification, while reports on IT's effects on inhibitory control are still incomplete. Conclusions about the overall influence of drinking behavior severity are hampered by the non-uniform use of sample descriptions. Conclusions: In clinical samples, ApBM has shown more consistent beneficial effects, while evidence on AtBM is more inconsistent, and data on IT still lacks important information. Conclusions about the influence of drinking behavior severity would be facilitated by a uniform use of clearly defined sample descriptions.
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Affiliation(s)
- Hallie M Batschelet
- University Hospital of Psychiatry, Translational Research Center, Division of Clinical Research, University of Bern, Bern, Switzerland
| | - Maria Stein
- University Hospital of Psychiatry, Translational Research Center, Division of Clinical Research, University of Bern, Bern, Switzerland.,Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Raphaela M Tschuemperlin
- University Hospital of Psychiatry, Translational Research Center, Division of Clinical Research, University of Bern, Bern, Switzerland.,Clinic Suedhang, Center for Treatment of Addictive Disorders, Kirchlindach, Switzerland
| | - Leila M Soravia
- University Hospital of Psychiatry, Translational Research Center, Division of Clinical Research, University of Bern, Bern, Switzerland.,Clinic Suedhang, Center for Treatment of Addictive Disorders, Kirchlindach, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry, Translational Research Center, Division of Clinical Research, University of Bern, Bern, Switzerland
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132
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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133
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Jones A, McGrath E, Robinson E, Houben K, Nederkoorn C, Field M. A randomized controlled trial of inhibitory control training for the reduction of alcohol consumption in problem drinkers. J Consult Clin Psychol 2018; 86:991-1004. [PMID: 30507225 PMCID: PMC6277130 DOI: 10.1037/ccp0000312] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/15/2017] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We conducted a randomized controlled trial to compare the effects of three types of Internet-delivered Inhibitory Control Training (ICT) with each other and with an active control intervention on alcohol consumption in a community sample of problem drinkers. METHOD Two hundred and 46 heavy drinkers, who were motivated to reduce their alcohol consumption (mean age 41.32, 130 female) self-monitored their alcohol consumption for 1 week before being randomized to receive 1 of 3 variants of ICT (Associative No-Go, Associative Stop Signal, General Inhibition) or an active control. Participants then completed up to 14 ICT/control sessions on the Internet over a 4-week period, while regularly recording their alcohol consumption. RESULTS There were significant reductions in alcohol consumption across all groups over the 4-week training period (main effect of time, F(2, 402) = 77.12, p < .01, ηp2 = .28, BF10 > 99), however there were no differences between ICT groups, or between ICT groups and the active control group (Group × Time interaction, F(6, 402) = 1.10, p = .36, ηp2 = .02, BF10 = 0.03). Contrary to hypotheses, there were no changes in general inhibitory control, the disinhibiting effects of alcohol cues, or alcohol affective associations after ICT. CONCLUSIONS In this study, which attempted to translate findings from proof-of-concept laboratory studies into a viable behavior change intervention, we found that multiple sessions of ICT delivered over the Internet did not help heavy drinkers to reduce their alcohol consumption beyond nonspecific effects associated with taking part in a trial. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Katrijn Houben
- Faculty of Psychology and Neuroscience, Maastricht University
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134
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Zhang M, Ying J, Amron SB, Mahreen Z, Song G, Fung DS, Smith H. A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study. JMIR Res Protoc 2018; 7:e11822. [PMID: 30455170 PMCID: PMC6277827 DOI: 10.2196/11822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
Background Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Objective This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. Methods This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. Results This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. Conclusions To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. International Registered Report Identifier (IRRID) PRR1-10.2196/11822
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Syidda B Amron
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Zaakira Mahreen
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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135
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Naish KR, Vedelago L, MacKillop J, Amlung M. Effects of neuromodulation on cognitive performance in individuals exhibiting addictive behaviors: A systematic review. Drug Alcohol Depend 2018; 192:338-351. [PMID: 30317162 PMCID: PMC8995136 DOI: 10.1016/j.drugalcdep.2018.08.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is growing interest in non-invasive brain stimulation techniques as treatments for addictive disorders. While multiple reviews have examined the effects of neuromodulation on craving and consumption, there has been no review of how neuromodulation affects cognitive functioning in addiction. This systematic review examined studies of the cognitive effects of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in individuals exhibiting addictive behavior. METHODS Articles were identified through searches in PubMed and PsycINFO conducted in October 2017. Eligible studies investigated the effects of tDCS or TMS on cognitive task performance in participants reporting substance use (e.g., alcohol, tobacco, or drugs) or addictive behaviors (e.g., gambling). Tasks were organized into five domains: (1) Inhibitory control, (2) Risk-taking, (3) Impulsive choice (delay discounting), (4) Executive function, and (5) Implicit biases. RESULTS Twenty-four articles met the inclusion criteria. Fifty-seven percent of studies used tDCS and 43% used TMS, with nearly all studies (96%) targeting the dorsolateral prefrontal cortex. Ten studies reported significant within-subject modulation of cognitive functioning associated with active TMS or tDCS, with the same number reporting no change in cognitive performance. Of four studies that included both an experimental and control participant group, three showed between-group differences in the effects of neuromodulation. CONCLUSIONS While positive effects in several studies suggest that tDCS and TMS improve cognitive functioning in addiction, there is substantial heterogeneity across studies. We discuss person-related and methodological factors that could explain inconsistencies, and propose individualized stimulation protocols may sharpen the cognitive effects of neuromodulation in addiction.
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Affiliation(s)
- Katherine R. Naish
- Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton and McMaster University 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada
| | - Lana Vedelago
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Michael G. DeGroote Centre for Medicinal Cannabis Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
| | - Michael Amlung
- Peter Boris Centre for Addictions Research, Michael G. DeGroote Centre for Medicinal Cannabis Research, St. Joseph's Healthcare Hamilton and McMaster University, 100 West 5th Street, Hamilton, Ontario, L8P 3R2, Canada.
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136
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Krishna A, Eder AB. No effects of explicit approach-avoidance training on immediate consumption of soft drinks. Appetite 2018; 130:209-218. [DOI: 10.1016/j.appet.2018.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/09/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
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137
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Leins J, Waldorf M, Kollei I, Rinck M, Steins-Loeber S. Approach and avoidance: Relations with the thin body ideal in women with disordered eating behavior. Psychiatry Res 2018; 269:286-292. [PMID: 30172185 DOI: 10.1016/j.psychres.2018.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 08/11/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
Recent research suggests that automatic cognitive biases are linked to body dissatisfaction and disordered eating behavior. However, little is known about automatic action tendencies in the field of body image research. The aim of the present study was to examine approach and avoidance biases toward the thin body ideal and normal weight bodies and whether these are pronounced in individuals showing disordered eating behavior. Participants were divided into a group with disordered eating behavior (n = 55) and without disordered eating behavior (n = 45). To assess approach and avoidance tendencies, the Approach-Avoidance Task was used during which the participants were instructed to approach or avoid thin and normal weight body pictures. Our results indicated faster push than pull movements towards thin and normal weight body pictures. However, participants with and without disordered eating behavior did not differ with regard to their reactions. Furthermore, we found positive associations between the avoidance of normal weight body pictures and perceived pressure to confirm to media ideals. Future research is warranted to replicate our findings and to extend our knowledge on approach and avoidance biases toward body pictures in patients suffering from eating disorders.
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Affiliation(s)
- Judith Leins
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
| | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Ines Kollei
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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Manning V, Garfield JBB, Campbell SC, Reynolds J, Staiger PK, Lum JAG, Hall K, Wiers RW, Lubman DI, Verdejo-Garcia A. Protocol for a randomised controlled trial of cognitive bias modification training during inpatient withdrawal from alcohol use disorder. Trials 2018; 19:598. [PMID: 30382877 PMCID: PMC6211457 DOI: 10.1186/s13063-018-2999-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/16/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND People with alcohol use disorders often exhibit an "alcohol approach bias", the automatically triggered action tendency to approach alcohol. Approach bias is likely to persist following withdrawal from alcohol, and contribute to the high rate of relapse following withdrawal treatment. Cognitive bias modification (CBM) training has been shown to attenuate approach biases and lead to reduced relapse rates. However, no large multisite trial of CBM specifically within a residential withdrawal treatment setting has previously been conducted. This study aims to test whether CBM delivered during residential withdrawal treatment leads to reduced relapse rates and reduced use of acute health services following discharge, and to test possible moderators of CBM's effect on alcohol use. METHODS Three hundred alcohol-dependent inpatients are being recruited from three withdrawal treatment units in the Melbourne metropolitan area. Participants complete baseline measures of alcohol approach bias and cue-evoked desire for alcohol, followed by four daily sessions of computerised CBM training (or sham training if randomised to the control group). Approach bias and cue-evoked desire are re-assessed following the fourth training session. Follow-up assessments administered 2 weeks and 3, 6, and 12 months following discharge from the withdrawal treatment unit compare abstinence rates and acute and emergency healthcare service use between conditions. Pre-admission and follow-up substance use is derived from the timeline follow-back method, and approach bias towards alcohol with a computerised Approach Avoidance Task. DISCUSSION This study is the first multisite randomised controlled trial of cognitive bias modification delivered during acute alcohol withdrawal treatment. Withdrawal is theoretically an ideal period to deliver neurocognitive interventions due to heightened neuroplasticity and cognitive recovery. If effective, the low cost and easy implementation of CBM training means it could be widely used as a standard part of alcohol withdrawal treatment to improve treatment outcomes. Moderation analyses may help better determine whether certain subgroups of patients are most likely to benefit from it and therefore should be prioritised for CBM during alcohol withdrawal treatment. TRIAL REGISTRATION Version 4 of the protocol (dated 1 August 2017) is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001241325 . Registered on 25 August 2017 (retrospectively registered).
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Affiliation(s)
- Victoria Manning
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Joshua B. B. Garfield
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Samuel C. Campbell
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC 3004 Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Jarrad A. G. Lum
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Kate Hall
- School of Psychology, Deakin University, Locked bag, Geelong, VIC 2200 Australia
| | - Reinout W. Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam, PB 15916, 1001 NK Amsterdam, Netherlands
| | - Dan I. Lubman
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC Australia
| | - Antonio Verdejo-Garcia
- Turning Point, Eastern Health, 110 Church Street, Richmond, VIC 3121 Australia
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences (MICCN), Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, VIC 3800 Australia
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139
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Wegmann E, Brand M. Reizreaktivität und Craving bei Verhaltenssüchten mit Fokus auf Internetnutzungsstörungen. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000493918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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140
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Vrijsen JN, Fischer VS, Müller BW, Scherbaum N, Becker ES, Rinck M, Tendolkar I. Cognitive bias modification as an add-on treatment in clinical depression: Results from a placebo-controlled, single-blinded randomized control trial. J Affect Disord 2018; 238:342-350. [PMID: 29908472 DOI: 10.1016/j.jad.2018.06.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Only 60% of depressed patients respond sufficiently to treatment, so there is a dire need for novel approaches to improve treatment effects. Cognitive Bias Modification (CBM) may be an effective and easily implemented computerized add-on to treatment-as-usual. Therefore, we investigated the effects of a positivity-attention training and a positivity-approach training compared to control trainings. METHODS In a blinded randomized-controlled design, 139 depressed inpatients received either the CBM Attention Dot-Probe Training (DPT) or the CBM Approach-Avoidance Training (AAT), next to treatment as usual. N = 121 finished all four training sessions. Both trainings had an active and a control condition. In both active conditions, patients were trained to preferentially process generally positive pictures over neutral pictures. Depressive symptom severity was assessed before and after CBM, and positivity bias was measured at the start and end of each session. RESULTS Clinician-rated depressive symptom severity decreased more in patients who received the active condition of the DPT or the AAT compared to patients in the control conditions. Significant change in positivity bias was found for the DPT (not the AAT), but did not mediate the effect of the training on depressive symptoms. CONCLUSIONS The results suggest that both types of CBM (i.e., DPT and AAT) may provide a fitting add-on treatment option for clinical depression. The working mechanisms and optimal dose of CBM trainings, plus their possible combination, should be examined in more detail.
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Affiliation(s)
- Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Pro Persona Mental Health Care, Depression Expertise Center, Nijmegen, The Netherlands.
| | - Verena S Fischer
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Bernhard W Müller
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany; Department of Psychology, University of Wuppertal, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; LVR-Hospital Essen, Department for Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Germany
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141
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den Uyl TE, Gladwin TE, Lindenmeyer J, Wiers RW. A Clinical Trial with Combined Transcranial Direct Current Stimulation and Attentional Bias Modification in Alcohol-Dependent Patients. Alcohol Clin Exp Res 2018; 42:1961-1969. [PMID: 30025152 PMCID: PMC6175348 DOI: 10.1111/acer.13841] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Modifying attentional processes with attentional bias modification (ABM) might be a relevant add-on to treatment in addiction. This study investigated whether influencing cortical plasticity with transcranial direct current stimulation (tDCS) could increase training effects. tDCS could also help alcohol-dependent patients to overcome craving and reduce relapse, independent of training. These approaches were combined to investigate effects in the treatment of alcoholism. METHODS Ninety-eight patients (analytical sample = 83) were randomly assigned to 4 groups in a 2-by-2 factorial design. Patients received 4 sessions of ABM (control or real training) combined with 2 mA tDCS (active: 20 minutes or sham: 30 seconds) over the left dorsolateral prefrontal cortex. Alcohol bias and craving were assessed, and treatment outcome was measured as relapse after 1 year. RESULTS Attentional bias scores indicated that during the training only the group with active tDCS and real ABM displayed an overall avoidance bias (p < 0.05). From pre- to postassessment, there were no main or interaction effects of tDCS and ABM on the bias scores, craving, or relapse (p > 0.2). However, effects on relapse after active tDCS were in the expected direction. CONCLUSIONS There was no evidence of a beneficial effect of tDCS or ABM or the combination. Whether the absence of effect was due to issues with the outcome measurements (e.g., lack of craving, high dropout, and unreliable measurements) or aspects of the intervention should be further investigated.
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Affiliation(s)
- Tess E. den Uyl
- Addiction, Development and Psychopathology (ADAPT) LabDepartment of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Brain & Cognition (ABC)University of AmsterdamAmsterdamThe Netherlands
| | | | | | - Reinout W. Wiers
- Addiction, Development and Psychopathology (ADAPT) LabDepartment of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Brain & Cognition (ABC)University of AmsterdamAmsterdamThe Netherlands
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142
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de Kogel CH. More Autonomous or more Fenced-in? Neuroscientific Instruments and Intervention in Criminal Justice. NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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143
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Stop Pushing Me Away: Relative Level of Facebook Addiction Is Associated With Implicit Approach Motivation for Facebook Stimuli. Psychol Rep 2018; 122:2012-2025. [DOI: 10.1177/0033294118798624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of Facebook and other social media sites has increased to the point that some consider it to be a behavioral addiction. Previously, research has used the Approach–Avoidance Task to measure implicit approach and withdrawal tendencies in response to a variety of stimuli, including alcohol, desserts, cigarettes, spiders, and cannabis. When responding to these types of stimuli, individuals typically evidence an approach bias toward appetitive images and a withdrawal bias in response to undesirable and/or fearful stimuli. The present study was designed to test the validity of an adapted version of the Approach–Avoidance Task by investigating how self-reported Facebook addiction tendencies, measured via the Bergen Facebook Addiction Scale, predicted automatic approach tendencies toward Facebook-related stimuli using the Facebook-Approach–Avoidance Task. Participants with higher self-reported tendencies of Facebook addiction tended to approach Facebook-related stimuli faster. The present study is the first to indicate a relationship between self-reported Facebook addiction tendencies and implicit approach motivation using a behavioral measure. This finding provides initial support for the use of the Facebook-Approach–Avoidance Task as a measure of Facebook addiction, and further validation could lead to the development of additional assessment and training paradigms in the future.
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144
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Zhang M, Ying J, Song G, Fung DS, Smith H. Web-Based Cognitive Bias Intervention for Psychiatric Disorders: Protocol for a Systematic Review. JMIR Res Protoc 2018; 7:e10427. [PMID: 30087091 PMCID: PMC6104442 DOI: 10.2196/10427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/12/2018] [Accepted: 06/20/2018] [Indexed: 01/29/2023] Open
Abstract
Background Traditional psychological therapies focus mainly on modification of individuals’ conscious decision-making process. Unconscious processes, such as cognitive biases, have been found accountable for various psychiatric psychopathologies, and advances in technologies have transformed how bias modification programs are being delivered. Objective The primary aim of this review is to synthesize evidence of Web-based cognitive bias modification intervention for bias reduction. The secondary aim is to determine the change in symptoms for individual psychiatric disorders following bias modification. Methods A systematic review will be conducted including only randomized trials. There will be no restrictions on participants included in the study. A search will be conducted on the respective databases until 2017. Selection of studies will be by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA-P) guidelines. Quality assessment of included studies will be conducted using the Cochrane Risk of Bias tool. A narrative synthesis of identified articles will then be conducted. A meta-analysis will be considered only if there are sufficient articles in a domain for statistical analysis. Ethical approval for this protocol and the planned systematic review was not required. Results We expect that the review will be completed 12 months from publication of this protocol. Conclusions This review is of importance given how technology has transformed delivery of conventional therapies. Findings from this review will guide future research involving technology and cognitive bias modification interventions. Trial Registration International Prospective Register for Systematic Reviews (PROSPERO): 2017 CRD42017074754; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=74754 (Archived by WebCite at http://www.webcitation.org/ 71AvSgZGn) Registered Report Identifier RR1-10.2196/10427
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Blackwell SE, Westermann K, Woud ML, Cwik JC, Neher T, Graz C, Nyhuis PW, Margraf J. Computerized positive mental imagery training versus cognitive control training versus treatment as usual in inpatient mental health settings: study protocol for a randomized controlled feasibility trial. Pilot Feasibility Stud 2018; 4:133. [PMID: 30123524 PMCID: PMC6091085 DOI: 10.1186/s40814-018-0325-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/26/2018] [Indexed: 02/03/2023] Open
Abstract
Background Enhancing the capacity to experience positive affect could help improve recovery across a range of areas of mental health. Experimental psychopathology research indicates that a computerized cognitive training paradigm involving generation of positive mental imagery can increase state positive affect, and more recent clinical studies have suggested that this training could be used as an adjunct treatment module to target symptoms related to positive affect deficits, specifically anhedonia. The current study investigates the feasibility of adding a positive mental imagery computerized training module to treatment for patients in inpatient mental health settings, with a focus on increasing positive affect and reducing anhedonia. The positive mental imagery training (PMIT) is added to treatment as usual (TAU) in the inpatient setting, and compared to TAU alone, or TAU plus an alternative cognitive training module not hypothesized to increase positive affect, cognitive control training (CCT). Methods The study is a feasibility randomized controlled trial with three parallel arms. Up to 90 patients admitted to inpatient mental health treatment clinics in Germany will be randomized to PMIT + TAU, CCT + TAU, or TAU on a 1:1:1 ratio. PMIT or CCT consist of an introductory session followed by up to 8 full training sessions over 2 weeks. All three arms (including TAU) include regular completion of mood measures over the 2-week period. Outcome measures are completed pre and post this 2-week training/monitoring period, and at 2-week follow-up. Data will be presented in the form of both raw means and standardized effect sizes, with 95% confidence intervals, for both intention-to-treat and per-protocol samples. Discussion The study will inform feasibility of conducting a fully powered randomized controlled trial investigating the addition of the positive mental imagery training as a treatment adjunct to inpatient treatments for mental health, including potential refinement of study procedures, inclusion/exclusion criteria, and preliminary indications of the likely range of effect sizes. Trial registration clinicaltrials.gov, NCT02958228 (date registered: 4 November 2016).
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Affiliation(s)
- Simon E Blackwell
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Katharina Westermann
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Marcella L Woud
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Jan C Cwik
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Torsten Neher
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Christian Graz
- Nexus-Klinik Baden-Baden, Hermann-Sielcken-Straße 80, 76530 Baden-Baden, Germany
| | - Peter W Nyhuis
- 3St. Marien Hospital Eickel, Marienstraße 2, 44651 Herne, Germany
| | - Jürgen Margraf
- 1Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
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146
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Yip SW, Potenza MN. Application of Research Domain Criteria to childhood and adolescent impulsive and addictive disorders: Implications for treatment. Clin Psychol Rev 2018; 64:41-56. [PMID: 27876165 PMCID: PMC5423866 DOI: 10.1016/j.cpr.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/18/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022]
Abstract
The Research Domain Criteria (RDoC) initiative provides a large-scale, dimensional framework for the integration of research findings across traditional diagnoses, with the long-term aim of improving existing psychiatric treatments. A neurodevelopmental perspective is essential to this endeavor. However, few papers synthesizing research findings across childhood and adolescent disorders exist. Here, we discuss how the RDoC framework may be applied to the study of childhood and adolescent impulsive and addictive disorders in order to improve neurodevelopmental understanding and to enhance treatment development. Given the large scope of RDoC, we focus on a single construct highly relevant to addictive and impulsive disorders - initial responsiveness to reward attainment. Findings from genetic, molecular, neuroimaging and other translational research methodologies are highlighted.
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Affiliation(s)
- Sarah W Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; The National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; The National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT, United States; Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, United States.
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147
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Mehl N, Mueller-Wieland L, Mathar D, Horstmann A. Retraining automatic action tendencies in obesity. Physiol Behav 2018; 192:50-58. [DOI: 10.1016/j.physbeh.2018.03.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/11/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
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148
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McAteer AM, Hanna D, Curran D. Age-related differences in alcohol attention bias: a cross-sectional study. Psychopharmacology (Berl) 2018; 235:2387-2393. [PMID: 29947915 DOI: 10.1007/s00213-018-4935-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/30/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Addiction models theorise that alcohol attention bias (AAB) for alcohol-related cues develops through a process of classical conditioning and that attentional processes shift from controlled to automatically modulated responses. At the point of automaticity, alcohol cues grab the attention of problem drinkers beyond conscious control and can trigger alcohol use. To fully understand this shift, AAB should be thought of as developing on a continuum from when alcohol use commences. Despite this, little is known about AAB differences in younger populations who are at an early stage in their exposure to alcohol and related cues. RATIONALE This study compared AAB for alcohol cues across age groups (early adolescent, late adolescent, and young adult) and drinking groups (heavy drinkers, light drinkers, and non-drinkers) to provide a cross-sectional examination of differences in AAB and their relationship to alcohol use and age. METHODS Eye tracking was employed to measure several elements of attentional processing during exposure to alcohol cues. Differences across age groups and drinking groups were examined. RESULTS Differences in controlled attention were found between heavy and light drinkers. As age increases, a shift towards automaticity can be seen with alcohol-related cues attracting the attention of young adult drinkers earlier in stimulus presentation. CONCLUSIONS This cross-sectional approach provides an insight into AAB across a key developmental period. It highlights that influential processes underpinning AAB may change and how rapidly it may approach automaticity. The implications of these findings are discussed.
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Affiliation(s)
| | - Donncha Hanna
- School of Psychology, Queen's University, Belfast, Northern Ireland
| | - David Curran
- School of Psychology, Queen's University, Belfast, Northern Ireland
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149
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Beraha EM, Salemink E, Krediet E, Wiers RW. Can baclofen change alcohol-related cognitive biases and what is the role of anxiety herein? J Psychopharmacol 2018; 32:867-875. [PMID: 29897022 PMCID: PMC6125818 DOI: 10.1177/0269881118780010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Baclofen has shown promise in the treatment of alcohol dependence. However, its precise (neuro-) psychological working mechanism is still under debate. AIMS This study aimed to get a better understanding of baclofen's working mechanism by examining the effect of baclofen on cognitive biases. It was hypothesized that baclofen, compared to placebo, would lead to weaker cognitive biases. Furthermore, given a suggested anxiolytic effect of baclofen, we expected that anxiety would moderate this effect. METHODS From a larger randomized clinical trial (RCT) with 151 participants, a subset of 143 detoxified alcohol-dependent patients, either taking baclofen or placebo, was examined. Attentional bias for alcohol (500 and 1500 ms), alcohol approach tendencies, implicit alcohol-relaxation associations and trait anxiety were assessed before the administration of baclofen or placebo. Four weeks later, 94 patients were still abstinent (53 in the baclofen and 41 in the placebo condition) and cognitive biases were assessed again. RESULTS At baseline, patients showed a vigilance-avoidance pattern for the attentional bias (at 500 and 1500 ms, respectively) and alcohol-negative associations. After 4 weeks, an indication for an attentional bias away from alcohol at 500 ms was found only in the baclofen group; however, cognitive biases did not differ significantly between treatment groups. No moderating role of anxiety on cognitive biases was found. CONCLUSIONS Baclofen did not lead to a differential change in cognitive biases compared with placebo, and trait anxiety levels did not moderate this. A better understanding of the working mechanism of baclofen and predictors of treatment success would allow prescribing of baclofen in a more targeted manner.
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Affiliation(s)
- Esther M Beraha
- Esther M Beraha, Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands.
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Luo X, Rinck M, Bekkering H, Becker ES. The processing of task-irrelevant emotion and colour in the Approach-Avoidance Task. Cogn Emot 2018; 33:548-562. [PMID: 29985106 DOI: 10.1080/02699931.2018.1497951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
When processing information about human faces, we have to integrate different sources of information like skin colour and emotional expression. In 3 experiments, we investigated how these features are processed in a top-down manner when task instructions determine the relevance of features, and in a bottom-up manner when the stimulus features themselves determine process priority. In Experiment 1, participants learned to respond with approach-avoidance movements to faces that presented both emotion and colour features (e.g. happy faces printed in greyscale). For each participant, only one of these two features was task-relevant while the other one could be ignored. In contrast to our predictions, we found better learning of task-irrelevant colour when emotion was task-relevant than vice versa. Experiment 2 showed that the learning of task-irrelevant emotional information was improved in general when participants' awareness was increased by adding NoGo-trials. Experiment 3 replicated these results for faces and emotional words. We conclude that during the processing of faces, both bottom-up and top-down processes are involved, such that task instructions and feature characteristics play a role. Ecologically significant features like emotions are not necessarily processed with high priority. The findings are discussed in the light of theories of attention and cognitive biases.
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Affiliation(s)
- Xijia Luo
- a Behavioural Science Institute , Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Mike Rinck
- a Behavioural Science Institute , Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Harold Bekkering
- b Donders Institute for Brain, Cognition and Behaviour , Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Eni S Becker
- a Behavioural Science Institute , Radboud University Nijmegen , Nijmegen , The Netherlands
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