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Wiers CE, Wiers RW. Imaging the neural effects of cognitive bias modification training. Neuroimage 2016; 151:81-91. [PMID: 27450074 DOI: 10.1016/j.neuroimage.2016.07.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 01/31/2023] Open
Abstract
Cognitive bias modification (CBM) was first developed as an experimental tool to examine the causal role of cognitive biases, and later developed into complementary interventions in experimental psychopathology research. CBM involves the "re-training" of implicit biases by means of multiple trials of computerized tasks, and has been demonstrated to change anxious, depressive and drug-seeking behavior, including clinically relevant effects. Recently, the field has progressed by combining CBM with neuroimaging techniques, which provides insight into neural mechanisms underlying how CBM affects implicit biases in anxiety, depression, and addiction, and potentially other pathologies. This narrative literature review summarizes the state of the art of studies on the neural effects of CBM and provides directions for future research in the field. A total of 13 published studies were found and discussed: n=9 in anxiety, n=2 in depressive behavior, and n=2 in addiction.
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Affiliation(s)
- Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, MD, USA.
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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202
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Martin Braunstein L, Kuerbis A, Ochsner K, Morgenstern J. Implicit Alcohol Approach and Avoidance Tendencies Predict Future Drinking in Problem Drinkers. Alcohol Clin Exp Res 2016; 40:1945-52. [PMID: 27421061 DOI: 10.1111/acer.13151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/05/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Addiction is characterized by compulsive drug seeking and substance use, yet many individuals break free of these patterns and change their behavior. Traditional candidate predictors of behavior change/persistence rely on self-reports of factors such as readiness to change. However, explicit measures only characterize top-down influences on behavior. The incentive sensitization model of addition suggests that more implicit, automatic processes, such as the tendency to approach substance cues, play a major role in behavior. METHODS We examined implicit alcohol approach and avoidance tendencies using a reaction time (RT) task in a sample of problem drinkers with alcohol use disorder (AUD) seeking to reduce heavy drinking. We measured alcohol approach and avoidance tendencies at baseline and at outcome, 12 weeks later. We asked whether alcohol approach and avoidance tendencies (i) changed over time, (ii) related to current drinking, and (iii) predicted changes in drinking from baseline to outcome. RESULTS Approach and avoidance tendencies did not significantly change over time, nor did they correlate with current drinking, but these tendencies at baseline did predict drinking weeks later. Faster alcohol approach was associated with greater overall drinking at outcome, and faster alcohol avoidance predicted fewer drinking days per week at outcome. Exploratory analyses examined the relationship between approach and avoidance and traditional explicit measures including appraisals of alcohol and motivation to change. Implicit approach tendencies were largely distinct from explicit measures, and approach and avoidance tendencies explained unique variance in outcome drinking. CONCLUSIONS The current findings suggest that implicit alcohol approach and avoidance tendencies assessed via a simple reaction time task can predict relative changes in drinking weeks later. Given that many explicit measures typically used in treatment studies fail to predict who will change, approach and avoidance tendencies are promising candidates to understand individual differences in treatment responses.
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Affiliation(s)
| | - Alexis Kuerbis
- Silberman School of Social Work at Hunter College, City University of New York, New York, New York
| | - Kevin Ochsner
- Department of Psychology, Columbia University, New York, New York
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203
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Pronk T, van Deursen DS, Beraha EM, Larsen H, Wiers RW. Validation of the Amsterdam Beverage Picture Set: A Controlled Picture Set for Cognitive Bias Measurement and Modification Paradigms. Alcohol Clin Exp Res 2016; 39:2047-55. [PMID: 26431117 PMCID: PMC5054858 DOI: 10.1111/acer.12853] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 07/23/2015] [Indexed: 11/30/2022]
Abstract
Background Alcohol research may benefit from controlled and validated picture sets. We have constructed the Amsterdam Beverage Picture Set (ABPS), which was designed for alcohol research in general and cognitive bias measurement and modification in particular. Here, we first formulate a position on alcohol stimulus validity that prescribes that alcohol‐containing pictures, compared to nonalcohol‐containing pictures, should induce a stronger urge to drink in heavy drinkers than in light drinkers. Because a perceptually simple picture might induce stronger cognitive biases but the presence of a drinking context might induce a stronger urge to drink, the ABPS contains pictures with and without drinking context. By limiting drinking contexts to simple consumption scenes instead of real‐life scenes, complexity was minimized. A validation study was conducted to establish validity, to examine ABPS drinking contexts, and to explore the role of familiarity, valence, arousal, and control. Methods Two hundred ninety‐one psychology students completed the Alcohol Use Disorders Identification Test, as well as rating and recognition tasks for a subset of the ABPS pictures. Results The ABPS was well‐recognized, familiar, and heavy drinkers reported a greater urge to drink in response to the alcohol‐containing pictures only. Alcohol presented in drinking context did not elicit a stronger urge to drink but was recognized more slowly than alcohol presented without context. Conclusions The ABPS was found to be valid, although pictures without context might be preferable for measuring cognitive biases than pictures with context. We discuss how an explicit approach to picture construction may aid in creating variations of the ABPS. Finally, we describe how ABPS adoption across studies may allow more reproducible and comparable results across paradigms, while allowing researchers to apply picture selection criteria that correspond to a wide range of theoretical positions. The latter is exemplified by ABPS derivatives and adoptions that are currently under way.
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Affiliation(s)
- Thomas Pronk
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Amsterdam, the Netherlands
| | - Denise S van Deursen
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Amsterdam, the Netherlands
| | - Esther M Beraha
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Amsterdam, the Netherlands
| | - Helle Larsen
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinout W Wiers
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Amsterdam, the Netherlands
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204
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Garnett C, Crane D, Michie S, West R, Brown J. Evaluating the effectiveness of a smartphone app to reduce excessive alcohol consumption: protocol for a factorial randomised control trial. BMC Public Health 2016; 16:536. [PMID: 27392430 PMCID: PMC4939028 DOI: 10.1186/s12889-016-3140-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background Excessive alcohol consumption is a leading cause of death and morbidity worldwide and interventions to help people reduce their consumption are needed. Interventions delivered by smartphone apps have the potential to help harmful and hazardous drinkers reduce their consumption of alcohol. However, there has been little evaluation of the effectiveness of existing smartphone interventions. A systematic review, amongst other methodologies, identified promising modular content that could be delivered by an app: self-monitoring and feedback; action planning; normative feedback; cognitive bias re-training; and identity change. This protocol reports a factorial randomised controlled trial to assess the comparative potential of these five intervention modules to reduce excessive alcohol consumption. Methods A between-subject factorial randomised controlled trial. Hazardous and harmful drinkers aged 18 or over who are making a serious attempt to reduce their drinking will be randomised to one of 32 (25) experimental conditions after downloading the ‘Drink Less’ app. Participants complete baseline measures on downloading the app and are contacted after 1-month with a follow-up questionnaire. The primary outcome measure is change in past week consumption of alcohol. Secondary outcome measures are change in AUDIT score, app usage data and usability ratings for the app. A factorial between-subjects ANOVA will be conducted to assess main and interactive effects of the five intervention modules for the primary and secondary outcome measures. Discussion This study will establish the extent to which the five intervention modules offered in this app can help reduce hazardous and harmful drinking. This is the first step in optimising and understanding what component parts of an app could help to reduce excessive alcohol consumption. The findings from this study will be used to inform the content of a future integrated treatment app and evaluated against a minimal control in a definitive randomised control trial with long-term outcomes. Trial registration ISRCTN40104069 Date of registration: 10/2/2016 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3140-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.
| | - David Crane
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.,Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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205
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Approach and avoidance towards aggressive stimuli and its relation to reactive and proactive aggression. Psychiatry Res 2016; 240:196-201. [PMID: 27111213 DOI: 10.1016/j.psychres.2016.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 03/11/2016] [Accepted: 04/15/2016] [Indexed: 11/23/2022]
Abstract
This study assessed the association between indirectly measured behavioural approach- and avoidance-related tendencies on the one hand, and reactive versus proactive aggression on the other hand. Reactive aggression (i.e. the impulsive, anger-driven aggression expressed in response to threatening stimuli) was differentiated from proactive aggression (i.e. the more controlled aggression motivated towards obtaining specific goals). A mixed sample of 118 patients and healthy controls filled out a self-report measure to assess their degree of reactive and proactive aggression, and then performed an Approach Avoidance Task in which they were asked to pull or push a joystick in response to a format-feature of a series of pictures, irrespective of their contents. The pictorial stimuli used in this task included attack-related scenes and angry faces, along with neutral, positive and negative control stimuli. The results were controlled for the level of personality disorder pathology, gender, and age. The findings indicated that reactive but not proactive aggression was related to the relative behavioural tendency to approach attack-related scenes, along with positive stimuli. These findings reflect the hyper-reactivity of the approach-related reward system in reactive aggression, and further our knowledge into the distinct correlates and precursors of reactive and proactive aggression.
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206
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Kong G, Larsen H, Cavallo DA, Becker D, Cousijn J, Salemink E, Collot D'Escury-Koenigs AL, Morean ME, Wiers RW, Krishnan-Sarin S. Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 41:425-32. [PMID: 26186485 DOI: 10.3109/00952990.2015.1049492] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers. METHODS Sixty adolescent smokers received four weeks of Cognitive Behavioral Therapy (CBT) for smoking cessation, with CBM (90% avoidance/10% approach for smoking stimuli and 10% avoidance/90% approach for neutral stimuli) or sham (50% avoidance/50% approach for smoking and neutral stimuli) training in the Netherlands (n = 42) and the United States (n = 18). RESULTS While we did not observe changes in action tendencies related to CBM, adolescents with higher smoking approach biases at baseline had greater decreases in approach biases at follow-up, compared to adolescents with smoking avoidance biases, regardless of treatment condition (p = 0.01). Intent-to-treat (ITT) analyses showed that CBM, when compared with sham trended toward higher end-of-treatment, biochemically-confirmed, seven-day point prevalence abstinence, (17.2% vs. 3.2%, p = 0.071). ITT analysis also showed that regardless of treatment condition, cotinine level (p = 0.045) and average number of cigarette smoked (p ≤ 0.001) significantly decreased over the course of treatment. CONCLUSIONS The findings from this pilot study suggests that re-training approach biases toward cigarettes shows promise for smoking cessation among adolescent smokers. Future research should utilize larger samples and increased distinction between CBM and sham conditions, and examine mechanisms underlying the CBM approach.
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Affiliation(s)
- Grace Kong
- a Department of Psychiatry , Yale University School of Medicine , New Haven , CT , USA
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207
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Machulska A, Zlomuzica A, Rinck M, Assion HJ, Margraf J. Approach bias modification in inpatient psychiatric smokers. J Psychiatr Res 2016; 76:44-51. [PMID: 26874269 DOI: 10.1016/j.jpsychires.2015.11.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
Drug-related automatic approach tendencies contribute to the development and maintenance of addictive behavior. The present study investigated whether a nicotine-related approach bias can be modified in smokers undergoing inpatient psychiatric treatment by using a novel training variant of the nicotine Approach-Avoidance-Task (AAT). Additionally, we assessed whether the AAT-training would affect smoking behavior. Inpatient smokers were randomly assigned to either an AAT-training or a sham-training condition. In the AAT-training condition, smokers were indirectly instructed to make avoidance movements in response to nicotine-related pictures and to make approach movements in response to tooth-cleaning pictures. In the sham-training condition, no contingency between picture content und arm movements existed. Trainings were administered in four sessions, accompanied by a brief smoking-cessation intervention. Smoking-related self-report measures and automatic approach biases toward smoking cues were measured before and after training. Three months after training, daily nicotine consumption was obtained. A total of 205 participants were recruited, and data from 139 participants were considered in the final analysis. Prior to the trainings, smokers in both conditions exhibited a stronger approach bias for nicotine-related pictures than for tooth-cleaning pictures. After both trainings, this difference was no longer evident. Although reduced smoking behavior at posttest was observed after both trainings, only the AAT-training led to a larger reduction of nicotine consumption at a three-month follow-up. Our preliminary data partially support the conclusion that the AAT might be a feasible tool to reduce smoking in the long-term in psychiatric patients, albeit its effect on other smoking-related measures remains to be explored.
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Affiliation(s)
| | | | - Mike Rinck
- Ruhr-Universität Bochum, Germany; Behavioral Science Institute, Radboud University Nijmegen, The Netherlands
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208
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Stuke H, Gutwinski S, Wiers CE, Schmidt TT, Gröpper S, Parnack J, Gawron C, Attar CH, Spengler S, Walter H, Heinz A, Bermpohl F. To drink or not to drink: Harmful drinking is associated with hyperactivation of reward areas rather than hypoactivation of control areas in men. J Psychiatry Neurosci 2016; 41:E24-36. [PMID: 26900791 PMCID: PMC4853213 DOI: 10.1503/jpn.150203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The maintenance of harmful alcohol use can be considered a reiterated decision in favour of alcohol in concrete drinking occasions. These decisions are often made despite an intention to quit or reduce alcohol consumption. We tested if a hyperactive reward system and/or an impaired cognitive control system contribute to such unfavourable decision-making. METHODS In this fMRI study, men with modest to harmful drinking behaviour, which was measured using the Alcohol Use Disorders Identification Test (AUDIT), repeatedly made decisions between alcoholic and nonalcoholic drinks. Based on prior individual ratings, decision pairs were created with an alcoholic decision option considered more desirable but less beneficial by the participant. By correlating AUDIT scores with brain activation during decision-making, we determined areas explicitly related to pro-alcohol decisions in men with greater drinking severity. RESULTS Thirty-eight men participated in our study. Behaviourally, we found a positive correlation between AUDIT scores and the number of decisions for desired alcoholic drinks compared with beneficial nonalcoholic drinks. The fMRI results show that AUDIT scores were positively associated with activation in areas associated with reward and motivation processing (i.e., ventral striatum, amygdala, medial prefrontal cortex) during decisions favouring a desired, nonbeneficial alcoholic drink. Conversely, we did not find hypoactivation in areas associated with self-control (dorsolateral prefrontal cortex). These effects were not present when participants chose a desired, nonbenefical, nonalcoholic drink. LIMITATIONS The men participating in our study had to be abstinent and would potentially consume an alcoholic drink at the end of the experiment. Hence, we did not define manifest alcohol dependence as an inclusion criterion and instead focused on less severely affected individuals. CONCLUSION Our results indicate that with growing drinking severity, decisions for alcoholic drinks are associated with increasing activity in reward-associated neural systems, rather than decreasing activity in self-control-associated systems.
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Affiliation(s)
- Heiner Stuke
- Correspondence to: H. Stuke, Department of Psychiatry and Psychotherapy, Charité — Universitätsmedizin Berlin, Campus Mitte, Charité-platz 1, D-10117 Berlin, Germany;
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209
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Hague B, Kellett S, Sheeran P. Testing the Generalizability of Impulse Control Problems in Compulsive Buying. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.4.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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210
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Dickson H, Kavanagh DJ, MacLeod C. The pulling power of chocolate: Effects of approach–avoidance training on approach bias and consumption. Appetite 2016; 99:46-51. [DOI: 10.1016/j.appet.2015.12.026] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
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211
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Woud ML, Maas J, Wiers RW, Becker ES, Rinck M. Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers. Front Psychol 2016; 7:172. [PMID: 26955359 PMCID: PMC4767899 DOI: 10.3389/fpsyg.2016.00172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 01/29/2016] [Indexed: 11/17/2022] Open
Abstract
According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.
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Affiliation(s)
- Marcella L Woud
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum Bochum, Germany
| | - Joyce Maas
- Behavioural Science Institute, Radboud University Nijmegen Nijmegen, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology Lab, University of Amsterdam Amsterdam, Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen Nijmegen, Netherlands
| | - Mike Rinck
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität BochumBochum, Germany; Behavioural Science Institute, Radboud University NijmegenNijmegen, Netherlands
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212
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The effect of acute alcohol on motor-related EEG asymmetries during preparation of approach or avoid alcohol responses. Biol Psychol 2016; 114:81-92. [DOI: 10.1016/j.biopsycho.2015.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 11/15/2015] [Accepted: 12/21/2015] [Indexed: 11/22/2022]
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213
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Schumacher S, Kemps E, Tiggemann M. Bias modification training can alter approach bias and chocolate consumption. Appetite 2016; 96:219-224. [DOI: 10.1016/j.appet.2015.09.014] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/13/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022]
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214
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Brockmeyer T, Hahn C, Reetz C, Schmidt U, Friederich HC. Approach bias and cue reactivity towards food in people with high versus low levels of food craving. Appetite 2015; 95:197-202. [DOI: 10.1016/j.appet.2015.07.013] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/30/2015] [Accepted: 07/12/2015] [Indexed: 11/25/2022]
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215
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The manipulation of alcohol-related interpretation biases by means of Cognitive Bias Modification--Interpretation (CBM-I). J Behav Ther Exp Psychiatry 2015; 49:61-8. [PMID: 25818001 DOI: 10.1016/j.jbtep.2015.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/19/2015] [Accepted: 03/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a large body of evidence demonstrating that alcohol abuse and misuse is characterized by alcohol-related interpretation biases (IBs). The present study tested whether alcohol-related IBs can be trained, and whether this has an effect on alcohol-related associations and drinking behavior. A newly developed alcohol Cognitive Bias Modification - Interpretation (CBM-I) training was employed. The potential moderating effect of executive control on CBM-I training effects was tested. METHOD Participants were hazardously male drinking students. A classical Stroop was used to assess levels of executive control. Half of the sample was trained to interpret ambiguous alcohol-related scenarios in an alcohol-related manner (alcohol training group), whereas the other half was trained to interpret ambiguous alcohol-related scenarios in a neutral manner (neutral training group). A Single Target Implicit Association Test (STIAT) was used to test whether the training would generalize to implicit alcohol-related associations (target words: alcohol, attributes: positive vs. neutral). To test the training's effect on drinking behavior, a bogus taste test and a one week follow-up measure assessing participant's real life drinking behavior were used. RESULTS The CBM-I training was partly successful: When presented with novel ambiguous alcohol-related scenarios, participants of the alcohol training group interpreted these scenarios as more alcohol-related after the training. However, there was no reduction in alcohol-related IBs in the neutral training group. Results of the STIAT demonstrated that both training groups showed stronger positive than neutral alcohol-related associations. However, there were no between-group differences in alcohol-related associations. Moreover, the CBM-I training's effect was not moderated by levels of executive control. Finally, no group differences were found on levels of alcohol consumption (bogus taste test and at one week follow-up). LIMITATIONS The neutral training might have been operationalized sub-optimally. A multi-session training might have resulted in stronger effects. CONCLUSIONS These findings are the first to show that alcohol-related IBs can be trained. However, the training effect only partly generalized so more research is needed to advance our understanding of alcohol CBM-I effects.
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216
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Gladwin TE, Wiers CE, Wiers RW. Cognitive neuroscience of cognitive retraining for addiction medicine: From mediating mechanisms to questions of efficacy. PROGRESS IN BRAIN RESEARCH 2015; 224:323-44. [PMID: 26822365 DOI: 10.1016/bs.pbr.2015.07.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cognitive retraining or cognitive bias modification (CBM) involves having subjects repeatedly perform a computerized task designed to reduce the impact of automatic processes that lead to harmful behavior. We first discuss the theory underlying CBM and provide a brief overview of important research progress in its application to addiction. We then focus on cognitive- and neural-mediating mechanisms. We consider recent criticism of both CBM and its theoretical foundations. Evaluations of CBM could benefit from considering theory-driven factors that may determine variations in efficacy, such as motivation. Concerning theory, while there is certainly room for fundamental advances in current models, we argue that the basic view of impulsive behavior and its control remains a useful and productive heuristic. Finally, we briefly discuss some interesting new directions for CBM research: enhancement of training via transcranial direct current stimulation, online training, and gamification, i.e., the use of gameplay elements to increase motivation.
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Affiliation(s)
- Thomas E Gladwin
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research Centre-Military Mental Health, Ministry of Defense, Utrecht, The Netherlands.
| | - Corinde E Wiers
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu, Berlin, Germany; National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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217
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Boendermaker WJ, Boffo M, Wiers RW. Exploring Elements of Fun to Motivate Youth to Do Cognitive Bias Modification. Games Health J 2015; 4:434-43. [PMID: 26421349 DOI: 10.1089/g4h.2015.0053] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Heavy drinking among young adults poses severe health risks, including development of later addiction problems. Cognitive retraining of automatic appetitive processes related to alcohol (so-called cognitive bias modification [CBM]) may help to prevent escalation of use. Although effective as a treatment in clinical patients, the use of CBM in youth proves more difficult, as motivation in this group is typically low, and the paradigms used are often viewed as boring and tedious. This article presents two separate studies that focused on three approaches that may enhance user experience and motivation to train: a serious game, a serious game in a social networking context, and a mobile application. MATERIALS AND METHODS In the Game Study, 77 participants performed a regular CBM training, aimed at response matching, a gamified version, or a placebo version of that training. The gamified version was presented as a stand-alone game or in the context of a social network. In the Mobile Study, 64 participants completed a different CBM training, aimed at approach bias, either on a computer or on their mobile device. RESULTS Although no training effects were found in the Game Study, adding (social) game elements did increase aspects of the user experience and motivation to train. The mobile training appeared to increase motivation to train in terms how often participants trained, but this effect disappeared after controlling for baseline motivation to train. CONCLUSIONS Adding (social) game elements can increase motivation to train, and mobile training did not underperform compared with the regular training in this sample, which warrants more research into motivational elements for CBM training in younger audiences.
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Affiliation(s)
- Wouter J Boendermaker
- Department of Developmental Psychology, University of Amsterdam , Amsterdam, The Netherlands
| | - Marilisa Boffo
- Department of Developmental Psychology, University of Amsterdam , Amsterdam, The Netherlands
| | - Reinout W Wiers
- Department of Developmental Psychology, University of Amsterdam , Amsterdam, The Netherlands
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218
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Implicit measures of "wanting" and "liking" in humans. Neurosci Biobehav Rev 2015; 57:350-64. [PMID: 26432503 DOI: 10.1016/j.neubiorev.2015.09.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 11/22/2022]
Abstract
Incentive Sensitization Theory (IST; e.g., Robinson and Berridge, 1993. Brain Res. Rev., 18, 291; Robinson and Berridge, 2003 Trends Neurosci., 26, 507) suggests that a common dopamine system that deals with incentive salience attribution is affected by different types of drugs. Repeated drug use will sensitize this neural system, which means that drugs increasingly trigger the experience of incentive salience or "wanting". Importantly, Robinson and Berridge stress that there is a dissociation between drug "wanting" (the unconscious attribution of incentive salience) and drug "liking" (the unconscious hedonic experience when one consumes drugs). Whereas the former plays an essential role in the development and maintenance of drug addiction, the latter does not. Although this model was based mainly on research with non-human animals, more recently the dissociation between "wanting" and "liking" has been examined in humans as well. A widely used and promising means of studying these processes are behavioral implicit measures such as the Implicit Association Test (IAT), the Approach-Avoidance Task (AAT), different types of Stimulus-Response Compatibility (SRC) tasks, and Affective Simon Tasks (AST). IST makes the clear prediction that (1) there should be a positive correlation between indices of "wanting" (e.g., drug consumption) and implicit "wanting" scores. Similarly, there should be a positive correlation between indices of "liking" (e.g., various expressions of subjective pleasure) and implicit "liking" scores; (2) there should be higher "wanting" scores in substance abusers or frequent substance users compared to non-users or infrequent users, and there should be no differences in "liking" between these groups (or even less "liking" in frequent substance users); (3) manipulations of "wanting" should affect implicit "wanting" scores whereas manipulations of "liking" should affect implicit "liking" scores. However, studies that tested these hypotheses did not produce equivocal results. To shed light on these discrepancies, we first discuss the different definitions of "wanting" and "liking" and the different tests that have been used to assess these processes. Then, we discuss whether it is reasonable to assume that these tests are valid measures of "wanting" and "liking" and we review correlational, quasi-experimental, and experimental studies that inform us about this issue. Finally, we discuss the future potential of implicit measures in research on IST and make several recommendations to improve both theory and methodology.
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Always Approach the Bright Side of Life: A General Positivity Training Reduces Stress Reactions in Vulnerable Individuals. COGNITIVE THERAPY AND RESEARCH 2015; 40:57-71. [PMID: 26855458 PMCID: PMC4729786 DOI: 10.1007/s10608-015-9716-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emotional disorders are characterized by cognitive biases towards negative stimuli, and a lack of biases towards positive ones. Therefore, we developed a cognitive bias modification training, modifying approach-avoidance tendencies to diverse emotional pictures. In Study 1, a negative training (pull negative, push positive pictures) was compared to a positive training (vice versa) in 141 students. The pre-existing positivity bias remained after positive training, but reversed into a negativity bias after negative training. This effect transferred to an attentional bias. The training affected neither mood nor emotional vulnerability to stress. In Study 2, we investigated the effects of the positive training in 102 dysphoric and non-dysphoric students, all in a sad mood state. Compared to placebo training, the positive training strengthened a positivity bias, and it reduced emotional vulnerability in dysphoric students. This suggests potential therapeutic value of the training, but further studies are needed.
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220
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Rabinovitz S, Nagar M. Possible End to an Endless Quest? Cognitive Bias Modification for Excessive Multiplayer Online Gamers. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2015; 18:581-7. [PMID: 26383549 DOI: 10.1089/cyber.2015.0173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cognitive biases have previously been recognized as key mechanisms that contribute to the development, maintenance, and relapse of addictive behaviors. The same mechanisms have been recently found in problematic computer gaming. The present study aims to investigate whether excessive massively multiplayer online role-playing gamers (EG) demonstrate an approach bias toward game-related cues compared to neutral stimuli; to test whether these automatic action tendencies can be implicitly modified in a single session training; and to test whether this training affects game urges and game-seeking behavior. EG (n=38) were randomly assigned to a condition in which they were implicitly trained to avoid or to approach gaming cues by pushing or pulling a joystick, using a computerized intervention (cognitive bias modification via the Approach Avoidance Task). EG demonstrated an approach bias for gaming cues compared with neutral, movie cues. Single session training significantly decreased automatic action tendencies to approach gaming cues. These effects occurred outside subjective awareness. Furthermore, approach bias retraining reduced subjective urges and intentions to play, as well as decreased game-seeking behavior. Retraining automatic processes may be beneficial in changing addictive impulses in EG. Yet, large-scale trials and long-term follow-up are warranted. The results extend the application of cognitive bias modification from substance use disorders to behavioral addictions, and specifically to Internet gaming disorder. Theoretical implications are discussed.
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Affiliation(s)
| | - Maayan Nagar
- 2 Department of Criminology, Bar-Ilan University , Ramat-Gan, Israel
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221
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Wiers CE, Ludwig VU, Gladwin TE, Park SQ, Heinz A, Wiers RW, Rinck M, Lindenmeyer J, Walter H, Bermpohl F. Effects of cognitive bias modification training on neural signatures of alcohol approach tendencies in male alcohol-dependent patients. Addict Biol 2015; 20:990-9. [PMID: 25639749 DOI: 10.1111/adb.12221] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Alcohol-dependent patients have been shown to faster approach than avoid alcohol stimuli on the Approach Avoidance Task (AAT). This so-called alcohol approach bias has been associated with increased brain activation in the medial prefrontal cortex and nucleus accumbens. Cognitive bias modification (CBM) has been used to retrain the approach bias with the clinically relevant effect of decreasing relapse rates one year later. The effects of CBM on neural signatures of approach/avoidance tendencies remain hitherto unknown. In a double-blind placebo-controlled design, 26 alcohol-dependent in-patients were assigned to a CBM or a placebo training group. Both groups performed the AAT for three weeks: in CBM training, patients pushed away 90 percent of alcohol cues; this rate was 50 percent in placebo training. Before and after training, patients performed the AAT offline, and in a 3 T magnetic resonance imaging scanner. The relevant neuroimaging contrast for the alcohol approach bias was the difference between approaching versus avoiding alcohol cues relative to soft drink cues: [(alcohol pull > alcohol push) > (soft drink pull > soft drink push)]. Before training, both groups showed significant alcohol approach bias-related activation in the medial prefrontal cortex. After training, patients in the CBM group showed stronger reductions in medial prefrontal cortex activation compared with the placebo group. Moreover, these reductions correlated with reductions in approach bias scores in the CBM group only. This suggests that CBM affects neural mechanisms involved in the automatic alcohol approach bias, which may be important for the clinical effectiveness of CBM.
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Affiliation(s)
- Corinde E. Wiers
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Germany
- Berlin School of Mind and Brain; Humboldt Universität zu Berlin; Germany
| | - Vera U. Ludwig
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Germany
- Berlin School of Mind and Brain; Humboldt Universität zu Berlin; Germany
| | | | | | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Germany
- Berlin School of Mind and Brain; Humboldt Universität zu Berlin; Germany
- Berlin Center for Advanced Neuroimaging; Charité-Universitätsmedizin Berlin; Germany
| | | | - Mike Rinck
- Radboud University Nijmegen; the Netherlands
| | | | - Henrik Walter
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Germany
- Berlin School of Mind and Brain; Humboldt Universität zu Berlin; Germany
- Berlin Center for Advanced Neuroimaging; Charité-Universitätsmedizin Berlin; Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin; Germany
- Berlin School of Mind and Brain; Humboldt Universität zu Berlin; Germany
- Berlin Center for Advanced Neuroimaging; Charité-Universitätsmedizin Berlin; Germany
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van Deursen DS, Salemink E, Boendermaker WJ, Pronk T, Hofmann W, Wiers RW. Executive Functions and Motivation as Moderators of the Relationship Between Automatic Associations and Alcohol Use in Problem Drinkers Seeking Online Help. Alcohol Clin Exp Res 2015; 39:1788-96. [DOI: 10.1111/acer.12822] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Denise S. van Deursen
- Addiction Development and Psychopathology (ADAPT) Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - Elske Salemink
- Addiction Development and Psychopathology (ADAPT) Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - Wouter J. Boendermaker
- Addiction Development and Psychopathology (ADAPT) Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - Thomas Pronk
- Addiction Development and Psychopathology (ADAPT) Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - Wilhelm Hofmann
- Social Cognition Center Cologne; University of Cologne; Cologne Germany
| | - Reinout W. Wiers
- Addiction Development and Psychopathology (ADAPT) Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
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223
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Snelleman M, Schoenmakers TM, van de Mheen D. Attentional Bias and Approach/Avoidance Tendencies Do Not Predict Relapse or Time to Relapse in Alcohol Dependency. Alcohol Clin Exp Res 2015; 39:1734-9. [DOI: 10.1111/acer.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/16/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Michelle Snelleman
- IVO Addiction Research Institute; Rotterdam the Netherlands
- Erasmus Medical Center; Rotterdam the Netherlands
| | - Tim Michaël Schoenmakers
- IVO Addiction Research Institute; Rotterdam the Netherlands
- Erasmus Medical Center; Rotterdam the Netherlands
| | - Dike van de Mheen
- IVO Addiction Research Institute; Rotterdam the Netherlands
- Erasmus Medical Center; Rotterdam the Netherlands
- Department of Health Promotion; Maastricht University; Maastricht the Netherlands
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Attempted Training of Alcohol Approach and Drinking Identity Associations in US Undergraduate Drinkers: Null Results from Two Studies. PLoS One 2015; 10:e0134642. [PMID: 26241316 PMCID: PMC4524630 DOI: 10.1371/journal.pone.0134642] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/11/2015] [Indexed: 11/19/2022] Open
Abstract
There is preliminary evidence that approach avoid training can shift implicit alcohol associations and improve treatment outcomes. We sought to replicate and extend those findings in US undergraduate social drinkers (Study 1) and at-risk drinkers (Study 2). Three adaptations of the approach avoid task (AAT) were tested. The first adaptation – the approach avoid training – was a replication and targeted implicit alcohol approach associations. The remaining two adaptations – the general identity and personalized identity trainings – targeted implicit drinking identity associations, which are robust predictors of hazardous drinking in US undergraduates. Study 1 included 300 undergraduate social drinkers. They were randomly assigned to real or sham training conditions for one of the three training adaptations, and completed two training sessions, spaced one week apart. Study 2 included 288 undergraduates at risk for alcohol use disorders. The same training procedures were used, but the two training sessions occurred within a single week. Results were not as expected. Across both studies, the approach avoid training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. The general identity training also yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes with one exception; individuals who completed real training demonstrated no changes in drinking refusal self-efficacy whereas individuals who completed sham training had reductions in self-efficacy. Finally, across both studies, the personalized identity training yielded no evidence of training effects on implicit alcohol associations or alcohol outcomes. Despite having relatively large samples and using a well-validated training task, study results indicated all three training adaptations were ineffective at this dose in US undergraduates. These findings are important because training studies are costly and labor-intensive. Future research may benefit from focusing on more severe populations, pairing training with other interventions, increasing training dose, and increasing gamification of training tasks.
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225
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Carpenter KM, Bedi G, Vadhan NP. Understanding and shifting drug-related decisions: contributions of automatic decision-making processes. Curr Psychiatry Rep 2015; 17:607. [PMID: 26084667 PMCID: PMC4684598 DOI: 10.1007/s11920-015-0607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While substance use is common, only a minority of individuals who use drugs or alcohol develop problematic use. An understanding of the factors underlying the transition from substance use to misuse may improve prevention and intervention efforts. A key feature of substance misuse is ongoing decisions to use drugs or alcohol despite escalating negative consequences. Research findings highlight the importance of both relatively automatic, associative cognitive processes and relatively controlled, deliberative, and rational-analytic cognitive processes, for understanding situational decisions to use drugs. In this review, we discuss several cognitive component processes that may contribute to decision-making that promotes substance use and misuse, with a focus on more automatic processes. A growing body of evidence indicates that relative differences in the strength of these component processes can account for individual differences in the transition from substance use to misuse and may offer important avenues for developing novel intervention strategies.
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Affiliation(s)
- Kenneth M. Carpenter
- Department of Psychiatry, Columbia University Medical Center, Center for Motivation and Change, Division on Substance Abuse, New York State Psychiatric Institute, 1051 Riverside Drive, MC 120, NY, NY, 10032, ph: 646-774-8176
| | - Gillinder Bedi
- Division on Substance Abuse, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, 1051 Riverside Drive, MC 120, NY, NY, 10032, ph: 646 774 6133
| | - Nehal P. Vadhan
- Department of Psychiatry, Stony Brook University School of Medicine, Health Sciences Tower 10-040K, Stony Brook, NY 11794-8101, ph: 631-638-1543
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226
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Brockmeyer T, Hahn C, Reetz C, Schmidt U, Friederich HC. Approach Bias Modification in Food Craving-A Proof-of-Concept Study. EUROPEAN EATING DISORDERS REVIEW 2015; 23:352-60. [DOI: 10.1002/erv.2382] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg Germany
| | - Carolyn Hahn
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg Germany
| | - Christina Reetz
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg Germany
| | - Ulrike Schmidt
- King's College London; Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders; London UK
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics; University Hospital Heidelberg; Heidelberg Germany
- Department of Psychosomatic Medicine and Psychotherapy; LVR Klinik, University of Duisburg-Essen; Essen Germany
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227
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Implicit attitudes towards smoking predict long-term relapse in abstinent smokers. Psychopharmacology (Berl) 2015; 232:2551-61. [PMID: 25761836 DOI: 10.1007/s00213-015-3893-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE It has previously been argued that implicit attitudes toward substance-related cues drive addictive behavior. Nevertheless, it remains an open question whether behavioral markers of implicit attitude activation can be used to predict long-term relapse. OBJECTIVES The main objective of this study was to examine the relationship between implicit attitudes toward smoking-related cues and long-term relapse in abstaining smokers. METHODS Implicit attitudes toward smoking-related cues were assessed by means of the Implicit Association Test (IAT) and the evaluative priming task (EPT). Both measures were completed by a group of smokers who volunteered to quit smoking (patient group) and a group of nonsmokers (control group). Participants in the patient group completed these measures twice: once prior to smoking cessation and once after smoking cessation. Relapse was assessed by means of short telephone survey, 6 months after completion of the second test session. RESULTS EPT scores obtained prior to smoking cessation were related to long-term relapse and correlated with self-reported nicotine dependence as well as daily cigarette consumption. In contrast, none of the behavioral outcome measures were found to correlate with the IAT scores. CONCLUSIONS These findings corroborate the idea that implicit attitudes toward substance-related cues are critically involved in long-term relapse. A potential explanation for the divergent findings obtained with the IAT and EPT is provided.
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228
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Snagowski J, Brand M. Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users. Front Psychol 2015; 6:653. [PMID: 26052292 PMCID: PMC4441125 DOI: 10.3389/fpsyg.2015.00653] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/04/2015] [Indexed: 11/17/2022] Open
Abstract
There is no consensus regarding the phenomenology, classification, and diagnostic criteria of cybersex addiction. Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli. In the current study 123 heterosexual males completed an Approach-Avoidance-Task (AAT; Rinck and Becker, 2007) modified with pornographic pictures. During the AAT participants either had to push pornographic stimuli away or pull them toward themselves with a joystick. Sensitivity toward sexual excitation, problematic sexual behavior, and tendencies toward cybersex addiction were assessed with questionnaires. Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction. Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use. The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.
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Affiliation(s)
- Jan Snagowski
- Department of General Psychology: Cognition, University of Duisburg-Essen Duisburg, Germany
| | - Matthias Brand
- Department of General Psychology: Cognition, University of Duisburg-Essen Duisburg, Germany ; Erwin L. Hahn Institute for Magnetic Resonance Imaging Essen, Germany
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229
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Cousijn J, van Benthem P, van der Schee E, Spijkerman R. Motivational and control mechanisms underlying adolescent cannabis use disorders: A prospective study. Dev Cogn Neurosci 2015; 16:36-45. [PMID: 25922296 PMCID: PMC6989823 DOI: 10.1016/j.dcn.2015.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/27/2015] [Accepted: 04/01/2015] [Indexed: 01/23/2023] Open
Abstract
Adolescents with a CUD had an attentional but no approach bias towards cannabis. Cannabis craving significantly predicted cannabis use 6 months later. These findings identify craving as a predictor of treatment outcome. This study is among the first to investigate neuropsychological mechanisms underlying adolescent CUDs.
Cannabis use disorders (CUDs) are the most prevalent substance use disorders among adolescents in treatment. Yet, little is known about the neuropsychological mechanisms underlying adolescent CUDs. Studies in adult cannabis users suggest a significant role for cognitive control and cannabis-oriented motivational processes, such as attentional bias, approach bias, and craving in CUDs. The current 6-month prospective study investigated the relationships between attentional bias, approach bias, craving, cognitive control, and cannabis use in adolescent patients in treatment for a primary or secondary CUD. Moreover, we investigated if these motivational processes and cognitive control could predict treatment progression after 6 months. Adolescents with a CUD had an attentional but no approach bias towards cannabis. In contrast to adult findings on the role of attentional bias, approach bias and cognitive control, only cannabis craving significantly correlated with current cannabis use and predicted cannabis use-related problems and abstinence from cannabis 6 months later. These findings identify craving as a predictor of treatment outcome, thereby supporting an important role for craving in the course of adolescent cannabis use and dependence. This prospective study is among the first to investigate neuropsychological mechanisms underlying adolescent CUDs, warranting future longitudinal studies.
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Affiliation(s)
- Janna Cousijn
- Consortium Individual Development, Departments of Developmental and Experimental Psychology, Utrecht University, Utrecht, The Netherlands; ADAPT-lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Patty van Benthem
- Parnassia Addiction Research Center (PARC), Brijder Addiction Care, The Hague, The Netherlands
| | - Evelien van der Schee
- Parnassia Addiction Research Center (PARC), Brijder Addiction Care, The Hague, The Netherlands
| | - Renske Spijkerman
- Parnassia Addiction Research Center (PARC), Brijder Addiction Care, The Hague, The Netherlands
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230
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Combined effects of cognitive bias for food cues and poor inhibitory control on unhealthy food intake. Appetite 2015; 87:358-64. [DOI: 10.1016/j.appet.2015.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 01/14/2023]
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231
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Wittekind CE, Feist A, Schneider BC, Moritz S, Fritzsche A. The approach-avoidance task as an online intervention in cigarette smoking: a pilot study. J Behav Ther Exp Psychiatry 2015; 46:115-20. [PMID: 25306247 DOI: 10.1016/j.jbtep.2014.08.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Dual-process models posit that addictive behaviors are characterized by strong automatic processes that can be assessed with implicit measures. The present study investigated the potential of a cognitive bias modification paradigm, the Approach-Avoidance Task (AAT), for retraining automatic behavioral tendencies in cigarette smoking. METHODS The study was set up as an online intervention. After completing an online survey, 257 smokers were randomly allocated either to one of two experimental conditions (AAT) or a waitlist control group. Participants responded to different pictures by pushing or pulling the computer mouse, depending on the format of the picture. Pictures in portrait format depicted smoking-related items and were associated with pushing, pictures in landscape format depicted neutral items and were associated with pulling. One version of the AAT provided individual feedback after each trial whereas the standard version did not. After four weeks, participants were re-assessed in an online survey. RESULTS Analyses revealed that the standard AAT, in particular, led to a significant reduction in cigarette consumption, cigarette dependence, and compulsive drive; no effect was found in the control group. LIMITATIONS Interpretability of the study is constrained by the fact that no active control condition was applied. CONCLUSIONS Notwithstanding the limitations, our findings indicate that the AAT might be a feasible instrument to reduce tobacco dependence and can be applied as an online intervention. Future studies should investigate whether the effects of behavior therapy can be augmented when combined with retraining interventions.
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Affiliation(s)
- Charlotte E Wittekind
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
| | - Ansgar Feist
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Brooke C Schneider
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Fritzsche
- University Hamburg, Department of Psychology and Psychotherapy, Von-Melle-Park 5, 20246 Hamburg, Germany
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232
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Boffo M, Pronk T, Wiers RW, Mannarini S. Combining cognitive bias modification training with motivational support in alcohol dependent outpatients: study protocol for a randomised controlled trial. Trials 2015; 16:63. [PMID: 25888158 PMCID: PMC4347655 DOI: 10.1186/s13063-015-0576-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addiction research has hypothesised that automatic and reflective cognitive processes play an important role in the onset and maintenance of alcohol (ab)use, wherein automatic reactions to drug-related cues steer the drug user towards consuming before reflective processes can get over and steer towards a different behavioural response. These automatic processes include the tendency to attend and approach alcohol cues. These biases may be trained away from alcohol via computerised cognitive bias modification (CBM). The present protocol describes the design of a double-blind randomised controlled trial (RCT) testing the effectiveness of attentional bias and approach bias re-training with a 2×2 factorial design, alongside a brief motivational support (MS) program. METHODS/DESIGN Participants (n = 120) are adult alcohol dependent outpatients, recruited from a public health service for addiction in Italy, who have been abstinent for at least two months, and with a main diagnosis of alcohol dependence disorder. Participants are randomly assigned to one of four experimental conditions and complete 11 sessions of training after a baseline assessment. The MS takes place before each training session. Post-intervention and three-month follow-up assessments examine the change in clinical outcome variables and attentional and approach biases (measured with the Visual Probe Task and the Approach-Avoidance Task, respectively). Alcohol approach-avoidance implicit memory associations (measured with the Brief Implicit Association Test) are also evaluated at pre- and post-intervention to explore generalisation effects. Primary outcome measure is relapse rate at follow-up. Secondary outcome measures include change in cognitive biases, in alcohol-related implicit memory associations, and in the clinical variables assessed. An exploratory analysis is also planned to detect interaction effects between the CBM modules and possible moderators (interference control capacity, gender, age, number of previous detoxifications) and mediators (change in cognitive bias) of the primary outcome measure. DISCUSSION This RCT is the first to test the effectiveness of a combined CBM intervention alongside motivational support in alcohol-dependent outpatients. The results of this study can be extremely valuable for future research in the optimisation of CBM treatment for alcohol addiction. TRIAL REGISTRATION Current Controlled Trials ISRCTN01005959 (registration date: 24 October 2013).
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Affiliation(s)
- Marilisa Boffo
- Department of Philosophy, Sociology, Education, and Applied Psychology (FISPPA), University of Padova, via Venezia 8, 35131, Padova, Italy. .,Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands. .,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerpen, Universiteitsplein 1, 2610, Antwerpen, Belgium.
| | - Thomas Pronk
- Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Department of Psychology, Addiction Development and Psychopathology (ADAPT)-lab, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands.
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology (FISPPA), University of Padova, via Venezia 8, 35131, Padova, Italy. .,Interdepartmental Centre for Family Research, FISPPA, University of Padova, Piazza Capitaniato 3, 35139, Padova, Italy.
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Machulska A, Zlomuzica A, Adolph D, Rinck M, Margraf J. "A cigarette a day keeps the goodies away": smokers show automatic approach tendencies for smoking--but not for food-related stimuli. PLoS One 2015; 10:e0116464. [PMID: 25692468 PMCID: PMC4333198 DOI: 10.1371/journal.pone.0116464] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022] Open
Abstract
Smoking leads to the development of automatic tendencies that promote approach behavior toward smoking-related stimuli which in turn may maintain addictive behavior. The present study examined whether automatic approach tendencies toward smoking-related stimuli can be measured by using an adapted version of the Approach-Avoidance Task (AAT). Given that progression of addictive behavior has been associated with a decreased reactivity of the brain reward system for stimuli signaling natural rewards, we also used the AAT to measure approach behavior toward natural rewarding stimuli in smokers. During the AAT, 92 smokers and 51 non-smokers viewed smoking-related vs. non-smoking-related pictures and pictures of natural rewards (i.e. highly palatable food) vs. neutral pictures. They were instructed to ignore image content and to respond to picture orientation by either pulling or pushing a joystick. Within-group comparisons revealed that smokers showed an automatic approach bias exclusively for smoking-related pictures. Contrary to our expectations, there was no difference in smokers’ and non-smokers’ approach bias for nicotine-related stimuli, indicating that non-smokers also showed approach tendencies for this picture category. Yet, in contrast to non-smokers, smokers did not show an approach bias for food-related pictures. Moreover, self-reported smoking attitude could not predict approach-avoidance behavior toward nicotine-related pictures in smokers or non-smokers. Our findings indicate that the AAT is suited for measuring smoking-related approach tendencies in smokers. Furthermore, we provide evidence for a diminished approach tendency toward food-related stimuli in smokers, suggesting a decreased sensitivity to natural rewards in the course of nicotine addiction. Our results indicate that in contrast to similar studies conducted in alcohol, cannabis and heroin users, the AAT might only be partially suited for measuring smoking-related approach tendencies in smokers. Nevertheless, our findings are of special importance for current etiological models and smoking cessation programs aimed at modifying nicotine-related approach tendencies in the context of a nicotine addiction.
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Affiliation(s)
- Alla Machulska
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Mike Rinck
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
- Behavioral Science Institute, Radboud University Nijmegen, The Netherlands
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
- * E-mail:
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234
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den Uyl TE, Gladwin TE, Wiers RW. Transcranial direct current stimulation, implicit alcohol associations and craving. Biol Psychol 2015; 105:37-42. [DOI: 10.1016/j.biopsycho.2014.12.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/24/2022]
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235
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Approach avoidance training in the eating domain: Testing the effectiveness across three single session studies. Appetite 2015; 85:58-65. [DOI: 10.1016/j.appet.2014.11.017] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/23/2014] [Accepted: 11/14/2014] [Indexed: 11/21/2022]
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236
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Gladwin TE, Rinck M, Eberl C, Becker ES, Lindenmeyer J, Wiers RW. Mediation of Cognitive Bias Modification for Alcohol Addiction via Stimulus-Specific Alcohol Avoidance Association. Alcohol Clin Exp Res 2015; 39:101-7. [DOI: 10.1111/acer.12602] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/15/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas E. Gladwin
- Adapt Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - Mike Rinck
- Behavioural Science Institute; Radboud University Nijmegen; Nijmegen the Netherlands
| | | | - Eni S. Becker
- Behavioural Science Institute; Radboud University Nijmegen; Nijmegen the Netherlands
| | | | - Reinout W. Wiers
- Adapt Lab; Department of Psychology; University of Amsterdam; Amsterdam the Netherlands
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237
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Blackwell SE, Browning M, Mathews A, Pictet A, Welch J, Davies J, Watson P, Geddes JR, Holmes EA. Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial. Clin Psychol Sci 2015; 3:91-111. [PMID: 25984421 PMCID: PMC4359210 DOI: 10.1177/2167702614560746] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/25/2014] [Indexed: 12/21/2022]
Abstract
Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work.
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Affiliation(s)
| | | | - Andrew Mathews
- Department of Psychology, University of California, Davis ; Institute of Psychiatry, King's College London
| | - Arnaud Pictet
- Department of Psychiatry, University of Oxford ; Department of Psychology, University of Geneva
| | - James Welch
- Department of Computer Science, University of Oxford
| | - Jim Davies
- Department of Computer Science, University of Oxford
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit
| | | | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit ; Department of Psychiatry, University of Oxford
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238
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Wiers RW, Houben K, Fadardi JS, van Beek P, Rhemtulla M, Cox WM. Alcohol cognitive bias modification training for problem drinkers over the web. Addict Behav 2015; 40:21-6. [PMID: 25218067 DOI: 10.1016/j.addbeh.2014.08.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 07/09/2014] [Accepted: 08/23/2014] [Indexed: 01/10/2023]
Abstract
Following successful outcomes of cognitive bias modification (CBM) programs for alcoholism in clinical and community samples, the present study investigated whether different varieties of CBM (attention control training and approach-bias re-training) could be delivered successfully in a fully automated web-based way and whether these interventions would help self-selected problem drinkers to reduce their drinking. Participants were recruited through online advertising, which resulted in 697 interested participants, of whom 615 were screened in. Of the 314 who initiated training, 136 completed a pretest, four sessions of computerized training and a posttest. Participants were randomly assigned to one of four experimental conditions (attention control or one of three varieties of approach-bias re-training) or a sham-training control condition. The general pattern of findings was that participants in all conditions (including participants in the control-training condition) reduced their drinking. It is suggested that integrating CBM with online cognitive and motivational interventions could improve results.
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Affiliation(s)
- Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Katrijn Houben
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Javad S Fadardi
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran; School of Psychology, Bangor University, United Kingdom
| | - Paul van Beek
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; RIVM, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Mijke Rhemtulla
- Methods and Statistics, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - W Miles Cox
- School of Psychology, Bangor University, United Kingdom
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239
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Cristea IA, Kok RN, Cuijpers P. Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis. Br J Psychiatry 2015; 206:7-16. [PMID: 25561486 DOI: 10.1192/bjp.bp.114.146761] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive bias modification (CBM) interventions are strongly advocated in research and clinical practice. AIMS To examine the efficiency of CBM for clinically relevant outcomes, along with study quality, publication bias and potential moderators. METHOD We included randomised controlled trials (RCTs) of CBM interventions that reported clinically relevant outcomes assessed with standardised instruments. RESULTS We identified 49 trials and grouped outcomes into anxiety and depression. Effect sizes were small considering all the samples, and mostly non-significant for patient samples. Effect sizes became non-significant when outliers were excluded and after adjustment for publication bias. The quality of the RCTs was suboptimal. CONCLUSIONS CBM may have small effects on mental health problems, but it is also very well possible that there are no significant clinically relevant effects. Research in this field is hampered by small and low-quality trials, and by risk of publication bias. Many positive outcomes are driven by extreme outliers.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Robin N Kok
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
| | - Pim Cuijpers
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeʂ-Bolyai University, Cluj-Napoca, Romania and Clinical Psychology Branch, Department of Surgical, Medical, Molecular and Critical Pathology, University of Pisa, Pisa, Italy; Robin N. Kok, MSc, Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands and Centre for Mental Health Research, The Australian National University, Acton, Australia; Pim Cuijpers, PhD, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands and Leuphana University, Lüneburg, Germany
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240
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Does a Dieting Goal Affect Automatic Cognitive Processes and Their Trainability? COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9658-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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241
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Sokunbi MO, Linden DEJ, Habes I, Johnston S, Ihssen N. Real-time fMRI brain-computer interface: development of a "motivational feedback" subsystem for the regulation of visual cue reactivity. Front Behav Neurosci 2014; 8:392. [PMID: 25505392 PMCID: PMC4243563 DOI: 10.3389/fnbeh.2014.00392] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/20/2014] [Indexed: 11/13/2022] Open
Abstract
Here we present a novel neurofeedback subsystem for the presentation of motivationally relevant visual feedback during the self-regulation of functional brain activation. Our “motivational neurofeedback” approach uses functional magnetic resonance imaging (fMRI) signals elicited by visual cues (pictures) and related to motivational processes such as craving or hunger. The visual feedback subsystem provides simultaneous feedback through these images as their size corresponds to the magnitude of fMRI signal change from a target brain area. During self-regulation of cue-evoked brain responses, decreases and increases in picture size thus provide real motivational consequences in terms of cue approach vs. cue avoidance, which increases face validity of the approach in applied settings. Further, the outlined approach comprises of neurofeedback (regulation) and “mirror” runs that allow to control for non-specific and task-unrelated effects, such as habituation or neural adaptation. The approach was implemented in the Python programming language. Pilot data from 10 volunteers showed that participants were able to successfully down-regulate individually defined target areas, demonstrating feasibility of the approach. The newly developed visual feedback subsystem can be integrated into protocols for imaging-based brain-computer interfaces (BCI) and may facilitate neurofeedback research and applications into healthy and dysfunctional motivational processes, such as food craving or addiction.
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Affiliation(s)
- Moses O Sokunbi
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University Cardiff, UK ; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University Cardiff, UK
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University Cardiff, UK ; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University Cardiff, UK
| | - Isabelle Habes
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University Cardiff, UK ; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University Cardiff, UK
| | | | - Niklas Ihssen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff School of Medicine, Cardiff University Cardiff, UK ; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University Cardiff, UK
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242
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Schulte MH, Cousijn J, den Uyl TE, Goudriaan AE, van den Brink W, Veltman DJ, Schilt T, Wiers RW. Recovery of neurocognitive functions following sustained abstinence after substance dependence and implications for treatment. Clin Psychol Rev 2014; 34:531-50. [DOI: 10.1016/j.cpr.2014.08.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/19/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
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243
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Jones A, McGrath E, Houben K, Nederkoorn C, Robinson E, Field M. A comparison of three types of web-based inhibition training for the reduction of alcohol consumption in problem drinkers: study protocol. BMC Public Health 2014; 14:796. [PMID: 25090915 PMCID: PMC4131042 DOI: 10.1186/1471-2458-14-796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/21/2014] [Indexed: 11/14/2022] Open
Abstract
Background Problem drinkers have poor inhibitory control (disinhibition). Previous studies have demonstrated that various forms of ‘inhibition training’ can reduce alcohol consumption in the laboratory and at short-term follow-up, but their longer-term efficacy and mechanisms of action are unknown. In this phase 2 randomised controlled trial we will contrast the effects of three forms of inhibition training and a control intervention, delivered via the Internet in multiple sessions over four weeks, on alcohol consumption in heavy drinkers. Methods/design Heavy drinkers who are interested in reducing their alcohol consumption will receive a brief intervention and will monitor their own alcohol intake for one week before being randomised to one of four treatment groups: 1. General inhibition training; 2. Cue-Specific inhibition training; 3. Alcohol No-Go training; or 4. Control. They will complete up to 14 sessions of training via the Internet over a four-week period, and will be followed-up for a further six weeks after the end of the training period. Primary outcome measures are reductions in alcohol consumption and heavy drinking days. The number of abstinent days is a secondary outcome measure. We will also investigate changes in inhibitory control and automatic alcohol affective associations in response to training. Discussion This study will establish if web-based inhibition training can help problem drinkers to reduce their alcohol intake, and it will identify which form(s) of inhibition training are most effective. Trial registation Trial Registation number: ISRCTN55671858.
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Affiliation(s)
| | | | | | | | | | - Matt Field
- Department of Psychological Sciences, University of Liverpool, United Kingdom and UK Centre for Tobacco and Alcohol Studies (UKCTAS), Liverpool L69 7ZA, UK.
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244
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Hogarth L, Retzler C, Munafò MR, Tran DMD, Troisi JR, Rose AK, Jones A, Field M. Extinction of cue-evoked drug-seeking relies on degrading hierarchical instrumental expectancies. Behav Res Ther 2014; 59:61-70. [PMID: 25011113 PMCID: PMC4119239 DOI: 10.1016/j.brat.2014.06.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 11/08/2022]
Abstract
There has long been need for a behavioural intervention that attenuates cue-evoked drug-seeking, but the optimal method remains obscure. To address this, we report three approaches to extinguish cue-evoked drug-seeking measured in a Pavlovian to instrumental transfer design, in non-treatment seeking adult smokers and alcohol drinkers. The results showed that the ability of a drug stimulus to transfer control over a separately trained drug-seeking response was not affected by the stimulus undergoing Pavlovian extinction training in experiment 1, but was abolished by the stimulus undergoing discriminative extinction training in experiment 2, and was abolished by explicit verbal instructions stating that the stimulus did not signal a more effective response-drug contingency in experiment 3. These data suggest that cue-evoked drug-seeking is mediated by a propositional hierarchical instrumental expectancy that the drug-seeking response is more likely to be rewarded in that stimulus. Methods which degraded this hierarchical expectancy were effective in the laboratory, and so may have therapeutic potential.
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Affiliation(s)
- Lee Hogarth
- School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter EX4 4QG, UK; School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Chris Retzler
- Department of Behavioural and Social Sciences, University of Huddersfield, Huddersfield, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit and School of Experimental Psychology, 12a Priory Road, University of Bristol, Bristol BS8 1TU, UK; UK Centre for Tobacco and Alcohol Studies, UK
| | - Dominic M D Tran
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Joseph R Troisi
- Department of Psychology, Saint Anselm College, Manchester, NH 03102, USA
| | - Abigail K Rose
- School of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Andrew Jones
- School of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Matt Field
- School of Psychology, University of Liverpool, Liverpool, L69 7ZA, UK; UK Centre for Tobacco and Alcohol Studies, UK
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245
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Macy JT, Chassin L, Presson CC, Sherman JW. Changing implicit attitudes toward smoking: results from a web-based approach-avoidance practice intervention. J Behav Med 2014; 38:143-52. [PMID: 25059750 DOI: 10.1007/s10865-014-9585-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022]
Abstract
Implicit attitudes have been shown to predict smoking behaviors. Therefore, an important goal is the development of interventions to change these attitudes. This study assessed the effects of a web-based intervention on implicit attitudes toward smoking and receptivity to smoking-related information. Smokers (N = 284) were recruited to a two-session web-based study. In the first session, baseline data were collected. Session two contained the intervention, which consisted of assignment to the experimental or control version of an approach-avoidance task and assignment to an anti-smoking or control public service announcement (PSA), and post-intervention measures. Among smokers with less education and with plans to quit, implicit attitudes were more negative for those who completed the approach-avoidance task. Smokers with more education who viewed the anti-smoking PSA and completed the approach-avoidance task spent more time reading smoking-related information. An approach-avoidance task is a potentially feasible strategy for changing implicit attitudes toward smoking and increasing receptivity to smoking-related information.
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Affiliation(s)
- Jonathan T Macy
- Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th St, Bloomington, IN, 47405, USA,
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246
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Wilcox CE, Dekonenko CJ, Mayer AR, Bogenschutz MP, Turner JA. Cognitive control in alcohol use disorder: deficits and clinical relevance. Rev Neurosci 2014; 25:1-24. [PMID: 24361772 DOI: 10.1515/revneuro-2013-0054] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/27/2013] [Indexed: 01/25/2023]
Abstract
Cognitive control refers to the internal representation, maintenance, and updating of context information in the service of exerting control over thoughts and behavior. Deficits in cognitive control likely contribute to difficulty in maintaining abstinence in individuals with alcohol use disorders (AUD). In this article, we define three cognitive control processes in detail (response inhibition, distractor interference control, and working memory), review the tasks measuring performance in these areas, and summarize the brain networks involved in carrying out these processes. Next, we review evidence of deficits in these processes in AUD, including both metrics of task performance and functional neuroimaging. Finally, we explore the clinical relevance of these deficits by identifying predictors of clinical outcome and markers that appear to change (improve) with treatment. We observe that individuals with AUD experience deficits in some, but not all, metrics of cognitive control. Deficits in cognitive control may predict clinical outcome in AUD, but more work is necessary to replicate findings. It is likely that performance on tasks requiring cognitive control improves with abstinence, and with some psychosocial and medication treatments. Future work should clarify which aspects of cognitive control are most important to target during treatment of AUD.
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247
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Sharbanee JM, Stritzke WGK, Jamalludin ME, Wiers RW. Approach-alcohol action tendencies can be inhibited by cognitive load. Psychopharmacology (Berl) 2014; 231:967-75. [PMID: 24177315 DOI: 10.1007/s00213-013-3318-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Dysregulated alcohol consumption has been attributed to an imbalance between an approach-alcohol action tendency and executive control processes. However, which specific executive control processes are involved is not known. One candidate executive process is interference suppression, which refers to the suppression of task-irrelevant information through the active maintenance of task-relevant information or a cognitive load. OBJECTIVE The present study aimed to (1) establish whether alcohol action tendency can be inhibited by interference suppression through the use of cognitive loads and (2) to assess whether individual differences in the degree of interference suppression from cognitive loads is related to individual differences in the ability to regulate alcohol consumption. METHOD Two groups of social drinkers (total N = 58) who differed in their ability to regulate their alcohol consumption completed a novel cognitive load variant of the approach avoidance task (AAT) and an alcohol taste test. RESULTS Results indicated that (1) there was a relationship between alcohol bias on the AAT and alcohol consumption under low load, but not high load, consistent with the hypothesis that the action tendency would be inhibited through interference suppression, and (2) this effect of load was not modified by drinking group, with both groups demonstrating equivalent ability to inhibit the action tendency. CONCLUSIONS The present findings suggest that alcohol action tendency can be inhibited through interference suppression, and that this is effective even for those that have difficulty regulating their alcohol consumption.
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Affiliation(s)
- Jason M Sharbanee
- School of Psychology, University of Western Australia, Crawley, WA, 6009, Australia,
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248
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Neural correlates of alcohol-approach bias in alcohol addiction: the spirit is willing but the flesh is weak for spirits. Neuropsychopharmacology 2014; 39:688-97. [PMID: 24060832 PMCID: PMC3895246 DOI: 10.1038/npp.2013.252] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 01/14/2023]
Abstract
Behavioral studies have shown an alcohol-approach bias in alcohol-dependent patients: the automatic tendency to faster approach than avoid alcohol compared with neutral cues, which has been associated with craving and relapse. Although this is a well-studied psychological phenomenon, little is known about the brain processes underlying automatic action tendencies in addiction. We examined 20 alcohol-dependent patients and 17 healthy controls with functional magnetic resonance imaging (fMRI), while performing an implicit approach-avoidance task. Participants pushed and pulled pictorial cues of alcohol and soft-drink beverages, according to a content-irrelevant feature of the cue (landscape/portrait). The critical fMRI contrast regarding the alcohol-approach bias was defined as (approach alcohol>avoid alcohol)>(approach soft drink>avoid soft drink). This was reversed for the avoid-alcohol contrast: (avoid alcohol>approach alcohol)>(avoid soft drink>approach soft drink). In comparison with healthy controls, alcohol-dependent patients had stronger behavioral approach tendencies for alcohol cues than for soft-drink cues. In the approach, alcohol fMRI contrast patients showed larger blood-oxygen-level-dependent responses in the nucleus accumbens and medial prefrontal cortex, regions involved in reward and motivational processing. In alcohol-dependent patients, alcohol-craving scores were positively correlated with activity in the amygdala for the approach-alcohol contrast. The dorsolateral prefrontal cortex was not activated in the avoid-alcohol contrast in patients vs controls. Our data suggest that brain regions that have a key role in reward and motivation are associated with the automatic alcohol-approach bias in alcohol-dependent patients.
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249
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Sharbanee JM, Hu L, Stritzke WGK, Wiers RW, Rinck M, MacLeod C. The effect of approach/avoidance training on alcohol consumption is mediated by change in alcohol action tendency. PLoS One 2014; 9:e85855. [PMID: 24465750 PMCID: PMC3899082 DOI: 10.1371/journal.pone.0085855] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022] Open
Abstract
Training people to respond to alcohol images by making avoidance joystick movements can affect subsequent alcohol consumption, and has shown initial efficacy as a treatment adjunct. However, the mechanisms that underlie the training’s efficacy are unknown. The present study aimed to determine 1) whether the training’s effect is mediated by a change in action tendency or a change in selective attention, and 2) whether the training’s effect is moderated by individual differences in working memory capacity (WMC). Three groups of social drinkers (total N = 74) completed either approach-alcohol training, avoid-alcohol training or a sham-training on the Approach-Avoidance Task (AAT). Participants’ WMC was assessed prior to training, while their alcohol-related action tendency and selective attention were assessed before and after the training on the recently developed Selective-Attention/Action Tendency Task (SA/ATT), before finally completing an alcohol taste-test. There was no significant main effect of approach/avoidance training on alcohol consumption during the taste-test. However, there was a significant indirect effect of training on alcohol consumption mediated by a change in action tendency, but no indirect effect mediated by a change in selective attention. There was inconsistent evidence of WMC moderating training efficacy, with moderation found only for the effect of approach-alcohol training on the AAT but not on the SA/ATT. Thus approach/avoidance training affects alcohol consumption specifically by changing the underlying action tendency. Multiple training sessions may be required in order to observe more substantive changes in drinking behaviour.
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Affiliation(s)
- Jason M. Sharbanee
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Australia
- * E-mail: .
| | - Litje Hu
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Werner G. K. Stritzke
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Australia
| | - Reinout W. Wiers
- Addiction, Development, and Psychopathology (Adapt) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Mike Rinck
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Crawley, Australia
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"Killing Two Birds with One Stone": Alcohol Use Reduction Interventions with Potential Efficacy in Enhancing Self-Control. CURRENT ADDICTION REPORTS 2014; 1:41-52. [PMID: 24914414 DOI: 10.1007/s40429-013-0008-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We review interventions with empirical support for reducing alcohol use and enhancing self-control. While any intervention that decreases drinking could improve self-control, we focus here on interventions with evidence of direct benefit for both indications. Although no intervention yet shows strong evidence for dual efficacy, multiple interventions have strong evidence for one indication and solid or suggestive evidence for the other. Among pharmacotherapies, opioid antagonists currently have the best evidence for reducing alcohol use and enhancing self-control. Nicotinic partial agonist varenicline also appears to be efficacious for alcohol use and self-control. Many psychosocial and behavioral interventions (e.g., cognitive behavioral therapy, contingency management, mindfulness training) may have efficacy for both indications based on purported mechanisms of action and empirical evidence. Cognitive bias modification and neurophysiological interventions have promise for alcohol use and self-control as well and warrant further research. We offer several other suggestions for future research directions.
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