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Schenkel EJ, Schöneck R, Becker ES, Wiers RW, Lindenmeyer J, Rinck M. Long-term effects of alcohol-avoidance training: Do changes in approach bias predict who will remain abstinent? ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1979-1990. [PMID: 39191659 DOI: 10.1111/acer.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/09/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) tend to selectively approach alcohol cues in the environment, demonstrating an alcohol-approach bias. Alcohol-approach-bias modification (Alcohol-ApBM) effectively increases abstinence rates in patients with AUD when added to abstinence-focused treatment, but the evidence for its proposed working mechanism (reduction of the alcohol-approach bias) is limited. Moreover, not all patients benefit from Alcohol-ApBM, and previous research did not identify reliable pretreatment predictors of Alcohol-ApBM effectiveness. Therefore, the current study focused on learning processes during the Alcohol-ApBM training itself. Specifically, we examined whether changes in approach-avoidance tendencies over the course of Alcohol-ApBM would predict abstinence after inpatient treatment. METHODS The training data of 543 AUD patients in Germany (70% male, M = 47.96, SD = 9.08), receiving Alcohol-ApBM training during inpatient treatment, were used to examine whether various aspects of learning during training predicted abstinence 1 year after treatment discharge, both separately and in interaction with potential sociodemographic and clinical moderators of Alcohol-ApBM effectiveness. RESULTS Overall, successful learning across six Alcohol-ApBM training sessions was observed; that is, the approach tendency toward alcoholic stimuli was reduced over time. However, none of the examined learning parameters were predictive of abstinence, neither separately nor in combination with clinical or sociodemographic variables. CONCLUSIONS Previous studies have shown that Alcohol-ApBM is an effective add-on to abstinence-focused treatment for AUD, and this study showed that learning took place during Alcohol-ApBM training. However, specific learning parameters during training did not predict abstinence 1 year after treatment discharge. Therefore, we cannot specify which patients are most likely to benefit from ApBM with regard to abstinence after 1 year.
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Affiliation(s)
- Edwin J Schenkel
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Salus Clinic Lindow, Lindow, Germany
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Lindenmeyer
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Salus Clinic Lindow, Lindow, Germany
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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2
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Schroeder PA, Collantoni E, Lohmann J, Butz MV, Plewnia C. Virtual reality assessment of a high-calorie food bias: Replication and food-specificity in healthy participants. Behav Brain Res 2024; 471:115096. [PMID: 38849007 DOI: 10.1016/j.bbr.2024.115096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Theoretical models and behavioural studies indicate faster approach behaviour for high-calorie food (approach bias) among healthy participants. A previous study with Virtual Reality (VR) and online motion-capture quantified this approach bias towards food and non-food cues in a controlled VR environment with hand movements. The aim of this study was to test the specificity of a manual approach bias for high-calorie food in grasp movements compared to low-calorie food and neutral objects of different complexity, namely, simple balls and geometrically more complex office tools. METHODS In a VR setting, healthy participants (N = 27) repeatedly grasped or pushed high-calorie food, low-calorie food, balls and office tools in randomized order with 30 item repetitions. All objects were rated for valence and arousal. RESULTS High-calorie food was less attractive and more arousing in subjective ratings than low-calorie food and neutral objects. Movement onset was faster for high-calorie food in push-trials, but overall push responses were comparable. In contrast, responses to high-calorie food relative to low-calorie food and to control objects were faster in grasp trials for later stages of interaction (grasp and collect). Non-parametric tests confirmed an approach bias for high-calorie food. CONCLUSION A behavioural bias for food was specific to high-calorie food objects. The results confirm the presence of bottom-up advantages in motor-cognitive behaviour for high-calorie food in a non-clinical population. More systematic variations of object fidelity and in clinical populations are outstanding. The utility of VR in assessing approach behaviour is confirmed in this study by exploring manual interactions in a controlled environment.
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Affiliation(s)
- Philipp A Schroeder
- Department of Psychology, University of Tübingen, Schleichstr. 4, Tübingen 72076, Germany; German Center for Mental Health (DZPG), Germany.
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Italy; Padova Neuroscience Center, University of Padova, Italy
| | - Johannes Lohmann
- Cognitive Modeling, Department of Computer Science, University of Tübingen, Sand 14, Tübingen 72076, Germany
| | - Martin V Butz
- Department of Psychology, University of Tübingen, Schleichstr. 4, Tübingen 72076, Germany; Cognitive Modeling, Department of Computer Science, University of Tübingen, Sand 14, Tübingen 72076, Germany
| | - Christian Plewnia
- German Center for Mental Health (DZPG), Germany; Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Calwerstr. 14, Tübingen 72076, Germany
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3
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Watson P, Prior K, Ridley N, Monds L, Manning V, Wiers RW, Le Pelley ME. Sign-tracking to non-drug reward is related to severity of alcohol-use problems in a sample of individuals seeking treatment. Addict Behav 2024; 154:108010. [PMID: 38479081 DOI: 10.1016/j.addbeh.2024.108010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND A prominent neuroscientific theory of drug addiction is the incentive sensitization model. Individual differences in the tendency to ascribe motivational salience to cues that predict reward, and involuntary "sign-tracking" (orientation towards) such cues have been identified as potentially important in understanding vulnerability to addiction and relapse. However, to date this behaviour has not been assessed in a treatment-seeking clinical population, who typically represent those most susceptible to alcohol-related harms and episodes of relapse. This highlights a significant gap in the literature pertaining to incentive sensitization and drug dependence. METHODS Individuals accessing inpatient drug and alcohol services with alcohol as primary drug of concern were recruited to participate in a Cognitive Bias Modification (CBM) intervention. At the baseline assessment, participants completed various self-report measures (including the Alcohol Use Disorders Identification Test; AUDIT) in addition to a visual search task measuring sign-tracking to cues signalling monetary reward. At 3-month follow up, abstinence from alcohol was the primary outcome measure. All analyses and hypotheses were pre-registered. RESULTS At baseline (57 participants), AUDIT scores correlated with sign-tracking to signals of monetary reward. In a subsequent regression analysis sign-tracking, gender and self-reported alcohol craving predicted abstinence at 3-month follow up (41 participants). CONCLUSIONS Our work demonstrates that involuntary sign-tracking to cues signalling non-drug reward is associated with problematic alcohol use and return to use at 3-month follow up, in a treatment-seeking sample. Whether this automatic prioritisation of cues signalling reward is a consequence or vulnerability for problematic alcohol use remains to be investigated.
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Affiliation(s)
- Poppy Watson
- University of Technology Sydney, Australia; UNSW Sydney, Australia.
| | - Katrina Prior
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicole Ridley
- South Eastern Sydney Local Health District Drug and Alcohol Services, Sydney, Australia
| | - Lauren Monds
- Specialty of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Reinout W Wiers
- Developmental Psychology, University of Amsterdam, Netherlands
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Maurage P, Boudehent C, Ferrié L, Cabé N, Pitel AL. Are we just talking in circles? Impact of psychoeducation on disease knowledge and relapse in severe alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1383-1394. [PMID: 38811340 DOI: 10.1111/acer.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Psychoeducation constitutes a routine therapeutic practice in most treatment settings for severe alcohol use disorder (sAUD). This technique is considered an efficient way to help patients to learn more about their disease and achieve therapeutic objectives. However, this approach capitalizes on three untested assumptions: namely, that (1) patients with sAUD possess insufficient knowledge about sAUD at treatment entry; (2) patients with sAUD have the cognitive resources to learn new information and benefit from psychoeducation; and (3) psychoeducation positively impacts clinical outcomes. METHODS We tested these assumptions in two experimental studies. In the first experiment in 66 recently detoxified patients with sAUD and 102 matched healthy controls, we measured baseline knowledge on sAUD through self-reported questionnaires, determined whether an up-to-date psychoeducation program can improve this knowledge, explored the role of cognitive abilities in such learning, and established the impact of psychoeducation on relapse rates. In a second experiment in 23 patients and 17 healthy controls, we examined whether the increased knowledge following psychoeducation is alcohol specific, and whether the motivation to change influences the relation between psychoeducation and clinical outcomes. RESULTS At treatment entry, patients with sAUD presented with more sAUD-related knowledge than healthy controls, and were able to increase this knowledge following psychoeducation, independently of their cognitive status. However, psychoeducation did not impact either the motivation to change or relapse rates. CONCLUSIONS Psychoeducation can increase patients' knowledge about sAUD, but it does not increase the likelihood of abstinence or controlled low consumption after discharge. Thus, clinicians should question whether psychoeducation should occupy a central position in the therapeutic programs and reconsider what can be expected from psychoeducation in terms of achieving therapeutic objectives.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Céline Boudehent
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
| | - Louise Ferrié
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Cabé
- Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
| | - Anne-Lise Pitel
- UNICAEN, INSERM, U1237, PhIND « Physiopathology and Imaging of Neurological Disorders », Neuropresage Team, Cyceron, Normandie Univ, Caen, France
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Snippe L, Boffo M, Galvin H, Willemen R, Pronk T, Dom G, Wiers RW. How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers. J Gambl Stud 2024; 40:521-554. [PMID: 38006537 DOI: 10.1007/s10899-023-10263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/27/2023]
Abstract
Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.
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Affiliation(s)
- Leroy Snippe
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium.
| | - Marilisa Boffo
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Harriet Galvin
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Thomas Pronk
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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Peerenboom N, Guzman NV, Kvamme T, Ritou V, Casero V, Voon V. Developing digital interventions for a post-Covid world: A smartphone-based approach-avoidance training to reduce alcohol craving. Scand J Psychol 2024; 65:264-274. [PMID: 37853915 DOI: 10.1111/sjop.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
Harmful alcohol use is a major public health issue. In-person treatment has been hindered by the restrictions necessary during the Covid-19 pandemic. This study examined the effects of an at-home smartphone-based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20-30-min smartphone-based approach-avoidance training (AAT) on image-induced craving at a 1-day follow-up. Sixty-two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1-week follow-up were compared to an active control group. Experiment 1 showed a significant reduction in image-induced craving for the training group at 1-day follow-up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1-week follow-up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone-based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1-week follow-up.
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Affiliation(s)
- Nele Peerenboom
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Natalie V Guzman
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timo Kvamme
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cognitive Neuroscience Research Unit, Aarhus University, Aarhus, Denmark
| | - Valentin Ritou
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Violeta Casero
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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7
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Bolt GL, Piercy H, Bradshaw J, Manning V. Smartphone-delivered approach bias modification for reducing harmful drinking amongst middle-older age adults: Secondary analyses of a single-arm pilot study. Drug Alcohol Rev 2024. [PMID: 38444082 DOI: 10.1111/dar.13827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Novel, scalable, low-cost interventions are needed to reduce harmful drinking amongst middle-older adults. Approach bias modification (ApBM) is a promising form of cognitive training for preventing/reducing alcohol use that can be delivered via smartphone. This study explored the acceptability and preliminary effectiveness of smartphone delivered and personalised ApBM amongst Australians ≥55 years, an age cohort at risk of alcohol-related harms. METHODS Secondary analyses in a middle-older adult subsample (≥55 years, n = 289) of an open-label pilot study using a retrospective, repeated measures design. We explored acceptability (adherence, user mobile acceptability ratings, free-text responses) and preliminary effectiveness (changes in drinking quantity and frequency, craving, dependence and proportion drinking within government-recommended guidelines) of two sessions/week over 4 weeks of evidence-based ApBM training, adapted to include personalisation and smartphone delivery amongst Australians ≥55 years. RESULTS Although minor adaptations to training were suggested, the intervention was acceptable amongst survey completers, with 72% training adherence. Relative to baseline, there was a significant increase in the proportion of drinking within recommended single-session and weekly guidelines post-training (from 25% to 41% and 6% to 28%, respectively, p < 0.001), with past-week standard drinks significantly decreasing by 18% (p < 0.001) and significant reductions in drinking days, mean craving and dependence scores (p < 0.001). DISCUSSION AND CONCLUSIONS Findings suggest smartphone ApBM is acceptable amongst middle-to-older aged Australians and may support this 'at risk' cohort to remain within government-recommended alcohol consumption guidelines to optimise healthy aging, although, in the context of a single-arm study, preliminary results should be interpreted cautiously.
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Affiliation(s)
- Georgia L Bolt
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Neuropsychology Service, Turning Point, Eastern Health, Melbourne, Australia
- Neuropsychology Department, Austin Health, Melbourne, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Neuropsychology Service, Turning Point, Eastern Health, Melbourne, Australia
| | - Jennifer Bradshaw
- Neuropsychology Department, Austin Health, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Neuropsychology Service, Turning Point, Eastern Health, Melbourne, Australia
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van der Baan HS, Collot D'Escury-Koenigs DAL, Wiers DRW. The effectiveness of cognitive bias modification in reducing substance use in detained juveniles: An RCT. J Behav Ther Exp Psychiatry 2024; 82:101916. [PMID: 37837770 DOI: 10.1016/j.jbtep.2023.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Young offenders show high levels of substance use. Treatment programs within detention settings are less effective. Cognitive bias modification (CBM) is a promising supplement to substance use treatment. This study tests the effectiveness of CBM in young offenders to reduce cannabis and alcohol use, and delinquent recidivism. METHOD A randomized controlled trial added CBM to treatment as usual (TAU), among 181 youth in juvenile detention centers. In a factorial design, participants were randomly assigned to either active- or sham-training for two varieties of CBM, targeting attentional-bias (AtB) and approach-bias (ApB) for their most used substance. Substance use was measured with the Alcohol and Cannabis Use Disorder Identification Tests. Delinquent recidivism was measured with the International Self-Report Delinquency (ISRD) survey. RESULTS At pretest, participants showed AtB but no ApB for both substances. For alcohol, a decrease was found in AtB in the active-training group. For cannabis, a decrease was found in AtB for both active- and sham-training groups. Regardless of condition, no effects were found on substance use or ISRD scores at follow-up. LIMITATIONS The sample is judicial, not clinical, as is the setting. TAU and participant goals are not necessarily substance related. CONCLUSIONS Young offenders show a significant attentional-bias towards substance cues. CBM changed attentional-biases but not substance use. Combining CBM with a motivational intervention is advised. Follow-up research should better integrate CBM with running treatment programs. New developments regarding CBM task design could be used that link training better to treatment.
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Affiliation(s)
- Hans S van der Baan
- Department of Psychology, University of Amsterdam, PB 15916, 1001 NK, Amsterdam, the Netherlands; Department of Pedagogical Sciences, Utrecht University, PB 15916, 1001 NK, Amsterdam, the Netherlands.
| | | | - Dr Reinout W Wiers
- Developmental Psychopathology at the Department of Psychology, Universiteit van Amsterdam, Co-Chair Urban Mental Health, Uva.nl/Urban-Mental-Health, PB 15916, 1001 NK, Amsterdam, the Netherlands.
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Treiber MC, Grünberger J, Vyssoki B, Szeles JC, Kaniusas E, Kampusch S, Stöhr H, Walter H, Lesch OM, König D, Kraus C. Pupillary response to percutaneous auricular vagus nerve stimulation in alcohol withdrawal syndrome: A pilot trial. Alcohol 2024; 114:61-68. [PMID: 37661002 DOI: 10.1016/j.alcohol.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Autonomic symptoms in alcohol withdrawal syndrome (AWS) are associated with a sympathetic-driven imbalance of the autonomic nervous system. To restore autonomic balance in AWS, novel neuromodulatory approaches could be beneficial. We conducted a pilot trial with percutaneous auricular vagus nerve stimulation (pVNS) in AWS and hypothesized that pVNS will enhance the parasympathetic tone represented by a reduction of pupillary dilation in a parasympatholytic pharmacological challenge. METHODS Thirty patients suffering from alcohol use disorder, undergoing AWS, and stable on medication, were recruited in this open-label, single-arm pilot trial with repeated-measure design. Peripheral VNS (monophasic volt impulses of 1 msec, alternating polarity, frequency 1 Hz, amplitude 4 mV) was administered at the left cymba conchae for 72 h, followed by pupillometry under a tropicamide challenge. We assessed craving with a visual analog scale. We used pupillary mean as the dependent variable in a repeated-measures ANOVA (rmANOVA). RESULTS A repeated-measures ANOVA resulted in a significant difference for pupillary diameter across time and condition (F(2,116) = 27.97, p < .001, ηp2 > .14). Tukey-adjusted post hoc analysis revealed a significant reduction of pupillary diameter after pVNS. Alcohol craving was significantly reduced after pVNS (p < .05, Cohen's d = 1.27). CONCLUSION Our study suggests that pVNS activates the parasympathetic nervous system in patients with acute AWS, and that this activation is measurable by pupillometry. To this end, pVNS could be beneficial as a supportive therapy for AWS. Potential confounding effects of anti-craving treatment should be kept in mind.
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Affiliation(s)
- M C Treiber
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria.
| | - J Grünberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
| | - B Vyssoki
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
| | - J C Szeles
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Austria
| | - E Kaniusas
- Institute of Biomedical Electronics, Vienna University of Technology, Austria
| | | | - H Stöhr
- Faculty of Computer Science, University of Vienna, Austria
| | - H Walter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
| | - O M Lesch
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
| | - D König
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
| | - C Kraus
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Austria
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Lopez-Veneros D, Cumella R, Kronish IM, Lazarov A, Birk JL. Home-based cognitive bias modification training for reducing maladaptive fear in patients with suspected acute coronary syndrome: a pilot randomized clinical trial. Pilot Feasibility Stud 2024; 10:7. [PMID: 38212853 PMCID: PMC10782680 DOI: 10.1186/s40814-024-01442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Patients evaluated in an emergency department for suspected acute coronary syndromes (ACS; e.g., myocardial infarction) often experience a lingering fear of recurrence, which may adversely affect their mental health and adherence to recommended health behaviors. Cognitive bias modification training (CBMT) is an acceptable, easy-to-use intervention that reduces fear of recurrence in cancer patients, and reduces fear and anxiety in other populations, providing an alternative to psychotherapy or counseling-based approaches. Feasibility testing is needed to assess whether a cardiac-related version of CBMT is acceptable to patients with elevated threat perceptions related to their suspected ACS. METHODS We developed a tablet-based CBMT intervention tailored to reduce cardiac-related fear of recurrence. In this double-blinded feasibility trial, patients with elevated threat perceptions related to a recent suspected ACS were randomized either to a 4-week, 8-session, tablet-delivered intervention (CBMT) group or to a sham attention control group. Feasibility outcomes included the proportion of eligible patients who enrolled, drop-out rate, intervention compliance rate, acceptability/pleasantness and usability ratings, and task engagement (i.e., accuracy, response time). RESULTS Of 49 eligible patients with suspected ACS and elevated threat perceptions recruited from NewYork-Presbyterian Hospital, over half (53.1%) enrolled after receiving a description of study procedures. Of the 26 randomized patients (mean age 59.15 years, 50% women), 2 patients (7.7%) dropped out. Additionally, 4 (15.4%) enrolled patients were not able to complete the tablet tasks, either due to difficulties with the technology or an inability to process the visually presented linguistic information at a sufficient speed. Still, among patients who returned the tablets (19 returned/20 received; 95%), most completed all assigned tablet tasks (intervention or control; 10/19; 52.6%), reporting that the tablets were easy to use and that the tasks were pleasant to complete. CONCLUSION Current findings suggest that cardiac-related CBMT is a promising and generally acceptable intervention for suspected ACS patients with cardiac-related threat perceptions which are akin to fear of recurrence. Nevertheless, challenges related to tablet usage indicate that the intervention user-experience should be further refined to optimize usability. TRIAL REGISTRATION Registered at ClinicalTrials.gov on 2/25/2019; NCT03853213. Registered with the Open Science Framework on 11/20/2017; https://osf.io/k7g8c/ .
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Affiliation(s)
- David Lopez-Veneros
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Robin Cumella
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jeffrey L Birk
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
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Weber A, Shevchenko Y, Gerhardt S, Hoffmann S, Kiefer F, Vollstädt-Klein S. Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial. JMIR Form Res 2023; 7:e42194. [PMID: 37934561 PMCID: PMC10664013 DOI: 10.2196/42194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/23/2023] [Accepted: 09/28/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. OBJECTIVE This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. METHODS In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. RESULTS We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. CONCLUSIONS The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. TRIAL REGISTRATION ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476.
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Affiliation(s)
- Antonia Weber
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yury Shevchenko
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Research Methods, Assessment, and iScience, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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12
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Böhmer J, Reinhardt P, Garbusow M, Marxen M, Smolka MN, Zimmermann US, Heinz A, Bzdok D, Friedel E, Kruschwitz JD, Walter H. Aberrant functional brain network organization is associated with relapse during 1-year follow-up in alcohol-dependent patients. Addict Biol 2023; 28:e13339. [PMID: 37855075 DOI: 10.1111/adb.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/12/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Alcohol dependence (AD) is a debilitating disease associated with high relapse rates even after long periods of abstinence. Thus, elucidating neurobiological substrates of relapse risk is fundamental for the development of novel targeted interventions that could promote long-lasting abstinence. In the present study, we analysed resting-state functional magnetic resonance imaging (rsfMRI) data from a sample of recently detoxified patients with AD (n = 93) who were followed up for 12 months after rsfMRI assessment. Specifically, we employed graph theoretic analyses to compare functional brain network topology and functional connectivity between future relapsers (REL, n = 59), future abstainers (ABS, n = 28) and age- and gender-matched controls (CON, n = 83). Our results suggest increased whole-brain network segregation, decreased global network integration and overall blunted connectivity strength in REL compared with CON. Conversely, we found evidence for a comparable network architecture in ABS relative to CON. At the nodal level, REL exhibited decreased integration and decoupling between multiple brain systems compared with CON, encompassing regions associated with higher-order executive functions, sensory and reward processing. Among patients with AD, increased coupling between nodes implicated in reward valuation and salience attribution constitutes a particular risk factor for future relapse. Importantly, aberrant network organization in REL was consistently associated with shorter abstinence duration during follow-up, portending to a putative neural signature of relapse risk in AD. Future research should further evaluate the potential diagnostic value of the identified changes in network topology and functional connectivity for relapse prediction at the individual subject level.
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Affiliation(s)
- Justin Böhmer
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Pablo Reinhardt
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Garbusow
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Marxen
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Ulrich S Zimmermann
- Department of Addiction Medicine and Psychotherapy, kbo-Isar-Amper-Klinikum München-Ost, Haar, Germany
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Canada
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Canada
- Mila - Quebec Artificial Intelligence Institute, Montreal, Canada
| | - Eva Friedel
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Johann D Kruschwitz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Collaborative Research Centre (SFB 940) "Volition and Cognitive Control", Technische Universität Dresden, Dresden, Germany
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13
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Prior K, Salemink E, Piggott M, Manning V, Wiers RW, Teachman BA, Teesson M, Baillie AJ, Mahoney A, McLellan L, Newton NC, Stapinski LA. Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study. JMIR Form Res 2023; 7:e46008. [PMID: 37878363 PMCID: PMC10632924 DOI: 10.2196/46008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. OBJECTIVE This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use ("Re-Train Your Brain") when delivered in conjunction with treatment as usual (TAU). METHODS The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the "integrated" Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the "alternating" Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. RESULTS Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. CONCLUSIONS Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non-labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/28667.
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Affiliation(s)
- Katrina Prior
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Elske Salemink
- Experimental Psychopathology Lab, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Monique Piggott
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Bethany A Teachman
- Department of Psychology, School of Arts and Sciences, University of Virginia, Charlottesville, VA, United States
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Public Hospital, Sydney, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Lauren McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nicola C Newton
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Lexine A Stapinski
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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14
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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15
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Laurens MC, Postel MG, Brusse-Keizer M, Pieterse ME, Ben Allouch S, Bohlmeijer ET, Salemink E. Augmenting outpatient alcohol treatment as usual with online approach bias modification training: A double-blind randomized controlled trial. Addict Behav 2023; 142:107630. [PMID: 36881944 DOI: 10.1016/j.addbeh.2023.107630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training. 139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training. No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.
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Affiliation(s)
- Melissa C Laurens
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands; Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands.
| | - Marloes G Postel
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands; Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Somaya Ben Allouch
- Informatics Institute, University of Amsterdam, Netherlands; Research Group Digital Life, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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McNally GP, Jean-Richard-Dit-Bressel P, Millan EZ, Lawrence AJ. Pathways to the persistence of drug use despite its adverse consequences. Mol Psychiatry 2023; 28:2228-2237. [PMID: 36997610 PMCID: PMC10611585 DOI: 10.1038/s41380-023-02040-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023]
Abstract
The persistence of drug taking despite its adverse consequences plays a central role in the presentation, diagnosis, and impacts of addiction. Eventual recognition and appraisal of these adverse consequences is central to decisions to reduce or cease use. However, the most appropriate ways of conceptualizing persistence in the face of adverse consequences remain unclear. Here we review evidence that there are at least three pathways to persistent use despite the negative consequences of that use. A cognitive pathway for recognition of adverse consequences, a motivational pathway for valuation of these consequences, and a behavioral pathway for responding to these adverse consequences. These pathways are dynamic, not linear, with multiple possible trajectories between them, and each is sufficient to produce persistence. We describe these pathways, their characteristics, brain cellular and circuit substrates, and we highlight their relevance to different pathways to self- and treatment-guided behavior change.
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Affiliation(s)
- Gavan P McNally
- School of Psychology, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - E Zayra Millan
- School of Psychology, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3010, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, 3010, Australia
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Wiers RW, Pan T, van Dessel P, Rinck M, Lindenmeyer J. Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients. Curr Top Behav Neurosci 2023. [PMID: 37221351 DOI: 10.1007/7854_2023_421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.
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Affiliation(s)
- Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Ting Pan
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Ruhr University Bochum, Bochum, Germany
| | - Johannes Lindenmeyer
- Salus Klinik, Lindow, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Germany
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Barillot L, Chauvet C, Besnier M, Jaafari N, Solinas M, Chatard A. Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial. BMJ Open 2023; 13:e069249. [PMID: 37173113 PMCID: PMC10186436 DOI: 10.1136/bmjopen-2022-069249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR). METHODS AND ANALYSIS A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks. ETHICS AND DISSEMINATION All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.
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Affiliation(s)
- Lila Barillot
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Claudia Chauvet
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Marc Besnier
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Nematollah Jaafari
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
| | - Marcello Solinas
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
- Université de Poitiers, Laboratoire de Neurosciences Expérimentales et Cliniques U1084, Poitiers, France
| | - Armand Chatard
- Université de Poitiers, Centre de Recherches sur la Cognition et l'Apprentissage, Poitiers, Nouvelle-Aquitaine, France
- Unité de Recherche Clinique Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, Poitou-Charentes, France
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Verdejo-Garcia A, Rezapour T, Giddens E, Khojasteh Zonoozi A, Rafei P, Berry J, Caracuel A, Copersino ML, Field M, Garland EL, Lorenzetti V, Malloy-Diniz L, Manning V, Marceau EM, Pennington DL, Strickland JC, Wiers R, Fairhead R, Anderson A, Bell M, Boendermaker WJ, Brooks S, Bruno R, Campanella S, Cousijn J, Cox WM, Dean AC, Ersche KD, Franken I, Froeliger B, Gamito P, Gladwin TE, Goncalves PD, Houben K, Jacobus J, Jones A, Kaag AM, Lindenmeyer J, McGrath E, Nardo T, Oliveira J, Pennington CR, Perrykkad K, Piercy H, Rupp CI, Schulte MHJ, Squeglia LM, Staiger P, Stein DJ, Stein J, Stein M, Stoops WW, Sweeney M, Witkiewitz K, Woods SP, Yi R, Zhao M, Ekhtiari H. Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study. Addiction 2023; 118:935-951. [PMID: 36508168 PMCID: PMC10073279 DOI: 10.1111/add.16109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
AIMS Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
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Affiliation(s)
- Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Emily Giddens
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Rafei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamie Berry
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain
| | | | - Matt Field
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Leandro Malloy-Diniz
- Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Victoria Manning
- Turning Point Drug and Alcohol Centre and Monash Addiction Research Centre (MARC), Monash University, Melbourne, VIC, Australia
| | - Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - David L Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reinout Wiers
- Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Rahia Fairhead
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Alexandra Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Morris Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Samantha Brooks
- Research Centre for Brain and Behaviour, School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Raimondo Bruno
- School of Psychology, University of Tasmania, TAS, Hobart, Australia
| | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles, Bruxelles, Belgium
| | - Janna Cousijn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - W Miles Cox
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Andrew C Dean
- Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA, USA
| | - Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ingmar Franken
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands
| | - Brett Froeliger
- Department of Psychiatry and Psychological Sciences, University of Missouri, Columbia, MO, USA
| | | | | | - Priscila D Goncalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Katrijn Houben
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Joanna Jacobus
- Department of Psychiatry, University of California San Diego, CA, USA
| | - Andrew Jones
- Department of Psychology, University of Liverpool, UK
| | - Anne M Kaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Elly McGrath
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Talia Nardo
- School of Psychological Sciences, Macquarie University, NSW, Australia
| | | | | | - Kelsey Perrykkad
- Cognition and Philosophy Laboratory, Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Claudia I Rupp
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinics of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Mieke H J Schulte
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Lindsay M Squeglia
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Petra Staiger
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jeff Stein
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginial Tech, VA, USA
| | - Maria Stein
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - William W Stoops
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Mary Sweeney
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, NM, USA
| | - Steven P Woods
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Richard Yi
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Min Zhao
- Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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20
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Stein M, Soravia LM, Tschuemperlin RM, Batschelet HM, Jaeger J, Roesner S, Keller A, Gomez Penedo JM, Wiers RW, Moggi F. Alcohol-specific inhibition training in patients with alcohol use disorder: a multi-centre, double-blind randomized clinical trial examining drinking outcome and working mechanisms. Addiction 2023; 118:646-657. [PMID: 36468408 DOI: 10.1111/add.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022]
Abstract
AIMS For the first time, to our knowledge, in a clinical sample with alcohol use disorder (AUD), this study compared the effects of two versions of alcohol-specific inhibition training (Alc-IT) on drinking outcomes and on experimental parameters assessing two possible working mechanisms: stimulus devaluation and inhibitory enhancement. DESIGN Multi-centre, double-blind, three-arm clinical RCT with 3-, 6- and 12-month follow-up comparing standard Alc-IT, improved Alc-IT and an active control condition. SETTING Three specialized AUD treatment centres in Switzerland. PARTICIPANTS A total of 242 detoxified, recently abstinent patients with severe AUD (18-60 years; 29.8% female). INTERVENTION AND COMPARATOR Both interventions [standard Alc-IT (n = 84) and improved Alc-IT (n = 79)] and the comparator [unspecific inhibition training (n = 79)] consisted of six sessions of a modified inhibitory task (Go/NoGo task) with alcohol-related and neutral stimuli. Both versions of Alc-IT required response inhibition in alcohol-related trials but differed in Go/NoGo ratios (standard: 50/50; improved: 75/25), with improved Alc-IT posing higher inhibitory demands. The control condition, an unspecific inhibition training, featured alcohol-related pictures in Go as well as NoGo trials. MEASUREMENTS The primary outcome, percentage of days abstinent, was assessed at 3-month follow-up with a time-line follow-back interview. FINDINGS The group receiving improved Alc-IT showed a significantly higher percentage of days abstinent at 3-month follow-up compared with the control group [γcontrol = 74.30; γimproved = 85.78; β = 11.48, 95% confidence interval (CI) = 2.57, 20.40, P = 0.012, adjusted r2 = 0.062], while for standard Alc-IT no effect significantly different from zero was detected (γstandard = 70.95; β = -3.35, 95% CI = -12.20, 5.50, P = 0.457, adjusted r2 = -0.04). CONCLUSIONS Alcohol-specific inhibition training with high inhibitory demands increased days abstinent at 3-month follow-up in patients with severe alcohol use disorder. Such an improved, inhibitory-demanding, alcohol-specific inhibition training outperformed the standard version of alcohol-specific inhibition training, suggesting an inhibitory working mechanism.
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Affiliation(s)
- Maria Stein
- University Hospital of Psychiatry and Psychotherapy, Translational Research Center, University of Bern, Bern, Switzerland.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Leila M Soravia
- University Hospital of Psychiatry and Psychotherapy, Translational Research Center, University of Bern, Bern, Switzerland.,Clinic Suedhang, Center for Treatment of Addictive Disorders, Kirchlindach, Switzerland
| | - Raphaela M Tschuemperlin
- University Hospital of Psychiatry and Psychotherapy, Translational Research Center, University of Bern, Bern, Switzerland.,Clinic Suedhang, Center for Treatment of Addictive Disorders, Kirchlindach, Switzerland
| | - Hallie M Batschelet
- University Hospital of Psychiatry and Psychotherapy, Translational Research Center, University of Bern, Bern, Switzerland
| | - Joshua Jaeger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland.,Clinic Suedhang, Center for Treatment of Addictive Disorders, Kirchlindach, Switzerland
| | - Susanne Roesner
- Forel Clinic, Addiction Treatment Center, Ellikon an der Thur, Switzerland
| | - Anne Keller
- Forel Clinic, Addiction Treatment Center, Ellikon an der Thur, Switzerland
| | | | - Reinout W Wiers
- Addiction, Development and Psychopathology (ADAPT-) Labotratory, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.,Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, Translational Research Center, University of Bern, Bern, Switzerland
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21
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Watson P, Onie S. Images of Australian alcoholic and non-alcoholic beverages: A validation dataset. Data Brief 2023; 47:108914. [PMID: 36747978 PMCID: PMC9898584 DOI: 10.1016/j.dib.2023.108914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
For multi-session alcohol cognitive bias modification, a large image dataset depicting both alcohol and non-alcoholic beverages is required. We photographed a wide range of beverages and then validated them in a group of Australian community participants: 47 women and 39 men, aged from 18 to 73, who drank alcohol at least occasionally in the last year, with Alcohol Use Disorder Identification Test (AUDIT) scores ranging from 1 to 33. Participants were asked to categorize images as alcoholic vs non-alcoholic, rate the familiarity of each beverage and rate their craving for each beverage. The dataset includes all images and ratings for each image, stratified by gender and high/low AUDIT scores. Mean ratings per participant per beverage category are also provided.
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Affiliation(s)
- Poppy Watson
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, New South Wales 2052, Australia
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22
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Fridland E, Wiers CE, Rinck M, Becker ES, Gladwin TE. An experimental test of integrating imagery with approach bias modification for alcohol: A cautionary tale. Br J Health Psychol 2022; 28:383-396. [PMID: 36336992 DOI: 10.1111/bjhp.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/25/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In terms of dual process models, behaviour can be conceived of as the outcome of an interplay between reflective, top-down and impulsive, bottom-up processes. Behaviour change interventions may benefit from targeting both types of processes in a coherent way. One approach to this, in the context of reducing hazardous drinking, is to combine imagery involving real-life situations involving alcohol with the simple actions involved in Approach Bias Modification (ApBM), a form of Cognitive Bias Modification. DESIGN We developed and tested a version of this Imagery-enhanced Approach Bias Modification (IApBM) in an experimental design, with two independent factors: imagery versus control and ApBM versus control training components (N = 139). METHODS An effect of integrating the training factors was hypothesized on the alcohol-approach bias of an alcohol Approach-Avoidance Task. Further exploratory analyses were performed for the bias on alcohol-related Single Attribute Implicit Association Tests and on alcohol-related questionnaires. Finally, the psychometric properties of an imagery interference effect during training were explored. RESULTS Results showed no benefit of the training and in fact suggested a negative interaction in which combining the training components appeared to block reductions in craving effected by each in isolation. The reliability of the imagery-related interference effect was high and the effect was correlated with alcohol-related scales. CONCLUSIONS In conclusion, it appears that interference between training components decreases their individual effects when combining imagery and ApBM in the current way. The imagery-related interference effects that could be measured during training conditions may be useful as an implicit measure of automatic processes underlying hazardous drinking.
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Affiliation(s)
| | - Corinde E. Wiers
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Mike Rinck
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
| | - Eni S. Becker
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
| | - Thomas E. Gladwin
- Behavioural Science Institute Radboud University Nijmegen Nijmegen The Netherlands
- Institute of Lifecourse Development University of Greenwich London UK
- Department of Psychology and Counselling University of Chichester Chichester UK
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23
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Manning V, Garfield JBB, Reynolds J, Staiger PK, Piercy H, Bonomo Y, Lloyd‐Jones M, Jacka D, Wiers RW, Verdejo‐Garcia A, Lubman DI. Alcohol use in the year following approach bias modification during inpatient withdrawal: secondary outcomes from a double-blind, multi-site randomized controlled trial. Addiction 2022; 117:2837-2846. [PMID: 35792053 PMCID: PMC9796776 DOI: 10.1111/add.15989] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Approach bias modification (ApBM) targeting alcohol approach bias has been previously shown to reduce likelihood of relapse during the first 2 weeks following inpatient withdrawal treatment (IWT). We tested whether ApBM's effects endure for a longer period by analysing alcohol use outcomes 3, 6 and 12 months post-discharge. DESIGN A double-blind, sham-controlled randomized controlled trial. SETTING Four IWT units in Melbourne, Australia. PARTICIPANTS Three hundred alcohol IWT patients (173 men, 126 women, 1 non-binary; mean age 43.5 years) were recruited between 4 June 2017 and 14 July 2019. Follow-up data collection was completed on 22 September 2020. INTERVENTION AND CONTROL TRAINING Four ApBM sessions were delivered during IWT. ApBM trained participants (n = 147) to avoid alcohol and approach non-alcohol beverage cues. Controls (n = 153) responded to the same stimuli, but without approach/avoidance training. MEASUREMENTS Date of first lapse was recorded for non-abstinent participants to determine time to first lapse. Time-line follow-back interviews assessed past-month alcohol consumption at each follow-up, with participants reporting no alcohol consumption classified as abstinent. In analyses of past-month abstinence, non-abstinence was assumed in participants lost to follow-up. Number of past-month drinking days, standard drinks and heavy drinking days (five or more standard drinks for women or non-binary; six or more standard drinks for men) were calculated for non-abstinent participants at each follow-up. FINDINGS ApBM significantly delayed time to first lapse [ApBM median: 53 days, 95% confidence interval (CI) = 21-61; controls = 12 days, 95% CI = 9-21, P = 0.045]. Past-month abstinence rates at 3-, 6- and 12-month follow-ups were 33/153 (21.6%), 30/153 (19.6%), and 24/153 (15.7%) in controls; and 51/147 (34.7%), 30/147 (20.4%) and 29/147 (19.7%) in the ApBM group, respectively. Past-month abstinence was significantly more likely in ApBM participants than controls at the 3-month follow-up [odds ratio (OR) = 1.93, 95% CI = 1.16-3.23, P = 0.012], but not at 6- or 12-month follow-ups (6-month OR = 1.05, 95% CI = 0.60-1.95, P = 0.862; 12-month OR = 1.32, 95% CI = 0.73-2.40, P = 0.360). No significant group differences were found for indices of alcohol consumption in non-abstinent participants. CONCLUSIONS Approach bias modification for alcohol delivered during inpatient withdrawal treatment helps to prevent relapse, increasing rates of abstinence from alcohol for at least 3 months post-discharge.
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - Joshua B. B. Garfield
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | - Petra K. Staiger
- School of PsychologyDeakin UniversityGeelongAustralia,Centre for Drug use, Addictive and Antisocial behaviour Research (CEDAAR)Deakin UniversityGeelongAustralia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
| | - Yvonne Bonomo
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneAustralia,Division of Medicine, Dentistry, and Health SciencesUniversity of MelbourneMelbourneAustralia
| | - Martyn Lloyd‐Jones
- Department of Addiction MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Jacka
- Monash Health Drug and Alcohol Service, Monash HealthMelbourneAustralia
| | - Reinout W. Wiers
- Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology and Center for Urban Mental HealthUniversity of AmsterdamAmsterdamthe Netherlands
| | - Antonio Verdejo‐Garcia
- Turning PointEastern HealthMelbourneAustralia,School of Psychological Sciences and Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia,Turning PointEastern HealthMelbourneAustralia
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Bolt G, Piercy H, Barnett A, Manning V. ‘A circuit breaker’ – Interrupting the alcohol autopilot: A qualitative exploration of participants’ experiences of a personalised mHealth approach bias modification intervention for alcohol use. Addict Behav Rep 2022; 16:100471. [DOI: 10.1016/j.abrep.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
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25
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Garfield JBB, Piccoli LR, Whelan D, Staiger PK, Reynolds J, Piercy H, Lubman DI, Verdejo-Garcia A, Manning V. The effect of approach bias modification during alcohol withdrawal treatment on craving, and its relationship to post-treatment alcohol use in a randomised controlled trial. Drug Alcohol Depend 2022; 239:109621. [PMID: 36087564 DOI: 10.1016/j.drugalcdep.2022.109621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approach bias modification (ApBM) for alcohol use disorder helps prevent relapse, yet the psychological mechanisms underlying its efficacy remain unclear. Alcohol craving predicts relapse and appears to be related to the biased processing of alcohol stimuli which is reduced by ApBM. However, there is little research examining whether ApBM reduces alcohol craving. METHODS In a randomised controlled trial testing the effect of 4 ApBM sessions (vs. sham training) on post-treatment alcohol use in 300 alcohol withdrawal inpatients, we administered the Alcohol Craving Questionnaire - Short Form - Revised (ACQ-SF-R) pre and post-training and at 2-week, 3, 6 and 12-month follow ups; and a cue-induced craving measure pre and post training. RESULTS Groups did not significantly differ in terms of declines in ACQ-SF-R total scores (p = .712) or cue-induced craving (p = .841) between the first and last training session, nor in terms of ACQ-SF-R scores at follow-ups (p = .509). However, the ACQ-SF-R Expectancy subscale, which assesses craving based on anticipated positive reinforcement from alcohol, was significantly lower in the ApBM group than in controls following training (p = .030), although the group x time interaction for this subscale was non-significant (p = .062). Post-intervention Expectancy scores mediated only a small portion of ApBM's effect on post-discharge alcohol use (14% in intention-to-treat analysis, p = .046; 15% in per-protocol analysis, p = .020). CONCLUSIONS ApBM does not appear to have robust, sustained effects on alcohol craving. Reduced craving is unlikely to account for ApBM's relapse prevention effects. However, further research on whether ApBM's effects are related to devaluation of alcohol reward expectancy is warranted. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
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Affiliation(s)
- Joshua B B Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Lara R Piccoli
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Danielle Whelan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Australia.
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Antonio Verdejo-Garcia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
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26
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Maddern XJ, Walker LC, Campbell EJ, Arunogiri S, Haber PS, Morley K, Manning V, Millan EZ, McNally GP, Lubman DI, Lawrence AJ. Can we enhance the clinical efficacy of cognitive and psychological approaches to treat substance use disorders through understanding their neurobiological mechanisms? Neurosci Biobehav Rev 2022; 142:104899. [PMID: 36183863 DOI: 10.1016/j.neubiorev.2022.104899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022]
Abstract
Despite decades of research in the field of addiction, relapse rates for substance use disorders remain high. Consequently, there has been growing focus on providing evidence-based treatments for substance use disorders, resulting in the increased development and use of cognitive and psychological interventions. Such treatment approaches, including contingency management, community-reinforcement approach, and cognitive bias modification, have shown promising clinical efficacy in reducing substance use and promoting abstinence during treatment. However, these interventions are still somewhat limited in achieving sustained periods of abstinence post-treatment. The neurobiological mechanisms underpinning these treatment approaches remain largely unknown and under-studied, in part, due to a lack of translational animal models. The adoption of a reverse translational approach may assist in development of more representative models that can facilitate elucidation of the mechanisms behind these clinically relevant interventions. This review examines our current understanding of addiction neurobiology from clinical, preclinical research and existing animal models, and considers how the efficacy of such behavioral-oriented interventions alone, or in combination with pharmacotherapy, may be enhanced to improve treatment outcomes.
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Affiliation(s)
- Xavier J Maddern
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia.
| | - Leigh C Walker
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia
| | - Erin J Campbell
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Brain Neuromodulation Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Paul S Haber
- Edith Collins Centre, Drug Health Services, Sydney Local Health District, Camperdown, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Kirsten Morley
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | | | | | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia.
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Seesink HJ, Schaap-Jonker H, Ostafin B, Lokman JC, Wiers RW. Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program. BMJ Open 2022; 12:e060820. [PMID: 36130749 PMCID: PMC9494557 DOI: 10.1136/bmjopen-2022-060820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM. METHODS AND ANALYSIS Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NL75499.018.20.
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Affiliation(s)
- Henk-Jan Seesink
- Department of Research, De Hoop ggz, Dordrecht, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
| | - Hanneke Schaap-Jonker
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
- Department of Religion and Theology, Faculteit der Geesteswetenschappen, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brian Ostafin
- Experimental and Clinical Psychology, Department of Psychology, Rijksuniversiteit Groningen Faculteit Gedrags en Maatschappijwetenschappen, Groningen, The Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC - University Medical Centers, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Solzbacher J, Czeszumski A, Walter S, König P. Evidence for the embodiment of the automatic approach bias. Front Psychol 2022; 13:797122. [PMID: 36160565 PMCID: PMC9505509 DOI: 10.3389/fpsyg.2022.797122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
Tendencies of approach and avoidance seem to be a universal characteristic of humans. Specifically, individuals are faster in avoiding than in approaching negative stimuli and they are faster in approaching than in avoiding positive stimuli. The existence of this automatic approach-avoidance bias has been demonstrated in many studies. Furthermore, this bias is thought to play a key role in psychiatric disorders like drug addiction and phobias. However, its mechanisms are far from clear. Theories of embodied cognition postulate that the nature of gestures plays a key role in this process. To shed light on the role of the involved gesture we employed a 2 × 2 factorial design with two types of stimuli. Participants had either to approach positive and avoid negative stimuli (congruent conditions) or to avoid positive stimuli and approach negative stimuli (incongruent conditions). Further, they responded either with a joystick or a button press on a response pad. Participants reacted faster in congruent conditions, i.e., avoiding negative stimuli and approaching positive stimuli, than in incongruent conditions. This replicates the known approach and avoidance bias. However, direct analysis of the button press condition revealed no reaction time advantage for congruent trials compared to incongruent trials. In contrast, in the joystick condition participants were significantly faster performing congruent reactions than incongruent reactions. This interaction, a significant reaction time advantage, when the response is enacted by moving a joystick towards or away from the body provides evidence that approach-avoidance tendencies have a crucial bodily component.
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Affiliation(s)
- Johannes Solzbacher
- Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
- *Correspondence: Johannes Solzbacher,
| | - Artur Czeszumski
- Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sven Walter
- Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
| | - Peter König
- Institute of Cognitive Science, Osnabrück University, Osnabrück, Germany
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Walter S, Stephan A. Situated Affectivity and Mind Shaping: Lessons from Social Psychology*. EMOTION REVIEW 2022. [DOI: 10.1177/17540739221112419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Proponents of situated affectivity hold that “tools for feeling” are just as characteristic of the human condition as are “tools for thinking” or tools for carpentry. An agent’s affective life, they argue, is dependent upon both physical characteristics of the agent and the agent’s reciprocal relationship to an appropriately structured natural, technological, or social environment. One important achievement has been the distinction between two fundamentally different ways in which affectivity might be intertwined with the environment: the “user-resource-model” and the “mind-invasion-model.” The twofold purpose of this paper is to complement the debate about situated affectivity in general and about “mind invasion” in particular by, firstly, connecting it to situationist research in social psychology and, secondly, broadening the perspective to not only accommodate decidedly detrimental “invasions” but also potentially beneficial forms of “mind shaping” that include the manipulation of an agent’s experiential life and behaviour through the moulding of both the agent’s environment and the agent’s body.
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Affiliation(s)
- Sven Walter
- Institute of Cognitive Science, Osnabrück University, Germany
| | - Achim Stephan
- Institute of Cognitive Science, Osnabrück University, Germany
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The current evidence for substance use disorder apps. Curr Opin Psychiatry 2022; 35:237-245. [PMID: 35674724 DOI: 10.1097/yco.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW New mHealth (smartphone) apps for substance use disorders (SUD) are emerging at an accelerated rate, with consumer choice typically guided by app-store user ratings rather than their effectiveness. The expansive reach, low-cost and accessibility of mHealth apps have driven their popularity and appeal as alternatives to traditional treatment; as such, rigorously establishing their effectiveness is of paramount importance. RECENT FINDINGS Several systematic reviews conclude that the evidence-base for mHealth SUD apps is weak, inconclusive and hampered by substantial heterogeneity in study designs. However, there have been a number of interesting and novel developments in this area in recent years, which have not been synthesised to date. SUMMARY Most mHealth apps deliver either multiple-component behaviour change techniques, discrete psychological interventions or cognitive training interventions, or are designed to act as adjuncts to facilitate the delivery of clinical or continuing care. There are promising signals of their feasibility, acceptability and preliminary effectiveness in numerous open-label pilot studies of mHealth apps targeting alcohol and smoking. However, only a handful of sufficiently-powered, well-designed randomised controlled trials have been conducted to date with mixed findings. Furthermore, there has been limited recent attention on mHealth apps aiming to improve outcomes for individuals using other drugs.
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Dousset C, Schroder E, Ingels A, Kajosch H, Hanak C, Veeser J, Amiot M, Kornreich C, Campanella S. Intact Error-Related Negativity at the Start of a Three-Week Detoxification Program Reflects a Short-Term Protective Factor Against Relapse in Alcoholic Patients: Some Preliminary Evidence from a Follow-up Event-Related Potentials Study. Clin EEG Neurosci 2022; 53:316-325. [PMID: 35125020 DOI: 10.1177/15500594221076579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Clémence Dousset
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Elisa Schroder
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Anaïs Ingels
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Hendrik Kajosch
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Catherine Hanak
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Johannes Veeser
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Maud Amiot
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Charles Kornreich
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
| | - Salvatore Campanella
- ULB Neuroscience Institute, CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Belgium
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Cofresí RU, Kohen CB, Motschman CA, Wiers RW, Piasecki TM, Bartholow BD. Behavioral response bias and event-related brain potentials implicate elevated incentive salience attribution to alcohol cues in emerging adults with lower sensitivity to alcohol. Addiction 2022; 117:892-904. [PMID: 34697852 PMCID: PMC8904297 DOI: 10.1111/add.15728] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
AIMS This study used a behavioral approach-avoidance task including images of alcoholic beverages to test whether low sensitivity to alcohol (LS) is a phenotypical marker of a dispositional propensity to attribute bottom-up incentive value to naturally conditioned alcohol cues. DESIGN, SETTING AND PARTICIPANTS Experimental study with a measured individual difference variable at a university psychology laboratory in Missouri, MO, USA. Participants were 178 emerging adults (aged 18-20 years) varying in self-reported sensitivity to alcohol's acute effects. MEASUREMENTS Participants completed the alcohol approach-avoidance task while behavior (response time; RT) and the electroencephalogram (EEG) were recorded. Stimulus-locked event-related potentials (ERPs) provided indices of integrated (top-down and bottom-up) stimulus incentive value (P3 amplitude) and conflict between top-down task demands and bottom-up response propensities (N450 amplitude). FINDINGS Linear mixed models showed faster RT for 'alcohol-approach' relative to 'alcohol-avoid' trials for lower-sensitivity (LS) [meanD ± standard errorD (MD ± SED ) = 29.51 ± 9.74 ms, t(328) = 3.03, P = 0.003] but not higher-sensitivity (HS) individuals (MD ± SED = 2.27 ± 9.33 ms, t(328) = 0.243, P = 0.808). There was enhanced N450 amplitude (response conflict) for alcohol-avoid relative to alcohol-approach trials for LS participants (MD ± SED = 0.811 ± 0.198 μV, Z = 4.108, P < 0.001) and enhanced N450 amplitude for alcohol-approach relative to alcohol-avoid for HS participants (MD ± SED = 0.419 ± 0.188 μV, Z = 2.235, P = 0.025). There was also enhanced P3 amplitude for alcohol-approach relative to alcohol-avoid for LS (MD ± SED = 0.825 ± 0.204 μV, Z = 4.045, P < 0.001) but not HS (MD ± SED = 0.013 ± 0.194 μV, Z = 0.068, P = 0.946). CONCLUSIONS Findings from a human laboratory study appear to support the notion that low sensitivity to alcohol indexes a propensity to attribute bottom-up incentive value to naturally conditioned alcohol cues.
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Affiliation(s)
- Roberto U. Cofresí
- Department of Psychological Sciences, University of Missouri,Corresponding author: Roberto Cofresí, University of Missouri, Department of Psychological Sciences, Columbia, MO, 65211. Phone: 469-323-0181
| | - Casey B. Kohen
- Department of Psychological Sciences, University of Missouri
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Wittekind CE, Takano K, Sckopke P, Winkler MH, Werner GG, Ehring T, Rüther T. Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial. Trials 2022; 23:223. [PMID: 35313949 PMCID: PMC8935694 DOI: 10.1186/s13063-022-06155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated. Methods The study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures. Discussion This is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome. Trial registration German Clinical Trials Register, DRKS00019221, 11/11/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06155-6.
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Day E, Daly C. Clinical management of the alcohol withdrawal syndrome. Addiction 2022; 117:804-814. [PMID: 34288186 DOI: 10.1111/add.15647] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Up to half of individuals with a history of long-term, heavy alcohol consumption will experience the alcohol withdrawal syndrome (AWS) when consumption is significantly decreased or stopped. In its most severe form, AWS can be life-threatening. Medically assisted withdrawal (MAW) often forms the first part of a treatment pathway. This clinical review discusses key elements of the clinical management of MAW, necessary adjustments for pregnancy and older adults, likely outcome of an episode of MAW, factors that might prevent completion of the MAW process and ways of overcoming barriers to ongoing treatment of alcohol use disorder. The review also discusses the use of benzodiazepines in MAW. Although there is clear evidence for their use, benzodiazepines have been associated with abuse liability, blunting of cognition, interactions with depressant drugs, craving, delirium, dementia and disrupted sleep patterns. Because glutamatergic activation and glutamate receptor upregulation contribute to alcohol withdrawal, anti-glutamatergic strategies for MAW and other potential treatment innovations are also considered.
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Affiliation(s)
- Ed Day
- Addiction Psychiatry, Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Chris Daly
- Addiction Psychiatry, Greater Manchester Mental Health FT, Chapman Barker Unit, Prestwich Hospital, Manchester, UK
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Mejía D, Avila-Chauvet L, Toledo-Fernández A. Decision-Making Under Risk and Uncertainty by Substance Abusers and Healthy Controls. Front Psychiatry 2022; 12:788280. [PMID: 35153858 PMCID: PMC8833085 DOI: 10.3389/fpsyt.2021.788280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment characterized by high impulsivity and risk-taking has been correlated with substance-related disorders. However, it is unclear if the decision-making process is well known upon consideration of factors such as uncertainty environments, risk, and time manipulation in different decision-making procedures. The main objective of this study was to identify behavioral differences between substance abusers and healthy control participants in a behavioral test battery, including (1) two uncertainty decision-making tasks, the Balloon Analog Risk Task (BART) and the Iowa Gambling Task (IGT, trial 1-40); (2) three risk-taking tasks, the Columbia Card Task Hot version (CCT-hot), Columbia Card Task Cold version (CCT-cold), and the IGT (trial 41-100); and (3) an impulsivity task, the Delay Discounting task (DD). The second objective looked at how the six behavioral tests correlate. We worked with a sample of 54 adult participants (Substance abusers: n = 28; Healthy controls: n = 26). An anonymous survey website was created to execute all the cognitive tasks. The results showed no statistically significant differences between the groups in any of the tasks. However, the results showed an upward trend of impulsive (i.e., steeply discounting curve) and risk-taking behaviors (i.e., a low learning curve in IGT) in substance abuse participants. The factor analysis results showed four different main factors: (1) risk-taking task in the IGT (trial 40-100), (2) uncertainty task in BART, (3) impulsivity in DD, IGT (trial 1-40), and (4) deliberate process in the Columbia card task (cold and hot). We conclude that factors such as the uncertainty tasks in the BART and the first block of IGT trials, the risk cues in the CCT tasks (i.e., number of loss, number of gains, and loss cards), and the time to delivery in the DD task, can affect the complex decision-making process in both clinical and healthy groups.
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Affiliation(s)
- Diana Mejía
- Psychology Department, Instituto Tecnológico de Sonora (ITSON), Ciudad Obregón, Mexico
| | - Laurent Avila-Chauvet
- Psychology Department, Instituto Tecnológico de Sonora (ITSON), Ciudad Obregón, Mexico
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Zhang L, Li N, Li Y, Zhang T, Li D, Liu Y, Liu X, Hao W. Preliminary efficacy of a digital therapeutics smartphone application for methamphetamine use disorder: An experimental study. Front Psychiatry 2022; 13:1027695. [PMID: 36339836 PMCID: PMC9627209 DOI: 10.3389/fpsyt.2022.1027695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Methamphetamine is the most widely used illicit drug in China. Treating methamphetamine use disorder (MUD) is challenging due to the lack of effective pharmacotherapies. This study is an experimental study to investigate the efficacy of smartphone-based digital therapeutics in treating MUD at the community level. One hundred participants were recruited and randomized into a digital therapeutics (DTx) group (n = 52) and a treatment as usual (TAU) group (n = 48). The DTx group used a smartphone application to deliver cognitive behavioral therapy, approach bias modification, cognitive training, and contingency management for 8 weeks. The TAU group received counseling from social workers and professional psychotherapists. Cue-induced craving, cognitive functions, PHQ9, and GAD7 were measured at baseline and post-intervention. Wilcoxon tests were performed with bootstrap and multiply imputation to estimate the treatment effect size. The DTx group showed a significant reduction in drug craving [Wilcoxon effect size = -0.267, 95% CI = (-0.435, -0.099), p = 0.002] and a significant improvement in cognitive function [Wilcoxon effect size = 0.220, 95% CI = (0.009, 0.432), p = 0.041]. The DTx group had overall 1, 8, and 24-week attritions of 8%, 11.5%, and 38.5%, respectively. The study shows that Digital therapeutics is feasible and potentially beneficial as a complement to community substance use treatment programs.
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Affiliation(s)
- Liqun Zhang
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Nan Li
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Yuanhui Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | | | - Dai Li
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Yanru Liu
- Adai Technology (Beijing) Co., Ltd., Beijing, China
| | - Xiang Liu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wei Hao
- National Clinical Research Center on Mental Disorders, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
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Manning V, Piercy H, Garfield JBB, Clark SG, Andrabi MN, Lubman DI. A Personalized Approach Bias Modification Smartphone App ("SWiPE") to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study. JMIR Mhealth Uhealth 2021; 9:e31353. [PMID: 34890355 PMCID: PMC8709909 DOI: 10.2196/31353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 10/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) RR2-10.2196/21278
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Joshua Benjamin Bernard Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | | | | | - Dan Ian Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
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Navas JF, Verdejo-García A, Vadillo MA. The evidential value of research on cognitive training to change food-related biases and unhealthy eating behavior: A systematic review and p-curve analysis. Obes Rev 2021; 22:e13338. [PMID: 34617392 DOI: 10.1111/obr.13338] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Cognitive bias modification (CBM), which retrains implicit biases towards unhealthy foods, has been proposed as a promising adjunct to improve the efficacy of weight loss interventions. We conducted a systematic review of research on three CBM approaches (i.e., cue-specific inhibitory control, approach bias modification, and attentional bias modification) for reducing unhealthy eating biases and behavior. We performed a p-curve analysis to determine the evidential value of this research; this method is optimally suited to clarify whether published results reflect true effects or false positives due to publication and reporting biases. When considering all CBM approaches, our results suggested that the findings of CBM trials targeting unhealthy eating are unlikely to be false positives. However, only research on attentional bias modification reached acceptable levels of power. These results suggest that CBM interventions may be an effective strategy to enhance the efficacy of weight loss interventions. However, there is room for improvement in the methodological standards of this area of research, especially increasing the statistical power can help to fully clarify the clinical potential of CBM, and determine the role of potential moderators.
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Affiliation(s)
- Juan F Navas
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Antonio Verdejo-García
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Miguel A Vadillo
- Department of Basic Psychology, Autonomous University of Madrid, Madrid, Spain
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Hughes LK, Hayden MJ, Bos J, Lawrence NS, Youssef GJ, Borland R, Staiger PK. A Randomised Controlled Trial of Inhibitory Control Training for Smoking Cessation: Outcomes, Mediators and Methodological Considerations. Front Psychol 2021; 12:759270. [PMID: 34803842 PMCID: PMC8595834 DOI: 10.3389/fpsyg.2021.759270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Inhibitory control training (ICT) has shown promise for improving health behaviours, however, less is known about its mediators of effectiveness. The current paper reports whether ICT reduces smoking-related outcomes such as craving and nicotine dependence, increases motivation to quit and whether reductions in smoking or craving are mediated by response inhibition or a devaluation of smoking stimuli. Method: Adult smokers (minimum 10 cigarettes per day; N = 107, Mage = 46.15 years, 57 female) were randomly allocated to receive 14 days of smoking-specific ICT (named INST; a go/no-go task where participants were trained to not respond to smoking stimuli) or active control training (participants inhibited responding toward neutral stimuli). Participants were followed up to 3-months post-intervention. This trial was preregistered (Australian and New Zealand Clinical Trials Registry ID: ACTRN12617000252314; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370204). Results: There were no significant differences between ICT and active control training groups. Specifically, participants in both groups showed significant reductions in craving, nicotine dependence, motivation and a devaluation (reduced evaluation) of smoking-stimuli up to 3-months follow-up compared to baseline. Inhibition and devaluation of smoking stimuli did not act as mediators. Devaluation of smoking stimuli was an independent predictor of smoking and craving at follow-up. Conclusion: Inhibitory control training (ICT) was no more effective at reducing smoking-related outcomes compared to the active control group, however, significant improvements in craving, dependence indicators and evaluation of smoking stimuli were observed across both groups. A return to basic experimental research may be required to understand the most effective ICT approach to support smoking cessation.
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Affiliation(s)
- Laura K Hughes
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Melissa J Hayden
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia
| | - Jason Bos
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - George J Youssef
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Anti-social Behaviour Research (CEDAAR), Deakin University, Geelong, VIC, Australia
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Transcranial direct current stimulation combined with alcohol cue inhibitory control training reduces the risk of early alcohol relapse: A randomized placebo-controlled clinical trial. Brain Stimul 2021; 14:1531-1543. [PMID: 34687964 DOI: 10.1016/j.brs.2021.10.386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD. OBJECTIVE To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence. METHODS A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year). RESULTS Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT. CONCLUSIONS AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Cheval B, Finckh A, Maltagliati S, Fessler L, Cullati S, Sander D, Friese M, Wiers RW, Boisgontier MP, Courvoisier DS, Luthy C. Cognitive-bias modification intervention to improve physical activity in patients following a rehabilitation programme: protocol for the randomised controlled IMPACT trial. BMJ Open 2021; 11:e053845. [PMID: 34548372 PMCID: PMC8458354 DOI: 10.1136/bmjopen-2021-053845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Being physically active is associated with a wide range of health benefits in patients. However, many patients do not engage in the recommended levels of physical activity (PA). To date, interventions promoting PA in patients mainly rely on providing knowledge about the benefits associated with PA to develop their motivation to be active. Yet, these interventions focusing on changing patients' conscious goals have proven to be rather ineffective in changing behaviours. Recent research on automatic factors (eg, automatic approach tendencies) may provide additional targets for interventions. However, the implementation and evaluation of intervention designed to change these automatic bases of PA are rare. Consequently, little is known about whether and how interventions that target automatically activated processes towards PA can be effective in changing PA behaviours. The Improving Physical Activity (IMPACT) trial proposes to fill this knowledge gap by investigating the effect of a cognitive-bias modification intervention aiming to modify the automatic approach towards exercise-related stimuli on PA among patients. METHODS AND ANALYSIS The IMPACT trial is a single-centre, placebo (sham controlled), triple-blinded, phase 3 randomised controlled trial that will recruit 308 patients enrolled in a rehabilitation programme in the Division of General Medical Rehabilitation at the University Hospital of Geneva (Switzerland) and intends to follow up them for up to 1 year after intervention. Immediately after starting a rehabilitation programme, patients will be randomised (1:1 ratio) to receive either the cognitive-bias modification intervention consisting of a 12-session training programme performed over 3 weeks or a control condition (placebo). The cognitive-bias modification intervention aims to improve PA levels through a change in automatic approach tendencies towards PA and sedentary behaviours. The primary outcome is the sum of accelerometer-based time spent in light-intensity, moderate-intensity and vigorous-intensity PA over 1 week after the cognitive-bias modification intervention (in minutes per week). Secondary outcomes are related to changes in (1) automatic approach tendencies and self-reported motivation to be active, (2) physical health and (3) mental health. Sedentary behaviours and self-reported PA will also be examined. The main time point of the analysis will be the week after the end of the intervention. These outcomes will also be assessed during the rehabilitation programme, as well as 1, 3, 6 and 12 months after the intervention for secondary analyses. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. This trial was approved by the Ethics Committee of Geneva Canton, Switzerland (reference number: CCER2019-02257). All participants will give an informed consent to participate in the study. Results will be published in relevant scientific journals and be disseminated in international conferences. TRIAL REGISTRATION DETAILS The clinical trial was registered at the German clinical trials register (reference number: DRKS00023617); Pre-results.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvio Maltagliati
- Laboratory SENS, Department of Sport Science, University Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Layan Fessler
- Laboratory SENS, Department of Sport Science, University Grenoble Alpes, Saint-Martin-d'Heres, France
| | - Stéphane Cullati
- Population Health Laboratory, Department of Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbrucken, Germany
| | - Reinout W Wiers
- Department of Psychology and center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Christophe Luthy
- Division of General Medical Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
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Computergestütztes Training (CBM) während der stationären Alkohol-Entzugsbehandlung. SUCHTTHERAPIE 2021. [DOI: 10.1055/a-1502-3480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Computergestützte Trainings,
„Cognitive-bias-modification“-Programme (CBM), zielen darauf ab,
Verzerrungen in der kognitiven Verarbeitung zu verändern und wurden
für unterschiedliche psychische Erkrankungen entwickelt. Bei einer
Alkoholabhängigkeit wird davon ausgegangen, dass bestimmte
alkoholbezogene Hinweisreize das Verlangen nach Alkohol steigern und somit die
Gefahr eines Rückfalls erhöhen. Bei CBM-Trainings werden die
Teilnehmenden angehalten, auf Bilder auf einem Computerbildschirm mittels
Joystick in einer bestimmten Art und Weise zu reagieren. Neutrale, nicht
alkoholassoziierte Stimuli sollen damit verstärkt werden.
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Dezza IC, Noel X, Cleeremans A, Yu AJ. Distinct motivations to seek out information in healthy individuals and problem gamblers. Transl Psychiatry 2021; 11:408. [PMID: 34312367 PMCID: PMC8313706 DOI: 10.1038/s41398-021-01523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
As massive amounts of information are becoming available to people, understanding the mechanisms underlying information-seeking is more pertinent today than ever. In this study, we investigate the underlying motivations to seek out information in healthy and addicted individuals. We developed a novel decision-making task and a novel computational model which allows dissociating the relative contribution of two motivating factors to seek out information: a desire for novelty and a general desire for knowledge. To investigate whether/how the motivations to seek out information vary between healthy and addicted individuals, in addition to healthy controls we included a sample of individuals with gambling disorder-a form of addiction without the confound of substance consumption and characterized by compulsive gambling. Our results indicate that healthy subjects and problem gamblers adopt distinct information-seeking "modes". Healthy information-seeking behavior was mostly motivated by a desire for novelty. Problem gamblers, on the contrary, displayed reduced novelty-seeking and an increased desire for accumulating knowledge compared to healthy controls. Our findings not only shed new light on the motivations driving healthy and addicted individuals to seek out information, but they also have important implications for the treatment and diagnosis of behavioral addiction.
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Affiliation(s)
- Irene Cogliati Dezza
- grid.4989.c0000 0001 2348 0746Centre for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Bruxelles, Belgium ,grid.83440.3b0000000121901201Department of Experimental Psychology, Faculty of Brain Sciences, University College London, London, UK ,grid.83440.3b0000000121901201The Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK ,grid.5342.00000 0001 2069 7798Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Xavier Noel
- grid.4989.c0000 0001 2348 0746Faculty of Medicine, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Axel Cleeremans
- grid.4989.c0000 0001 2348 0746Centre for Research in Cognition and Neurosciences, ULB Neuroscience Institute, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Angela J. Yu
- grid.266100.30000 0001 2107 4242Department of Cognitive Science, University of California San Diego, San Diego, USA
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Prior K, Salemink E, Wiers RW, Teachman BA, Piggott M, Newton NC, Teesson M, Baillie AJ, Manning V, McLellan LF, Mahoney A, Stapinski LA. A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial. JMIR Res Protoc 2021; 10:e28667. [PMID: 34255726 PMCID: PMC8295835 DOI: 10.2196/28667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. OBJECTIVE This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention-an adjunct web-based ApBM+IBM program-among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. METHODS The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. RESULTS This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. CONCLUSIONS This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28667.
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Affiliation(s)
- Katrina Prior
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Elske Salemink
- Experimental Psychopathology Lab, Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.,Center for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Bethany A Teachman
- Department of Psychology, School of Arts and Sciences, University of Virginia, Virginia, VA, United States
| | - Monique Piggott
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Public Hospital, Sydney, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Piercy H, Manning V, Staiger PK. Pushing or Pulling Your "Poison": Clinical Correlates of Alcohol Approach and Avoidance Bias Among Inpatients Undergoing Alcohol Withdrawal Treatment. Front Psychol 2021; 12:663087. [PMID: 34113294 PMCID: PMC8186551 DOI: 10.3389/fpsyg.2021.663087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification (ABM) trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on demographic and drinking measures, and to examine the clinical correlates of approach bias. Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM. Results: At trial entry (day 3 or 4 of inpatient withdrawal), 155 (57.8%) had an alcohol approach bias and 113 (42.2%) had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days (r = 0.277, p = 0.001) but no other indices of alcohol consumption or problem severity. Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures.
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Affiliation(s)
- Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, VIC, Australia
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Campanella S. Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach. World J Psychiatry 2021; 11:153-168. [PMID: 34046312 PMCID: PMC8134870 DOI: 10.5498/wjp.v11.i5.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/05/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Relapse prevention remains a major challenge in psychiatry, thus indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. In recent years, several intervention strategies have been devised that are aimed at improving psychiatric treatment by providing a complementary set of add-on tools that can be used by clinicians to improve current patient assessment. Among these, cognitive event-related potentials (ERPs) have been indexed as valuable biomarkers of the pathophysiological mechanisms of various mental illnesses. However, despite decades of research, their clinical utility is still controversial and a matter of debate. In this opinion review, I present the main arguments supporting the use of cognitive ERPs in the management of psychiatric disorders, stressing why it is currently still not the case despite the vast number of ERP studies to date. I also propose a clinically-oriented suitable way in which this technique could - in my opinion - be effectively incorporated into individual patient care by promotion of the use of individual ERP test-retest sessions and the use of a multi-component approach.
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Affiliation(s)
- Salvatore Campanella
- Laboratoire de Psychologie Médicale et d’Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels 1020, Belgium
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48
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Sweet AM, Pearlstein SL, Paulus MP, Stein MB, Taylor CT. Computer-delivered behavioural activation and approach-avoidance training in major depression: Proof of concept and initial outcomes. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:357-374. [PMID: 33772806 DOI: 10.1111/bjc.12287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Individuals with major depressive disorder (MDD) have problems with engaging in approach behaviour to potentially rewarding encounters, which contributes to the maintenance of depressive symptoms. Approach-avoidance training (AAT) retrains implicit approach tendencies, and behavioural activation (BA) promotes explicit approach behaviour in MDD. As a novel MDD treatment strategy, this study aimed to implement a brief, computerized version of BA integrated with implicit AAT. DESIGN Adults with a principal diagnosis of MDD (N = 25) were randomly assigned to complete one of two versions of AAT - approach-positive faces (n = 12) or balanced approach of positive and neutral faces (n = 13) - concurrently with self-guided BA twice weekly for 2 weeks. METHODS Outcomes included treatment completion rates; bias scores for automatic approach towards positive social cues; and symptom scales for depression, positive affect, social relationship functioning, anhedonia, and anxiety. RESULTS Feasibility and acceptability of computerized BA + AAT were supported by moderate pre-treatment credibility and expectancy ratings and 80% treatment completion. Participants across both conditions displayed significant and large sized reductions in depression from pre- to post-assessment (Cohen's d = -1.23) that maintained three months later, as well as decreased anxiety and anhedonia and increased positive affect and social relationship functioning (medium to large effects). CONCLUSION Results support the feasibility and potential efficacy of brief, computerized BA + AAT. Research is needed to determine whether AAT is additive to BA, and what AAT parameters best enhance treatment outcomes. PRACTITIONER POINTS Brief, computerized behavioral activation plus approach/avoidance training (BA + AAT) may be acceptable and beneficial for some patients with moderate-to-severe major depression. Computer-delivered BA + AAT can be implemented as a largely self-guided program for MDD and could be administered remotely and/or with minimal clinician interaction. As this was a small proof of concept study, it cannot be determined which treatment components - AAT, BA, or both - contributed to positive clinical outcomes. Because BA + AAT was implemented in a research clinic, it remains unknown what treatment engagement and response would look like in community settings.
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Affiliation(s)
- Alison M Sweet
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Sarah L Pearlstein
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Department of Psychology, San Diego State University, California, USA
| | | | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Charles T Taylor
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Garfield JBB, Piercy H, Arunogiri S, Lubman DI, Campbell SC, Sanfilippo PG, Gavin J, Hopwood M, Kotler E, George S, Okedara G, Piccoli LR, Manning V. Protocol for the methamphetamine approach-avoidance training (MAAT) trial, a randomised controlled trial of personalised approach bias modification for methamphetamine use disorder. Trials 2021; 22:21. [PMID: 33407781 PMCID: PMC7788914 DOI: 10.1186/s13063-020-04927-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/21/2020] [Indexed: 01/23/2023] Open
Abstract
Background Globally, methamphetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for methamphetamine use disorder (MUD). While residential rehabilitation is more effective for MUD than withdrawal treatment (i.e. “detoxification”) alone, relapse rates remain high, with approximately half of rehabilitation clients using methamphetamine within 3 months of rehabilitation. “Approach bias modification” (ABM) is a computerised cognitive training approach that aims to dampen automatically triggered impulses to approach drugs and drug-related stimuli. ABM has been demonstrated to reduce alcohol relapse rates, but no randomised controlled trials of ABM for MUD have yet been conducted. We aim to test whether a novel “personalised” form of ABM, delivered during rehabilitation, reduces post-treatment methamphetamine use, relative to a sham-training control condition. Secondary outcomes will include dependence symptoms, cravings, and approach bias. Methods We aim to recruit 100 participants attending residential rehabilitation for MUD at 3 sites in the Melbourne metropolitan area. Participants will complete baseline measures of methamphetamine use, craving, dependence severity, and approach bias before being randomised to receiving 6 sessions of ABM or “sham” training. In the active condition, ABM will be personalised for each participant, using those methamphetamine images that they rate as most relevant to their recent methods of methamphetamine use as “avoidance” images and using positive images representing their goals or healthy sources of pleasure as “approach” images. Approach bias and craving will be re-assessed following completion of training, and methamphetamine use, dependence, and craving will be assessed 4 weeks and 3 months following discharge from residential treatment. Discussion This study is the first randomised controlled trial of ABM for MUD and also the first ABM study to test using a personalised set of both approach and avoid images for ABM training. If effective, the low cost and easy implementation of ABM means it could be widely implemented as a standard part of MUD treatment. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true
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Affiliation(s)
- Joshua B B Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia. .,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
| | - Samuel C Campbell
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
| | - Paul G Sanfilippo
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
| | - Jeff Gavin
- Association of Participating Service Users (APSU), Self Help Addiction Resource Centre (SHARC), 140 Grange Road, Carnegie, Melbourne, Victoria, 3163, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Albert Road Clinic, Ramsay Health, 31-33 Albert Road, Melbourne, Victoria, 3004, Australia
| | - Eli Kotler
- Malvern Private Hospital, 5 Wilton Vale Crescent, Malvern East, Melbourne, Victoria, 3145, Australia.,Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Suzanne George
- Malvern Private Hospital, 5 Wilton Vale Crescent, Malvern East, Melbourne, Victoria, 3145, Australia
| | - Goke Okedara
- Albert Road Clinic, Ramsay Health, 31-33 Albert Road, Melbourne, Victoria, 3004, Australia
| | - Lara R Piccoli
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia
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