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Gehlenborg J, Göritz AS, Kempken J, Wirtz J, Schuurmans L, Moritz S, Kühn S. Randomized Controlled Trial on Imaginal Retraining for Problematic Alcohol Use: A Dismantling Study. Clin Psychol Psychother 2024; 31:e3010. [PMID: 38785407 DOI: 10.1002/cpp.3010] [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: 03/09/2023] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Imaginal retraining (IR) is an approach-avoidance procedure that has shown promising results in previous studies. The aim of the present study was to dismantle the efficacy of IR's components in a randomized controlled trial (RCT). We conducted a RCT with nine conditions comprising eight intervention groups and a waitlist control group (WLC). Alcohol craving (primary outcome), consumption, depressive symptoms, quality of life, subjective appraisal, and side effects were assessed online at baseline, post intervention (6 weeks), and follow-up (12 weeks). The sample consisted of 426 participants (age: M = 47.22, SD = 11.82, women: 50.5%). The intervention groups received instructions for four different components of IR (mood induction, mental avoidance of unhealthy stimuli, motor avoidance of unhealthy stimuli, approach to healthy stimuli) that were each conveyed with or without prior psychoeducation (PE). The intervention was delivered online. At total of 163 individuals (42.9%) used the intervention at least once. No group differences were found for any primary or secondary outcome after Šidák correction. Uncorrected statistics showed effects of significantly decreased alcohol consumption for the approach + PE group in the intention-to-treat and the merged motor avoidance group in the per-protocol analyses at post assessment compared with the WLC. Exploratory moderation analyses revealed that individuals with high visualization skills benefited most. The authors conclude that visualization training and motivational components may increase the efficacy and adherence of IR.
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Affiliation(s)
- Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja S Göritz
- Behavioral Health Technology, University of Augsburg, Augsburg, Germany
| | - Joana Kempken
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lea Schuurmans
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Gehlenborg J, Göritz AS, Moritz S, Kühn S. Long-term effects of imaginal retraining in overweight and obesity: A controlled study. J Behav Ther Exp Psychiatry 2023; 78:101794. [PMID: 36435539 DOI: 10.1016/j.jbtep.2022.101794] [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: 10/22/2021] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Imaginal retraining (IR) is a self-help technique that targets automatic approach tendencies toward appetitive stimuli. In a randomized controlled trial (RCT; N = 384), IR reduced craving for high-calorie foods after a six-week intervention period (small effect). The aim of the present study was to evaluate long-term effects of IR in this sample. METHODS One year after baseline, participants from the initial RCT were recontacted. A visual analogue scale measuring craving, the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), the Three-Factor Eating Questionnaire, the Beck Depression Inventory, quality of life, and subjective appraisal of the intervention were assessed online. Participants were classified as users or nonusers based on self-reported usage of IR over the previous year. RESULTS Linear-mixed models showed no significant interaction effects of time and group for any outcome (trend level effects were found for two subscales of the FCQ-T-r). Yet, higher usage of IR was associated with greater symptom reduction. Although overall subjective appraisal of the intervention was comparably good to the initial study, usage of IR and completion rate were unsatisfactory. LIMITATIONS Main limitations of the present study include the nonrandomized group allocation and the low completion rate. CONCLUSIONS This study did not find evidence for the long-term efficacy of IR in individuals with craving for high-calorie foods. Only upon high usage of IR, improvement was found. However, low completion rate and usage of the intervention may have resulted in a Type-II error. Future studies may consider low-intensity professional guidance to increase adherence and assess the long-term effects of IR in RCTs.
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Affiliation(s)
- Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Anja S Göritz
- Department of Occupational and Consumer Psychology, University of Freiburg, Freiburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Moritz S, Göritz AS, Kühn S, Gallinat J, Gehlenborg J. Imaginal retraining reduces craving for high-calorie food. Appetite 2023; 182:106431. [PMID: 36539158 DOI: 10.1016/j.appet.2022.106431] [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: 04/13/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
Imaginal retraining (IR) is a treatment derived from approach bias modification to reduce strong craving for high-calorie food. The push component (IRpush) seems to be the most effective element according to a recent dismantling trial. Conclusions derived from prior studies are limited, however, by small sample sizes and restriction of participants to women. The present study aimed to overcome these limitations and also tested a new variant of IR (3P; decoupling with the elements pull, pause, push), which has previously been found to be more effective than the standard protocol in individuals with problematic alcohol use. The study was conducted online. A total of 1,106 participants with strong craving for high-calorie food were randomized to different brief interventions of IR or a passive control group. Before and after the interventions, participants indicated their craving for high-calorie food and appraised food pictures. The main conditions of interest were IRpush and 3P. The other two experimental conditions did not contain a motor element and served as active control conditions. IRpush proved the most effective intervention and reduced craving by approximately 18%, which was significantly larger than in the passive control group. IRpush worked especially well for those with higher initial weight, higher cravings, and more dysfunctional eating behavior. The novel 3P technique significantly reduced craving across time and was especially effective for those with high BMI and craving. The study suggests that a simple self-help component of imaginal retraining, IRpush, can decrease craving for high-calorie food to a relevant extent. Future trials should elucidate whether different forms of substance-related and behavioral addictions require adapted IR or 3P protocols to increase effectiveness.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246, Hamburg, Germany.
| | - Anja S Göritz
- Behavioral Health Technology, University of Augsburg, Augsburg, Germany; Occupational and Consumer Psychology, Freiburg University, Engelbergerstraße 41, D-79085, Freiburg, Germany
| | - Simone Kühn
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246, Hamburg, Germany; Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Jürgen Gallinat
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246, Hamburg, Germany
| | - Josefine Gehlenborg
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246, Hamburg, Germany
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Wirtz J, Moritz S, Gehlenborg J, Ascone L, Kühn S. Is less more? Dismantling imaginal retraining and examining the effects of psychoeducation and embodied cognition on craving and alcohol consumption in problem drinkers. A randomized controlled trial. Addict Behav 2022; 135:107429. [DOI: 10.1016/j.addbeh.2022.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/25/2022] [Accepted: 07/12/2022] [Indexed: 11/01/2022]
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Gehlenborg J, Göritz AS, Moritz S, Lüdtke T, Kühn S. Imaginal Retraining Reduces Craving for Tobacco in 1-Year Controlled Follow-Up Study. Eur Addict Res 2021; 28:68-79. [PMID: 34569480 DOI: 10.1159/000518678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Imaginal retraining is a self-help technique that adapts the principles of approach bias modification to the imagination. Imaginal retraining has been shown to reduce craving and addictive behaviours in 3 randomized controlled trials (RCTs) on problematic alcohol consumption, overweight, and tobacco use. To date, there have been no studies evaluating the long-term efficacy of the intervention. The aim of the present study was to generate first hypotheses on the long-term efficacy of imaginal retraining in smokers in a controlled 1-year follow-up study. MATERIALS AND METHODS We recontacted the 345 participants who had taken part in an RCT on imaginal retraining for smokers 1 year later. The survey was carried out online and assessed craving for tobacco (primary outcome), smoking behaviour, well-being, and subjective appraisal. Individuals who applied the technique at least once during the previous year were categorized as the training group, whereas participants who never performed the training were categorized as the no-training group. Data were analysed using linear mixed models (LMMs). The study was preregistered as DRKS00021044. RESULTS The completion rate was 45.5%. Less than 40% used the intervention at least once in the previous 12 months. LMM analyses showed a significant reduction in craving for tobacco for the training compared to the no-training group after 1 year. No significant group differences emerged in smoking behaviour, depressive symptoms, or quality of life. Subjective appraisal of the intervention was favorable, similar to the initial study. CONCLUSION The present study provides preliminary support for the long-term efficacy of imaginal retraining on craving for tobacco but not on smoking behaviour, highlighting the importance of multimodal treatment concepts in smoking cessation that target a variety of maintaining factors. Future studies need to investigate the long-term efficacy of the intervention in prospective RCTs that test alternative ways of conveying the technique to improve adherence.
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Affiliation(s)
- Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja S Göritz
- Department of Occupational and Consumer Psychology, University of Freiburg, Freiburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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Wirtz J, Ascone L, Gehlenborg J, Moritz S, Kühn S. A dismantling study on imaginal retraining in overweight or obese women. Transl Psychiatry 2021; 11:481. [PMID: 34535631 PMCID: PMC8448732 DOI: 10.1038/s41398-021-01595-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/09/2022] Open
Abstract
Imaginal retraining is a variant of approach bias modification and transfers the method into one's own mind. As the technique contains multiple elements, this pilot study aimed to dismantle which of its components is most efficient in reducing craving for high-calorie food. A total of 113 women were randomly allocated to one out of six conditions containing a short intervention to mentally manipulate a picture displaying high-calorie foods. Four of the interventions involved different combinations of elements of the imaginal retraining technique, while the remaining two conditions comprised thought suppression or merely observing a picture. Participants rated their level of craving, as well as three pictures containing healthy and unhealthy foods regarding their pleasantness before and after the interventions took place. Within-group changes were assessed with paired t-tests (in case of non-normal data Wilcoxon paired t-tests) and between-group differences with one-way ANOVAs (non-parametric Kruskal-Wallis tests). A trend level reduction in craving was found in the imaginal retraining condition with and without a movement. A post hoc analysis of both conditions joint together showed a statistically significant reduction in craving. In addition, positive picture appraisal for unhealthy foods was significantly reduced in both imaginal retraining conditions (with and without movement) with medium to large effect sizes. This study demonstrated that imaginal retraining with an arm movement can reduce craving and picture appraisal for high-calorie foods significantly in a one-time application. It is a promising technique to reduce appraisal for unhealthy high-calorie foods. Future studies should repeat the experiment in situations of high craving and allow for a personalized selection of stimuli.
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Affiliation(s)
- Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Leonie Ascone
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Josefine Gehlenborg
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Steffen Moritz
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. .,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.
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Moritz S, Gehlenborg J, Wirtz J, Ascone L, Kühn S. A dismantling study on imaginal retraining in smokers. Transl Psychiatry 2021; 11:92. [PMID: 33531467 PMCID: PMC7854587 DOI: 10.1038/s41398-020-01191-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
Imaginal retraining is a noncomputerized variant of cognitive bias modification, an intervention aimed at reducing craving in substance use disorders and behavioral addictions. We conducted a dismantling study to elucidate which of its multiple components are effective and hence essential ingredients of the training and which are ineffective (and hence perhaps dispensable) in reducing craving. We randomized 187 smokers to one out of six conditions that instructed participants to perform a brief intervention. In four of these, participants were instructed to perform isolated components of the imaginal retraining protocol, and in the two other conditions participants either suppressed or simply observed (control condition) the image of a cigarette. Before and after the intervention, participants were asked to rate their level of craving and how pleasant they found three smoking-related images. We examined within-group changes by means of paired t-tests separately across conditions (trial registration: DRKS00021044). Mental distancing from cigarettes (without a corresponding actual physical movement; non-motor retraining) led to a significant decline in craving (paired t-test), which remained significant when compared to the control condition. The effects of other components of the retraining were less consistent. The present study shows that a single therapeutic "dose" of distinct components involved in imaginal retraining can reduce craving for cigarettes. Future trials should investigate the effectiveness of components of imaginal retraining not yet tested (e.g., mood induction) and whether combinations and repetition of single components strengthen or dilute efficacy.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Leonie Ascone
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.
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Benvegnù G, Tommasi F, Ferraro S, Libener E, Di Chio M, Bosi S, Zandonai T, Chiamulera C. Smokers "Context Reactivity" in Virtual Domestic Environments. Eur Addict Res 2021; 27:439-446. [PMID: 33940577 DOI: 10.1159/000515301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although the effects of proximal smoking cues have been widely studied in smokers, little is known on the features associated with background spatial context effect, that is, "context reactivity." The aim of this study was to investigate context reactivity exhibited by smokers in virtual cue-free domestic scenarios. METHODS Sixty-nine participants divided in 2 cohorts (33 smokers and 36 non-smokers) were exposed to a virtual reality session with 4 domestic room scenarios presented in a balanced order: bedroom, bathroom, kitchen, and living room. RESULTS We showed that (i) it is possible to elicit smoking craving in smokers in virtual reality, and (ii) these effects are room dependent and (iii) associated with a lower sense of presence; furthermore, (iv) smokers reported higher craving scores for alcohol and food in a room-dependent fashion compared to non-smokers. CONCLUSION Our study provides an experimental paradigm for assessing context reactivity in smokers and suggests a potential use for the identification of non-pharmacological interventions as a co-adjuvant of smoking cessation treatment.
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Affiliation(s)
- Giulia Benvegnù
- Department of General Psychology, University of Padua, Padua, Italy.,Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Francesco Tommasi
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Stefano Ferraro
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Elettra Libener
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Marzia Di Chio
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
| | - Sandra Bosi
- Italian League against Cancer (LILT), Reggio Emilia, Italy
| | - Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain
| | - Cristiano Chiamulera
- Department of Diagnostic and Public Health, Pharmacology Section, Neuropsychopharmacology Lab, University of Verona, Verona, Italy
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