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Larsen JK, Hollands GJ, Garland EL, Evers AWM, Wiers RW. Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions. Neurosci Biobehav Rev 2023; 153:105408. [PMID: 37758008 DOI: 10.1016/j.neubiorev.2023.105408] [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: 06/20/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands.
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, USA
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, NL, and Medical Delta, Leiden University, TU Delft and Erasmus University, UK
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
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Schröder B, Mühlberger A. Measuring attentional bias in smokers during and after psychosocial stress induction with a Trier Social Stress Test in virtual reality via eye tracking. Front Psychol 2023; 14:1129422. [PMID: 37063522 PMCID: PMC10103713 DOI: 10.3389/fpsyg.2023.1129422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionAttentional bias (AB) is considered an important factor not only in the etiology of addiction, but also with respect to relapse. However, evidence for the predictive ability of AB for relapse is not robust. One reason for this might be fluctuations of AB due to stress. Therefore, the current study investigated whether AB was present during and after stress induction and whether AB was enhanced by stress induction.MethodsA Virtual Reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) was used to induce psychosocial stress in smokers (n = 34) and non-smokers (n = 37) followed by a novel free-viewing task in VR. Eye tracking data was recorded to examine gaze behavior to smoking-related and neutral stimuli presented in the VR-TSST and the free-viewing task.ResultsStress ratings increased significantly from baseline to post VR-TSST in smokers and non-smokers. During the VR-TSST we observed, more frequent, longer, and earlier fixations on smoke-related compared with neutral stimuli without significant group differences. However, in the free-viewing task following the stress induction, a specific AB of smokers in terms of earlier and longer fixations on smoke stimuli was found.ConclusionResults indicate that AB is not a persistent trait in smokers, but is context dependent. It is suggested that emotional learning processes such as smoking in the context of relief after stress may contribute to changes of AB both in terms of increased initial attention and deeper stimulus processing. Additionally, the potential of the VR-TSST to induce psychosocial stress could be replicated.
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Schröder B, Mühlberger A. Assessing the attentional bias of smokers in a virtual reality anti-saccade task using eye tracking. Biol Psychol 2022; 172:108381. [PMID: 35710075 DOI: 10.1016/j.biopsycho.2022.108381] [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: 01/14/2022] [Revised: 05/20/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cognitive biases (among them attentional bias, AB) are considered an important factor in the development, maintenance, and recurrence of addiction. However, traditional paradigms to measure AB have been criticized regarding external validity and methodical issues. Therefore, and because the neurophysiological correlates of anti-saccade tasks are known, we implemented a novel smoking anti-saccade task in virtual reality (VR) to measure AB and inhibitory control in different contexts and with higher ecological validity. METHODS Smokers (n = 20) and non-smokers (n = 20) were tested on a classic pro- and anti-saccade task, a VR anti-saccade task and a VR attention fixation task (all containing smoking-related and neutral stimuli) while eye-tracking data was collected. Two VR contexts (park and office room) were applied. RESULTS Saccade latencies were significantly higher for the smoking group in the VR anti-saccade task. However, this effect did not differ between smoking-related and neutral stimuli, thus overall no AB was observed. Instead, AB was only present in the park context. Additionally, saccade latencies and error rates were significantly higher in the park context. CONCLUSIONS Results indicate impaired inhibitory control in smokers relative to non-smokers. The lack of evidence for a general AB might be due to the lower severity of smoking dependence in the smoking sample. Instead, results suggest context specificity of AB. Implications for smoking cessation interventions in the field of inhibitory control training and attention bias modification are discussed.
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Affiliation(s)
- Benedikt Schröder
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Germany.
| | - Andreas Mühlberger
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Germany
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Ma L, Cunningham KA, Anastasio NC, Bjork JM, Taylor BA, Arias AJ, Riley BP, Snyder AD, Moeller FG. A serotonergic biobehavioral signature differentiates cocaine use disorder participants administered mirtazapine. Transl Psychiatry 2022; 12:187. [PMID: 35523779 PMCID: PMC9076859 DOI: 10.1038/s41398-022-01934-w] [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] [Received: 06/02/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Cocaine use disorder (CUD) patients display heterogenous symptoms and unforeseeable responses to available treatment approaches, highlighting the need to identify objective, accessible biobehavioral signatures to predict clinical trial success in this population. In the present experiments, we employed a task-based behavioral and pharmacogenetic-fMRI approach to address this gap. Craving, an intense desire to take cocaine, can be evoked by exposure to cocaine-associated stimuli which can trigger relapse during attempted recovery. Attentional bias towards cocaine-associated words is linked to enhanced effective connectivity (EC) from the anterior cingulate cortex (ACC) to hippocampus in CUD participants, an observation which was replicated in a new cohort of participants in the present studies. Serotonin regulates attentional bias to cocaine and the serotonergic antagonist mirtazapine decreased activated EC associated with attentional bias, with greater effectiveness in those CUD participants carrying the wild-type 5-HT2CR gene relative to a 5-HT2CR single nucleotide polymorphism (rs6318). These data suggest that the wild-type 5-HT2CR is necessary for the efficacy of mirtazapine to decrease activated EC in CUD participants and that mirtazapine may serve as an abstinence enhancer to mitigate brain substrates of craving in response to cocaine-associated stimuli in participants with this pharmacogenetic descriptor. These results are distinctive in outlining a richer "fingerprint" of the complex neurocircuitry, behavior and pharmacogenetics profile of CUD participants which may provide insight into success of future medications development projects.
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Affiliation(s)
- Liangsuo Ma
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States.
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States.
| | - Kathryn A Cunningham
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Noelle C Anastasio
- Center for Addiction Research and Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, United States
| | - James M Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Brian A Taylor
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
| | - Albert J Arias
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Brien P Riley
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Andrew D Snyder
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - F Gerard Moeller
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
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Houghton B, Kouimtsidis C, Duka T, Paloyelis Y, Bailey A. Can intranasal oxytocin reduce craving in automated addictive behaviours? A systematic review. Br J Pharmacol 2021; 178:4316-4334. [PMID: 34235724 DOI: 10.1111/bph.15617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Existing pharmacotherapies for managing craving, a strong predictor of relapse to automated addictive behaviours, are limited in efficacy and characterised by increased health risks associated with their pharmacological profile. Preclinical studies have identified oxytocin as a promising pharmacotherapy with anticraving properties for addictive behaviours. Here, we provide the first systematic review of 17 human studies (n = 722; 30% female) investigating the efficacy of intranasal oxytocin to reduce craving or consumption in addictive behaviours. We identify intranasal oxytocin as a method that warrants further investigation regarding its capacity to decrease cue-induced, acute stress-induced or withdrawal-related craving and relapse related to alcohol, cannabis, opioids, cocaine or nicotine, including a potential role as ad hoc medication following exposure to drug-related cues. Future studies should investigate the role of factors such as treatment regimens and sample characteristics, including the role of the amygdala, which we propose as a distinct mechanism mediating oxytocin's anticraving properties.
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Affiliation(s)
- Ben Houghton
- Pharmacology Section, Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | | | - Theodora Duka
- Behavioural and Clinical Neuroscience, School of Psychology, University of Sussex, Brighton, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis Bailey
- Pharmacology Section, Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Cognitive Bias Modification for Addictive Disorders: Emerging Knowledge and Persistent Gaps. PSYCHIATRY INTERNATIONAL 2020. [DOI: 10.3390/psychiatryint1020009] [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] Open
Abstract
The advances in experimental psychology have led to the discovery of unconscious, automatic biases (attentional and approach biases) that account for the lapse and relapses amongst individuals with addictive disorders. To date, there has been extensive investigation into the assessment and modification of attention biases amongst individuals with the highly prevalent substance use disorders. Alternative modalities, such as technology, has also been evaluated for the delivery of these interventions. Given this, the specific objectives of this perspective article are in highlighting the emerging knowledge that has accrued over the last three years, and in addressing several of the research gaps in the previous article. Firstly, this perspective article will examine the evidence for biases and bias modification amongst the highly prevalent substance use disorders. This article will also examine how such bias modification has been utilized clinically. Secondly, this perspective article will also examine how technology has been applied to these bias modification interventions. Thirdly, this article will also examine the literature to highlight the biological underpinnings following bias modification. Fourthly, this article also examines the limitations of existing bias modification paradigms and methods taken to better these conventional interventions. The article concludes with highlighting the outstanding gaps in the current knowledge. To date, there remains mixed evidence for the modification of attention biases; and there are a paucity of studies examining the effectiveness of mobile delivery of bias intervention. Only one study has considered patients’ perspective in the development of an intervention. There remained several gaps in the knowledge, which future research could address.
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Erguzel TT, Uyulan C, Unsalver B, Evrensel A, Cebi M, Noyan CO, Metin B, Eryilmaz G, Sayar GH, Tarhan N. Entropy: A Promising EEG Biomarker Dichotomizing Subjects With Opioid Use Disorder and Healthy Controls. Clin EEG Neurosci 2020; 51:373-381. [PMID: 32043373 DOI: 10.1177/1550059420905724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Electroencephalography (EEG) signals are known to be nonstationary and often multicomponential signals containing information about the condition of the brain. Since the EEG signal has complex, nonlinear, nonstationary, and highly random behaviour, numerous linear feature extraction methods related to the short-time windowing technique do not satisfy higher classification accuracy. Since biosignals are highly subjective, the symptoms may appear at random in the time scale and very small variations in EEG signals may depict a definite type of brain abnormality it is valuable and vital to extract and analyze the EEG signal parameters using computers. The challenge is to design and develop signal processing algorithms that extract this subtle information and use it for diagnosis, monitoring, and treatment of subjects suffering from psychiatric disorders. For this purpose, finite impulse response-based filtering process was employed rather than traditional time and frequency domain methods. Finite impulse response subbands were analyzed further to obtain feature vectors of different entropy markers and these features were fed into a classifier namely multilayer perceptron. The performances of the classifiers were finally compared considering overall classification accuracies, area under receiver operating characteristic curve scores. Our results underline the potential benefit of the introduced methodology is promising and is to be treated as a clinical interface in dichotomizing substance use disorders subjects and for other medical data analysis studies. The results also indicate that entropy estimators can distinguish normal and opioid use disorder subjects. EEG data and theta frequency band have distinctive capability for almost all types of entropies while nonextensive Tsallis entropy outperforms compared with other types of entropies.
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Affiliation(s)
- Turker Tekin Erguzel
- Department of Software Engineering, Faculty of Engineering and Natural Sciences, Uskudar University, Istanbul, Turkey
| | - Caglar Uyulan
- Department of Mechatronics, Faculty of Engineering, Bulent Evevit University, Zonguldak, Turkey
| | - Baris Unsalver
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Alper Evrensel
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Merve Cebi
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey
| | - Cemal Onur Noyan
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Baris Metin
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Gul Eryilmaz
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Gokben Hizli Sayar
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
| | - Nevzat Tarhan
- Department of Psychology, Faculty of Humanities and Social Sciences, Uskudar University, Istanbul, Turkey.,NP Istanbul Brain Hospital, Istanbul, Turkey
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Zhang M, Ying J, Amron SB, Mahreen Z, Song G, Fung DS, Smith H. A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study. JMIR Res Protoc 2018; 7:e11822. [PMID: 30455170 PMCID: PMC6277827 DOI: 10.2196/11822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
Background Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Objective This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. Methods This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. Results This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. Conclusions To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. International Registered Report Identifier (IRRID) PRR1-10.2196/11822
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Syidda B Amron
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Zaakira Mahreen
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Zhang MWB, Ying J, Wing T, Song G, Fung DSS, Smith HE. Cognitive Biases in Cannabis, Opioid, and Stimulant Disorders: A Systematic Review. Front Psychiatry 2018; 9:376. [PMID: 30158880 PMCID: PMC6104190 DOI: 10.3389/fpsyt.2018.00376] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Opiates, cannabis, and stimulants are highly abused and are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. The dual-process theory has posited that while the repeated use of a substance leads to increased automatic processing and increased automatic tendencies to approach substance-specific cues, in addition to the inhibition of other normal cognitive processes. Prior reviews are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have not reviewed the published literature extensively. Objectives: The primary aim of this review is to synthesize the evidence for cognitive biases in opioid use, cannabis use, and stimulant use disorders. The secondary aim of the review is to determine if cognitive bias could be consistently detected using the different methods. Lastly, this review will narratively synthesize the evidence of possible associations between cognitive biases and other addiction-related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. Articles were included if participants had a primary diagnosis of opioid use, cannabis use, or stimulant use disorder. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Results: A total of 38 studies were identified. The main finding is the evidence that cognitive biases are present in the 38 studies identified, except for a single study on opioid use and stimulant use disorders. Cognitive biases were reported despite a variety of different methods being utilized. Synthesis of secondary outcome was not feasible, due to the varied outcomes reported. Conclusions: Cognitive biases have been consistently observed in opioid use, cannabis use, and stimulant use disorders, despite a range of assessment tools being utilized in the assessment for these biases.
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Affiliation(s)
- Melvyn W B Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jiangbo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Tracey Wing
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Guo Song
- National Addiction Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel S S Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen E Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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