Evaluating the effectiveness of a mobile app-based self-guided psychological interventions to reduce relapse in substance use disorder: protocol for a randomized controlled trial

Background

Substance Use Disorder (SUD) persists as a significant public health challenge worldwide, with an estimated prevalence of approximately 10-15% across the global populace. This condition is characterized by a notably high risk of lapses and relapses, even subsequent to treatment interventions. Mobile health interventions, owing to their widespread accessibility, emerge as a promising approach to diminish the risk of relapse post-treatment and to broaden the scope of care, especially in regions with a scarcity of trained medical professionals.

Method

This study is designed to assess the effectiveness of mobile interventions in mitigating cravings and preventing lapses among individuals diagnosed with SUD. Employing a two-armed, randomized controlled trial framework, the study will evaluate a self-administered psychological intervention delivered through a mobile application, Nałogometr 2.0. Over a period of three months, participants will engage with intervention modules that primarily incorporate mindfulness techniques and Cognitive Behavioral Therapy (CBT) principles. Ecological Momentary Assessment (EMA) will be utilized to gather longitudinal data on a range of variables that are indicative of craving intensity and the risk of lapse. In addition to this, a monthly-administered battery of questionnaires will be employed to gauge the severity of substance dependence, as well as to measure levels of anxiety, depression, and overall life satisfaction.

Results

Results will be submitted for publication in peer-reviewed journals.

Clinical trial registration

https://clinicaltrials.gov/, identifier [NCT05730504].

Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener

OBJECTIVE

We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener.

METHOD

Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57).

RESULTS

The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed.

CONCLUSIONS

Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Evaluating the effectiveness of mobile app-based self-guided psychological intervention to reduce craving and lapse risk in problematic substance use and behaviors: Protocol for a randomized control trial in the general population

Background

The prevalence of substance and behavioral addiction is estimated between 10 and 15% of the global population and remains a severe public health concern. Moreover, addiction treatment has several barriers, such as a lack of access to professional treatment or stigmatization. Mobile health interventions emerge as a promising solution.

Methods

This two-armed randomized controlled trial (RCT) aims to assess the efficacy of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic behaviors and substance use compared to a control condition. Participant recruitment and data collection will start in June 2022 and end in September 2022. Due to the nature of the study, i.e., a nationwide study of problematic substance use and behaviors, we will aim to recruit all individuals willing to participate. The four-week intervention condition includes short-term and long-term modules based mainly on mindfulness and cognitive behavioral therapy. Longitudinal data on several variables related to craving and lapse risk are collected daily using ecological momentary assessment (EMA). The primary outcomes of interest will be the self-reported number of lapses and craving level in daily EMA. Moreover, a questionnaire battery assessment is administered at baseline in the first week following onboarding, after five weeks, and after six months. The secondary outcome measures will include the severity of problematic substance use or behaviors, anxiety and depression, and life satisfaction.

Results

Results will be submitted for publication in peer-reviewed journals.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT054 34,429].

Effectiveness of emotion regulation strategies measured by self-report and EMG as a result of strategy used, negative emotion strength and participants' baseline HRV

We investigated how emotion regulation (ER) effectiveness-on both a self-reported rating as well as emotional expression (corrugator supercilii muscle activity) level-is affected by the characteristics of the situation (low vs. high negativity), the strategy used (reinterpretation, distraction, suppression, no regulation control condition) and individual dispositions (low vs. high baseline Heart Rate Variability) as well as their interaction. For this purpose, 54 adult women participated in a laboratory study. All the included factors significantly influenced both corrugator activity and appraisals of pictures' negativity (in specific experimental conditions). For example, for high HRV participants, (1) distraction, suppression and reinterpretation significantly decreased corrugator activity compared to the control condition, and (2) distraction decreased appraised picture negativity for high negativity photos. For low HRV participants, distraction and suppression were most effective in decreasing corrugator responses, while suppression was more effective than reinterpretation in decreasing perceived picture negativity in the high negativity condition. Subjectively reported effort and success in applying ER strategies were also dependent on manipulated and dispositional factors. Overall, our results lend support to the flexible emotion regulation framework, showing that emotion regulation effectiveness relies on situational context as well as individual dispositions and their interaction.

People conform to social norms when gambling with lives or money

Many consider moral decisions to follow an internal "moral compass", resistant to social pressures. Here we examine how social influence shapes moral decisions under risk, and how it operates in different decision contexts. We employed an adapted Asian Disease Paradigm where participants chose between certain losses/gains and probabilistic losses/gains in a series of moral (lives) or financial (money) decisions. We assessed participants' own risk preferences before and after exposing them to social norms that are generally risk-averse or risk-seeking. Our results showed that participants robustly shifted their own choices towards the observed risk preferences. This conformity holds even after a re-testing in three days. Interestingly, in the monetary domain, risk-averse norms have more influence on choices in the loss frame, whereas risk-seeking norms have more influence in the gain frame, presumably because norms that contradict default behavior are most informative. In the moral domain, risk-averse as opposed to risk-seeking norms are more effective in the loss frame but in the gain frame different norms are equally effective. Taken together, our results demonstrate conformity in risk preferences across contexts and highlight unique features of decisions and conformity in moral and monetary domains.

Corrigendum: Reducing craving and lapse risk in alcohol and stimulants dependence using mobile app involving ecological momentary assessment and self-guided psychological interventions: Protocol for a randomized controlled trial

[This corrects the article DOI: 10.3389/fpsyt.2022.1011585.].

Reducing craving and lapse risk in alcohol and stimulants dependence using mobile app involving ecological momentary assessment and self-guided psychological interventions: Protocol for a randomized controlled trial

Background

The prevalence of alcohol consumption in Poland is estimated to be as high as 80% of the adult population. The use of stimulants is the second most common reason for seeking addiction treatment. However, treatment outcomes remain unsatisfactory, as 40-85% of individuals who complete various treatment programs relapse and fall back into addiction within 2 years following program completion.

Methods

The 13-armed randomized controlled trial aimed to assess the effectiveness of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic alcohol or stimulants use. Participant recruitment and data collection will be performed from June 2022 to September 2022. The 4-week mobile intervention program will include short-term and long-term intervention modules based mainly on mindfulness and cognitive-behavioral therapy. Intervention effectiveness assessment will include Ecological Momentary Assessment. That is, we will collect longitudinal data on a set of characteristics of day-to-day functioning. The primary outcomes will include a self-reported number of lapses and addiction craving level. In contrast, the secondary outcomes will be the severity of problematic substance use, anxiety and depression scores, and life satisfaction scores.

Conclusion

This study will establish how mobile app-based self-guided psychological interventions can help reduce craving and lapse risk in alcohol and stimulant dependence. If successful, this randomized controlled trial (RCT) may provide an innovative, easily available, and cost-effective mHealth approach for craving and lapse risk in substance addictions.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT054 34429].

Everything Comes at a Price: Considerations in Modeling Effort-Based Choice

When observing human behavior, one of the key factors determining choice is effort. It is often assumed that people prefer an easier course of action when the alternative yields the same benefits. However, recent research demonstrates that this is not always the case: effort is not always costly and can also add value. A promising avenue to study effort-based choice is to utilize formal decision models that enable quantitative modeling. In this paper, we aim to present an overview of the current approaches to modeling effort-based choice and discuss some considerations that stem from theoretical and practical issues (present and previous) in studies on the role of effort, focusing on the connections and discrepancies between formal models and the findings from the body of empirical research. Considering that effort can, in some circumstances, act as a cost and as a benefit, reconciling these discrepancies is a practical and theoretical challenge that can ultimately lead to better predictions and increased model validity. Our review identifies and discusses these discrepancies providing direction for future empirical research.

Gain-loss asymmetry in delay and effort discounting of different amounts

Loss aversion entails that people attribute greater weight to losses than to equivalent gains. In terms of discounting, it is reflected in a higher discounting rate for gains than for losses. Research on delay discounting indicates that such gain-loss asymmetry may depend on the amount of the outcome being considered. Consequently, here we address the question of how gains and losses are discounted in delay or effort conditions (physical or cognitive) across four outcome amounts. Our results replicate previous findings for intertemporal choices by showing that losses are discounted more slowly than gains, but only for smaller amounts-with no evidence of an asymmetrical evaluation for larger amounts. In physical effort discounting, we found an inverse asymmetry for the smallest amount tested (gains are discounted less steeply than losses). However, this effect was absent for larger amounts. We found no evidence to support a gain-loss asymmetry in the evaluation of gains or losses in cognitive effort. Overall, our findings indicate that loss aversion may not be as pervasive as previously expected, at least when decisions are effort-based.

Comparison of multiplicative and additive hyperbolic and hyperboloid discounting models in delayed lotteries involving gains and losses

Many day-to-day decisions may involve risky outcomes that occur at some delay after a decision has been made. We refer to such scenarios as delayed lotteries. Despite human choice often involves delayed lotteries, past research has primarily focused on decisions with delayed or risky outcomes. Comparatively, less research has explored how delay and probability interact to influence decisions. Within research on delayed lotteries, rigorous comparisons of models that describe choice from the discounting framework have not been conducted. We performed two experiments to determine how gain or loss outcomes are devalued when delayed and risky. Experiment 1 used delay and probability ranges similar to past research on delayed lotteries. Experiment 2 used individually calibrated delay and probability ranges. Ten discounting models were fit to the data using a genetic algorithm. Candidate models were derived from past research on discounting delayed or probabilistic outcomes. We found that participants' behavior was best described primarily by a three-parameter multiplicative model. Measures based on information criteria pointed to a solution in which only delay and probability were psychophysically scaled. Absolute measures based on residuals pointed to a solution in which amount, delay, and probability are simultaneously scaled. Our research suggests that separate scaling parameters for different discounting factors may not be necessary with delayed lotteries.

Path Dependency in the Discounting of Delayed and Probabilistic Gains and Losses

Human decision making often involves outcomes that are both risky and delayed. In such delayed lottery scenarios, the question of how such prospects are evaluated arises. An individual can arrive at their choice by following three different subjective value elicitation paths: (1) a direct path by considering the delay and risk of an outcome simultaneously; (2) a delay-probability path by first considering the delay and then the risk of an outcome; and (3) a probability-delay path by first considering the probability and then the delay of an outcome. Using a discounting framework, we conducted an experiment to investigate whether individual choices are path dependent, i.e., if the three paths elicit different subjective values of risky and delayed gains or losses. The experiment included an arbitrary selection of delays and individual probability estimates corresponding to each delay, obtained in an additional delay-probability trade-off task. Such approach ensured the equal individual decision factor strength of each outcome delay and probability. Our findings demonstrate that the human choice of risky and delayed gains or losses is indeed path dependent, which contrasts with the normative view. Furthermore, we present evidence that human choice more closely follows the delay-probability elicitation path than the probability-delay path in the domain of gains.

Risk inherent in delay accounts for magnitude effects in intertemporal decision making

If the future is indeed uncertain, then is the subjective riskiness of future gains and losses amount-dependent? To address this question, we performed two experiments, one regarding hypothetical monetary gains and the other regarding hypothetical monetary losses. Our main objective was to determine whether the magnitude effect observed in delay discounting can be explained by the subjective probability of receiving a future outcome. We employed a well-grounded discounting paradigm with a fixed-sequence procedure and the Subjective Probability Questionnaire across different magnitudes of gains and losses. We replicated prior findings indicating that the magnitude effect (observed in delay discounting) or the reverse magnitude effect (observed in probability discounting) are present for monetary gains but not for monetary losses. We found that the subjective probability of receiving future outcomes is amount-dependent for gains but not for losses. We propose that the magnitude effect can be a by-product of the risk associated with future payoffs of different magnitudes, as shown by mediation analysis. Our secondary goal was to investigate the form of the subjective probability function over time to determine if the change in risk inherent in delay is best described by the hyperbolic or exponential equations. We demonstrate that delay and probability discounting, as well as the subjective probability function, are best described by a simple hyperbolic model.

Physical and cognitive effort discounting across different reward magnitudes: Tests of discounting models

The effort required to obtain a rewarding outcome is an important factor in decision-making. Describing the reward devaluation by increasing effort intensity is substantial to understanding human preferences, because every action and choice that we make is in itself effortful. To investigate how reward valuation is affected by physical and cognitive effort, we compared mathematical discounting functions derived from research on discounting. Seven discounting models were tested across three different reward magnitudes. To test the models, data were collected from a total of 114 participants recruited from the general population. For one-parameter models (hyperbolic, exponential, and parabolic), the data were explained best by the exponential model as given by a percentage of explained variance. However, after introducing an additional parameter, data obtained in the cognitive and physical effort conditions were best described by the power function model. Further analysis, using the second order Akaike and Bayesian Information Criteria, which account for model complexity, allowed us to identify the best model among all tested. We found that the power function best described the data, which corresponds to conventional analyses based on the R2 measure. This supports the conclusion that the function best describing reward devaluation by physical and cognitive effort is a concave one and is different from those that describe delay or probability discounting. In addition, consistent magnitude effects were observed that correspond to those in delay discounting research.

Differences in Delay, but not Probability Discounting, in Current Smokers, E-cigarette Users, and Never Smokers

Steeper delay discounting in substance abuse populations, compared to non-abusing populations, has been well-established in prior studies. Despite the growing interest in e-cigarettes as a novel and relatively understudied form of nicotine consumption, relatively little is known as to how e-cigarette users discount rewards compared to traditional cigarette smokers and never smokers. In the present study, we measured delay and probability discounting rates, as well as perceived risk inherent to a delayed reward, in current traditional cigarette smokers, e-cigarette users, and never smokers. We found that traditional cigarette smokers and e-cigarette users discounted delayed rewards at a similar rate—and both were steeper than never smokers. However, no differences were observed in probability discounting or in perceived risk inherent in reward delay.