Lower motivation for rewarded mental effort in tobacco dependence.

Tobacco dependence is characterized by decision-making impairments, which may increase the risk of smoking relapse by lowering the capacity to resist the immediate gratification of nicotine consumption. Because controlling one's desires for immediate rewards is experienced as effortful, aversion to effortful control processes may also influence the prospects of successful smoking cessation. We therefore tested whether persons who smoke, compared with persons who do not smoke, show a lower willingness to engage in goal-directed mental effort. Thirty-seven persons who smoke and 38 persons who do not smoke performed a decision task requiring choices on whether to exert a demanding attention task for monetary rewards. Using state-of-the-art drift-diffusion modeling, we found that persons who smoke showed a stronger starting bias toward effort-free rewards. Taken together, our process model approach allowed us to identify the subcomponents of the decision process underlying the stronger aversion against mental effort in tobacco dependence, which may contribute to altered decision making by lowering the motivation to engage in effortful control processes when trying to suppress the desire for nicotine consumption. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward.

Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.

Dynamic symptom associations in posttraumatic stress disorder: a network approach.

Background and objective: The current study aimed to investigate the within-day symptom dynamics in PTSD patients, specifically focusing on symptoms that most predict changes in other symptoms. The study included a baseline diagnostic assessment, followed by an assessment using the experience sampling method (ESM) via a smartphone.Method: Participants answered questions related to their PTSD symptoms four times per day for 15 consecutive days (compliance rate 75%). The clinical sample consisted of 48 treatment-seeking individuals: 44 with PTSD as a primary diagnosis, and four patients with subsyndromal PTSD, all of whom had not yet begun trauma-focused treatment. The ESM assessment included the 20 items from the PTSD Checklist for DSM-5, five items from the International Trauma Questionnaire (ITQ) assessing disturbances in relationships and functional impairment, and two items from the Clinician-Administered PTSD Scale for DSM-5 assessing symptoms of depersonalization and derealization.Results: Temporal networks (prospective associations between symptoms) showed that changes in hypervigilance predicted changes in the greatest number of symptoms at the next time point. Furthermore, hypervigilance showed temporal connections with at least one additional symptom from each of the DSM-5 PTSD symptom clusters.Conclusions: Results show that the contemporaneous network (representing the relationship between given symptoms within the same assessment occasion) and the temporal network (representing prospective associations between symptoms) differ and that it is important to estimate both. Some findings from earlier research are replicated, but heterogeneity across studies remains. Future studies should include potential moderators.

We investigated within-day symptom dynamics in PTSD patients using experience sampling technology.Temporal and contemporaneous symptom networks differed; thus, it is important to estimate both.Changes in hypervigilance were an important predictor of symptoms at the next time point.

The influence of outcome expectancy on interpretation bias training in social anxiety: an experimental pilot study.

BACKGROUND: Cognitive bias modification for interpretation (CBM-I) trainings have shown positive effects on interpretation bias in both active interpretation bias training conditions and structurally similar control conditions. Outcome expectations have been suggested to contribute to these placebo effects. The goal of this pilot experimental study was to test the feasibility of positive expectancy induction, to gain preliminary insight into whether this has implications for the efficacy of CBM-I training, and to assess the feasibility of recruitment and the overall study design. METHODS: Socially anxious individuals aged 18 years and older received a single session (approx. 45 min) of either CBM-I or placebo training preceded by either a positive expectancy induction or no expectancy induction. We first tested whether the expectancy induction had modified participants' expectations of training. We then explored the effects of CBM-I training and expectancy induction on interpretation bias. Finally, we assessed the feasibility of recruitment and further study procedures. RESULTS: Due to pandemic-related difficulties, fewer participants were recruited than initially planned. Thirty-four (22 females and 12 males) participants were randomly assigned to one of four conditions (interpretation bias training + high expectancy = 10, interpretation bias training + no expectancy = 8, placebo training + high expectancy = 11, placebo training + no expectancy = 5). Participants in the positive expectancy condition had more positive expectations of the training (CBM-I or placebo) than participants in the no expectancy condition. We were unable to conduct the planned 2 × 2 × 2 analysis of interpretation bias due to the small sample size. When looking at these groups individually, we found that participants in the active training condition and participants in the high expectancy condition showed increases in positive interpretation bias and decreases in negative interpretation bias from pre- to post-training, while participants in the placebo and no expectancy conditions showed no change. CONCLUSIONS: These findings suggest that the expectancy manipulation utilized in this study may be adopted by future studies which investigate outcome expectations as an unspecific mechanism of CBM-I. Preliminary analyses suggest that participants' expectations are likely to play a role in the effect of CBM-I training, although these effects require replication in a larger sample. Several observations about the study feasibility were made which could inform future trials. TRIAL REGISTRATION: Retrospectively registered on the August 23, 2022, through the German Clinical Trials Register ( DRKS00029768 ).

The interplay between cognitive biases, attention control, and social anxiety symptoms: A network and cluster approach.

Cognitive models of social anxiety highlight the importance of different cognitive biases (e.g., attention bias, interpretation bias) and executive dysfunctions, which have, however, mostly been investigated in isolation. The present study explored their interplay using two statistical approaches: (1) network analysis to identify the unique associations between cognitive functions, and (2) cluster analysis to reveal how these associations (or combinations) are manifested in a population. Participants from the general population (N = 147) completed measures of attention control, attention bias, interpretation bias, and social anxiety symptoms. Network analysis showed an association between social anxiety symptoms and interpretation bias, although no other significant associations emerged. Cluster analysis identified a group of participants characterized by an adaptive cognitive pattern (i.e., low cognitive biases, good executive function); and a group exhibiting a more maladaptive pattern (i.e., high interpretation bias, good alerting but poor executive function). The maladaptive group showed higher levels of social anxiety than the adaptive group. Results highlight the strong association between social anxiety symptoms and interpretation bias, while challenging the putative role of attention bias. Attention control, particularly executive function, may limit the impact of cognitive bias on anxiety symptoms.

Reliability of and associations between cognitive bias measures and response inhibition in smoking.

BACKGROUND AND OBJECTIVE: Theoretical models propose that different cognitive biases are caused by a common underlying mechanism (incentive salience/"wanting") and should, therefore, be interrelated. Additionally, stronger impulsive processes should be related to weaker inhibitory abilities. However, these assumptions have hardly been empirically tested and key psychometric information have hardly been reported in samples of smokers. To extent previous research, the present study aimed (1) to estimate the reliability (split-half) of different cognitive bias measures and (2) to investigate associations between attention, approach and associative biases, response inhibition, and smoking-related variables. METHODS: Eighty current, non-deprived smokers completed the following tasks in random order: Approach-Avoidance Task (AAT), Stimulus-Response Compatibility Task (SRCT), Implicit-Association Tests (IAT, approach-avoid, valence), Dotprobe Task, Go-/NoGo Task (GNGT). Additionally, different smoking-related variables were assessed. Split-half reliabilities of the different cognitive (bias) measures and correlations between them were calculated. RESULTS: Split-half reliabilities of the AAT, the SRCT, and the Dotprobe Task were unacceptable whereas both IATs and the GNGT showed good to excellent reliability. Smoking-approach associations were significantly related to nicotine dependence; however, none of the cognitive bias measures correlated with response inhibition or smoking-related variables. LIMITATIONS: Pictorial stimuli were the same across paradigms and might not have been relevant to all participants. CONCLUSIONS: This is the first study to investigate the association between different cognitive biases, response inhibition, and smoking-related variables. Although findings are at odds with theoretical assumptions, their interpretation is clearly restricted by the low reliability of the cognitive bias measures.

Temporal associations between trauma-related sleep disturbances and PTSD symptoms: An experience sampling study.

OBJECTIVE: There is robust evidence for the influence of sleep disturbances on the maintenance of PTSD symptoms. However, little is known about day-to-day variation in trauma-related sleep disturbances (namely insomnia symptoms and nightmares) and their associations with PTSD symptoms. Therefore, we explored the dynamic interplay of these symptoms in daily life using an experience sampling method (ESM). METHOD: For 15 consecutive days, participants with PTSD symptomatology as primary complaint (N = 48) reported momentary levels of insomnia symptoms and nightmares as well as PTSD symptoms via a mobile app. RESULTS: Multilevel model analyses revealed that insomnia and nightmares were significant predictors of PTSD symptomatology on the following day; furthermore, nightmares were predictive of each of the four PTSD symptom clusters, namely reexperiencing, avoidance, cognition and hyperarousal as well as symptoms of dissociation. However, PTSD symptoms did not predict insomnia or nightmares during the following night. Multilevel mediation analyses suggested that nightmares mediate the relationship between insomnia and next-day PTSD symptoms. CONCLUSIONS: These findings support accumulating evidence that trauma-related sleep disturbances play an important role in the maintenance of PTSD symptoms, by elevating symptoms daily. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Metacognitive deficits are associated with lower sensitivity to preference reversals in nicotine dependence.

Deficits in impulse control belong to the core profile of nicotine dependence. Smokers might thus benefit from voluntarily self-restricting their access to the immediate temptation of nicotine products (precommitment) in order to avoid impulse control failures. However, little is known about how smokers' willingness to engage in voluntary self-restrictions is determined by metacognitive insight into their general preferences for immediate over delayed rewards. Here, with a series of monetary intertemporal choice tasks, we provide empirical evidence for reduced metacognitive accuracy in smokers relative to non-smokers and show that smokers overestimate the subjective value of delayed rewards relative to their revealed preferences. In line with the metacognitive deficits, smokers were also less sensitive to the risk of preference reversals when deciding whether or not to restrict their access to short-term financial rewards. Taken together, the current findings suggest that deficits not only in impulse control but also in metacognition may hamper smokers' resistance to immediate rewards and capacity to pursue long-term goals.

Comparing PTSD symptom networks in type I vs. type II trauma survivors.

Background: Network analysis has gained increasing attention as a new framework to study complex associations between symptoms of post-traumatic stress disorder (PTSD). A number of studies have been published to investigate symptom networks on different sets of symptoms in different populations, and the findings have been inconsistent. Objective: We aimed to extend previous research by testing whether differences in PTSD symptom networks can be found in survivors of type I (single event; sudden and unexpected, high levels of acute threat) vs. type II (repeated and/or protracted; anticipated) trauma (with regard to their index trauma). Method: Participants were trauma-exposed individuals with elevated levels of PTSD symptomatology, most of whom (94%) were undergoing assessment in preparation for PTSD treatment in several treatment centres in Germany and Switzerland (n = 286 with type I and n = 187 with type II trauma). We estimated Bayesian Gaussian graphical models for each trauma group and explored group differences in the symptom network. Results: First, for both trauma types, our analyses identified the edges that were repeatedly reported in previous network studies. Second, there was decisive evidence that the two networks were generated from different multivariate normal distributions, i.e. the networks differed on a global level. Third, explorative edge-wise comparisons showed moderate or strong evidence for specific 12 edges. Edges which emerged as especially important in distinguishing the networks were between intrusions and flashbacks, highlighting the stronger positive association in the group of type II trauma survivors compared to type I survivors. Flashbacks showed a similar pattern of results in the associations with detachment and sleep problems (type II > type I). Conclusion: Our findings suggest that trauma type contributes to the heterogeneity in the symptom network. Future research on PTSD symptom networks should include this variable in the analyses to reduce heterogeneity.

Antecedentes: El análisis de redes ha ganado cada vez más atención como un nuevo marco para estudiar asociaciones complejas entre síntomas del Trastorno de Estrés Postraumático (TEPT). Se han publicado una cantidad de estudios para investigar las redes de síntomas en diferentes conjuntos de síntomas en distintas poblaciones, y los hallazgos han sido inconsistentes.Objetivos: Nuestro objetivo fue ampliar la investigación previa probando si se pueden encontrar diferencias entre las redes de síntomas del TEPT en sobrevivientes de trauma de tipo 1 (evento único; súbito e inesperado, niveles elevados de amenaza aguda) versus los de tipo 2 (eventos repetidos y/o prolongados; anticipados) (con respecto a su trauma índice).Métodos: Los participantes eran individuos expuestos al trauma con niveles elevados de sintomatología de TEPT, la mayoría de los cuales (94%) se sometían a una evaluación en preparación para el tratamiento del TEPT en varios centros de Alemania y Suiza (n = 286 con tipo 1 y n = 187 con tipo 2 de trauma). Estimamos modelos gráficos Bayesianos Gaussianos para cada tipo de grupo de trauma y exploramos las diferencias entre los grupos en la red de síntomas.Resultados: En primer lugar, para ambos tipos de trauma, nuestros análisis identificaron los bordes que se reportaron repetidamente en estudios de redes anteriores. En segundo lugar, hubo evidencia decisiva que las dos redes fueron generadas de diferentes distribuciones normales multivariadas, es decir, las redes diferían a nivel global. En tercer lugar, las comparaciones exploratorias de los bordes mostraron una evidencia de moderada a fuerte para 12 bordes específicos. Los bordes que surgieron como especialmente importantes para distinguir las redes fueron las intrusiones y flashbacks, destacando la asociación fuertemente positiva entre los grupos de tipo 2 en comparación con los sobrevivientes de trauma del grupo de tipo 1. Los flashbacks mostraron un patrón similar de resultados en las asociaciones con desapego y problemas de sueño (tipo 2 > tipo 1).Conclusiones: Nuestros resultados sugieren que el tipo de trauma contribuye a la heterogeneidad en los síntomas de red. La investigación futura sobre las redes de los síntomas de TEPT debería incluir esta variable en los análisis para reducir la heterogeneidad.

(When and how) does basic research in clinical psychology lead to more effective psychological treatment for mental disorders?

An important aim of basic research in Clinical Psychology is to improve clinical practice (e.g., by developing novel interventions or improving the efficacy of existing ones) based on an improved understanding of key mechanisms involved in psychopathology. In the first part of this article, we examine how frequently this translation has happened in the past by reviewing all 40 evidence-based psychological interventions recommended in current clinical guidelines for five important (groups of) mental disorders. Results show that only 23% of treatments showed a very strong link between basic research and the development of the intervention, and further 20% showed a strong link. These findings thus suggest that the route from basic research to clinical innovation may not be as strong historically as is commonly assumed. Important challenges for translational research in clinical psychology are reviewed, leading to the introduction of a new framework, and a discussion of possible solutions to overcome these challenges. Suggestions include increased attention to robust and replicable research findings, a stronger focus on experimental psychopathology research to establish causality of psychopathological mechanisms, a more systematic structural integration of basic and applied research in clinical psychology, a stronger emphasis on mechanisms of change and moderators of clinical interventions, increased attention to clinical subgroups, and emphasizing improvements to existing interventions over the development of novel interventions.

Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial.

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.

Comparison of different response devices to assess behavioral tendencies towards chocolate in the approach-avoidance task.

Behavioral tendencies in the Approach-Avoidance Task (AAT) have mostly been assessed using a joystick as a response device. In recent years, other hardware devices such as tablets, smartphones, and computer mice have also been used. However, it remains unclear whether different response devices yield similar results and show comparable psychometric properties. The aim of the present study was to assess approach biases towards chocolate with different response devices and to compare their reliability and validity. Forty-five individuals with regular chocolate consumption completed three different AATs (joystick, computer mouse, touchscreen), each comprised of two blocks. In the compatible block of trials, chocolate-related pictures had to be pulled near while object-related pictures had to be pushed away. In the incompatible block of trials, instructions were reversed. Preregistered analyses revealed that participants were faster to pull than to push chocolate-related pictures relative to object-related pictures, indicating an approach bias for chocolate with no significant differences between response devices. Correlations among the three response devices were low to medium. Exploratory analyses revealed that approach biases were moderated by block order such that biases were only present and associated with craving (joystick AAT only) when the incongruent block was completed first. Internal consistencies of the bias score ranged between rSB = 0.67-0.76. Results of the present study point to the existence of an approach bias to chocolate regardless of response device, albeit each task seems to measure a different aspect of it. Order effects point to specific temporal dynamics in the acquisition of stimulus response (e.g., chocolate-pull) mappings that require further study.

Disentangling temporal dynamics in attention bias from measurement error: A state-space modeling approach.

Temporal dynamics in attention bias (AB) have gained increasing attention in recent years. It has been proposed that AB is variable over trials within a single test session of the dot-probe task, and that the variability in AB is more predictive of psychopathology than the traditional mean AB score. More important, one of the dynamics indices has shown better reliability than the traditional mean AB score. However, it has been also suggested that the dynamics indices are unable to uncouple random measurement error from true variability in AB, which questions the estimation precision of the dynamics indices. To clarify and overcome this issue, the current article introduces a state-space modeling (SSM) approach to estimate trial-level AB more accurately by filtering random measurement error. The estimation error of the extant dynamics indices versus SSM were evaluated by computer simulations with different parameter settings for the temporal variability and between-person variance in AB. Throughout the simulations, SSM showed robustly lower estimation error than the extant dynamics indices. We also applied these indices to real data sets, which revealed that the dynamics indices overestimate within-person variability relative to SSM. Here SSM indicated less temporal dynamics in AB than previously proposed. These findings suggest that SSM might be a better alternative to estimate trial level AB than the extant dynamics indices. However, it is still unclear whether AB has meaningful in-session variability that is predictive of psychopathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Imagery Rescripting Versus Cognitive Restructuring for Social Anxiety: Treatment Effects and Working Mechanisms.

Background: Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Method: Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Results: Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. Conclusions: The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.

Improving imagery rescripting treatments: Comparing an active versus passive approach.

BACKGROUND AND OBJECTIVES: In imagery rescripting (ImRs), aversive mental images are modified to reduce symptoms in a variety of psychological disorders. However, uniform guidelines on how to optimally implement ImRs do currently not exist. It remains unclear whether therapists should stimulate patients to imagine themselves to actively intervene within the new image, or whether they may imagine helpers to change the situation. We aimed to compare these two variants of ImRs within an analogue experimental setting. METHODS: After having watched an aversive film, one-hundred participants were randomly assigned to active ImRs (ImRs-A), passive ImRs (ImRs-P), imagery rehearsal (IRE), or no-intervention control (NIC). Participants were either instructed to rescript the film by imagining themselves intervening in the new script (ImRs-A) or encouraged to imagine helpers to intervene in the imagined situation (ImRs-P). RESULTS: Both ImRs increased mastery and elicited less distress than IRE with ImRs-P being experienced as less distressing than ImRs-A. Only ImRs-A led to a stronger increase in positive affect than IRE, whereas groups did not differ with respect to negative affect and self-efficacy. Conditions did not differ regarding the number of film-related intrusive memories. LIMITATIONS: As a convenience sample was investigated, results cannot be generalized to clinical samples. CONCLUSION: Even though differences regarding symptomatic outcome could not be detected, ImRs-P was experienced as less distressing than ImRs-A. Results suggest that both ImRs lead to different processes during the intervention than mere exposure. Compared to IRE, ImRs increases mastery with ImRs-A and ImRs-P being equally effective.

Web-based Approach Bias Modification in smokers: A randomized-controlled study.

Smoking is associated with automatic approach tendencies towards smoking-related stimuli. Therefore, it has been investigated whether training smoking individuals to consistently avoid smoking-related stimuli exerts positive effects on smoking behavior (Approach-Bias Modification [AppBM]). A web-based pilot study provided preliminary evidence for the effectiveness of AppBM in smokers; however, interpretability was constrained by several limitations. The aim of the present study was to replicate and extend previous findings. A web-based three group parallel (1:1:1) randomized-controlled study with adult smokers (N = 149) was conducted (DRKS00011901). Upon completion of a baseline assessment, participants were randomized to either six sessions of AppBM or Sham training or a waitlist control group. In both trainings, participants were presented smoking-related and neutral pictures. While all smoking-related pictures were associated with pushing and all neutral pictures with pulling in AppBM training, the contingency was 50:50 in Sham training. Participants were re-assessed directly and six months after training. Primary outcome was daily cigarette consumption at follow-up. At follow-up, no significant group differences emerged, although AppBM training significantly reduced daily cigarette consumption directly after training. No consistent change of bias through AppBM training emerged. This study does not provide support for the long-term effectiveness of AppBM training as a stand-alone training in smoking. PRE-REGISTRATION: German Clinical Trials Register (DRKS00011901).

Approach-avoidance modification as an add-on in smoking cessation: A randomized-controlled study.

Biases in information processing are attributed an important role in the maintenance of tobacco dependence. As these biases are not sufficiently taken into account in current treatments, the aim of the present study was to investigate whether clinical outcome can be improved by combining treatment-as-usual (TAU) with Approach-Avoidance Modification Training (AAMT). A two group parallel (1:1) randomized-controlled single-blind study with adult smokers (N = 105) was conducted (DRKS00011406). Participants received three sessions of TAU and either six sessions of AAMT or Sham training. During AAMT, participants were trained to implicitly avoid all smoking-related and to approach all smoking-unrelated pictures, while the contingency was 50:50 in Sham training. Participants were assessed after the intervention and 6 months later. Primary outcome was daily cigarette consumption at follow-up. Participants receiving TAU + AAMT did not show a significantly greater reduction of daily cigarette consumption at follow-up compared to TAU + Sham (per-protocol: 95% CI: -2.56-4.89, p = .608; intention-to-treat: 95% CI: -3.11-2.96, p = .968). Using an implicit AAMT (vs. Sham) as an add-on to TAU did not improve clinical outcome. However, no consistent evidence for a change of bias was found. It is important for future research to explore the effectiveness of optimized training versions (e.g., explicit instructions). PRE-REGISTRATION: German Clinical Trials Register (DRKS00011406).

Approach and Avoidance Biases Toward Sexual Stimuli and Their Association with the Dual Control Model of Sexual Response in Heterosexual Men.

Many models of human behavior work in an interaction of a dual system. While one system usually represents controlled and reflective behavioral responses, the other system reflects automatic and impulsive actions. In the impulsive system, positive stimuli initiate approach reactions and negative cues avoidance reactions. Besides stimulus valence, the behavioral response triggered by the impulsive system is influenced by personality (e.g., the propensity to react with approach or avoidance biases in a specific situation). The present study applied a computerized Approach-Avoidance Task (AAT; Rinck & Becker, 2007) to assess automatic behavioral approach and avoidance biases toward sexual and neutral stimuli in heterosexual men (N = 40). Individual AAT-performance was furthermore related to sexual excitation (SES) and the two sexual inhibition factors (SIS1 and SIS2) as proposed by the Dual Control Model of sexual response (Bancroft & Janssen, 2000). Against our hypotheses, participants did not show a stronger approach bias toward sexually preferred (i.e., images of women) than sexually not preferred stimuli (i.e., images of men or children). However, stronger approach biases toward images of women were positively associated with sexual excitation and negatively correlated with sexual inhibition due to a threat of performance failure (SIS1) even after controlling for potential confounds (i.e., general behavioral activation and inhibition). The results support the importance of the influence of dispositional traits measured with the Dual Control Model of sexual response on approach and avoidance biases toward sexually preferred stimuli in heterosexual men.

Effects of imagery rescripting on consolidated memories of an aversive film.

BACKGROUND AND OBJECTIVES: Imagery rescripting (ImRs) is a promising intervention targeting emotional memory. Previous analogue studies have mainly investigated effects of ImRs during memory encoding and consolidation; experimental research on the effects and mechanisms of change in ImRs targeting consolidated memories is largely missing. The present study aimed to investigate effects of ImRs on consolidated memories using a multiple-day trauma film paradigm. METHODS: Eighty-eight participants were randomly assigned to either ImRs, imagery rehearsal (IRE), or no intervention control (NIC). In Session 1, participants watched an aversive film. In Session 2 (24 h after Session 1), the analogue trauma memory was reactivated and the intervention took place. Participants reported intrusive memories of the aversive film for one week and then returned to the laboratory for a follow-up (Session 3). RESULTS: Compared to IRE, ImRs was experienced as less distressing and elicited less negative emotions. In addition, ImRs accelerated the decline of intrusive memories when compared to NIC. However, ImRs, IRE, and NIC did not differ with respect to the total number of intrusive memories during the week following the intervention. LIMITATIONS: There was a floor effect of intrusive memories, which may have obscured a potential superiority of the active interventions over NIC. CONCLUSIONS: Adding to the current literature on ImRs as an intervention for emotional memories, the current study underscores that a multiple-day trauma film paradigm can be used to investigate the short-term efficacy and working mechanisms of ImRs, but also points toward useful modifications to the paradigm.

Cognitive bias modification in problem and pathological gambling using a web-based approach-avoidance task: A pilot trial.

There is evidence that training addicted participants to implicitly avoid disorder-related stimuli by using a training version of the Approach-Avoidance Task (AAT) results in reduced substance consumption (i.e., Approach Bias Modification [AppBM]). The aim of the present web-based study was to investigate the feasibility and effectiveness of AppBM in reducing gambling-related symptoms. A self-selected sample of participants with problem/pathological slot-machine gambling completed an online survey and received either AppBM or Sham training (final N = 131). Attrition during study participation was high (66%). In both conditions slot-machine related and neutral pictures were presented. Within the AppBM condition all slot-machine related pictures had to be pushed and all neutral pictures had to be pulled, whereas in the Sham condition the contingency was 50:50. Eight weeks after baseline, participants were re-assessed. Both groups showed a similar reduction in gambling-related symptoms. Findings are at odds with the hypothesis claiming that only contingency trainings yield beneficial effects. However, it cannot be ruled out that effects result from other factors unrelated to training such as expectancy effects. We think this study holds valuable information how to conduct larger trials in the future and may prove helpful to improve training and its delivery.