Mediation of cognitive bias modification for alcohol addiction via stimulus-specific alcohol avoidance association.

BACKGROUND: Cognitive bias modification (CBM) studies have provided evidence that cognitive biases play a causal role in alcohol use disorders. In this study, data from a CBM experiment in alcoholic patients were re-analyzed. In the original study, no mediation by associations measured with an Implicit Association Test (IAT) was found. In this study, we explored the possibility that relevant alcohol-related automatic processes may be cue-specific. METHODS: Data from a previous clinical study in a sample of 214 alcohol-addicted patients were re-analyzed. Patients were assigned to a CBM intervention or control condition, performed an alcohol-approach IAT, and were followed up for relapse data a year after training. In this study, bias scores measured via the IAT were calculated and analyzed separately for different stimulus categories: Alcohol, Soft drink, Approach, and Avoid. RESULTS: Training reversed the alcohol-approach bias for all categories. This reversal of bias also predicted reduced relapse, but involved a complex stimulus category-dependent pattern in which an avoidance bias for Alcohol stimuli was most predictive of reduced relapse. CONCLUSIONS: The results contribute to evidence that CBM indeed affects relapse probability via changes in automatic processes, although future study is needed to determine the precise nature of mediating processes. Automatic processes underlying alcohol-related associations may be stimulus-specific, which may be important for the methods of future studies involving implicit measures.

Implementation of approach bias re-training in alcoholism-how many sessions are needed?

BACKGROUND: Computerized cognitive bias modification (CBM) programs have generated promising results regarding the treatment of alcohol dependence and anxiety disorders. However, there is hardly any research yet on the implementation of alcohol-CBM into clinical practice. This article addresses the question of the optimal number of training sessions for a specific form of CBM: approach bias re-training in alcohol-dependent patients. METHODS: Participants were 111 alcohol-dependent patients of an inpatient rehabilitation clinic. In addition to treatment as usual, they took part in a 12-session CBM protocol, aimed at re-training alcohol approach tendencies, with an adapted Alcohol Approach-Avoidance Task. Learning curves and 2-level fitted mean trends were analyzed. Furthermore, parameters of the fitted mean trend and information on the most effective number of training sessions were used to predict 1-year follow-up data. RESULTS: Two-level analyses revealed 6 training sessions to be the mean optimum, yet many patients improve further after that. Prediction of the individual optimum (speed of response) and parameters of the fitted mean trends failed. The linear term of the graph describing the mean trend of training effects, but not the speed of response, predicted 1-year follow-up data. CONCLUSIONS: Suggestions for practical implementations of CBM are discussed.

Retraining automatic action tendencies changes alcoholic patients' approach bias for alcohol and improves treatment outcome.

This study tested the effects of a new cognitive-bias modification (CBM) intervention that targeted an approach bias for alcohol in 214 alcoholic inpatients. Patients were assigned to one of two experimental conditions, in which they were explicitly or implicitly trained to make avoidance movements (pushing a joystick) in response to alcohol pictures, or to one of two control conditions, in which they received no training or sham training. Four brief sessions of experimental CBM preceded regular inpatient treatment. In the experimental conditions only, patients' approach bias changed into an avoidance bias for alcohol. This effect generalized to untrained pictures in the task used in the CBM and to an Implicit Association Test, in which alcohol and soft-drink words were categorized with approach and avoidance words. Patients in the experimental conditions showed better treatment outcomes a year later. These findings indicate that a short intervention can change alcoholics' automatic approach bias for alcohol and may improve treatment outcome.

Self-esteem consistency predicts the course of therapy in depressed patients.

Previous studies on self-esteem and depression demonstrated the usefulness of both implicit and explicit self-esteem as well as their congruence (also known as self-esteem consistency) to predict future depressive symptoms. High self-esteem consistency describes when implicit and explicit self-esteem match (e.g., both high or both low). In the current study, we investigated if implicit and explicit self-esteem and self-esteem consistency predict the course of treatment efficacy of a cognitive behavioral depression therapy. Explicit self-esteem was assessed by the Rosenberg Self-Esteem Scale, implicit self-esteem by a priming task. Participants were 31 patients with a major depressive or recurrent depressive disorder receiving cognitive behavioral therapy treatment in an inpatient setting. Self-esteem measures were administered before treatment. The development of depression symptoms during treatment and at the 4-month follow-up was measured on the Beck Depression Inventory. Implicit and explicit self-esteem did not predict the course of the therapy. Patients with congruent self-esteem, however, improved faster and showed lower severity of symptoms throughout treatment. In contrast, neither explicit nor implicit self-esteem nor self-esteem consistency predicted the stability of effects after treatment. Practical implications such as targeting discrepancies in self-esteem during treatment are discussed.

Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?

BACKGROUND: Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation. METHODS: 509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected. RESULTS: The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM. CONCLUSIONS: CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism.