Implicit beliefs and automatic associations in smoking.

BACKGROUND AND OBJECTIVES: Dual process models of addiction suggest that controlled, goal-directed processes prevent drug-use, whereas impulsive, stimulus-driven processes promote drug-use. The most frequently used measure of automatic smoking-related processes, the implicit association test (IAT), has yielded mixed results. We examine the validity of two alternative implicit measures: 1) the affect misattribution procedure (AMP), a measure of automatic evaluations, and 2) the relational responding task (RRT), a measure of implicit beliefs. METHODS: Smokers and non-smokers performed smoking-related versions of the AMP and the RRT and filled in questionnaires for smoking dependence. Smokers participated in two sessions: once after they just smoked, and once after being deprived for 10 h. Smokers also kept a smoking diary for a week after the second session. RESULTS: We found significant differences between smokers and non-smokers on the RRT, t (86) = 2.86, p = .007, d = 0.61, and on the AMP, F (1, 85) = 6.22, p = .015, pƞ2 = 0.07. Neither the AMP nor the RRT were affected by the deprivation manipulation. Smoking dependence predicted smoking behavior in the following week; the AMP and RRT did not explain additional variance. LIMITATIONS: Possibly, our manipulation was not strong enough to affect the motivational state of participants in a way that it changed their implicit cognitions. Future research should examine the sensitivity of implicit measures to (motivational) context. CONCLUSIONS: We found limited evidence for the validity of the smoking-AMP and the smoking-RRT, highlighting the need for a critical view on implicit measures.

Automaticity: schema modes in addiction.

Automaticity is a hallmark of substance use disorder. In Schema Therapy (an evidence-based form of psychotherapy, that has also been applied to substance use disorders), automaticity appears to be a relevant variable. However, the role of automaticity in Schema Therapy has never been made explicit. In the present article, we investigate the role of automaticity in schema modes and its role in different phases in Schema Therapy for substance use disorders. In performing this investigation, we facilitate a better understanding of the working mechanisms of Schema Therapy, and, vice versa, suggest an alternative understanding of automaticity in substance use disorders. We suggest that the automatic use of substances is way of coping with schemas and, therefore, is the consequence of schema mode activity. In the article, four characteristics of automaticity (unconscious, uncontrollable/uncontrolled, efficient, fast) are translated to schema modes. Subsequently, a Schema Therapy case of a patient suffering from an alcohol use disorder and a narcissistic personality disorder is discussed, focusing on the four facets of automaticity. Last, implications for theory, clinical practice and future research are discussed.

Dual processes in fear and anxiety: no effects of cognitive load on the predictive value of implicit measures.

Dual process models posit that combinations of impulsive and reflective processes drive behaviour, and that the capacity to engage in effortful cognitive processing moderates the relation between measures of impulsive or reflective processes and actual behaviour. When cognitive resources are low, impulsive processes are more likely to drive behaviour, while when cognitive resources are high, reflective processes will drive behaviour. In our current study, we directly addressed this hypothesis by comparing the capacity of implicit and explicit measures to predict fear and anxiety, either with or without additional cognitive load. In Experiment 1 (N = 83), only explicit measures of spider fear were predictive of spider avoidance, and manipulating cognitive load did not affect these relations. Experiment 2 (N = 70) confirmed these findings, as the capacity of explicit and implicit measures to predict self-reported and physiological responses to a social stressor was not moderated by cognitive load. In two experiments, we thus found no empirical support for the central dual process model assumption that cognitive control moderates the predictive value of implicit and explicit measures. While implicit measures and dual process accounts may still be valuable, we show that results in this field are not necessarily replicable and inconsistent.

Assessing the influence of warnings with testimonies from former smokers on smoking and quitting behaviour.

OBJECTIVES: Cigarette pack warnings are widely used internationally for reducing smoking behaviour. Current warnings typically consist of a textual or graphic warning that smoking can lead to negative (health) outcomes. Though these warnings have proven benefits, they also have important limitations. Most notably, they do not produce beneficial changes in important cognitive determinants of smoking cessation such as self-efficacy to refrain from smoking and they do not reduce smoking for specific subsets of the target population. Recent studies provide evidence for the effectiveness of health warnings that include health-related testimonies from former smokers. METHODS: We designed cigarette pack warnings that consist of more general testimonial statements from former smokers, selected in a pilot study for their potential impact on two important cognitive determinants of smoking (i.e., self-efficacy beliefs and outcome expectancies). In the main study, online participants were either exposed to the new testimonial warnings, to graphic health warnings, or to text-only health warnings on four separate occasions during a 24-h window. RESULTS: In a sample of 416 daily smokers, we observed beneficial changes in self-reported cigarette smoking, craving, quit intentions, evaluations of smoking, self-efficacy, and outcome expectancies, immediately after viewing the warnings a first time and after multiple exposures. These effects were comparable for participants in the three warning type groups, with some (small) differences for changes in outcome expectancies and craving. CONCLUSIONS: Warnings with general testimonies from former smokers might provide a useful evidence-based addition to currently used cigarette pack health warnings.

Attention for future reward.

When stimuli are consistently paired with reward, attention toward these stimuli becomes biased (e.g., Abrahamse, Braem, Notebaert & Verguts, et al., Psychological Bulletin 142:693-728, 2016, https://doi.org/10.1037/bul0000047). An important premise is that participants need to repeatedly experience stimulus-reward pairings to obtain these effects (e.g., Awh, Belopolsky & Theeuwes, Trends in Cognitive Sciences 16:437-443, 2012, https://doi.org/10.1016/j.tics.2012.06.010). This idea is based on associative learning theories (e.g., Pearce & Bouton, Annual Review of Psychology 52:111-139, 2001) that suggest that exposure to stimulus-reward pairings leads to the formation of stimulus-reward associations, and a transfer of salience of the reward to the neutral stimulus. However, novel learning theories (e.g., De Houwer, Learning and Motivation 53:7-23, 2009, https://doi.org/10.1016/j.lmot.2015.11.001) suggest such effects are not necessarily the result of associative learning, but can be caused by complex knowledge and expectancies as well. In the current experiment, we first instructed participants that a correct response to one centrally presented stimulus would be followed by a high reward, whereas a correct response to another centrally presented stimulus would be paired with a low reward. Before participants executed this task, they performed a visual probe task in which these stimuli were presented as distractors. We found that attention was drawn automatically toward high-reward stimuli relative to low-reward stimuli. This implies that complex inferences and expectancies can cause automatic attentional bias, challenging associative learning models of attentional control (Abrahamse et al., 2016; Awh et al., 2012).

Instructed fear stimuli bias visual attention.

We investigated whether stimuli merely instructed to be fear-relevant can bias visual attention, even when the fear relation was never experienced before. Participants performed a dot-probe task with pictures of naturally fear-relevant (snake or spider) or -irrelevant (bird or butterfly) stimuli. Instructions indicated that two pictures (one naturally fear-relevant and one fear-irrelevant) could be followed by an electrical stimulation (i.e., instructed fear). In reality, no stimulation was administered. During the task, two pictures were presented on each side of the screen, after which participants had to determine as fast as possible on which side a black dot appeared. After a first phase, fear was reinstated by instructing participants that the device was not connected but now was (reinstatement phase). Participants were faster when the dot appeared on a location where an instructed fear picture was presented. This effect seemed independent of whether picture content was naturally fear-relevant, but was only found in the first half of each phase, suggesting rapid extinction due to the absence of stimulation, and rapid re-evaluation after reinstatement. A second experiment similarly showed that instructed fear biases attention, even when participants were explicitly instructed that no stimulation would be given during the dot-probe task. Together, these findings demonstrate that attention can be biased towards instructed fear stimuli, even when these fear relations were never experienced. Future studies should test whether this is specific to fear, or can be observed for all instructions that change the relevance of a given stimulus.

Automatic stimulus evaluation depends on goal relevance.

To examine whether automatic stimulus evaluation is dependent upon goal relevance, participants were presented with a mixture of (a) goal-induction trials to create a set of goal-relevant and goal-irrelevant stimuli, and (b) evaluative priming trials to capture the automatic evaluation of these stimuli as good or bad. In line with our predictions, a reliable evaluative priming effect was obtained only for stimuli that were relevant for the goal-induction task. Implications for the use of the evaluative priming paradigm as an assessment tool and the replicability of the evaluative priming effect in the absence of dimensional overlap between the prime set and the target set are discussed. (PsycINFO Database Record

Mood effects on attentional control: a preregistered replication study and critical analysis.

In a widely cited paper, Jefferies et al. (2008) report a study in which they manipulated participants' mood and examined the effects of this manipulation on their performance on the Attentional Blink task. Their results revealed an interaction between emotional valence and arousal: attentional control of participants who experienced a negative mood with low arousal (i.e. sadness) was best, whereas it was worst for participants who experienced a negative mood with high arousal (i.e. anxiety). Performance for participants who were in a positive mood, either with low arousal (i.e. calmness) or high arousal (i.e. happiness) had intermediate scores. In this study, I examined the replicability of this effect and performed additional analyses to investigate the extent to which this effect is due to perceptual or attentional processes and to examine the role of distraction on AB performance. Importantly, the results showed that the crucial interaction between emotional valence and arousal did not reach significance. This could be due a diversity of factors that are addressed in the discussion.

Beyond associations: Do implicit beliefs play a role in smoking addiction?

BACKGROUND AND OBJECTIVES: Influential dual-system models of addiction suggest that an automatic system that is associative and habitual promotes drug use, whereas a controlled system that is propositional and rational inhibits drug use. It is assumed that effects on the Implicit Association Test (IAT) reflect the automatic processes that guide drug seeking. However, results have been inconsistent, challenging: (1) the validity of addiction IATs; and (2) the assumption that the automatic system contains only simple associative information. We aimed to further test the validity of IATs that are used within this field of research using an experimental design. Second, we introduced a new procedure aimed at examining the automatic activation of complex propositional knowledge, the Relational Responding Task (RRT) and examine the validity of RRT effects in the context of smoking. METHODS: In two experiments, smokers performed two different tasks: an approach/avoid IAT and a liking IAT in Experiment 1, and a smoking urges RRT and a valence IAT in Experiment 2. Smokers were tested once immediately after smoking and once after 10 hours of nicotine-deprivation. RESULTS: None of the IAT scores were affected by the deprivation manipulation. RRT scores revealed a stronger implicit desire for smoking in the deprivation condition compared to the satiation condition. CONCLUSIONS: IATs that are currently used to assess automatic processes in addiction have serious drawbacks. Furthermore, the automatic system may contain not only associations but complex drug-related beliefs as well. The RRT may be a useful and valid tool to examine these beliefs.

Attention to future actions: the influence of instructed S-R versus S-S mappings on attentional control.

Even though there is ample evidence that planning future actions plays a role in attentional processing (e.g., Downing Visual Cognition 11:689-703, 2000; Soto et al., Trends in Cognitive Sciences 12:248-342, 2008), it is not clear to what extent planning in itself (rather than the prior experience of the planned actions) controls attention. We suggest that attention can be biased towards stimuli that are associated with instructions for tasks that will be performed in the future even if those tasks have not yet been experienced. We performed two experiments in which participants receive instructions in which some objects were associated with a response (i.e., instructed S-R objects; "Experiment 1") or a stimulus property (i.e., instructed S-S objects; "Experiment 2"), whereas control objects were not. However, before participants were required to perform the S-R task ("Experiment 1") or perform an S-S memory task ("Experiment 2"), they performed a visual probe task in which target objects and control objects served as irrelevant cues. Our results show that attention was biased towards the S-R objects (compared to control stimuli) but not to S-S objects. These findings suggest that future plans can bias attention toward specific stimuli, but only when these stimuli are associated with a specific action. We discuss these findings in light of research concerning automatic effects of instructions and theories that view attention as a selection-for-action mechanism.

Implicit measures of "wanting" and "liking" in humans.

Incentive Sensitization Theory (IST; e.g., Robinson and Berridge, 1993. Brain Res. Rev., 18, 291; Robinson and Berridge, 2003 Trends Neurosci., 26, 507) suggests that a common dopamine system that deals with incentive salience attribution is affected by different types of drugs. Repeated drug use will sensitize this neural system, which means that drugs increasingly trigger the experience of incentive salience or "wanting". Importantly, Robinson and Berridge stress that there is a dissociation between drug "wanting" (the unconscious attribution of incentive salience) and drug "liking" (the unconscious hedonic experience when one consumes drugs). Whereas the former plays an essential role in the development and maintenance of drug addiction, the latter does not. Although this model was based mainly on research with non-human animals, more recently the dissociation between "wanting" and "liking" has been examined in humans as well. A widely used and promising means of studying these processes are behavioral implicit measures such as the Implicit Association Test (IAT), the Approach-Avoidance Task (AAT), different types of Stimulus-Response Compatibility (SRC) tasks, and Affective Simon Tasks (AST). IST makes the clear prediction that (1) there should be a positive correlation between indices of "wanting" (e.g., drug consumption) and implicit "wanting" scores. Similarly, there should be a positive correlation between indices of "liking" (e.g., various expressions of subjective pleasure) and implicit "liking" scores; (2) there should be higher "wanting" scores in substance abusers or frequent substance users compared to non-users or infrequent users, and there should be no differences in "liking" between these groups (or even less "liking" in frequent substance users); (3) manipulations of "wanting" should affect implicit "wanting" scores whereas manipulations of "liking" should affect implicit "liking" scores. However, studies that tested these hypotheses did not produce equivocal results. To shed light on these discrepancies, we first discuss the different definitions of "wanting" and "liking" and the different tests that have been used to assess these processes. Then, we discuss whether it is reasonable to assume that these tests are valid measures of "wanting" and "liking" and we review correlational, quasi-experimental, and experimental studies that inform us about this issue. Finally, we discuss the future potential of implicit measures in research on IST and make several recommendations to improve both theory and methodology.

Heavy social drinkers score higher on implicit wanting and liking for alcohol than alcohol-dependent patients and light social drinkers.

BACKGROUND AND OBJECTIVES: Automatic hedonic ("liking") and incentive ("wanting") processes are assumed to play an important role in addiction. Whereas some neurobiological theories suggest that these processes become dissociated when drug use develops into an addiction (i.e., "liking" becomes weaker, whereas "wanting" becomes exaggerated; e.g., Robinson & Berridge, 1993), other theories suggest that there is a linear relationship between these two processes (i.e., both "liking" and "wanting" increase equally; e.g., Koob & Le Moal, 1997). Our aim was to examine "wanting" and "liking" in three groups of participants: alcohol-dependent patients, heavy social drinkers, and light social drinkers. METHODS: Participants performed two different single target implicit association tests (ST-IATs; e.g., Bluemke & Friese, 2007) and explicit ratings that were designed to measure "liking" and "wanting" for alcohol. RESULTS: Our results are in sharp contrast with the theories of both Robinson and Berridge and Koob and Le Moal: heavy drinkers had higher scores than light drinkers and alcohol-dependent patients on both the wanting ST-IAT and the liking ST-IAT. There were no differences between alcohol-dependent patients and light drinkers. Explicit ratings mirrored these results. LIMITATIONS: These findings suggest that our ST-IATs are not valid measures of "wanting" and "liking". Instead, they might assess more complex knowledge regarding participants' experiences and goals. CONCLUSIONS: These findings suggest that the relationship between drug consumption and appetitive drug associations is not linear, highlighting the importance of testing both sub-clinical and clinical samples in future research.

On the automaticity of the evaluative priming effect in the valent/non-valent categorization task.

It has previously been argued (a) that automatic evaluative stimulus processing is critically dependent upon feature-specific attention allocation and (b) that evaluative priming effects can arise in the absence of dimensional overlap between the prime set and the response set. In line with both claims, research conducted at our lab revealed that the evaluative priming effect replicates in the valent/non-valent categorization task. This research was criticized, however, because non-automatic, strategic processes may have contributed to the emergence of this effect. We now report the results of a replication study in which the operation of non-automatic, strategic processes was controlled for. A clear-cut evaluative priming effect emerged, thus supporting initial claims concerning feature-specific attention allocation and dimensional overlap.

Implicit attitudes towards smoking predict long-term relapse in abstinent smokers.

RATIONALE: It has previously been argued that implicit attitudes toward substance-related cues drive addictive behavior. Nevertheless, it remains an open question whether behavioral markers of implicit attitude activation can be used to predict long-term relapse. OBJECTIVES: The main objective of this study was to examine the relationship between implicit attitudes toward smoking-related cues and long-term relapse in abstaining smokers. METHODS: Implicit attitudes toward smoking-related cues were assessed by means of the Implicit Association Test (IAT) and the evaluative priming task (EPT). Both measures were completed by a group of smokers who volunteered to quit smoking (patient group) and a group of nonsmokers (control group). Participants in the patient group completed these measures twice: once prior to smoking cessation and once after smoking cessation. Relapse was assessed by means of short telephone survey, 6 months after completion of the second test session. RESULTS: EPT scores obtained prior to smoking cessation were related to long-term relapse and correlated with self-reported nicotine dependence as well as daily cigarette consumption. In contrast, none of the behavioral outcome measures were found to correlate with the IAT scores. CONCLUSIONS: These findings corroborate the idea that implicit attitudes toward substance-related cues are critically involved in long-term relapse. A potential explanation for the divergent findings obtained with the IAT and EPT is provided.

A review of current evidence for the causal impact of attentional bias on fear and anxiety.

Prominent cognitive theories postulate that an attentional bias toward threatening information contributes to the etiology, maintenance, or exacerbation of fear and anxiety. In this review, we investigate to what extent these causal claims are supported by sound empirical evidence. Although differences in attentional bias are associated with differences in fear and anxiety, this association does not emerge consistently. Moreover, there is only limited evidence that individual differences in attentional bias are related to individual differences in fear or anxiety. In line with a causal relation, some studies show that attentional bias precedes fear or anxiety in time. However, other studies show that fear and anxiety can precede the onset of attentional bias, suggesting circular or reciprocal causality. Importantly, a recent line of experimental research shows that changes in attentional bias can lead to changes in anxiety. Yet changes in fear and anxiety also lead to changes in attentional bias, which confirms that the relation between attentional bias and fear and anxiety is unlikely to be unidirectional. Finally, a similar causal relation between interpretation bias and anxiety has been documented. In sum, there is evidence in favor of causality, yet a strict unidirectional cause-effect model is unlikely to hold. The relation between attentional bias and fear and anxiety is best described as a bidirectional, maintaining, or mutually reinforcing relation.

Implicit gambling attitudes in problem gamblers: positive but not negative implicit associations.

BACKGROUND AND OBJECTIVES: Implicit attitudes (associations) are involved in the generation of substance use behaviors. However, little is known about the role of this automatic cognitive processing in deregulated behaviors without substance use, such as abnormal gambling. This study examined whether problem gamblers exhibit both positive and negative implicit attitudes toward gambling-related stimuli. METHODS: Twenty-five problem gamblers and 25 control participants performed two unipolar (pleasant; unpleasant) Single-Target Implicit Association Tasks (unipolar ST-IAT), in which gambling pictures were associated with either pleasant (or unpleasant for the negative unipolar ST-IAT) or neutral words. Explicit attitudes toward gambling were also recorded. RESULTS: We found in problem gamblers: (i) both positive implicit and explicit attitudes toward gambling; (ii) no negative implicit gambling association; (iii) that only positive explicit attitudes positively correlated with the gambling severity score. LIMITATIONS: (i) the use of only one type of reaction time task; (ii) the use of both words and pictures in a same IAT; (iii) problem gamblers have been compared to non-gamblers instead of being contrasted with healthy non-problem gamblers. CONCLUSIONS: Whereas our gamblers experienced deleterious effects related to gambling, implicit attitude toward gambling remained positive, thus hampering attempts to quit gambling. Possible clinical interventions targeting implicit cognition in problem gamblers were discussed.

On the predictive validity of automatically activated approach/avoidance tendencies in abstaining alcohol-dependent patients.

BACKGROUND: Prominent addiction models posit that automatically activated approach/avoidance tendencies play a critical role in addiction. Nevertheless, only a limited number of studies have actually documented the relationship between relapse and automatically activated approach/avoidance tendencies. We compared automatically activated approach/avoidance tendencies towards alcohol in 40 abstaining alcohol-dependent patients and 40 controls. We also examined whether individual differences in automatically activated approach/avoidance tendencies towards alcohol are predictive of relapse in patients. METHODS: A Relevant Stimulus Response Compatibility task was used to measure relative approach/avoidance tendencies. In one block of trials, participants were asked to approach alcohol-related pictures and to avoid alcohol-unrelated pictures (i.e., compatible block). In a second block of trials, participants were asked to approach alcohol-unrelated pictures and to move away from alcohol-related pictures (i.e., incompatible block). Patients were tested between 18 and 21 days after they quit drinking. Relapse was assessed 3 months after patients were discharged from the hospital. RESULTS: Whereas abstaining alcohol-dependent patients were faster to respond to incompatible trials as compared to compatible trials, participants in the control group showed the exact opposite pattern. Within the patient group, the likelihood of relapse increased as participants were faster to respond to incompatible trials relative to compatible trials. CONCLUSIONS: Unlike controls, abstaining alcohol-dependent patients revealed a relative avoidance bias rather than relative approach bias. Moreover, relapse rates were found to increase as the relative tendency to avoid alcohol increased. This finding suggests that an avoidance orientation towards alcohol can potentially be harmful in clinical samples.

Is the emotional modulation of the attentional blink driven by response bias?

Several studies have shown that the attentional blink (AB; Raymond, Shapiro, & Arnell, 1992) is diminished for highly arousing T2 stimuli (e.g., Anderson, 2005). Whereas this effect is most often interpreted as evidence for a more efficient processing of arousing information, it could be due also to a bias to report more arousing stimuli than neutral stimuli. We introduce a paradigm that allows one to control for such a response bias. Using this paradigm, we obtained evidence that the diminished AB for taboo words cannot be explained by a response bias. This supports the idea that the emotional modulation of the AB is caused by attentional processes.

Effects of attention training on self-reported, implicit, physiological and behavioural measures of spider fear.

Cognitive theories hold that biased attention to threat plays a prominent role in the development and maintenance of anxiety disorders. In support of this view, attention training has been shown to affect emotional reactivity. An important limitation of most attention training studies is that they almost exclusively rely on self-report measures to assess changes in fear. In the present study, we trained attention towards or away from spiders. We assessed not only self-reported spider fear, but also implicit spider associations, physiological, and behavioural measures of spider fear. Although we successfully changed the attentional processing of spiders, attention training had no effect on any of the outcome variables. These results indicate that changes in attentional bias are not necessarily associated with changes in fear, suggesting that attention training may be unsuitable as a clinical intervention for spider fear.

Reduced attentional blink for gambling-related stimuli in problem gamblers.

Although there is considerable information concerning the attentional biases in psychoactive substance use and misuse, much less is known about the contribution of attentional processing in problem gambling. The aim of this study was to examine whether problem gamblers (PrG) exhibit attentional bias at the level of the encoding processing stage. Forty PrG and 35 controls participated in an attentional blink (AB) paradigm in which they were required to identify both gambling and neutral words that appeared in a rapid serial visual presentation. Explicit motivation (e.g., intrinsic/arousal, extrinsic, amotivation) toward the gambling cues was recorded. A diminished AB effect for gambling-related words compared to neutral targets was identified in PrG. In contrast, AB was similar when either gambling-related or neutral words were presented to controls. Furthermore, there was a significant positive correlation between the reduced AB for gambling-related words and the sub-score of intrinsic/arousal motivation to gamble in PrG. Such findings suggest that the PrG group exhibits an enhanced ability to process gambling-related information, which is associated with their desire to gamble for arousal reasons. Theoretical and clinical implications of these results are discussed.