Biased choice and incentive salience: Implications for addiction.

Before we can make any choice, we must gather information from the environment about what our options are. This information-gathering process is critically mediated by attention, and our attention is, in turn, shaped by our previous experiences with-and learning about-stimuli and their consequences. In this review, we highlight studies demonstrating a rapid and automatic influence of reward learning on attentional capture and argue that these findings provide a human analog of sign-tracking behavior observed in nonhuman animals-wherein signals of reward gain incentive salience and become attractive targets for attention (and overt behavior) in their own right. We then consider the implications of this idea for understanding the drivers of cue-controlled behavior, with focus on addiction as a case in which choices with regard to reward-related stimuli can become injurious to health. We argue that motivated behavior in general-and addiction in particular-can be understood within a "biased competition" framework: Different options and outcomes compete for attentional priority as a function of top-down goals, bottom-up salience, and prior experience, and the winner of this competition becomes the target for subsequent outcome-directed and flexible behavior. Finally, we outline the implications of the biased-competition framework for cognitive, behavioral, and socioeconomic interventions for addiction. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the unique relationships between problematic use of the internet and impulsive and compulsive tendencies: network approach.

BACKGROUND: Both impulsivity and compulsivity have been identified as risk factors for problematic use of the internet (PUI). Yet little is known about the relationship between impulsivity, compulsivity and individual PUI symptoms, limiting a more precise understanding of mechanisms underlying PUI. AIMS: The current study is the first to use network analysis to (a) examine the unique association among impulsivity, compulsivity and PUI symptoms, and (b) identify the most influential drivers in relation to the PUI symptom community. METHOD: We estimated a Gaussian graphical model consisting of five facets of impulsivity, compulsivity and individual PUI symptoms among 370 Australian adults (51.1% female, mean age = 29.8, s.d. = 11.1). Network structure and bridge expected influence were examined to elucidate differential associations among impulsivity, compulsivity and PUI symptoms, as well as identify influential nodes bridging impulsivity, compulsivity and PUI symptoms. RESULTS: Results revealed that four facets of impulsivity (i.e. negative urgency, positive urgency, lack of premeditation and lack of perseverance) and compulsivity were related to different PUI symptoms. Further, compulsivity and negative urgency were the most influential nodes in relation to the PUI symptom community due to their highest bridge expected influence. CONCLUSIONS: The current findings delineate distinct relationships across impulsivity, compulsivity and PUI, which offer insights into potential mechanistic pathways and targets for future interventions in this space. To realise this potential, future studies are needed to replicate the identified network structure in different populations and determine the directionality of the relationships among impulsivity, compulsivity and PUI symptoms.

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.

Investigating cognitive and motivational proximal outcomes in a randomized clinical trial of writing about the future self to reduce drinking.

BACKGROUND: Drinking identity (the extent to which one links the self with drinking alcohol) is a unique risk factor for college students' hazardous drinking that is not directly targeted by existing interventions. We conducted a study that aimed to decrease drinking identity among college students with hazardous drinking. We adapted a writing task about the future self and tested whether three writing sessions could decrease drinking identity and change drinking. We also investigated whether two additional factors (writing perspective and inclusion of participants' social networks) would enhance task impact. The present study evaluated whether posited proximal cognitive and motivational outcomes (drinking identity, self-efficacy, readiness to change, and drinking intentions) changed immediately after each writing session. METHOD: The study is a randomized clinical trial in which hypotheses and analyses were pre-registered. Participants were 328 college students who met hazardous drinking criteria. The study had a 2 (narrative writing topic: low-risk drinker vs. reduced smartphone use) × 2 (writing perspective: first-person vs. non-first-person) × 2 (social network instruction: instructed to include vs. not) factorial design. Proximal outcomes were drinking identity, self-efficacy, readiness to change, and drinking intentions. The clinical outcome was alcohol consumption. Participants completed three laboratory sessions at weekly intervals that included the writing task and pre- and post-task assessments. RESULTS: Results were largely null, except that readiness to reduce drinking was higher in the low-risk drinker condition and increased over the lab sessions. Time effects indicated that reductions in drinking identity, drinking intentions, and alcohol consumption, and increases in self-efficacy were observed but did not change above and beyond control conditions. CONCLUSIONS: Findings indicate the need to strengthen the writing task and select a more appropriate control task to target proposed proximal outcomes. Future studies might try personalizing the task, evaluating its efficacy with individuals motivated to change their drinking, and using a control task that does not involve imagining a future self.

From everyday life to measurable problematic smartphone use: The development and validation of the Smartphone Use Problems Identification Questionnaire (SUPIQ).

Background and aims: Problematic smartphone use (PSU) has gained attention, but its definition remains debated. This study aimed to develop and validate a new scale measuring PSU-the Smartphone Use Problems Identification Questionnaire (SUPIQ). Methods: Using two separate samples, a university community sample (N = 292) and a general population sample (N = 397), we investigated: (1) the construct validity of the SUPIQ through exploratory and confirmatory factor analyses; (2) the convergent validity of the SUPIQ with correlation analyses and the visualized partial correlation network analyses; (3) the psychometric equivalence of the SUPIQ across two samples through multigroup confirmatory factor analyses; (4) the explanatory power of the SUPIQ over the Short Version of Smartphone Addiction Scale (SAS-SV) with hierarchical multiple regressions. Results: The results showed that the SUPIQ included 26 items and 7 factors (i.e., Craving, Coping, Habitual Use, Social Conflicts, Risky Use, Withdrawal, and Tolerance), with good construct and convergent validity. The configural measurement invariance across samples was established. The SUPIQ also explained more variances in mental health problems than the SAS-SV. Discussion and conclusions: The findings suggest that the SUPIQ shows promise as a tool for assessing PSU. Further research is needed to enhance and refine the SUPIQ as well as to investigate its clinical utility.

Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT.

INTRODUCTION: Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches. METHODS: A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment. RESULTS: Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists. DISCUSSION/CONCLUSION: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.

Sign-tracking to non-drug reward is related to severity of alcohol-use problems in a sample of individuals seeking treatment.

BACKGROUND: A prominent neuroscientific theory of drug addiction is the incentive sensitization model. Individual differences in the tendency to ascribe motivational salience to cues that predict reward, and involuntary "sign-tracking" (orientation towards) such cues have been identified as potentially important in understanding vulnerability to addiction and relapse. However, to date this behaviour has not been assessed in a treatment-seeking clinical population, who typically represent those most susceptible to alcohol-related harms and episodes of relapse. This highlights a significant gap in the literature pertaining to incentive sensitization and drug dependence. METHODS: Individuals accessing inpatient drug and alcohol services with alcohol as primary drug of concern were recruited to participate in a Cognitive Bias Modification (CBM) intervention. At the baseline assessment, participants completed various self-report measures (including the Alcohol Use Disorders Identification Test; AUDIT) in addition to a visual search task measuring sign-tracking to cues signalling monetary reward. At 3-month follow up, abstinence from alcohol was the primary outcome measure. All analyses and hypotheses were pre-registered. RESULTS: At baseline (57 participants), AUDIT scores correlated with sign-tracking to signals of monetary reward. In a subsequent regression analysis sign-tracking, gender and self-reported alcohol craving predicted abstinence at 3-month follow up (41 participants). CONCLUSIONS: Our work demonstrates that involuntary sign-tracking to cues signalling non-drug reward is associated with problematic alcohol use and return to use at 3-month follow up, in a treatment-seeking sample. Whether this automatic prioritisation of cues signalling reward is a consequence or vulnerability for problematic alcohol use remains to be investigated.

Attentional Biases and Their Association with Substance-Use-Related Problems and Addictive Behaviors: The Utility of a Gamified Value-Modulated Attentional Capture Task.

Background: Attentional biases towards reward stimuli have been implicated in substance use-related problems. The value-modulated attentional capture (VMAC) task assesses such reward-related biases. The VMAC task widely used in lab studies tends to be monotonous and susceptible to low effort. We therefore tested a gamified online version of the VMAC that aimed to increase participant engagement. Our goal was to examine how VMAC is associated with substance use-related problems and addictive behaviors, and whether this association is moderated by cognitive control. Methods: We recruited 285 participants from an online community, including heavy alcohol users. All participants completed a novel gamified version of the VMAC task, measures of substance use and addictive behaviors (addictive-like eating behavior, problematic smartphone use), the WebExec measure of problems with executive functions, and the Stroop Adaptive Deadline Task (SDL) as a measure of cognitive control. Results: The gamified VMAC task successfully identified value-modulated attentional capture effects towards high-reward stimuli. We found no significant associations between VMAC scores, problematic alcohol or cannabis use, addictive behaviors, or any moderation by a behavioral measure of cognitive control. Exploratory analyses revealed that self-reported cognitive problems were associated with more alcohol-, and cannabis-related problems, and addictive behaviors. Greater attentional capture (VMAC) was associated with more cannabis use-related problems among individuals with higher levels of self-reported cognitive problems. Conclusions: Our study is one of the first to demonstrate the utility of the gamified version of the VMAC task in capturing attentional reward biases. Self-reported problems with cognitive functions represent a key dimension associated with substance use-related problems and addictive behaviors.

Evaluating distress as a moderator of the relationship between drinking identity and hazardous drinking during the post-college transition.

Drinking identity (the extent to which one associates the self with drinking alcohol) is a robust predictor of young adult hazardous drinking (HD; heavy drinking and alcohol-related problems), and decreases in drinking identity have been linked to the decline in HD that often occurs following college graduation. Identifying moderators is key to recognizing who is most at risk for continued HD given a drinking identity vulnerability. Using data from a longitudinal study of graduating college students from the U.S., we evaluated distress (depression, anxiety, stress symptoms) as a potential moderator. Between- and within-person components of drinking identity and distress were evaluated to consider both individual differences and variations within a person across time and changing contexts. Study hypotheses and data analysis plan were preregistered. Graduating college students who met HD criteria (N = 422) completed implicit and explicit drinking identity measures (assessed using reaction time and self-report measures, respectively), distress symptom questionnaires, and self-reported alcohol consumption and problems at four-month intervals for 2.5 years. Results supported moderation at the between-person level for alcohol consumption, with higher levels of implicit drinking identity and distress linked to greater subsequent alcohol consumption. Only between-person main effects for (explicit) identity and distress were linked to more subsequent alcohol-related problems. Though moderation findings were mixed, having a stronger drinking identity and/or greater distress was linked to continued HD risk in this sample. Individuals with these risk factors may benefit from enhanced prevention efforts to help graduates transition out of HD post-college.

The COVID generation: Online dyslexia treatment equally effective as face-to-face treatment in a Dutch sample.

Due to pandemic-induced lockdown(s) in 2020, dyslexia treatment was forced to move to online platforms. This study examined whether Dutch children who received online treatment progressed as much in their reading and spelling performance as children who received the usual face-to-face treatment. To this end, 254 children who received treatment-as-usual were compared to 162 children who received online treatment with Bayesian methods. The advantage of a Bayesian approach is that it can provide evidence for and against the null hypothesis whereas frequentist approaches only provide evidence against it. We found that children in the online treatment condition received slightly fewer treatment sessions but progressed equally after controlling for the number of sessions compared to the treatment-as-usual condition. These results have clinical and practical implications as they show that reading treatment can be successfully delivered online.

Craving modulates attentional bias towards alcohol in severe alcohol use disorder: An eye-tracking study.

BACKGROUND AND AIMS: Competing models disagree on three theoretical questions regarding alcohol-related attentional bias (AB), a key process in severe alcohol use disorder (SAUD): (1) is AB more of a trait (fixed, associated with alcohol use severity) or state (fluid, associated with momentary craving states) characteristic of SAUD; (2) does AB purely reflect the over-activation of the reflexive/reward system or is it also influenced by the activity of the reflective/control system and (3) does AB rely upon early or later processing stages? We addressed these issues by investigating the time-course of AB and its modulation by subjective craving and cognitive load in SAUD. DESIGN: A free-viewing eye-tracking task, presenting pictures of alcoholic and non-alcoholic beverages, combined with a concurrent cognitive task with three difficulty levels. SETTING: A laboratory setting in the detoxification units of three Belgian hospitals. PARTICIPANTS: We included 30 patients with SAUD self-reporting craving at testing time, 30 patients with SAUD reporting a total absence of craving and 30 controls matched on sex and age. All participants from SAUD groups met the DSM-5 criteria for SAUD. MEASUREMENTS: We assessed AB through early and late eye-tracking indices. We evaluated the modulation of AB by craving (comparison between patients with/without craving) and cognitive load (variation of AB with the difficulty level of the concurrent task). FINDINGS: Dwell time measure indicated that SAUD patients with craving allocated more attention towards alcohol-related stimuli than patients without craving (P < 0.001, d = 1.093), resulting in opposite approach/avoidance AB according to craving presence/absence. SAUD patients without craving showed a stronger avoidance AB than controls (P = 0.003, d = 0.806). AB did not vary according to cognitive load (P = 0.962, η2 p = 0.004). CONCLUSIONS: The direction of alcohol-related attentional bias (approach/avoidance) appears to be determined by patients' subjective craving at testing time and does not function as a stable trait of severe alcohol use disorder. Alcohol-related attentional bias appears to rely on later/controlled attentional stages but is not modulated by the saturation of the reflective/control system.

Life meaning and feelings of ineffectiveness as transdiagnostic factors in eating disorder and comorbid internalizing symptomatology - A combined undirected and causal network approach.

The field of eating disorders is facing problems ranging from a suboptimal classification system to low long-term success rates of treatments. There is evidence supporting a transdiagnostic approach to explain the development and maintenance of eating disorders. Meaning in life has been proposed as a promising key transdiagnostic factor that could potentially not only bridge between the different eating disorder subtypes but also explain frequent co-occurrence with symptoms of comorbid psychopathology, such as anxiety and depression. The present study used self-report data from 501 participants to construct networks of eating disorder and comorbid internalizing symptomatology, including factors related to meaning in life, i.e., presence of life meaning, perceived ineffectiveness, and satisfaction with basic psychological needs. In an undirected network model, it was found that ineffectiveness is a central node, also bridging between eating disorder and other psychological symptoms. A directed network model displayed evidence for a causal effect of presence of life meaning both on the core symptomatology of eating disorders and depressive symptoms via ineffectiveness. These results support the notion of meaning in life and feelings of ineffectiveness as transdiagnostic factors within eating disorder symptomatology in the general population.

Which individual, social, and urban factors in early childhood predict psychopathology in later childhood, adolescence and young adulthood? A systematic review.

Background: A comprehensive picture is lacking of the impact of early childhood (age 0-5) risk factors on the subsequent development of mental health symptoms. Objective: In this systematic review, we investigated which individual, social and urban factors, experienced in early childhood, contribute to the development of later anxiety and depression, behavioural problems, and internalising and externalising symptoms in youth. Methods: Embase, MEDLINE, Scopus, and PsycInfo were searched on the 5th of January 2022. Three additional databases were retrieved from a mega-systematic review source that focused on the identification of both risk and protective indicators for the onset and maintenance of prospective depressive, anxiety and substance use disorders. A total of 46,450 records were identified and screened in ASReview, an AI-aided systematic review tool. We included studies with experimental, quasi-experimental, prospective and longitudinal study designs, while studies that focused on biological and genetical factors, were excluded. Results: Twenty studies were included. The majority of studies explored individual-level risk factors (N = 16). Eleven studies also explored social risk factors and three studied urban risk factors. We found evidence for early predictors relating to later psychopathology measures (i.e., anxiety and depression, behavioural problems, and internalising and externalising symptoms) in childhood, adolescence and early adulthood. These were: parental psychopathology, exposure to parental physical and verbal violence and social and neighbourhood disadvantage. Conclusions: Very young children are exposed to a complex mix of risk factors, which operate at different levels and influence children at different time points. The urban environment appears to have an effect on psychopathology but it is understudied compared to individual-level factors. Moreover, we need more research exploring the interaction between individual, social and urban factors.

Improving physical activity using a single personalized consequence-based approach-avoidance training: Effects on self-reported behaviors, attitudes, and choices.

OBJECTIVE: Despite their potential in improving health behaviors, such as physical activity (PA), the effectiveness of interventions targeting automatic precursors remains contrasted. We examined the effects of a single session of ABC training - a personalized consequence-based approach-avoidance training - on PA, relative to an active control condition and a control condition. METHODS: Middle-aged US participants (N = 360, 53 % of women) either completed an ABC training (being instructed to approach PA to obtain self-relevant consequences), an approach-avoidance training (approaching PA in 90 % of trials), or a control training (approaching PA in 50 % of trials). Participants selected antecedents (e.g., "When I have little time") in which personalized choices between PA and sedentary alternatives were likely to occur. In the ABC training only, after approaching PA, self-relevant consequences were displayed (e.g., increase in the health status of participant's avatar). Primary outcome was self-reported PA seven days after the intervention. Secondary outcomes included choices for PA (vs sedentary) alternatives in a hypothetical free-choice task, intention, automatic and explicit attitudes toward PA. RESULTS: No significant effect of the ABC intervention on PA was observed, so as on intention and explicit attitudes. However, the ABC intervention was associated with higher odds of choosing PA alternatives in the free-choice task and with more positive automatic attitudes toward PA. CONCLUSIONS: While the ABC training was not effective at improving PA, its effects on choices and automatic attitudes suggest that this intervention may still have potential. Future studies with intensive trainings and device-based measures of PA remains needed.

Sources of stress among domestic and international students: a cross-sectional study of university students in Amsterdam, The Netherlands.

High perceived stress is associated with psychological and academic difficulties among college students. In this study, we aimed to investigate associations of student status (international vs domestic student in the Netherlands) with eight common sources of stress (i.e., financial, health, love life, relationship with family, relationship with people at work/ school, the health of loved ones, other problems of loved ones, and life in general). Participants were 2,196 college students (domestic: n = 1,642, international: n = 554) from two universities in Amsterdam, the Netherlands. Hierarchical linear regression analyses were used to estimate associations of student status with all eight sources of stress. Student status was significantly associated with higher levels of perceived stress in almost all life domains. International student status was significantly associated with higher perceived stress in the domains of financial situation and health of loved ones after adjusting for sociodemographic characteristics, depressive and anxiety symptoms, and other sources of stress. Findings highlight that several differences exist in the magnitude of perceived stress in certain areas between international and domestic students in the Netherlands. Consequently, it is essential to uncover the different needs of college students and develop specific strategies to deliver the most suitable services.

Use of tailoring features and reasons for dropout in a guided internet-based transdiagnostic individually-tailored cognitive behavioral therapy for symptoms of depression and/or anxiety in college students.

Transdiagnostic individually-tailored digital interventions reduce symptoms of depression and anxiety in adults with moderate effects. However, research into these approaches for college students is scarce and contradicting. In addition, the exact reasons for intervention dropout in this target group are not well known, and the use of individually-tailored intervention features, such as optional modules, has not yet been explored. The current study aimed to (1) investigate reasons for dropout from a guided internet-based transdiagnostic individually-tailored intervention for college students assessed in a randomized controlled trial (RCT) and (2) evaluate whether participants used tailoring features intended for their baseline symptoms. A sample of college students with mild to moderate depression and/or anxiety symptoms (n = 48) in the Netherlands (partially) followed a guided internet-based transdiagnostic individually-tailored intervention. We contacted those who did not complete the entire intervention (n = 29) by phone to report the reasons for intervention dropout. Further, we descriptively explored the use of tailoring features (i.e., depression versus anxiety trajectory) and optional modules of the intervention in the whole sample. We identified a range of person- and intervention-related reasons for intervention dropout, most commonly busy schedules, needs for different kinds of help, or absence of personal contact. Furthermore, only less than half of the participants used the individually-tailoring features to address the symptoms they reported as predominant. In conclusion, digital interventions clear about the content and targeted symptoms, tested in user research could prevent dropout and create reasonable expectations of the intervention. Participants would benefit from additional guidance when using tailoring features of digital interventions, as they often do not choose the tailoring features targeting their baseline symptoms.

How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers.

Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.

Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study.

BACKGROUND: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. OBJECTIVE: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use ("Re-Train Your Brain") when delivered in conjunction with treatment as usual (TAU). METHODS: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the "integrated" Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the "alternating" Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. RESULTS: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. CONCLUSIONS: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non-labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/28667.

Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions.

This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.