Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study.

AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

The role of neuropsychological mechanisms in implementation intentions to reduce alcohol consumption among heavy drinkers: a randomized trial.

Implementation intention formation, which involves identifying triggers and linking them with coping strategies, has proven effective at reducing alcohol consumption in general populations. For the first time, the present study tested the ability of implementation intentions to reduce alcohol consumption among heavy drinkers and to explore potential neuropsychological mechanisms. At baseline, participants were randomized to form implementation intentions or to an active control group. There was a 5.7 unit (1 unit = 10 ml or 8 g ethanol) per week reduction ([95%CI 0.15, 11.19], p = 0.048) in alcohol consumption at 1 month follow-up among participants who formed implementation intentions, which was significantly more than controls F(1, 91) = 3.95, p = 0.048, a medium effect size (d = 0.47, Cohen, 1992). No significant differences in performance on the neuropsychological tasks were found between groups. The present study demonstrates for the first time that implementation intentions reduce alcohol consumption among heavy drinkers.

Evidence That Implementation Intentions Enhance Cognitive Training and Reduce Alcohol Consumption in Heavy Drinkers: A Randomized Trial.

BACKGROUND: Current training tasks to improve the cognitive deficits thought to be involved in sustained heavy drinking need further investigation to optimize their effectiveness. PURPOSE: The present study investigated whether combining implementation intention provision with a cognitive training task had a measurable effect on alcohol consumption in heavy drinkers and explored the neural mechanisms underpinning any reductions in subsequent alcohol consumption. METHODS: Thirty-two heavy-drinking participants completed approach-avoidance and visual probe training tasks preintervention and postintervention during functional Magnetic Resonance Imaging. Participants in the intervention group were randomized to form implementation intentions and participants in the control condition read a goal intention. Alcohol consumption was recorded preintervention and at 1 month follow-up. RESULTS: Compared to the control group, implementation intention provision significantly improved performance on alcohol-avoidance tasks postintervention, t(30) = -2.315, p = .028, d = .85, and reduced alcohol consumption by 6.9 units/week (1 unit = 10 mL or 8 g ethanol), F(1,30) = 4.263, p = .048 (d = .74), at follow-up. However, the analysis of functional Magnetic Resonance Imaging data revealed no significant differences between groups. CONCLUSIONS: These findings show for the first time that implementation intentions targeting cognitive processes can significantly reduce alcohol consumption among heavy drinkers. However, there was no evidence that the effects were mediated by changes in neural activity. Further work is required to explore the neural mechanisms underpinning the operation of implementation intentions. TRIAL REGISTRATION: This trial was registered (ISRCTN:35503634) and is available at https://www.isrctn.com/ISRCTN35503634.

A randomized controlled trial of inhibitory control training for the reduction of alcohol consumption in problem drinkers.

OBJECTIVE: We conducted a randomized controlled trial to compare the effects of three types of Internet-delivered Inhibitory Control Training (ICT) with each other and with an active control intervention on alcohol consumption in a community sample of problem drinkers. METHOD: Two hundred and 46 heavy drinkers, who were motivated to reduce their alcohol consumption (mean age 41.32, 130 female) self-monitored their alcohol consumption for 1 week before being randomized to receive 1 of 3 variants of ICT (Associative No-Go, Associative Stop Signal, General Inhibition) or an active control. Participants then completed up to 14 ICT/control sessions on the Internet over a 4-week period, while regularly recording their alcohol consumption. RESULTS: There were significant reductions in alcohol consumption across all groups over the 4-week training period (main effect of time, F(2, 402) = 77.12, p < .01, ηp2 = .28, BF10 > 99), however there were no differences between ICT groups, or between ICT groups and the active control group (Group × Time interaction, F(6, 402) = 1.10, p = .36, ηp2 = .02, BF10 = 0.03). Contrary to hypotheses, there were no changes in general inhibitory control, the disinhibiting effects of alcohol cues, or alcohol affective associations after ICT. CONCLUSIONS: In this study, which attempted to translate findings from proof-of-concept laboratory studies into a viable behavior change intervention, we found that multiple sessions of ICT delivered over the Internet did not help heavy drinkers to reduce their alcohol consumption beyond nonspecific effects associated with taking part in a trial. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Acute stress increases ad-libitum alcohol consumption in heavy drinkers, but not through impaired inhibitory control.

RATIONALE: Stress increases alcohol consumption and the risk of relapse, but little is known about the psychological mechanisms that underlie these effects. One candidate mechanism is inhibitory control, which may be impaired by acute stress and is believed to exert a causal influence on alcohol consumption. OBJECTIVES: We investigated if acute stress would impair inhibitory control and if impaired inhibitory control would be associated with subsequent ad-libitum alcohol consumption in a naturalistic laboratory setting. MATERIALS AND METHODS: One hundred heavy drinkers took part in an experimental study in a naturalistic 'bar laboratory'. Participants were randomly assigned to an acute stress (n = 50) or control (n = 50) group. In the stress group, participants were exposed to the social evaluative threat of giving a self-critical presentation, whereas the control group completed simple anagrams. Prior to and following the manipulation, participants completed the stop signal task as a measure of inhibitory control. Finally, participants completed a bogus taste test, as a measure of ad-libitum alcohol consumption. RESULTS: The stress manipulation had no effect on performance on the stop signal task. However, there was a small but significant increase in ad-libitum alcohol consumption in the acute stress group compared to that in the control group. CONCLUSIONS: Acute stress increased alcohol consumption in heavy drinkers, in a semi-naturalistic setting. However, this was not through the hypothesised mechanism of a transient impairment in inhibitory control.

Screening for psychological distress in cancer: renewing the research agenda.

OBJECTIVE: Although health policy for cancer care promotes screening of patients for emotional distress, the utility and validity of screening have been questioned. Continued research to refine detection of distress or to evaluate outcomes of screening programmes is unlikely to end this controversy. Instead, we need to identify more fundamental research questions that address the validity or utility of screening in this context. METHOD: We critically and selectively review research and policy literature on psychological screening in cancer care, drawing also from research literature about the nature of psychological needs in cancer care and from relevant literature on psychological screening in mental health. RESULTS: We identify three broad research questions: (i) Apart from intensity of distress, what further information should screening seek about the context of distress, psychological processes that promote distress and patients' own perspective on their needs? (ii) What are the implications of the contextual dependence of disclosure of emotional feelings, given that screening questions can be asked in contexts ranging from an impersonal questionnaire to dialogue with a trusted practitioner? (iii) How should a screen be responded to, given the inherent uncertainty associated with screening results and given that distress in a cancer context can indicate instrumental as well as psychological needs? CONCLUSIONS: Examining these questions will mean exchanging a diagnostic framework for screening, in which health need is indicated by the presence of a psychological disorder, for a public health framework, in which health need is identified from multiple perspectives.

A comparison of three types of web-based inhibition training for the reduction of alcohol consumption in problem drinkers: study protocol.

BACKGROUND: Problem drinkers have poor inhibitory control (disinhibition). Previous studies have demonstrated that various forms of 'inhibition training' can reduce alcohol consumption in the laboratory and at short-term follow-up, but their longer-term efficacy and mechanisms of action are unknown. In this phase 2 randomised controlled trial we will contrast the effects of three forms of inhibition training and a control intervention, delivered via the Internet in multiple sessions over four weeks, on alcohol consumption in heavy drinkers. METHODS/DESIGN: Heavy drinkers who are interested in reducing their alcohol consumption will receive a brief intervention and will monitor their own alcohol intake for one week before being randomised to one of four treatment groups: 1. General inhibition training; 2. Cue-Specific inhibition training; 3. Alcohol No-Go training; or 4. Control. They will complete up to 14 sessions of training via the Internet over a four-week period, and will be followed-up for a further six weeks after the end of the training period. Primary outcome measures are reductions in alcohol consumption and heavy drinking days. The number of abstinent days is a secondary outcome measure. We will also investigate changes in inhibitory control and automatic alcohol affective associations in response to training. DISCUSSION: This study will establish if web-based inhibition training can help problem drinkers to reduce their alcohol intake, and it will identify which form(s) of inhibition training are most effective. TRIAL REGISTATION: Trial Registation number: ISRCTN55671858.

A randomised controlled trial of time limited CBT informed psychological therapy for anxiety in bipolar disorder.

BACKGROUND: Anxiety comorbidity is common in bipolar disorder and is associated with worse treatment outcomes, greater risk of self harm, suicide and substance misuse. To date however there have been no psychological interventions specifically designed to address this problem. The primary objective of this trial is to establish the acceptability and feasibility of a new integrated intervention for anxiety in bipolar disorder designed in collaboration with individuals with personal experience of both problems. METHODS AND DESIGN: Single blind randomised controlled trials to assess the feasibility and acceptability of a time limited CBT informed psychological intervention for anxiety in bipolar disorder (AIBD) compared with treatment as usual. Participants will be recruited from across the North West of England from specialist mental health services and through primary care and self referral. The primary outcome of the study is the feasibility and acceptability of AIBD assessed by recruitment to target and retention to follow-up, as well as absence of untoward incidents associated with AIBD. We will also estimate the effect size of the impact of the intervention on anxiety and mood outcomes, as well as calculate preliminary estimates of cost-effectiveness and investigate potential mechanisms for this (stigma, self appraisal and stability of social rhythms). DISCUSSION: This is the first trial of an integrated intervention for anxiety in bipolar disorder. It is of interest to researchers involved in the development of new therapies for bipolar disorder as well as indicating the wider potential for evaluating approaches to the treatment of comorbidity in severe mental illness.