Validation of the Amsterdam Beverage Picture Set: A Controlled Picture Set for Cognitive Bias Measurement and Modification Paradigms.

BACKGROUND: Alcohol research may benefit from controlled and validated picture sets. We have constructed the Amsterdam Beverage Picture Set (ABPS), which was designed for alcohol research in general and cognitive bias measurement and modification in particular. Here, we first formulate a position on alcohol stimulus validity that prescribes that alcohol-containing pictures, compared to nonalcohol-containing pictures, should induce a stronger urge to drink in heavy drinkers than in light drinkers. Because a perceptually simple picture might induce stronger cognitive biases but the presence of a drinking context might induce a stronger urge to drink, the ABPS contains pictures with and without drinking context. By limiting drinking contexts to simple consumption scenes instead of real-life scenes, complexity was minimized. A validation study was conducted to establish validity, to examine ABPS drinking contexts, and to explore the role of familiarity, valence, arousal, and control. METHODS: Two hundred ninety-one psychology students completed the Alcohol Use Disorders Identification Test, as well as rating and recognition tasks for a subset of the ABPS pictures. RESULTS: The ABPS was well-recognized, familiar, and heavy drinkers reported a greater urge to drink in response to the alcohol-containing pictures only. Alcohol presented in drinking context did not elicit a stronger urge to drink but was recognized more slowly than alcohol presented without context. CONCLUSIONS: The ABPS was found to be valid, although pictures without context might be preferable for measuring cognitive biases than pictures with context. We discuss how an explicit approach to picture construction may aid in creating variations of the ABPS. Finally, we describe how ABPS adoption across studies may allow more reproducible and comparable results across paradigms, while allowing researchers to apply picture selection criteria that correspond to a wide range of theoretical positions. The latter is exemplified by ABPS derivatives and adoptions that are currently under way.

Executive Functions and Motivation as Moderators of the Relationship Between Automatic Associations and Alcohol Use in Problem Drinkers Seeking Online Help.

BACKGROUND: Dual process models posit that problem drinking is maintained by an imbalance between relatively strong automatic processes and weak controlled processes, a combination of executive functions and motivation. Few studies have examined how the interplay between automatic processes and executive functions is affected by motivation to change. This study examined this relationship in problem drinkers seeking online help to change their alcohol use. It was expected that executive functions (i.e., working memory, response inhibition) would moderate the relationship between automatic (valence and approach) associations and alcohol use and that this effect would be stronger in individuals with strong motivation to change. METHODS: A sample of 302 problem drinkers (mean age: 51.7 years) participated in this study as part of the baseline assessment before an Internet intervention. Participants completed an online version of the brief Implicit Association Test (valence and approach associations), the self-ordered pointing task (working memory), the Stroop task (response inhibition), the Readiness to Change Questionnaire (motivation to change), and the Timeline Follow-Back Questionnaire (alcohol use). Hierarchical moderated regression analysis was used to test the 4 hypothesized 3-way interactions. RESULTS: As expected, the interaction between valence associations and working memory only predicted alcohol use among individuals with strong motivation. This pattern was neither found for response inhibition nor for approach associations. CONCLUSIONS: Results provide partial support for the moderating role of motivation in the interplay between automatic processes and executive functions. Future studies should investigate this relationship in participants with the full range of motivation and alcohol use.

Web-based cognitive bias modification for problem drinkers: protocol of a randomised controlled trial with a 2x2x2 factorial design.

BACKGROUND: The automatic tendency to attend to, positively evaluate and approach alcohol related stimuli has been found to play a causal role in problematic alcohol use and can be retrained by computerised Cognitive Bias Modification (CBM). In spite of CBMs potential as an internet intervention, little is known about the efficacy of web-based CBM. The study described in this protocol will test the effectiveness of web-based CBM in a double blind randomised controlled trial with a 2 (attention bias retraining: real versus placebo) x 2 (alcohol/no-go training: real versus placebo) x 2 (approach bias retraining: real versus placebo) factorial design. METHODS/DESIGN: The effectiveness of 12 sessions of CBM will be examined among problem drinkers aged 18-65 who are randomly assigned to one of the eight CBM conditions, after completing two modules of a validated cognitive behavioural intervention, DrinkingLess. The primary outcome measure is the change in alcohol use. It is expected that, for each of the CBM interventions, participants in the real CBM conditions will show a greater decrease in alcohol use than participants in the placebo conditions. Secondary outcome measures include the percentage of participants drinking within the limits for sensible drinking. Possible mediating (change in automatic biases) and moderating (working memory, inhibition) factors will be examined, as will the comparative cost-effectiveness of the various CBM strategies. DISCUSSION: This study will be the first to test the relative efficacy of various web-based CBM strategies in problem drinkers. If proven effective, CBM could be implemented as a low-cost, low-threshold adjuvant to CBT-based online interventions for problem drinkers. TRIAL REGISTRATION: Netherlands Trial register: NTR3875.

The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment.

INTRODUCTION: Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS: Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS: Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS: Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.

Reprint of The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment.

INTRODUCTION: Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS: Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS: Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS: Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.

Autobiographical memory specificity and symptoms of complicated grief, depression, and posttraumatic stress disorder following loss.

This study examined the specificity and content of autobiographical memories among bereaved individuals. Self-report measures of bereavement-related distress and a standard and trait version of the Autobiographical Memory Test (AMT) were administered to 109 bereaved people. We examined associations of memory specificity with (a) demographic and loss-related variables and with (b) symptom-levels of complicated grief (CG), depression, and posttraumatic stress disorder (PTSD), (c) associations of the content of memories (related vs. unrelated to the loss/lost person) with symptoms, and (d) the degree to which associations of symptom-levels with memory specificity and content differed between the standard and trait version of the AMT. Findings showed that (a) memory specificity varied as a function of age, education, and kinship; (b) reduced memory specificity was significantly associated with symptom-levels of CG, but not depression and PTSD; (c) symptom-levels of CG and PTSD were associated with a preferential retrieval of specific memories that were related to the loss/lost person on the standard AMT, whereas all three symptom-measures were associated with preferential retrieval of loss-related specific memories on the trait AMT; and (d) on the trait AMT, but not the standard AMT, symptom-measures remained significantly associated with a preferential retrieval of loss-related specific memories, when controlling for relevant background variables. Among other things, these results show that reduced memory specificity is associated with self-reported CG-severity but not depression and PTSD following loss. Moreover, the results are consistent with recent research findings showing that memories tied to the source of an individual's distress (e.g., loss) are immune to avoidant processes involved in the standard reduced specificity effect.