Lecture 5: Assessing and Changing Implicit Cognitive Processes in Addiction Flashcards
cognitive biases (toward addiction-related stimuli):
- attentional bias: engagement/disengagement
- approach bias: action tendencies
- memory bias: retrieval (antecedents/effects)
hoe zou je die 3 cognitive biases in het echt zien
Attention: where do you look?
Memory: first thing you think of?
Action tendency: what movement would you tend to do?
dual process models
system 1 (impulsive, thinking fast) and system 2 (reflective, thinking slow)
hoe ziet het dual process theory addiction
addiction as a conflict between:
- system 1 (impulsive, associative reflex)
- system 2 (reflective, propositional)
wat gebeurt er tijdens addiction volgens het dual process theory
with repeated use, system 1 leads to sensitization (stronger arousal reactions with the addiction cue)
- automatic appetitive action tendency (approach)
- sensitive to current needs (craving thirst)
dual process model kritiek =
- these characteristics are not well correlated
- many processes have some mixture of characteristics
- no isolatable systems
attentional-bias = wat is het en hoe meet je het
- Motivationally relevant stimuli attract and capture attention
- Related to subjective craving (with elaboration in WM)
Meten:
- Dot/visual probe test
- Eye movements
dot/visual probe test resultaten
addicted people would have a shorter reaction if the dot appeared after the drug cue, and longer reaction time if the dot appeared after the non-drug cue (bv spa)
hoe meet je approach bias
- met de SRC (stimulus response compatibility) task
- AAT (approach avoidance task): assessing automatically activated action-tendencies to approach alcohol
stimulus response compatibility task
mannequin task, people are explicitly told to:
Block 1: approach alcohol and avoid neutral stimuli.
Block 2: avoid alcohol and approach neutral
(in AAT geen explicit instructions, maar just picture cues -> tilt of the picture)
results of approach bias tests
light drinkers are more avoidant than heavy drinkers, these heavy drinkers approach alcohol more. especially those with risk allele OPRM1 (mu-opioid receptor gene, also related to cue-induced craving).
future relevant vs future irrelevant paradigms
future irrelevant (cues not related to abuse) have more indirect instructions but are less reliable. bijvoorbeeld de AAT dan future irrelevant (want gaat op basis van hoe de picture tilted is)
wat zijn measurement issues bij attentional and approach bias
- irrelevant feature methods: people respond to something else than the content
- also measures executive functions
- soms mensen meer en soms mensen minder cravings, dus kan verschillen per tijdsmoment
daarom goed voor automatic mechanisms on group level, but not for individual diagnosis
hoe meet je memory bias in addiction
with RT tests, eg. Implicit Association Test (IAT). bijvoorbeeld kijken welke ze eerder met ‘fun’ associeren: active alcohol/neutral softdrink. en dan is R2 “neutral alcohol” vs “active softdrink”en fun, dan is er een soort error. dit is dan de baseline.
dan RT2 - RT1
IAT predicts alcohol use in youth, one year later
- Related to drinking, also after controlling for explicit expectancies (Wiers et al 2002; Houben & Wiers, 2006; 2008);
- Best predictor of escalation of drinking in adolescents (Thush et al 2007)
- Not a pure measure of associations, for example EC artefact (switching)
- Possibilities to decompose score and estimate associations (Quad model)
- Alcohol-arousal associations related to heavy drinking, equivalent of sensitization? (Wiers et al 2002; Houben et al 2006)
- More recent work highlights relevance me-drinker associations (e.g., Lindgren et al 2012; 2016)
oke
non-RT tasks from memory research
- outcome-behaviour associations (having fun)
- cue-behaviour associations (friday night)
- word associations (bottle)
(these tests do not ask for introspection or recollection, just ask for the first word or behaviour that comes to mind)
wat is de rol van working memory
working memory capacity can moderate the process from implicit cognitive processes to alcohol use.
hoe meet je de invloed van WM
jongeren met lager iq moesten pictures selecteren die ze leuk vonden totdat alle fotos zijn geselecteerd (Self Ordered Pointing Task).
lager WM leidt tot specifieke associaties to predict alcohol use. higher WM leidt tot betere controle, explicit expectancies.
wat is er met executive functions
poorly developed executive functions make one more vulnerable to appetitive impulses (craving)
conclusions in cognitive processes
- Cognitive Biases related to substance use
- Biases in attention, action tendencies, cognitions
- Cognitive control processes (e.g., working
memory) moderator: stronger influence of
automatically activated cognitions in
individuals with relatively weak control
capacity
verschil general ability training en cognitive bias modification
general ability training: echt trainen, ook zonder cues
cognitive bias modification: als er wel cues zijn, change your associations
wat zijn voordelen en nadelen aan general ability training
- voordelen: opens up temporal window, opportunity for influence long goals
- issues: generalization difficult to: high risk situation, therapeutic goals, addiction outcomes
soorten cognitive bias modification
- attentional bias retraining
- approach bias retraining
- selective inhibition training
voordelen cognitive bias modification
- better integration with traditional therapy to enhance long term goals
- addiction cues are added in this therapy
waar is WM training effectief
kinderen met adhd
training WM does work in people with strong positive associations with alcohol volgens de IAT. maar andere studies lieten weer geen effect zien
oke
WM-training might be helpful in recovery process, when better integrated with recovery process
oke
dus wat is het doel van CBM
altering biases, retrain people to avoid the drug, not to think of it and not to approach it
hoe kan je attentional bias aanpakken in mensen met abuse
dot-probe task: laat de dot altijd na de neutrale stimulus komen. decrease in trained pictures of alcohol, but not in the untrained pictures of alcohol-> dus geen generalisatie naar de gehele categorie.
(maar: wel maar 1 sessie, en geen gemotiveerd sample)
conclusions single session attention retraining alcohol
- It is possible to train heavy drinking students toward alcohol (Field & Eastwood, 05; Field et al. 07)
- It is possible to train heavy drinking students away from alcohol, but:
- no generalization to new stimuli
- no effects on behavior
waar was wél generalisatie naar andere fotos
bij AAT! bijvoorbeeld na deze training ook generalisatie naar untrained pictures & IAT (dus alcohol avoid matchen)
CBM is added to the regular treatment -> dus geen alleenstaande therapie
oke
amygdala is correlated with…
cravings
wat was lastig aan die ene review
they mixed all the treatments, but CBM should actually be added to the treatment as usual. en ook zie je vaak geen effecten in healthy volunteers, as they are not motivated to change their behaviour
Adding CBM to CBT results in 13% less relapse a year later
oke
bij wie heeft CBM een sterk effect
in patients with comorbidity of internalising disorders, en alcohol
number needed to treat=
hoeveel mensen er nodig zijn voordat je een effect ziet
wat als je cbm wel goed meet
in clinical samples met gemotiveerde cliënten: wel consistent small positive effects.
(no effects in healthy volunteers as stand-alone intervention. also generally nuanced effects for smoking behaviours)
combining approach & avoidance behaviours werkte niet perse beter
oke
3 verschillende soorten trials
- experimental lab-studies: causality (students) -> small temporary effects
- online rcts: stand alone (volunteers) -> reductions
- clinical rcts: addition to TAU (clinical, motivated) -> consistent add on effects
discussie CBM
- Replicated beneficial training effects
- But we expected best outcomes of combined training.
- Probably too short for most (3 + 3); meanwhile we learned that median number of sessions needed in AAT-training is 6
so, CBM is effective as…
add-on in the treatment of alcohol abuse when people are motivated to change, but have issues succeeding due to cue-reactivity, strong bias, strong impulsivity
CBM is not effective in…
binge-drinkers not motivated to change or online training in people who want to reduce
cbm comparison with medication
similar small effects. NNT = 12 bij beiden
effect van gamification
niet echt beter.
waarom is alcohol wel effectief maar roken niet
makkelijker om alternatieven voor roken te bedenken
wat is nu de theoretische background
origineel: dual process models (CBM changes the automatic associative component of this system).
nu: alternative account mechanism with automatic inferential propositional mechanisms rather than associations. dus dit is automatic expectancies.
evidence voor inferential propositional mechanisms
- cbm effects occur only with conscious awareness
- some cbm effects can be generated by instruction only
- therefore important to include consequence in training
inferential explanation
- Antecedent cues trigger goal directed behaviours (real life context)
- personal related Behaviours, rather than neutral stimuli (smokers with negative affect increase alternative meaningful activities compared with smoking)
- learning about the Consequence shapes the behaviour (health-relevant feedback increases healthy eating)
voorbeeld abc training
Personalized: participants choose personally-relevant:
- As (Antecedent contexts), e.g., coming home stressed
- Bs (Behavioral Alternatives relevant in that context), e.g., go for a walk rather than smoke/drink (especially important for other
addictions than alcohol, where there is universal alternative) - Cs (Consequences), e.g., better health, save money
voordeel van abc training tov cbt
systematic and controllable personalized training rather than homework people have difficulties with
abc training 3 phases
- Forced choice to learn consequences (continued in sham-training)
- Open choice with consequences
- Speeded open choice with consequences, to foster automatization
conclusie abc
- ABC-training is theory-based new variety of cognitive training aimed at targeting actions based on automatic inferences (expectancies) rather than associations
- Promising initial results in volunteers
- Next step: RCTs in clinical samples
overall conclusions
- Cognitive Biases play a role in addiction
- Cognitive training to change biases can be
of use in the treatment of addictions: 1) General ability training some promise, but
long; probably only inpatient recovery, 2) CBM, effective as add-on to inpatient abstinence-oriented treatment for alcohol use disorders (small but reliable effect, in several clinical guidelines now) - Room for improvement: theory-based ABC-training
3 considerations of CBM
- assessment of attentional and approach bias has a low reliability
- the biases are relative, meaning that they represent an average tendency into mechanisms at the group level, not at an individual level
- IAT: best predictor of escalation drinking in adolescents, but it also measures executive control (people have to adapt their responses when the labels change)
evaluative conditioning
pairing alcohol to negative pictures resulted in more negative associations and a reduction in drinking. in addition it influenced explicit attitudes and craving
proof-of-principle-studies =
helemaal aan het begin, vaak met studenten.
