Module 5: Cognitive bias modification

Question 1

What does the dual-process account of CBM argue?

Answer 1

That biases are driven by bottom-up mental associations and their effect is moderated by top-down executive control processes

Question 2

What does the inferential account suggest?

Answer 2

The effectiveness of CBM depends on inferential processes

Question 3

How can approach bias be measured?

Answer 3

This is the tendency to approach appetitive stimuli which can be investigated with AAT (approach-avoidance task). Involves images of alcoholic and non-alcoholic drinks which can be tilted. Based on this irrelevant feature, participants can pull joystick towards them (approach) or away from them (avoidance response). The image can become larger or smaller based on this. A faster reaction time to draw the alcoholic drinks to you is an approach bias.

Question 4

How can an attention bias be measured?

Answer 4

Selective attention for drug-associated stimuli using dot-probe test. There are two stimuli presented, and then these are replaced with a more specific stimulus. A shorter response time to a stimulus which replaces a substance-related cue is seen as an attentional bias.

Question 5

How can a memory bias be measured?

Answer 5

Using Implicit Association Tasl which is when the participant has to categorize words or pictures into categories using left and right buttons. When alcohol is grouped with active and there is a shorter reaction time, alcohol is associated with high arousal

Question 6

Comparison of proof-of-principle studies to clinical studies

Answer 6

POP studies are in the lab to reveal psychological mechanisms using healthy volunteers. RCTS are in a clinical setting with patients in a clinical sample. RCTS look at the effect of treatment compared to a control and they are randomly assigned. Seen as agold standard

Question 7

What did Wiers find about the evidence of effectiveness of CBM interventions?

Answer 7

POP as they provide a basis for clinical trials but suggest that CBM has small, short-lived effects on drinking and not clinically relevant. Clinical trials suggest that CBM is a significant intervention to treat alcohol dependence patients.

Question 8

What is ABC training?

Answer 8

Training to identify antecedent cues to make goal directed choices given the consequences.

Question 9

How does addictive behaviour manifest in biases?

Answer 9

Behaviour can be governed by automatic processes outside of their conscious control and addictive behaviours can be seen to have an imbalance between impulsive or associative reactions to drug related cues and weak reflective or controlled processes which leaves them susceptible for certain cues. Can lead to attentional biases for alcohol-stimuli, memory bias for automatic activation of associations and bias towards action tendencies to approach alcohol

Question 10

Purposes of CBM

Answer 10

• test causal role of bias
• clinically applied to reduce maladaptive cognitive biases

Question 11

What has research found?

Answer 11

• in alcohol AAT drinkers showed an approach bias and were more likely to pull in response to alcohol pictures than positive or negative ones. Carriers of OPRMI G-allele showed approach bias the most
  -action tendencies were modified so that the approach bias generalized to new pictures in AAT and IAT. Retraining linked to less alcohol consumption

Question 12

How was IAT used in this study?

Answer 12

Speeded classification of sorting two target categories of alcohol and soft drinks and attribute categories by using response keys. The first block alcohol and approach were categorized together and in the second alcohol and avoidance were categorized together. The response time of first block in comparison to the second estimate the relative strength of alochol-approach associations

Question 13

What were the experimental conditions used?

Answer 13

One experimental condition was explicit and the other was implicit

Question 14

What did results find?

Answer 14

Patients in the experimental condition changed from a small approach bias to a strong avoidance bias for alcohol and the control group changed from a small approach bias to no bias. Also showed small increase in approach bias for soft drinks but decreased in the control group. Craving decreased for experimental group but remained constant in control group.

Question 15

What did clinical outcomes suggest?

Answer 15

46% of the experimental group had relapse. Women and those in the experimental group tended to do better in relapse. Mediation of the effect of condition on treatment outcome was not confirmed

Question 16

How could this intervention have strong effects?

Answer 16

It focusses of retraining of action tendencies which could be more important than attentional retraining, importance of pushing movement but associations between object and concepts of approach are important. AAT retraining had effects on IAT so changes in association with alcohol

Question 17

Limitations

Answer 17

• no mediation of clinical outcomes by changes in cognitive processes found
• no action tendencies for alcohol later during treatment and follow-up were measured

Question 18

What does incentive sensitization suggest about attentional bias?

Answer 18

That AB results from pairing of alcohol cues with direct effects of alcohol leading to a sensitized reaction to alcohol cues which leads to more salience.

Question 19

What is the relationship between AB and craving?

Answer 19

There is only a moderate correlation which can be explained by habit or incentive salience. But there are associations with AB and severity of addiction, poor treatment outcome, relapse after treatment and low AB leads to more likely success in cutting down.

Question 20

Attentional bias training

Answer 20

Based on visual probe task to modify early attention processes like speeded detection of disorder-related stimuli, large attentional processes like difficulty to disengage from stimuli

Question 21

Effectiveness of ABM

Answer 21

Mixed results as effects found not to generalize to new stimuli and showed no decrease in craving but other results suggests reduced alcohol use.

Question 22

Which 3 factors increase effectiveness of ABM?

Answer 22

• motivating participants to improve training performance and control over attention
• presenting large number of different stimuli in training and more stimuli
• performing multiple training sessions (repeated sessions lead to less trait anxiety than state vulnerability)

Question 23

Visual probe task

Answer 23

Reaction time task in which participants respond to probes at different locations on the screen but starts with a fixation cross. Two pictures presented left and right from centre of the screen. An arrow then replaces the screen and is classified.

Question 24

How does ABM training work?

Answer 24

The probe is always followed by the neutral pictures, never by the alcohol picture so more attention is drawn to the neutral pictured and changes their attentional bias

Question 25

What did results find?

Answer 25

That ABM did not influence speeded detection of alcohol cues but ABM was effective in reducing the difficulty from disengaging attention from alcohol cues. The effect generalized to other stimuli not used during training. Higher perceived control led to less difficulty to disengage. Around 25% of those in the experimental group had a relapse. Patients in the experimental condition were released a month earlier than controls. ABM effect was also found a few days after the intervention. ABM affects vulnerability to respond emotionally instead of affecting emotional states like craving directly.

Question 26

How do proof-of-principle studies differ from RCTs?

Answer 26

One meta-analysis found CBM to not have clinically relevant outcomes but this combined POP with RCTS. POP has healthy student volunteers not motivated to change, and test mechanisms while RCTS have clinical samples and look into insights into factors for effective treatments. CBM found to be effective and lead to long-term improvements for RCTS, but less effective with nonclinical volunteers.

Question 27

Roots underlying CBM

Answer 27

Targets distortions in automatic mental processes on associative representations and aims to change dominant associations underlying mental disorders. It changes propositional representations containing information about how concepts are causally related into behaviour. It does not reflect automatic activation of mental associations and reflects goal driven inferences which are learned.

Question 28

How do associative accounts differ from inferential accounts?

Answer 28

Associative argues that automatic changes are evoked by associations through repeated pairings, but inferential account argues that CBM interventions are more effective if they automatize goal-directed predictions. Like new inferences about action tendencies can be learned which results in valued outcomes and can facilitate in implementing similar actions when confronted with similar contextual cues. Then can be more well-practiced.

Question 29

How can CBM be improved?

Answer 29

• by improving goal-relevant alternative behaviours as when a visually matched alternative but not fully matched led to less effectiveness. The alternatives need to be more personalized
• personally relevant consequences as CBM effects need to experience their consequences and effectiveness of other behaviour to accomplish their goals. Not always made clear outside of clinical contexts. Need to be personalized to fit in with goals.
• personally relevant antecedent consequences as more real-life context cues are needed to transfer to real life but can be simple and extended to high-risk situations

Question 30

How does ABC compare to other therapies?

Answer 30

Training of specific associations determine beforehand as in standard treatment compared to automatizing behavioural choices relevant to client’s goal in a specific context. Can enhance CBT and behavioural analysis as it comes the two and targets automatization of adaptive inferences and related behaviours. Also involves practice with actions plans which reduces effortful control also in doing homework. Seen as more meaningful and e-therapy makes it easier for those with addictions to seek therapy. Seen as effective but high-drop out rate in CBM, but ABC can be more engaging and effective.