A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial

Abstract

Background Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. Objective This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention—an adjunct web-based ApBM+IBM program—among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. Methods The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. Results This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. Conclusions This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. 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) PRR1-10.2196/28667

Visualization and Interaction Technologies in Serious and Exergames for Cognitive Assessment and Training: A Survey on Available Solutions and Their Validation

“…As participants could suffer from visual and hearing problems or have troubles with atten- tion, visual scenes have to be as simple as possible and search space should be reduced. During gameplay, simple and immediate data as a countdown timer, the number of remained chances to guess an answer, the current score or achieved goals are often shown to incentive the subject to answer as quickly and accurately as possible [3], [14], [17], [19], [20], [22], [24], [26], [28]- [31], [33], [38]- [41], [44], [49], [50], [52], [53], [71], [72], [79], [83], [96], [97], [99], [100], [106], [109], [115], [120], [124], [125], [130]- [132], [137], [138], [142], [150], [161], [164], [179], [191], [209], [211], [212], [231],…”

“…Immediate feedback after actions can also be useful, as it could help the users knowing when they succeeded or failed and why, recognizing their errors, recovering strategies, reducing their frustration and increasing their motivation. To this purpose, multimodal feedback are often provided, through congratulation messages, hints or events, like objects disappearing if correctly selected or sounds of clapping hands to highlight the correctness of a given answer [4]- [6], [13], [20], [41], [43], [50], [57], [59], [106], [112], [125], [133], [162], [208], [210]- [212]. Finally, since the benefits of cognitive training might only be noticed in the long term, healthy competition is greatly appreciated as it can positively affect patients psychological well-being and promote social networking.…”

“…Dataset is sometimes made explicitly available online [49], [214] or from the corresponding author on reasonable request because of privacy policies, ethical or proprietary constraints [10], [15], [19], [23], [30], [34], [44], [59], [77], [79], [107], [109], [112], [114], [120], [136], [152], [173], [175], [208], [213], [215], [217]. Moreover, excluding commercial and proprietary applications, we can still find free download [64], [80], [99], [122], [184], open source [77] and freely accessible Web applications [21], [30], [106]. Finally, considering the effective use of proposed solutions with pathological subjects, patients involved in the experimental sessions usually have a diagnosed disease and are recruited from hospitals, clinics, community-dwelling, specialized day care centers or retirement homes.…”