Acute impact of self‐guided mental imagery on craving in cocaine use disorder: a mixed‐methods analysis of a randomized controlled trial

Abstract

Mental imagery manipulations are used to treat several psychological disorders, but their utility in treating cocaine use disorder (CUD) is unknown. Using prompted re-experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving. Design A quantitative-qualitative 'mixedmethods' analysis of data collected for a randomized controlled trial that was stopped prematurely. Setting UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory). Participants Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study). Interventions Personalized (3-minute) cue-exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5-minute, audio-recorded, self-guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re-experiences (positive image before initiation to cocaine use or a negative image of a 'worst time' adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD).Measurements Task transcripts were rated for imagery detail using five dimensions using a six-point scale of imagery detail (ID) (total score = 0-25) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire-strengths version (CEQ-S11; score = 0-110) reported at baseline, arrival at the laboratory, and immediately after the cue-exposure and mental imagery tasks. Findings A mixed-effects, longitudinal, restricted linear regression, with the past-positive imagery condition as referent, showed main effects of reduced craving after the imagery task (b = -29.2, 95% confidence interval (CI) = -45.3 to À13.1, P-value < 0.001) and increased craving for the futurenegative task (b = 14.2, 95% CI = 0.1-28.4, P-value 0.049). There was a future-negative task by post-imagery craving interaction (b = 28.1, 95% CI = 0.1-56.1, P-value 0.049). A theory-driven, deductive/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self-care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self-criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (r = -0.32, 95% CI = -0.69 to 0.13 and r = 0.06, 95% CI = -0.58 to 0.53, respectively). Conclusion In people with cocaine use disorder, after cue-exposure, a self-guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to.

Extended-release pharmacotherapy for opioid use disorder (EXPO): protocol for an open-label randomised controlled trial of the effectiveness and cost-effectiveness of injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone

“…At the South London site, EXPO will include a psychosocial intervention (PSI). The PSI was developed by EXPO investigators [33,34,[39][40][41]. The PSI represents a point of departure from the traditional manual-guided psychological therapy approach in the field in which there is proscription of a sequence of specific interventions offered to the patient.…”

Experience and response to a randomised controlled trial of extended-release injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone for opioid use disorder: protocol for a mixed-methods evaluation

“…22 A theory-driven, mixed-methods approach was successfully applied to the analysis of cocaine craving in a recent RCT. 23 The present study will draw on theoretical constructs from the 14-Item Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) instrument developed for OUD measurement-based care 24 ; Andersen's behavioural model for health service use 25 with a focus on how patients regard the utility of MOUD and other health services; and the health-related quality-of-life model (HRQoL), 26 which has been applied to the study of many health conditions. [27][28][29] Study aims are to investigate (1) the experiences of study participants who have been offered BUP-XR for 24 weeks (evaluation 1); (2) the experiences and healthrelated quality-of-life of study participants who have opted to receive BUP-XR for 12-24 months (evaluation 2); and…”

“… 22 A theory-driven, mixed-methods approach was successfully applied to the analysis of cocaine craving in a recent RCT. 23 …”

“…An approach underpinned by theory is also important because this provides structure to the comparison of populations and different health related domains, and in this context will help to integrate findings within the wider literature on OUD treatment and health service evaluation 22. A theory-driven, mixed-methods approach was successfully applied to the analysis of cocaine craving in a recent RCT 23…”

The Impact of Cue-Elicited Multisensory Imagery on Alcohol Craving: A Randomised Controlled Trial

“…In addition to this, EI theory suggests that imagery is central to desires and craving and moreover propounds that alcohol-related imagery is associated with greater frequency and amount of drinking [10]. Therefore, a component of craving draws increasing attention to the role of imagery [11][12][13].…”