Internet-based attentional bias modification training as add-on to regular treatment in alcohol and cannabis dependent outpatients: a study protocol of a randomized control trial

Abstract

BackgroundThe automatic tendency to attend to and focus on substance-related cues in the environment (attentional bias), has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, contribute to treatment outcome and the reduction of relapse rates. Based on some promising research findings, we designed a study to test the clinical relevance of ABM as an add-on component of regular intervention for alcohol and cannabis patients.Design/MethodsThe current protocol describes a study which will investigate the effectiveness and cost-effectiveness of a newly developed home-delivered, multi-session, internet-based ABM (iABM) intervention as an add-on to treatment as usual (TAU). TAU consists of cognitive behavioural therapy-based treatment according to the Dutch guidelines for the treatment of addiction. Participants (N = 213) will be outpatients from specialized addiction care institutions diagnosed with alcohol or cannabis dependency who will be randomly assigned to one of three conditions: TAU + iABM; TAU + placebo condition; TAU-only. Primary outcome measures are substance use, craving, and rates of relapse. Changes in attentional bias will be measured to investigate whether changes in primary outcome measures can be attributed to the modification of attentional bias. Indices of cost-effectiveness and secondary physical and psychological complaints (depression, anxiety, and stress) are assessed as secondary outcome measures.DiscussionThis randomized control trial will be the first to investigate whether a home-delivered, multi-session iABM intervention is (cost-) effective in reducing relapse rates in alcohol and cannabis dependency as an add-on to TAU, compared with an active and a waiting list control group. If proven effective, this ABM intervention could be easily implemented as a home-delivered component of current TAU.Trial registrationNetherlands Trial Register, NTR5497, registered on 18th September 2015.

Attention Bias in Individuals with Addictive Disorders: Systematic Review Protocol (Preprint)

“…Hence, the negative affective state leads them to seek for the same substance once again. More recently, the dual process model of addiction (10,11) has been posited to be accountable for the lapse and relapse among substance abusers. Based on the dual process model of addiction, two disparate processes are likely to be responsible for the lapse and relapse, namely that of the reflective and automatic process (10).…”

“…While the reflective process is important and could account for most of the relapses, it is also essential to take into consideration the automatic processes. Such forms of automatic processes would refer to that of attentional bias (11). Attentional bias could lead individuals to focus on substance-related cues in their environments, and by doing so have increased attention to these cues, but also would have a corresponding difficulty in disengaging from these cues (11).…”

“…Such forms of automatic processes would refer to that of attentional bias (11). Attentional bias could lead individuals to focus on substance-related cues in their environments, and by doing so have increased attention to these cues, but also would have a corresponding difficulty in disengaging from these cues (11). Such an automatic process would increase the salience of substance related cues and could potentially also draw abusers towards substances.…”

Mobile Phone Cognitive Bias Modification Research Platform for Substance Use Disorders: Protocol for a Feasibility Study (Preprint)

“…Attentional bias is thought to cause individuals with substance use disorders to automatically focus on substance-related stimuli in their environment, leading to a relapse back into drug usage (2). Attentional bias is also evident in other psychiatric disorders, such as depression and anxiety disorders.…”

“…Amongst individuals with anxiety disorders, it is thought that they are drawn towards threatening or unpleasant stimuli (3). Attentional bias would cause individuals not only to spend an increased amount of time focusing on the stimuli, with the resultant effect of triggering other emotions, but would also cause individuals to have difficulties with disengaging from the stimuli (2). Over the past decade, there has been much work looking at the efficacy of attentional bias modification for various disorders, particularly anxiety, depression and substance use disorders.…”