Attentional bias in opioid users: A systematic review and meta-analysis

Fung

Smith

2019

Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders—that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified for opioid use disorders, three for cannabis use disorders and four for stimulant use disorders. As evident from the synthesis, there is great variability in the paradigm adopted, with most articles including only information about the nature of the stimulus, the number of trials, the timings for the fixation cross and the timings for the stimulus set. Future research examining attentional biases among individuals with substance use disorders should take into consideration the paradigms that are commonly used and evaluate the optimal stimulus and stimulus-onset asynchrony timings.

Section: Visual Probe Trask Paradigms In Published Studiesmentioning

confidence: 99%

Variations in the Visual Probe Paradigms for Attention Bias Modification for Substance Use Disorders

Fung

Smith

2019

“…This was based on the evidence synthesized from 21 studies. Maclean et al (2018) [12] also reported there being a moderate to large effect size for the presence of attentional biases amongst individuals with opioid use disorders, as compared to healthy controls. With regard to attention bias modification, studies like that of Hietmann, J. et al (2018) [13] in their systematic review, which included nine studies on alcohol use disorder, six studies on nicotine use and three on opiate use disorders, reported that whilst there have been negative findings, multi-session attention bias modification has had positive effects on attentional change, particularly for alcohol use disorders.…”

Section: Introductionmentioning

confidence: 95%

“…The dual-process theoretical approach states that attention biases (preferential allocation of attention to substance-related cues) and approach biases (automatic action tendencies to reach out for substance-relate cues) develop as the repetitive usage of a substance leads to increased automatic processing and automatic tendencies to acquire the substance, with the inhibition of the normal cognitive control processes [10,11]. Maclean et al (2018) [12], in their prior review, highlighted there being robust attentional biases present amongst individuals with opioid use disorders. This was based on the evidence synthesized from 21 studies.…”

Section: Introductionmentioning

confidence: 99%

Gamified M-Health Attention Bias Modification Intervention for Individuals with Opioid Use Disorder: Protocol for a Pilot Randomised Study

Heng

Amron

et al. 2020

Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-blinded pilot randomized trial will be conducted. A total of 30 participants will be randomized to receive either the conventional application or the newly designed co-designed application. In order to identify these 30 participants, 60 participants will be recruited and screened to determine if they have baseline biases. Participants will be recruited from the inpatient unit at the National Addictions Management Service (NAMS) Singapore. All participants who are enrolled into the trial will complete a baseline assessment task, and a bias modification assessment and modification task daily. They will have to complete a baseline demographic and clinical information questionnaire, as well as a cravings rating scale before and after the intervention daily. Perspectives—that of self-reported experiences—will be sought from the participants following their completion of three intervention tasks. Descriptive statistical analyses will be performed, and chi-square and ANOVA analyses will be performed. Qualitative analyses will be undertaken for the perspectives shared. Ethics and Dissemination: Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (DSRB) (approval number that of 2019/00934). The findings arising from this study will be disseminated by means of conferences and publications.

“…One of these is that the magnitude of attentional and approach biases is dependent on individual factors. MacLean RR et al (2018) [4] reported the existence of robust biases amongst opioid users in their meta-analysis, but other individual studies have highlighted a dose-dependent relationship between the amount of opioids used and the magnitude of attentional biases (Bearre L et al, 2007) [7]. This relationship is not limited to opioid use disorders; Field M et al (2005) [8] similarly reported that attentional biases amongst cannabis users were dependent on both, the frequency of cannabis use and their subjective craving scores.…”

Section: Introductionmentioning

confidence: 99%

“…There are several reviews that have provided evidence for the existence of biases. For example, MacLean RR et al (2018) [4], in their review, describe the evidence for the existence of robust attentional biases amongst individuals who were using opioids. Similarly, O'Neil et al (2020) [5] reported that attentional biases are greater in individuals abusing cannabis.…”

Section: Introductionmentioning

confidence: 99%

Challenges When Evaluating Cognitive Bias Modification Interventions for Substance Use Disorder

Smith

2020

In recent years, advances in experimental psychology have led to a better understanding in automatic, unconscious processes, referred to as attentional and approach biases amongst individuals with substance use disorders. Attentional biases refer to the relatively automatic tendencies for attention to be preferentially allocated towards substance-related cues. Whereas, approach bias refers to the relatively automatic behavioral tendencies of individuals to reach out to substance-related cues in their natural environment. While, several reviews confirm the existence of these biases, and the effectiveness of bias modification, the conduct of cognitive bias modification amongst substance-using individuals is not without its challenges. One of these is that cognitive biases, both attentional and approach biases, are not universally present; and several individual differences factors modulate the magnitude of the biases. Another challenge that investigators faced in their conduct of cognitive bias modification relates to the selection of the appropriate task for bias assessment and modification. Other challenges intrinsic to cognitive bias modification intervention relates to that of participant attrition, much like conventional psychotherapies. Negative findings, of the absence of biases at baseline, or the lack of effectiveness of bias modification have been reported in studies of cognitive bias modification. All these challenges could have an impact on bias assessment and modification. In this perspective paper, we will explore the literature surrounding each of these challenges and discuss potential measures that could be undertaken to mitigate these clinical and research challenges.