Automatic Approach Behaviors in Alcohol Dependence: Does a Cognitive Bias Modification Training Affect Pavlovian-to-Instrumental Transfer Effects?

Abstract

<b><i>Introduction:</i></b> Positively conditioned Pavlovian cues tend to promote approach and negative cues promote withdrawal in a Pavlovian-to-instrumental transfer (PIT) paradigm, and the strength of this PIT effect was associated with the subsequent relapse risk in alcohol-dependent (AD) patients. When investigating the effect of alcohol-related background cues, instrumental approach behavior was inhibited in subsequent abstainers but not relapsers. An automatic approach bias towards alcohol can be modified using a cognitive bias modification (CBM) intervention, which has previously been shown to reduce the relapse risk in AD patients. Here we examined the effects of such CBM training on PIT effects and explored its effect on the relapse risk in detoxified AD patients. <b><i>Methods:</i></b> <i>N</i> = 81 recently detoxified AD patients performed non-drug-related and drug-related PIT tasks before and after CBM versus placebo training. In addition, an alcohol approach/avoidance task (aAAT) was performed before and after the training to assess the alcohol approach bias. Patients were followed up for 6 months. <b><i>Results:</i></b> A stronger alcohol approach bias as well as a stronger non-drug-related PIT effect predicted relapse status in AD patients. No significant difference regarding relapse status or the number of heavy drinking days was found when comparing the CBM training group versus the placebo group. Moreover, there was no significant modulation effect of CBM training on any PIT effect or the aAAT. <b><i>Conclusion:</i></b> A higher alcohol approach bias in the aAAT and a stronger non-drug-related PIT effect both predicted relapse in AD patients, while treatment outcome was not associated with the drug-related PIT effect. Unlike expected, CBM training did not significantly interact with the non-drug-related or the drug-related PIT effects or the alcohol approach bias.

Implementing Approach-Bias Modification as Add-On to Varieties of Clinical Treatment for Alcohol Use Disorders: Results of a Multicenter RCT

“…So far, only one clinical monocenter RCT by Eberl et al [26] established evidence for this, whereas others [20,27,28] did not, possibly because of suboptimal measurement properties of the assessment instrument used. Therefore, despite ApBM's value in promoting abstinence after inpatient treatment, future studies should apply stricter methodological standards to test the proposed underlying working mechanism of ApBM [39,40].…”

High stakes slow responding, but do not help overcome Pavlovian biases in humans

“…Recently, sign-tracking has been suggested to constitute a phenomenon shared across species, including humans (Colaizzi et al 2020;Garofalo and di Pellegrino 2015), which might contribute to the etiology and maintenance of drug abuse (Flagel and Robinson 2017;Flagel et al 2007). A better understanding of when Pavlovian biases occur and how they interact with other systems regulating behavior promises insights into the development and maintenance of psychiatry conditions such as alcohol or drug abuse (Chen et al 2022b;Schad et al 2020). So far, it has been unclear how behavior is guided in the presence of multiple rewards and/or threats of different magnitudes.…”

“…A better understanding of when Pavlovian biases occur and how they interact with other systems regulating behavior promises insights into the development and maintenance of psychiatry conditions such as alcohol or drug abuse (Chen et al 2022b;Schad et al 2020).…”

Targeting Learning Mechanisms in Addictive Disorders

“…Such PIT effects could be targeted by training programs that address the modification of automatic approach bias. Accordingly, Chen et al [13] report results of a study that examined whether one such training program, cognitive bias modification, modulates PIT effects. New digital tools may revolutionize addiction research and assessment.…”