Effect of Cognitive Bias Modification on Early Relapse Among Adults Undergoing Inpatient Alcohol Withdrawal Treatment

Abstract

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Protocol for the methamphetamine approach-avoidance training (MAAT) trial, a randomised controlled trial of personalised approach bias modification for methamphetamine use disorder

“…However, a high proportion of our participants were lost to follow-up, suggesting we may have overestimated the actual abstinence rate, and there was no control group to compare the abstinence rate to. Moreover, the proportion of participants who completed the full 4-session protocol (62%) was slightly lower than observed with an alcohol withdrawal sample [24,26]. Nevertheless, these data indicate good acceptability, moderate feasibility, and a possible clinical benefit of ABM.…”

“…This allows individuals to practise overriding their automatic approach tendency by repeatedly performing an avoidance response, such that avoidance becomes more automatic, thereby reducing or inhibiting approach bias. In AUD samples, 4-12 sessions of ABM reduces approach bias [14,[21][22][23][24] and reduces neural signatures of alcohol cue reactivity in the amygdala [25] and medial prefrontal cortex [23]. Importantly, when delivered during residential withdrawal or rehabilitation treatment, ABM training reduces rates of posttreatment alcohol relapse [14,22,24,26,27].…”

Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach

“…Starting with the fact that mental diseases are also brain disorders, a neurocognitive approach has emerged[ 100 ]. This can be summarized as follows: (1) Mental illness involves significant cognitive impairment[ 101 ]; (2) These cognitive alterations, subtended by perturbed brain networks, may trigger the onset and/or persistence of clinical symptoms, thereby defining valid therapeutic targets[ 24 ]; and (3) Retraining these cognitive functions (through the use of cognitive retraining programs and/or neuromodulation tools) has been reported to reduce clinical symptoms and to enhance patient quality of life[ 11 , 16 , 22 , 23 ]. Overall, once admitted to a psychiatric care unit, there is still a huge difficulty with assessing “partial recovery”, which allows patients to leave the hospital to return home, and achievement of long-term “complete clinical recovery”, defined as the reduction of psychiatric symptoms and functional disabilities[ 102 ].…”

“…In alcohol dependence, an increased salience of alcohol-related cues grasping drinkers’ attention (hyperactivated mesolimbic activity[ 18 ]) combined with a lack of inhibitory resources (anterior cingulate and frontal hypoactivity[ 19 ]) defines the main neurocognitive mechanisms triggering relapse[ 20 ]. In light of the modest effect of anti-craving medications[ 21 ], cognitive bias modification training alone[ 22 ] or combined with tDCS[ 23 ] has shown promising trend on treatment outcomes by reducing craving and by improving early abstinence. Overall, convergent empirical data illustrating alterations in brain networks that underlie cognitive impairments have provided foundational information about transdiagnostic circuits and promising targets for intervention[ 24 ].…”

Pushing or Pulling Your “Poison”: Clinical Correlates of Alcohol Approach and Avoidance Bias Among Inpatients Undergoing Alcohol Withdrawal Treatment

“…We recently conducted a large trial of approach bias modification (ABM) where we trained alcohol-dependent patients to push away alcohol cues and hence reduce their alcohol approach bias (Manning et al, 2021 ). We found that these participants had a mean approach bias on the IR-AAT at baseline, which is consistent with some other large ABM trials of alcohol-dependent patients (Wiers et al, 2011 ; Eberl et al, 2013 ).…”