Pilot study: Improving attention bias modification of alcohol cues through concealed gaze-contingent feedback in alcohol dependence

Timo L Kvamme,Mads U Pedersen,Morten Overgaard,Kristine Rømer Thomsen,Valerie Voon

doi:10.1016/j.abrep.2019.100231

Timo L Kvamme, Mads U Pedersen + Show 3 more

Open Access

https://doi.org/10.1016/j.abrep.2019.100231

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Abstract

In an attempt to improve attention bias modification (ABM), we tested whether an attentional training protocol which featured monetary operant conditioning of eye-gaze to avoid alcohol stimuli in alcohol-dependent patients could reduce attention, craving and relapse to alcohol. We employed a pilot randomized control trial (RCT) with 21 detoxified alcohol dependent patients (48.9 ± 10 years of age, 9 male) from an inpatient and outpatient treatment centre. The novel concealed operant conditioning paradigm provided monetary reinforcements or punishments respective to eye-gaze patterns towards neutral or towards alcohol stimuli along with an 80% probability of a to-be-detected probe appearing following neutral stimuli (ET-ABM group). Patients in the control-group received random monetary feedback and a 50/50 ABM contingency. We compared AB on trained and untrained stimuli and addiction severity measures of obsessive thoughts and desires to alcohol following training. We further assessed addiction severity and relapse outcome at a 3-month follow-up. Results indicate that this attentional retraining only worked for the trained stimuli and did not generalize to untrained stimuli or to addiction severity measures or relapse outcome. Potential explanations for lack of generalization include the low sample size and imbalances on important prognostic variables between the active-group and control-group. We discuss progress and challenges for further research on cognitive training using gaze-contingent feedback.

Highlights

Incentive-motivational models of addiction propose that variations in substance abuse maps onto biased cognitive processing of disorder-related stimuli (Franken, 2003; Robinson & Berridge, 2001)
One way to measure this “attentional bias” (AB) to alcohol-related cues is through the visual-probe task (VPT) where key-press latencies are generally faster to a to-be-detected target probe if it appears following an alcohol-related stimulus rather than a neutral stimulus (Field & Eastwood, 2005)
reaction times (RTs) from the alcohol VPT were excluded if they were above 2000 ms or below 200 ms and trials with erroneous indication of probe position (3.1% of data)

Summary

Introduction

Incentive-motivational models of addiction propose that variations in substance abuse maps onto biased cognitive processing of disorder-related stimuli (Franken, 2003; Robinson & Berridge, 2001). It has been suggested that AB has a bi-directional causal relationship with alcohol craving and that alcohol dependent patients may benefit from cognitive therapies aimed at reducing AB (Field & Cox, 2008). This is the goal of attention bias modification (ABM) which has been shown to reduce AB by presenting the target probe more often following the neutral stimulus (Field, Mogg, Mann, Bennett, & Bradley, 2013; Mathews & MacLeod, 2002; Schoenmakers et al, 2010). Despite some putative therapeutic effects, results of reaction-time-based ABM protocols for improving treatment outcome in alcohol dependence remains decidedly mixed (Christiansen, Schoenmakers, & Field, 2015; Wiers, Boffo, & Field, 2018)

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