Abstract
BackgroundAttentional bias modification (ABM) interventions have been developed to address addiction by reducing attentional bias for substance-related cues. This study provides a systematic review of the effectiveness of ABM interventions in decreasing symptoms of addictive behaviour, taking baseline levels of attentional bias and changes in attentional bias into account.MethodsWe included randomised and non-randomised studies that investigated the effectiveness of ABM interventions in heavy-using adults and treatment-seeking individuals with symptoms of substance use disorder to manipulate attentional bias and to reduce substance use-related symptoms. We searched for relevant English peer-reviewed articles without any restriction for the year of publication using PsycINFO, PubMed, and ISI Web in August 2016. Study quality was assessed regarding reporting, external validity, internal validity, and power of the study.ResultsEighteen studies were included: nine studies reported on ABM intervention effects in alcohol use, six studies on nicotine use, and three studies on opiate use. The included studies differed with regard to type of ABM intervention (modified dot probe task n = 14; Alcohol Attention Control Training Programme n = 4), outcome measures, amount and length of provided sessions, and context (clinic versus laboratory versus home environment). The study quality mostly ranged from low average to high average (one study scored below the quality cut-off). Ten studies reported significant changes of symptoms of addictive behaviour, whereas eight studies found no effect of ABM interventions on symptoms. However, when restricted to multi-session ABM intervention studies, eight out of ten studies found effects on symptoms of addiction. Surprisingly, these effects on symptoms of addictive behaviour showed no straightforward relationship with baseline attentional bias and its change from baseline to post-test.ConclusionsDespite a number of negative findings and the diversity of studies, multi-session ABM interventions, especially in the case of alcohol and when the Alcohol Attention Control Training Programme was used, appear to have positive effects on symptoms of addictive behaviour. However, more rigorous well-powered future research in clinical samples is needed before firm conclusions regarding the effectiveness of ABM interventions can be drawn.Systematic review registrationRegistration number PROSPERO: CRD42016046823
Highlights
Attentional bias modification (ABM) interventions have been developed to address addiction by reducing attentional bias for substance-related cues
Interventions that are especially designed to modify attentional bias are known as attentional bias modification (ABM) interventions, and one of their advantages is their possible delivery via the computer, making them available and easy to add to other face-to-face or computer-based treatments
Search terms used for substance use disorder were the following: substance use disorder, drug us*, drug abus*, alcohol abus*, drug dependen*, inhalant abuse, polydrug abuse, drug addiction, heroin addiction, drug addiction, substance us*, addiction, substance abus*, alcohol us*, alcohol drinking, alcoholism, tobacco*, nicotine, heavy drink*, and alcohol depend*
Summary
Current dual process models of addiction point to the relevance of differentiating between more explicit and more implicit processes guiding addictive behaviour. Attentional bias has been defined as the tendency to implicitly focus on and keep attention on substance -relevant cues in the environment [8, 9], such as the pub on the other side of the street Given that treatments, such as CBT and CM, mainly focus on explicit decision-making processes and have been found to be insufficiently effective in the adaptation of implicit processes like attentional bias [10], new interventions have been developed to directly modify these more implicit processes. Interventions that are especially designed to modify attentional bias are known as attentional bias modification (ABM) interventions, and one of their advantages is their possible delivery via the computer, making them available and easy to add to other face-to-face or computer-based treatments
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