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Randomized Controlled Trial
. 2013 Apr:4:38-51.
doi: 10.1016/j.dcn.2012.11.002. Epub 2012 Nov 14.

Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?

Carolin Eberl  1 , Reinout W Wiers, Steffen Pawelczack, Mike Rinck, Eni S Becker, Johannes Lindenmeyer
Affiliations
Randomized Controlled Trial

Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best?

Carolin Eberl et al. Dev Cogn Neurosci. 2013 Apr.

Abstract

Background: Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation.

Methods: 509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected.

Results: The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM.

Conclusions: CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism.

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Figures

Fig. 1
Fig. 1
D scores for soda pictures on the alcohol approach/avoidance task for participants in the two groups (experimental and control). D scores were derived at pretest and posttest from the difference between mean response latencies for avoidance movements to pictures (pushing a joystick) and approach movements to picture (pulling a joystick); a positive value indicates an approach bias, and a negative value indicates an avoidance bias. Error bars indicate ±1 SD.
Fig. 2
Fig. 2
D scores for soda pictures on the alcohol approach/avoidance task for participants in the two groups (experimental and control). D scores were derived at pretest and posttest from the difference between mean response latencies for avoidance movements to pictures (pushing a joystick) and approach movements to pictures (pulling a joystick), a positive value indicates an approach bias, and a negative value indicates an avoidance bias. Error bars indicate ±1 SD.
Fig. 3
Fig. 3
Mediation of treatment outcome.
See this image and copyright information in PMC

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