L5: Cognitive Bias Modification

Question 1

What are the 3 cognitive (or info processing) biases involved in addiction?

Answer 1

• attentional bias
• approach bias
• implicit association (memory) bias

Question 2

How does attentional bias play a role in addiction?

Answer 2

• form of selective attention that addicts have for drug-associated stimuli
• engagement/disengagement bias
• eye movements
• motivationally relevant stimuli attract & capture attention
• related to subjective craving

Question 3

How do implicit associations (memory bias) play a role in addiction?

Answer 3

automatically activated memory associations, retrieval bias

Question 4

How does approach bias play a role in addiction?

Answer 4

tendency to approach appetitive stimuli, action tendencies bias

Question 5

What is the clinicial relevance of studying cognitvie biases & their relation to addiction?

Answer 5

existing treatments (CBT) are not effective for all patients (high relapse rates), so additional cognitive bias retraining (CBM) could help reduce this rate

Question 6

What is the dual-process account of CBM?

Answer 6

says that biases involved in substance abuse (approach bias, memory bias, attention bias) are driven by
system 1: (bottom-up) impulsive unconscious mental associations (pavlovian and/or instrumental) -> sensitization to cues, automatic apporach tendency, craving, implicit cognitive processes!
system 2: moderated by (top-down) executive control processes
this confict between systems lies underneath Addiction

Question 7

How can working memory be measured? What do results show?

Answer 7

Self Ordered Pointing Task
results -> low working memory: implicit positive associations predict alcohol use/problems; high WM: explicit positive expectancies predict alcohol use/problems
-> automatic processes have stronger influence on alcohol/drug use in individuals w low executive control

Question 8

What are the differences between system 1: impulsive and system 2: reflective in the dual process models?

Answer 8

system 1:
- impulsive
- bottom up
- unconscious
- fast
system 2
- conscious
- slow
) top down

Question 9

what are the criticism on the dual process model?

Answer 9

• the characteristics within the systems are not well correlated
• many processes have some mixture of characteristics
• not isolated systems

Question 10

How can approach bias be measured?

Answer 10

AAT: approach-avoidance task
ex: picture of alcoholic & non alcoholic drinks shown on sscreen. if imagie is tilted to left u have to pull image towards you, if tilted to right you have to push it away. faster reaction time when drawing alcohol towards you then when pushing it way = approach bias
soft drink serves as baseline
-> results showed that heavy drinker faster to approach alcohol than light drinkers

Question 11

What are issues w the research into attentional & appraoch biases?

Answer 11

• measurement issues related to “irrelevant feature methods” -> ppl respond to something else than the contents
• rather unreliable
  -> so good for research into relatively automatic mechanisms (group level) but not for individual diagnosis

Question 12

How did Wiers use approach bias to treat addiction?

Answer 12

CBM: he retrained automatic action tendencies to become avoidance tendencies in alcoholics (by training them to push away when alcoholic drink showed up) which worked! craving also decreased following the attentional bias retraining: AAT
& enhanced treatment outcomes a year later

Question 13

How can attention bias be measured?

Answer 13

Dot-probe test: subjects presented w drug related stimuli & non drug related stimuli. then on eof the 2 is replaced w a specific stimulus to which the subject must respond: do u see 1 or 2 dots. faster reaction time to a stimulus that replaces a substance related cue = attentional bias for substance realted stimuli

Question 14

How did Schoenmakers use attention bias to treat addiction?

Answer 14

attentional bias modification training combined w CBT
trained patients to disengage attention from alcohol related stimuli using visual probe task to assess results
results: ABM incrased ability to disengage attention from alcohol related cues & this effect generalized to new, untrained stimuli. but no effects on craving.

Question 15

How can memory bias be measured?

Answer 15

Implicit Association Task (IAT)
subject has to categorize words or pics into 2x2 categories w a left and right button
ex: pics of drinks have to be categorized into nonalcohol vs alcohol and active vs passive dimension
if subjects respond more quickly when alcohol & active share a button (left key for ex), than when categories are divided over the buttons the opposite way, this would indicate they associate alcohol w high arousal
(categories could also be positive vs negative)

Question 16

What are some non-reaction time tasks from memory bias research?

Answer 16

• outcome behaviour associations: present outcome, assess spontaneously generated beahviour in top-of-mind awarness test
• cue behaviour assocations: present word/picture/cue/context, assess spontaneously generated behaviours
• word associations: first associations to ambiguous words which can be alcohol/drug related

Question 17

How can attention bias / approach bias be reduced by Cognitive Bias Modification?

Answer 17

directly influences cognitive biases
- attentional bias retraining
- approach bias retraining
- selective inhibition training

Question 18

What are the main differences between proof of principle studies & RCTs?

Answer 18

proof-of-principle studies: conducted in the lab to reveal psych mechanisms underlying human behaviour in the lab (usually in healthy volunteers)
RCTs: conducted in clinical setting w patients, to test the efficacy of an intervention in a clinical sample. effect of treatment is compared w control treatment effect. gold standard for testing effectiveness of treatment

Question 19

Why is it important to distinguish between proof-of-principles studies & RCT’s when weighing the effectiveness of CBM?

Answer 19

because different types of studies get different types of effects
- proof of principle studies: provide basis of clinical trials, but CMB tends to have small short lived effects
- clinical trials: CMB does hold promise as add on intervention for treatment
different findings due to different motivation, goals etc

Question 20

What are the differences between traditional CBM and ABC training? What is the rationale behind those changes?

Answer 20

CBM’s effects mixed & based on idea that addictive behaviours uniquely have automatic associative component that should be addressed by CBM
-> ABC training model: structured form of CBM that focuses on training individuals to make behavioural choices (B) that align w their health goals based on personally relevant antecedent cues (A) & consequences (C). so addictive behaviour based on automatic inferential mechanisms rather than associations, so should include cconsequence
= emphasizes personalized interventions that integrate cognitive behavioural elements + undersanding of the automatic & goal directed nature of behaviours (inferential account of Wiers)

Question 21

What does the inferential account proposer by Wiers say?

Answer 21

effectiveness of CMB depends on inferential processes

CBM can shift behavoiurs by changing one’s inference about action & outcomes, rather than by modifying associations
-> more focused & personalized so might be more engaging & effective

Question 22

Which antecedent cues, behavioural choices, and consequences should we incorporate as part of ABC training?

Answer 22

Personally relevant & systematic
Antecedent cues: internal/external triggers/stimuli that precede goal directed behaviour. simulate real life context (like location, feeling sad etc might trigger getting a drink)
Behavioural choices: actions that individual takes in response to A. aim is to train ppl to make healthier choices here, so in line w their goals rather than the addiction (ex: avoidance rather than approach)
Consequences: outcomes that follow B, which can either reinforce or deter the behaviour. here they should emphasize positive consequences in response to goal aligned choices

Question 24

Do cognitive biases play a causal role in addiction? and therefore, does cognitive bias modification really help in addiction?

Answer 24

attention retraining:
- possible to train heavy drinking students away from drinking but doesnt affect behaviour & doesnt generalize to new stimuli
lots of mixed results so likely not a very significant effect on addiction in experimental studies

but clinical trials showed some beneficial effects of CBM as add on in treatment of SUD when ppl are motivated to change

Question 25

How does CBM compare to meds for SUD treatment (like naltrexone & acoamprosate)?

Answer 25

similar (small) effect on addiction

Question 26

How can we improve cognitive training?

Answer 26

• gamification (more playful, but not necessarily better)
• more personalized alternative goals (like smoking)
• personalized learning parameters
• training based on more reliable assessment
• training after reactivation
• add neurostimulation