scholarly journals A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study

10.2196/15465 ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. e15465 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Syidda B Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Participatory Design ◽  
Attention Bias ◽  
Acceptance Rate ◽  
Management Service ◽  
Qualitative Synthesis ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Health Technologies ◽  
Bias Modification

Background Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. Objective This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. Methods A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. Results Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels. Conclusions Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. International Registered Report Identifier (IRRID) RR2-10.2196/11822

scholarly journals A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study (Preprint)

2019 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Syidda B Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Participatory Design ◽  
Attention Bias ◽  
Acceptance Rate ◽  
Management Service ◽  
Qualitative Synthesis ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Health Technologies ◽  
Bias Modification

BACKGROUND Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. OBJECTIVE This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. METHODS A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. RESULTS Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels. CONCLUSIONS Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11822

scholarly journals Gamified M-Health Attention Bias Modification Intervention for Individuals with Opioid Use Disorder: Protocol for a Pilot Randomised Study

2020 ◽  
Vol 17 (3) ◽  
pp. 752 ◽  
Author(s):  
Melvyn W. B. Zhang ◽  
Sandor Heng ◽  
Syidda B. Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Rating Scale ◽  
Attention Bias ◽  
Opioid Use Disorder ◽  
Management Service ◽  
Opioid Use ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Randomised Study ◽  
Bias Modification

Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-blinded pilot randomized trial will be conducted. A total of 30 participants will be randomized to receive either the conventional application or the newly designed co-designed application. In order to identify these 30 participants, 60 participants will be recruited and screened to determine if they have baseline biases. Participants will be recruited from the inpatient unit at the National Addictions Management Service (NAMS) Singapore. All participants who are enrolled into the trial will complete a baseline assessment task, and a bias modification assessment and modification task daily. They will have to complete a baseline demographic and clinical information questionnaire, as well as a cravings rating scale before and after the intervention daily. Perspectives—that of self-reported experiences—will be sought from the participants following their completion of three intervention tasks. Descriptive statistical analyses will be performed, and chi-square and ANOVA analyses will be performed. Qualitative analyses will be undertaken for the perspectives shared. Ethics and Dissemination: Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (DSRB) (approval number that of 2019/00934). The findings arising from this study will be disseminated by means of conferences and publications.

scholarly journals A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study (Preprint)

2018 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Syidda B Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Feasibility Study ◽  
Attention Bias ◽  
Mobile Technologies ◽  
Attentional Biases ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Bias Modification ◽  
Modification Intervention

BACKGROUND Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. OBJECTIVE This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. METHODS This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. RESULTS This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. CONCLUSIONS To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11822

scholarly journals Codesigning a mobile gamified attention bias modification intervention: research protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031897
Author(s):  
Melvyn WB Zhang ◽  
Sandor Heng ◽  
Guo Song ◽  
Daniel Shuen Sheng Fung ◽  
Helen Smith
Keyword(s):  
Participatory Design ◽  
Design Research ◽  
Healthcare Professionals ◽  
Cognitive Biases ◽  
Attention Bias ◽  
Second Phase ◽  
Attention Bias Modification ◽  
Ethical Approval ◽  
Bias Modification ◽  
Modification Intervention

IntroductionAdvances in experimental psychology has highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. While prior research has documented the effectiveness of cognitive bias modification, such interventions tend to be highly repetitive and individuals lack motivation to train over time. Participatory action research methods have been more widely applied in psychiatry to help design interventions that are of relevant to key stakeholders and end users. This study aimed to involve both healthcare professionals and patients in the joint codesign of a gamified mobile attention bias modification intervention.Methods and analysisThe participatory design research method adopted is that of a use-oriented design approach, in the form of a future workshop. 20 participants, comprising 10 healthcare professionals, 5 inpatients and 5 outpatients will be recruited to participate in three separate codesign workshops. In the first phase of the workshop, the participants share their critique of an attention bias modification intervention. In the second phase of the workshop, participants are asked to brainstorm features. The participants are also shown gamification approaches and are asked to consider if gaming elements could enhance the existing application. In the last phase, the participants are asked to sketch a new prototype.Ethics and disseminationEthical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (approval number 2018/01363). The findings arising from this study will be disseminated by means of conferences and publications.

scholarly journals Protocol for a Systematic Review of Gamified Attention Bias Interventions for Psychiatric Disorders (Preprint)

2018 ◽  
Author(s):  
Zhang Melvyn ◽  
Jiangbo Ying ◽  
Roger CM Ho
Keyword(s):  
Systematic Review ◽  
Psychiatric Disorders ◽  
Attention Bias ◽  
Evidence Base ◽  
Primary Objective ◽  
Current Evidence ◽  
Qualitative Synthesis ◽  
Attention Bias Modification ◽  
Technological Advances ◽  
Bias Modification

UNSTRUCTURED Background Attention biases are subconscious processes that tend to result in individuals having increased attention for threatening or stimuli with high salience. These biases have been posited to be involved in the psychopathologies of several psychiatric disorders. Technological advances have transformed how such interventions are being delivered. Gamification technologies are increasingly being used for bias modification, as it could help increase motivation to train and make these tasks more engaging. While there are published research on gamification and attention bias, there remains several gaps in knowledge. Objectives The primary objective of the review is thus to identify attention bias modification games that have been published in the literature and to synthesise the current evidence for such interventions and to identify, if possible, the rationale for gamification. The secondary objective is to determine if gamified attention or cognitive bias modification influences secondary outcomes measures, as such anxiety levels or severity of depressive symptoms. Methods To achieve the objective of this review, a systematic review will be undertaken. For the studies that are identified, they will be reviewed by independent assessors and screened against our predefined inclusion and exclusion criteria. The Cochrane risk of bias tool will be used for assessment of the risk of biases in randomised trials that have been identified. The evidence will be synthesized by means of a qualitative synthesis. Results We expect that the review will be completed 12 months from the publication of this protocol. Conclusions This review is pertinent as it helps to provide an overview of the evidence base for gamified attention bias interventions. The findings from the current review will help in the future conceptualisation of gamified attention bias interventions.

scholarly journals Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study

10.2196/16325 ◽  
2019 ◽  
Vol 7 (11) ◽  
pp. e16325 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Syidda B Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Attention Bias ◽  
Future Research ◽  
Attentional Biases ◽  
Chi Square ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Making Sense ◽  
Negative Findings ◽  
Positive Score ◽  
Bias Modification

Background Advances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53% of participants have had no baseline biases and 21% of those with positive baseline biases did not have a positive change in magnitude following intervention. Objective The aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases. Methods Participants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score. Results In our study, 53% (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21% (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances. Conclusions Our study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors.

scholarly journals Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Syidda B Amron ◽  
Zaakira Mahreen ◽  
Guo Song ◽  
...  
Keyword(s):  
Attention Bias ◽  
Future Research ◽  
Attentional Biases ◽  
Chi Square ◽  
Attention Bias Modification ◽  
Addictive Disorders ◽  
Making Sense ◽  
Negative Findings ◽  
Positive Score ◽  
Bias Modification

BACKGROUND Advances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53% of participants have had no baseline biases and 21% of those with positive baseline biases did not have a positive change in magnitude following intervention. OBJECTIVE The aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases. METHODS Participants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score. RESULTS In our study, 53% (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21% (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances. CONCLUSIONS Our study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors.

Lessons Learnt from the conduct of a Pilot Study of a Codesigned Mobile Attention Bias Modification Intervention during the COVID-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Melvyn Zhang ◽  
Syidda Amron ◽  
Zaakira Mahreen ◽  
Song Guo ◽  
Daniel SS Fung ◽  
...  
Keyword(s):  
Substance Use ◽  
Pilot Study ◽  
Substance Use Disorders ◽  
Randomised Trial ◽  
Attention Bias ◽  
Small Sample ◽  
Attentional Biases ◽  
Management Service ◽  
Attention Bias Modification ◽  
Bias Modification

BACKGROUND Substance use disorders are prevalent globally, that of opioid use disorders. Conventional treatment involves a combination of both pharmacological and psychological approaches. With advances in experimental psychology, there is now a better understanding of attentional biases in substance use disorders. Prior meta-analytical review has highlighted the existence of robust attentional biases amongst opioid using individuals. To date, there remains limited evaluation of bias modification amongst an Asian cohort of participants. Whilst there has been attempts to better the conventional methods of assessment through co-design, such co-designed application has yet to be evaluated. OBJECTIVE The primary objective of this pilot randomised trial was to refine the intended processes of the definitive study (i.e. the recruitment of participants, the process of randomisation into two separate intervention arms, and the administration of the intervention). METHODS The study design was that of a non-blinded randomised controlled trial. Participants were allocated to receiving either the conventional attention bias modification task or the newly designed co-designed task by means of simple randomisation. The study was conducted on the inpatient unit at the National Addictions Management Service, Institute of Mental Health Singapore. Convenience sampling was used to recruit participants over a period of 12 months, with all participants being screened for the presence of baseline biases. On each day of the intervention, participants must undertake both a bias assessment and modification task. RESULTS Over a period of 4 months, a total of 12 participants were invited to participate, of which 4 declined, thus leaving 8 participants who consented to participate. The study was terminated early because of the COVID-19 Pandemic. Of these 8 potential participants, only 3 screened positive. There was a 66.7% attrition rate as two of the 3 participants completed the planned interventions. CONCLUSIONS Our pilot study has provided preliminary evidence of the feasibility of the planned methods, despite the small sample size. Several findings arising from this current pilot (such as there being an absence of baseline biases in some participants) have resultant implications when planning the definitive randomised trial.

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