scholarly journals An open-label feasibility, acceptability and preliminary effectiveness study of “SWiPE”: A personalised approach bias modification smartphone application to reduce alcohol use (Preprint)

10.2196/31353 ◽  
2021 ◽  
Author(s):  
Victoria Manning ◽  
Hugh Piercy ◽  
Joshua Benjamin Bernard Garfield ◽  
Stuart Gregory Clark ◽  
Mah Noor Andrabi ◽  
...  
2021 ◽  
Author(s):  
Victoria Manning ◽  
Hugh Piercy ◽  
Joshua Benjamin Bernard Garfield ◽  
Stuart Gregory Clark ◽  
Mah Noor Andrabi ◽  
...  

BACKGROUND Background: Approach Bias Modification (ApBM), a computerised cognitive intervention which trains people to “avoid” alcohol-related images and “approach” neutral/non-alcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or cannot access residential treatment. Smartphone-delivered ApBM could offer an easily-accessible intervention to reduce alcohol consumption which can be personalised (e.g., allowing selection of personally-relevant alcohol and positive training images) and gamified to optimise engagement. OBJECTIVE Objective: We examined the feasibility, acceptability and preliminary effectiveness of “SWiPE”, a gamified, personalised alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes, in people drinking at hazardous levels (AUDIT score of 8+) who wanted to reduce their alcohol use. METHODS Methods: We conducted an open-label trial in which frequency and quantity of alcohol consumption, severity of alcohol dependence, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption each week during training, and 1-month after training, and completed measures of craving and dependence after 4-weeks of training. RESULTS Results: We recruited 1309 participants (mean age 47.0 years (SD 10.0); 57.9% female; mean AUDIT score 21.8 (SD 6.5)) over a 6-month period. Participants completed a median of 5 sessions (IQR 2-9), 409 (31.2%) completed at least 8 sessions and 455 (34.8%) completed the post-training survey. Mean Mobile Application Rating Scale scores were 4.4 (SD 0.5) for functionality, 4.2 (SD 0.5) for aesthetics and 3.4 (SD 0.8) for subjective quality. Among those who completed post-training assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001). Mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). In the 254 (19.4%) participants who completed a 1-month follow-up, mean past-week drinking days was 3.9 (SD 2.5) and mean standard drinks was 23.9 (SD 20.7), both significantly lower than at baseline (P<0.001). CONCLUSIONS Conclusion: The findings suggest SWiPE is feasible, acceptable and may be effective at reducing alcohol consumption and craving in a predominantly non-treatment seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomised controlled trial. Smartphone-delivered personalised ApBM has the potential to be a highly scalable, widely-accessible support tool for reducing alcohol use.


2020 ◽  
Author(s):  
Victoria Manning ◽  
Hugh Piercy ◽  
Joshua Benjamin Bernard Garfield ◽  
Dan Ian Lubman

BACKGROUND Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. OBJECTIVE We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. METHODS We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. RESULTS We expect to commence recruitment in August 2020 and complete data collection in March 2021. CONCLUSIONS This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p INTERNATIONAL REGISTERED REPORT PRR1-10.2196/21278


10.2196/21278 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e21278
Author(s):  
Victoria Manning ◽  
Hugh Piercy ◽  
Joshua Benjamin Bernard Garfield ◽  
Dan Ian Lubman

Background Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) PRR1-10.2196/21278


2018 ◽  
Author(s):  
Melvyn Zhang ◽  
JiangBo Ying ◽  
Guo Song ◽  
Daniel SS Fung ◽  
Helen Smith

BACKGROUND Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. OBJECTIVE The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. METHODS To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. RESULTS The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. CONCLUSIONS This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically.


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