scholarly journals Mobile Phone Cognitive Bias Modification Research Platform for Substance Use Disorders: Protocol for a Feasibility Study (Preprint)

2017 ◽  
Author(s):  
Melvyn Zhang ◽  
JiangBo Ying ◽  
Guo Song ◽  
Daniel SS Fung ◽  
Helen Smith

BACKGROUND Cognitive biases refer to automatic attentional and interpretational tendencies, which could be retained by cognitive bias modification interventions. Cristea et al and Jones et al have published reviews (in 2016 and 2017 respectively) on the effectiveness of such interventions. The advancement of technologies such as electronic health (eHealth) and mobile health (mHealth) has led to them being harnessed for the delivery of cognitive bias modification. To date, at least eight studies have demonstrated the feasibility of mobile technologies for the delivery of cognitive bias modification. Most of the studies are limited to a description of the conventional cognitive bias modification methodology that has been adopted. None of the studies shared the developmental process for the methodology involved, such that future studies could adopt it in the cost-effective replication of such interventions. OBJECTIVE It is important to have a common platform that could facilitate the design and customization of cognitive bias modification interventions for a variety of psychiatric and addictive disorders. It is the aim of the current research protocol to describe the design of a research platform that allows for customization of cognitive bias modification interventions for addictive disorders. METHODS A multidisciplinary team of 2 addiction psychiatrists, a psychologist with expertise in cognitive bias modification, and a computer engineer, were involved in the development of the intervention. The proposed platform would comprise of a mobile phone version of the cognitive bias task which is controlled by a server that could customize the algorithm for the tasks and collate the reaction-time data in realtime. The server would also allow the researcher to program the specific set of images that will be present in the task. The mobile phone app would synchronize with the backend server in real-time. An open-sourced cross-platform gaming software from React Native was used in the current development. RESULTS Multimedia Appendix 1 contains a video demonstrating the operation of the app, as well as a sample dataset of the reaction times (used for the computation of attentional biases) captured by the app. CONCLUSIONS The current design can be utilized for cognitive bias modification across a spectrum of disorders and is not limited to one disorder. It will be of value for future research to utilize the above platform and compare the efficacy of mHealth approaches, such as the one described in this study, with conventional Web-based approaches in the delivery of attentional bias modification interventions. REGISTERED REPORT IDENTIFIER RR1-10.2196/9740

Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying

Participatory action research was introduced in the 1960s and early 1970s, but it has only been more widely adopted in the recent years. Such methodologies have since been applied to several web & mobile-based interventions in psychiatry. To date no prior review has scoped the extent of the application of such methodologies for web & mobile-based interventions in psychiatry. In this article, a scoping literature review was performed, and seven articles have been identified. The most common methodologies are that of co-design workshops; and increasingly service users and participants are included in these workshops. There remains a lack of application of such methodologies for addiction research. Increasingly, attention and cognitive bias modification interventions are more commonplace, given that they have been found to be effective in modifying underlying biases amongst individuals with addictive disorders. Unfortunately, there remains to be inherent limitations with web and mobile versions of attention and cognitive bias modification interventions. Participatory design research methods could help address these limitations and future research involving the conceptualization of new attention or cognitive bias modification applications ought to consider the incorporation of these research methods.


Author(s):  
Zhang Melvyn ◽  
Aloysius Chow ◽  
Ranganath Vallabhajosyula ◽  
Daniel SS Fung

Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting emotional biases amongst individuals with ADHD. These studies provide us with preliminary evidence for the effectiveness of modifying emotional biases and how it could help in ameliorating symptoms related to emotional dysregulation. There needs to be future research in this area with further evidence supporting the effectiveness of modifying emotional biases. It is also crucial for future research to determine which of these tools is best at detecting such biases, and which of these tools are versatile enough and non-invasive that they could safely be implemented for both research and clinical needs.


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

BACKGROUND Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. OBJECTIVE This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. METHODS Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: (“attention bias” OR “cognitive bias” OR “approach bias” OR “avoidance bias” OR “interpretative bias”) AND (“Internet” OR “Web” OR “Online”). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. RESULTS Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. CONCLUSIONS This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions.


2020 ◽  
Author(s):  
Sarah Masterton ◽  
Charlotte Hardman ◽  
Andrew Jones

There is considerable interest in Cognitive Bias Modification (CBM) as a potential treatment for overweight / obesity. Inhibitory Control Training (ICT) and Evaluative Conditioning (EC) are two popular paradigms which rely on associatively learned responses (unhealthy food -> inhibition, or unhealthy food-> negative stimulus, respectively) through repeated cue-response contingencies. Both ICT and EC have demonstrated some effectiveness for reducing food intake, value and / or choice, when administered in the laboratory and online. However, studies have been criticised for inconsistencies in design (e.g. use of inadequate control groups) which makes it difficult to draw robust conclusions. In two pre-registered, online studies our aim was to examine active ICT (study 1) and EC (study 2) in multiple groups where the cue->response contingencies were systematically varied (100%, 75%, 50%, 25%), before examining food-cue valuations and hypothetical food choice. In both studies varying the cue-> response contingencies did not lead to significant changes in food-cue devaluation following training. ICT did not substantially influence hypothetical food choice, whereas there was weak evidence that EC reduced choice for unhealthy foods, compared to a control group with 50% cue-response contingencies. Taken together both studies provide limited evidence for online CBM as a viable psychological treatment – at least through the mechanism of food-cue devaluation or changes in healthy and unhealthy food choice. Future research is needed to investigate the factors that contribute towards successful CBM training to critically evaluate the potential for these strategies within health interventions.


10.2196/11841 ◽  
2019 ◽  
Vol 6 (10) ◽  
pp. e11841 ◽  
Author(s):  
Melvyn Zhang ◽  
Jiangbo Ying ◽  
Guo Song ◽  
Daniel S S Fung ◽  
Helen Smith

Background Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. Objective This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. Methods Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: (“attention bias” OR “cognitive bias” OR “approach bias” OR “avoidance bias” OR “interpretative bias”) AND (“Internet” OR “Web” OR “Online”). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. Results Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. Conclusions This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions. International Registered Report Identifier (IRRID) RR1-10.2196/10427


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

UNSTRUCTURED Background: Traditional psychological therapies focus mainly on modification of individuals’ conscious decision-making process. Unconscious processes such as cognitive biases have been found to be accountable for various psychiatric psychopathologies. The advances in technologies have transformed how bias modification programs are being delivered. Objective: We seek to synthesize the current evidence of web-based cognitive bias modification for psychiatric disorders, by identifying the range of conditions targeted and their current efficacy. We wish to determine if web-based attention bias modification is as efficacious as compared to conventional methods. Methods and analysis: A systematic review will be conducted, and all studies types will be included. There will not be any restrictions on the participants included in the study. A search will be conducted on the respective databases up till 2017. Selection of studies will be by the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA-P) guidelines. Quality assessment of the included studies will be assessed using the Cochrane Risk of Bias tool (for randomized trials) and the Newcastle-Ottawa scale for other study designs. A narrative synthesises of the identified articles will be conducted. A meta-analysis will be considered, only if there are sufficient articles in a domain for statistical analysis. Ethical approval for the current protocol and the planned systematic review was not required. Results: Results synthesized would be disseminated using conference presentation or published works in peer-reviewed journals. Conclusions: This review is of importance given how technology transformed the delivery of conventional therapies. The findings from this review will provide guidance for future research involving technology and cognitive bias modification interventions. Registration details: International Prospective Register for Systematic Reviews (PROSPERO) number 2017 CRD42017074754


Author(s):  
Anita Van Zwieten ◽  
Gail A. Alvares ◽  
Adam J. Guastella

This chapter discusses novel pharmacological and cognitive approaches in the treatment of anxiety disorders. In particular, evidence is reviewed for glucocorticoids, yohimbine chloride, and D-cycloserine (DCS) as pharmacological adjuncts that augment fear extinction processes in psychotherapy, as well as cognitive bias modification (CBM) programs designed to remediate biased cognitive processes. These treatment approaches aim to capitalize on the cognitive, neurobiological, and behavioral mechanisms that underlie anxiety disorders. Novel technological approaches that aim to enhance access to anxiety treatment are also reviewed, specifically in reference to internet- and computer-based psychotherapy (ICT). Along with their proposed mechanisms of action, empirical evidence for their efficacy, acceptability, and cost-effectiveness are explored, as well as directions for future research.


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

BACKGROUND Automatic biases, such as attentional biases and avoidance and interpretative biases, have been purported to be responsible for several psychiatric disorders. Gamification has been considered for cognitive bias modification, mainly to address the core issues of diminishing motivation to train over time, as bias modification intervention tasks tend to be highly repetitive. While a prior review has suggested how gamification strategies could be applied to such tasks, there remains a lack of systematic evaluation of gamified cognitive bias modification interventions in the literature. OBJECTIVE The objective of this review is to understand the overall effectiveness of a gamified approach for cognitive bias modification and inform future research that seeks to integrate gamification technologies into existing conventional bias modification interventions. METHODS To identify the relevant articles for our review, the following search terminologies were used: (“cognitive bias” OR “attention bias” OR “interpret* bias” OR “approach bias” OR “avoidance bias”) AND (“training” OR “modification” OR “practice” OR “therapy”) AND (“gamification” OR “game elements” OR “game” OR “gaming” OR “game mechanics”). PubMed, MEDLINE, PsycINFO, and Scopus databases were searched systematically for articles published after 2000. Articles were included if they described a gamified cognitive bias modification task and included participants with underlying psychopathological symptoms. Data were systematically extracted from the identified articles, and a qualitative synthesis was performed. RESULTS Four studies evaluated gamified cognitive bias modification interventions. Two studies included participants with anxiety symptoms, one with affective symptoms, and one with alcohol problems. The conventional visual probe task paradigm was used in 3 studies, and the attentional visual search task paradigm was used in the last study. We found gaming elements incorporated to include that of animations, sounds, feedback, and a point-scoring system for response time and difficulty. Of the 4 identified studies, only 2 reported their gamified interventions to be effective. CONCLUSIONS Our review is the first to systematically synthesize the evidence for gamified cognitive bias modification interventions. The results arising from our review should be considered in the future design and conceptualization of gamified cognitive bias modification interventions. INTERNATIONAL REGISTERED REPOR RR2-10.2196/10154


2020 ◽  
Vol 1 (2) ◽  
pp. 75-82
Author(s):  
Melvyn WB Zhang ◽  
Helen E. Smith

The advances in experimental psychology have led to the discovery of unconscious, automatic biases (attentional and approach biases) that account for the lapse and relapses amongst individuals with addictive disorders. To date, there has been extensive investigation into the assessment and modification of attention biases amongst individuals with the highly prevalent substance use disorders. Alternative modalities, such as technology, has also been evaluated for the delivery of these interventions. Given this, the specific objectives of this perspective article are in highlighting the emerging knowledge that has accrued over the last three years, and in addressing several of the research gaps in the previous article. Firstly, this perspective article will examine the evidence for biases and bias modification amongst the highly prevalent substance use disorders. This article will also examine how such bias modification has been utilized clinically. Secondly, this perspective article will also examine how technology has been applied to these bias modification interventions. Thirdly, this article will also examine the literature to highlight the biological underpinnings following bias modification. Fourthly, this article also examines the limitations of existing bias modification paradigms and methods taken to better these conventional interventions. The article concludes with highlighting the outstanding gaps in the current knowledge. To date, there remains mixed evidence for the modification of attention biases; and there are a paucity of studies examining the effectiveness of mobile delivery of bias intervention. Only one study has considered patients’ perspective in the development of an intervention. There remained several gaps in the knowledge, which future research could address.


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