A Pilot Study on Approach Bias Modification in Smoking Cessation: Activating Personalized Alternative Activities for Smoking in the Context of Increased Craving

Background The act of smoking has been associated with the automatic activation of approach biases towards smoking-related stimuli. However, previous research has produced mixed findings when smokers are trained to avoid such smoking-related stimuli through the application of Approach Bias Modification (ApBM). As such, this study aimed to test an improved ApBM (ApBM +), where smokers were trained to approach personalized alternative activities for smoking in the context of increased craving, in addition to training smoking-avoidance responses. Methods Sixty-seven daily smokers motivated to quit (M age = 29.27, 58.2% female) were randomly assigned to seven sessions of either ApBM + (n = 26), standard-ApBM (n = 19), or sham-ApBM (n = 22), after a brief motivational smoking intervention. Primary outcomes of approach biases for smoking and for alternative activities and secondary outcomes of smoking-related behaviors were assessed at pre-test, post-test, and 1-month follow-up. Results Overall, no group differences by condition were demonstrated in changing approach biases or smoking-related behaviors at post-test and 1-month follow-up. A trend level indication for differences in changes of smoking-approach biases between sham-ApBM and ApBM + for relatively heavy smokers was found at post-test. This was primarily driven by a significant increase in smoking-approach biases within the sham-ApBM condition and a trend decrease in smoking-approach biases within the ApBM + condition. Conclusions Our findings did not provide support for the current ApBM + concerning improved effects across the whole sample. Diverging training effects on approach biases for smoking in relatively heavy smokers warrants further research, for which we provide some suggestions.

Inhibitory Performance in Smokers Relative to Nonsmokers When Exposed to Neutral, Smoking- and Money-Related Pictures

Introduction: Smoking is associated with significant negative health consequences. It has been suggested that deficient inhibitory control may be implicated in (nicotine) addiction, but its exact role has not yet been elucidated. In the current study, our aim was to investigate the role of inhibitory control in relation to nicotine addiction in contexts that differ in terms of reward. Methods: Participants filled out questionnaires and performed a go/no-go task with three conditions. In one condition, the stimuli were neutral color squares, and in the reward conditions, these were smoking-related pictures and money-related pictures, respectively. In total, 43 non-abstinent individuals that smoke and 35 individuals that do not smoke were included in the sample. Results: The main results showed that individuals that smoke, relative to individuals that do not smoke, had reduced inhibitory control in both reward contexts, relative to a neutral context. The reductions in inhibitory control were mirrored by speeded responses. Conclusions: Individuals that smoke seem to present with reduced inhibitory control, which is most pronounced in contexts of reward. Consistent with incentive sensitization theory, the reduced inhibitory control may be (at least partly) due to the heightened approach bias to reward-related stimuli as indicated by the speeded responses.

Reliability and Convergence of Approach/Avoidance Bias Assessment Tasks in the Food Consumption Domain

Theories of motivation posit that people will more readily approach positive or appetitive stimuli while they are more likely to avoid negative or aversive stimuli. In recent years, there has been a growing interest in the relationship between biases in approach and avoidance behaviours for food cues and food craving and consumption behaviour. Two paradigms commonly employed by research to investigate this relationship are the Approach Avoidance Task (AAT) and the Stimulus Response Compatibility Task (SRCT). However, it is yet to be determined whether the measures yielded by these tasks reflect the same processes operating in the food craving and consumption domain. The purpose of the present study will be to address whether the AAT and SRCT paradigms provide internally reliable and convergent measures in their assessment of approach/avoidance bias to healthy and unhealthy food stimuli, and whether measures of approach/avoidance biases to healthy and unhealthy food yielded by the AAT and SRCT paradigms demonstrate comparable associations with individual differences in food craving and eating behaviour. The study will require participants to complete an SRCT, and two task variants of the AAT, and an estimate of participants’ approach bias towards unhealthy food relative to healthy food will be computed from each. Analyses will determine the internal reliability of each of the approach bias scores, the degree to which the approach bias scores show convergent validity, and the degree to which the approach bias scores from each task are concurrently associated with individual differences in food craving and eating behaviour.

SWiPE: a novel personalised approach bias modification smartphone application to reduce alcohol use among people drinking at hazardous levels: a feasibility, acceptability and preliminary effectiveness study (Preprint)

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.

Pushing or Pulling Your “Poison”: Clinical Correlates of Alcohol Approach and Avoidance Bias Among Inpatients Undergoing Alcohol Withdrawal Treatment

Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification (ABM) trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on demographic and drinking measures, and to examine the clinical correlates of approach bias.Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM.Results: At trial entry (day 3 or 4 of inpatient withdrawal), 155 (57.8%) had an alcohol approach bias and 113 (42.2%) had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days (r = 0.277, p = 0.001) but no other indices of alcohol consumption or problem severity.Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures.