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Neuropsychology Review
Published in: Neuropsychology Review 1/2019

Open Access 01-03-2019 | Addiction | Review

Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data

Authors: Marilisa Boffo, Oulmann Zerhouni, Quentin F. Gronau, Ruben J. J. van Beek, Kyriaki Nikolaou, Maarten Marsman, Reinout W. Wiers

Published in: Neuropsychology Review | Issue 1/2019

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Abstract

Cognitive Bias Modification (CBM) refers to a family of interventions targeting substance-related cognitive biases, which have been found to play a role in the maintenance of addictive behaviors. In this study, we conducted a Bayesian meta-analysis of individual patient data from studies investigating the effects of CBM as a behavior change intervention for the treatment of alcohol and tobacco use disorders, in individuals aware of the behavior change goal of the studies. Main outcomes included reduction in the targeted cognitive biases after the intervention and in substance use or relapse rate at the short-to-long term follow-up. Additional moderators, both at the study-level (type of addiction and CBM training) and at the participant-level (amount of completed training trials, severity of substance use), were progressively included in a series of hierarchical mixed-effects models. We included 14 studies involving 2435 participants. CBM appeared to have a small effect on cognitive bias (0.23, 95% credible interval = 0.06–0.41) and relapse rate (−0.27, 95% credible interval = −0.68 – 0.22), but not on reduction of substance use. Increased training practice showed a paradoxical moderation effect on relapse, with a relatively lower chance of relapse in the control condition with increased practice, compared to the training condition. All effects were associated with extremely wide 95% credible intervals, which indicate the absence of enough evidence in favor or against a reliable effect of CBM on cognitive bias and relapse rate in alcohol and tobacco use disorders. Besides the need for a larger body of evidence, research on the topic would benefit from a stronger adherence to the current methodological standards in randomized controlled trial design and the systematic investigation of shared protocols of CBM.
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Footnotes
1
All studies used the Approach Avoidance Task task to deliver the training. In Wiers et al. (2015a, b), one version of the Approach Bias Modification explicitly instructed participants to react to alcohol-related and non-alcohol-related stimuli, while the other two varieties implicitly instructed participants to react to the stimulus format in 90 and 100% of the trials, respectively. In ITT analyses, the three Approach Bias Modification conditions did not show any significant difference in the effect on drinking reduction at follow-up. Therefore, they were merged together for the current meta-analysis similar to Wiers et al. (2011), where no difference in training effects was found between explicit and implicit instructions. Similarly, in Wittekind et al. (2015), an additional Approach Bias Modification condition presented an adjusted version of the Approach Avoidance Task training presenting RT feedback at the end of each trial. Although this version underperformed the standard training in per-protocol analyses, both of them showed a significant reduction in the substance use outcome at follow-up in the ITT results.
 
2
Due to the small amount of observations, training setting (supervised, such as clinic or research lab, and unsupervised, such as online) was not included as a moderator in the models. The large majority of studies were conducted in supervised settings, providing too few observations to evaluate moderation effects of setting (i.e., very small variance in the moderator).
 
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Metadata
Title
Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data
Authors
Marilisa Boffo
Oulmann Zerhouni
Quentin F. Gronau
Ruben J. J. van Beek
Kyriaki Nikolaou
Maarten Marsman
Reinout W. Wiers
Publication date
01-03-2019
Publisher
Springer US
Published in
Neuropsychology Review / Issue 1/2019
Print ISSN: 1040-7308
Electronic ISSN: 1573-6660
DOI
https://doi.org/10.1007/s11065-018-9386-4

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