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Trials
Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial

Authors: Marilisa Boffo, Ronny Willemen, Thomas Pronk, Reinout W. Wiers, Geert Dom

Published in: Trials | Issue 1/2017

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Abstract

Background

Disordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.

Methods/design

Participants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.

Discussion

This study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.

Trial registration

Netherlands Trial Register, NTR5096. Registered on 11 March 2015.
Appendix
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Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.
2.
3.
Petry N. Comorbidity of disordered gambling and other psychiatric disorders. In: Petry N, editor. Pathological gambling: etiology, comorbidity and treatment. Washington, DC: American Psychological Association; 2005. p. 85–115.CrossRef
4.
Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction. 2011;106:490–8.CrossRefPubMed
5.
Goudriaan AE, Oosterlaan J, De Beurs E, Van Den Brink W. Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls. Addiction. 2006;101(4):534–47.CrossRefPubMed
6.
Goudriaan AE, De Ruiter MB, Van Den Brink W, Oosterlaan J, Veltman DJ. Brain activation patterns associated with cue reactivity and craving in abstinent problem gamblers, heavy smokers and healthy controls: an fMRI study. Addict Biol. 2010;15(4):491–503.CrossRefPubMedPubMedCentral
7.
8.
Brevers D, Cleeremans A, Bechara A, Laloyaux C, Kornreich C, Verbanck P, Noël X. Time course of attentional bias for gambling information in problem gambling. Psychol Addict Behav. 2011;25(4):675.CrossRefPubMedPubMedCentral
9.
Brevers D, Cleeremans A, Tibboel H, Bechara A, Kornreich C, Verbanck P, Noël X. Reduced attentional blink for gambling-related stimuli in problem gamblers. J Behav Ther Exp Psychiatry. 2011;42(3):265–9.CrossRefPubMed
10.
Romanczuk-Seiferth N, Van Den Brink W, Goudriaan AE. From symptoms to neurobiology: pathological gambling in the light of the new classification in DSM-5. Neuropsychobiology. 2014;70(2):95–102.CrossRefPubMed
11.
Goudriaan AE, Oosterlaan J, de Beurs E, van den Brink W. Decision making in pathological gambling: a comparison between pathological gamblers, alcohol dependents, persons with Tourette syndrome, and normal controls. Cogn Brain Res. 2005;23(1):137–51.CrossRef
12.
De Ruiter MB, Veltman DJ, Goudriaan AE, Oosterlaan J, Sjoerds Z, van den Brink W. Response perseveration and ventral prefrontal sensitivity to reward and punishment in male problem gamblers and smokers. Neuropsychopharmacology. 2009;34(4):1027–38.CrossRefPubMed
13.
Goudriaan AE, Yücel M, van Holst RJ. Getting a grip on problem gambling: what can neuroscience tell us? Front Behav Neurosci. 2014;1:8.
14.
Meng YJ, Deng W, Wang HY, Guo WJ, Li T, Lam C, Lin X. Reward pathway dysfunction in gambling disorder: a meta-analysis of functional magnetic resonance imaging studies. Behav Brain Res. 2014;275:243–51.CrossRefPubMed
15.
16.
van Holst RJ, van den Brink W, Veltman DJ, Goudriaan AE. Why gamblers fail to win: a review of cognitive and neuroimaging findings in pathological gambling. Neurosci Biobehav Rev. 2010;34(1):87–107.CrossRefPubMed
17.
Thomsen KR, Fjorback LO, Møller A, Lou HC. Applying incentive sensitization models to behavioral addiction. Neurosci Biobehav Rev. 2014;45:343–9.CrossRef
18.
Chamberlain SR, Lochner C, Stein DJ, Goudriaan AE, van Holst RJ, Zohar J, Grant JE. Behavioural addiction—a rising tide? Eur Neuropsychopharmacol. 2016;26(5):841–55.CrossRefPubMed
19.
Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci. 2005;8(11):1458–63.CrossRefPubMed
20.
21.
Wiers RW, Gladwin TE, Hofmann W, Salemink E, Ridderinkhof KR. Cognitive bias modification and cognitive control training in addiction and related psychopathology: mechanisms, clinical perspectives, and ways forward. Clin Psychol Sci. 2013;1:192–212.CrossRef
22.
Gladwin TE, Figner B. “Hot” cognition and dual systems: introduction, criticisms, and ways forward. In: Wilhelms EA, Reyna VF, editors. Neuroeconomics, judgement and decision making. Frontiers of cognitive psychology series. Oxford: Psychology Press; 2014. p. 157–80.
23.
Robinson TE, Berridge KC. The incentive sensitization theory of addiction: some current issues. Philos Trans R Soc Lond B Biol Sci. 2008;363:3137–46.CrossRefPubMedPubMedCentral
24.
Hønsi A, Mentzoni RA, Molde H, Pallesen S. Attentional bias in problem gambling: a systematic review. J Gambl Stud. 2013;29(3):359–75.CrossRefPubMed
25.
Boyer M, Dickerson M. Attentional bias and addictive behaviour: automaticity in a gambling‐specific modified Stroop task. Addiction. 2003;98(1):61–70.CrossRefPubMed
26.
Molde H, Pallesen S, Sætrevik B, Hammerborg DK, Laberg JC, Johnsen BH. Attentional biases among pathological gamblers. Int Gambl Stud. 2010;10(1):45–59.CrossRef
27.
Vizcaino EJV, Fernandez-Navarro P, Blanco C, Ponce G, Navio M, Moratti S, Rubio G. Maintenance of attention and pathological gambling. Psychol Addict Behav. 2013;27(3):861.CrossRefPubMed
28.
Field M, Cox WM. Attentional bias in addictive behaviors: a review of its development, causes, and consequences. Drug Alcohol Depend. 2008;97(1):1–20.CrossRefPubMed
29.
Wölfling K, Mörsen CP, Duven E, Albrecht U, Grüsser SM, Flor H. To gamble or not to gamble: at risk for craving and relapse–learned motivated attention in pathological gambling. Biol Psychol. 2011;87(2):275–81.CrossRefPubMed
30.
van Holst RJ, Veltman DJ, Büchel C, van den Brink W, Goudriaan AE. Distorted expectancy coding in problem gambling: is the addictive in the anticipation? Biol Psychiatry. 2012;71:741–8.CrossRefPubMed
31.
MacLeod C, Rutherford E, Campbell L, Ebsworthy G, Holker L. Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. J Abnorm Psychol. 2002;111(1):107.CrossRefPubMed
32.
Wiers RW, Rinck M, Kordts R, Houben K, Strack F. Retraining automatic action‐tendencies to approach alcohol in hazardous drinkers. Addiction. 2010;105(2):279–87.CrossRefPubMed
33.
Notebaert L, Clarke PJ, Grafton B, MacLeod C. Validation of a novel attentional bias modification task: the future may be in the cards. Behav Res Ther. 2015;65:93–100.CrossRefPubMed
34.
Wiers RW, Eberl C, Rinck M, Becker ES, Lindenmeyer J. Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychol Sci. 2011;22(4):490–7.CrossRefPubMed
35.
Eberl C, Wiers RW, Pawelczack S, Rinck M, Becker ES, Lindenmeyer J. Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best? Dev Cogn Neurosci. 2013;4:38–51.CrossRefPubMed
36.
Schoenmakers TM, de Bruin M, Lux IF, Goertz AG, Van Kerkhof DH, Wiers RW. Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients. Drug Alcohol Depend. 2010;109(1):30–6.CrossRefPubMed
37.
Verdejo-Garcia A, Manning V. Executive functioning in gambling disorder: cognitive profiles and associations with clinical outcomes. Curr Addict Rep. 2015;2(3):214–9.CrossRef
38.
Rabinovitz S, Nagar M. Possible End to an Endless Quest? Cognitive bias modification for excessive multiplayer online gamers. Cyberpsychol Behav Soc Netw. 2015;18(10):581–7.CrossRefPubMed
39.
40.
Rockloff MJ, Schofield G. Factor analysis of barriers to treatment for problem gambling. J Gambl Stud. 2004;20(2):121–6.CrossRefPubMed
41.
Evans L, Delfabbro PH. Motivators for change and barriers to help-seeking in Australian problem gamblers. J Gambl Stud. 2005;21(2):133–55.CrossRefPubMed
42.
Wiers RW, Houben K, Fadardi JS, van Beek P, Rhemtulla M, Cox WM. Alcohol cognitive bias modification training for problem drinkers over the web. Addict Behav. 2015;40:21–6.CrossRefPubMed
43.
Elfeddali I, Vries H, Bolman C, Pronk T, Wiers RW. Randomized controlled trial of web-based attentional bias modification to help smokers quit. Health Psychol. 2016;35(8):870-80.  
44.
Boffo M, Pronk T, Wiers RW, Mannarini S. Combining cognitive bias modification training with motivational support in alcohol dependent outpatients: study protocol for a randomised controlled trial. Trials. 2015;16(1):1.CrossRef
45.
Cunningham JA, Hodgins DC, Toneatto T, Murphy M. A randomized controlled trial of a personalized feedback intervention for problem gamblers. PLoS ONE. 2012;7(2):e31586.CrossRefPubMedPubMedCentral
46.
Hodgins DC, Currie SR, el-Guebaly N, 1. Motivational enhancement and self-help treatments for problem gambling. J Consult Clin Psychol. 2001;69:50.CrossRefPubMed
47.
Verdejo-García A, Lawrence AJ, Clark L. Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neurosci Biobehav Rev. 2008;32(4):777–810.CrossRefPubMed
48.
Kräplin A, Bühringer G, Oosterlaan J, van den Brink W, Goschke T, Goudriaan AE. Dimensions and disorder specificity of impulsivity in pathological gambling. Addict Behav. 2014;39(11):1646–51.CrossRefPubMed
49.
Eberl C, Wiers RW, Pawelczack S, Rinck M, Becker ES, Lindenmeyer J. Implementation of approach bias re‐training in alcoholism—how many sessions are needed? Alcohol Clin Exp Res. 2014;38(2):587–94.CrossRefPubMed
50.
Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleža-Jerić K. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.CrossRefPubMedPubMedCentral
51.
Volberg RA, Steadman HJ. Refining prevalence estimates of pathological gambling. Am J Psychiatry. 1988;145:502–5.CrossRefPubMed
52.
Rinck M, Becker ES. Approach and avoidance in fear of spiders. J Behav Ther Exp Psychiatry. 2007;38(2):105–20.CrossRefPubMed
53.
Pronk T, Deursen DS, Beraha EM, Larsen H, Wiers RW. Validation of the Amsterdam Beverage Picture Set: a controlled picture set for cognitive bias measurement and modification paradigms. Alcohol Clin Exp Res. 2015;39(10):2047–55.CrossRefPubMedPubMedCentral
54.
Miller WR, Rollnick S. Motivational interviewing: helping people change. New York: Guilford Press; 2012.
55.
Yakovenko I, Quigley L, Hemmelgarn BR, Hodgins DC, Ronksley P. The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis. Addict Behav. 2015;43:72–82.CrossRefPubMed
56.
Petry NM, Weinstock J, Ledgerwood DM, Morasco B. A randomized trial of brief interventions for problem and pathological gamblers. J Consult Clin Psychol. 2008;76(2):318.CrossRefPubMedPubMedCentral
57.
Toneatto T, Kosky B, Leo GI. How to quit or reduce your gambling: a personal workbook. Toronto: Centre for Addiction and Mental Health; 2003.
58.
Neighbors C, Lostutter TW, Cronce JM, Larimer ME. Exploring college student gambling motivation. J Gambl Stu. 2002;18(4):361–70.CrossRef
59.
Lesieur HR, Blume SB. The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers. Am J Psychiatry. 1987;144(9):1184–8.CrossRefPubMed
60.
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.
61.
Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction. 1993;88(6):791–804.CrossRefPubMed
62.
Patton JH, Stanford MS. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51(6):768–74.CrossRefPubMed
63.
Rosenberg M. Society and the adolescent self-image. New York. Princeton: Princeton University Press; 1965.CrossRef
64.
Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18(6):643.CrossRef
65.
Macy JT, Chassin L, Presson CC, Sherman JW. Changing implicit attitudes toward smoking: results from a web-based approach-avoidance practice intervention. J Behav Med. 2015;38(1):143–52.CrossRefPubMed
66.
Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86.CrossRefPubMed
67.
68.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.
69.
Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P, for the CONSORT NPT Group. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40. 
70.
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.CrossRefPubMed
71.
Wiers CE, Stelzel C, Gladwin TE, Park SQ, Pawelczack S, Gawron CK, Stuke H, Heinz A, Wiers RW, Rinck M, Lindenmeyer J. Effects of cognitive bias modification training on neural alcohol cue reactivity in alcohol dependence. Am J Psychiatry. 2015;172(4):335–43.CrossRefPubMed
72.
Fridrici C, Leichsenring-Driessen C, Driessen M, Wingenfeld K, Kremer G, Beblo T. The individualized alcohol Stroop task: no attentional bias toward personalized stimuli in alcohol-dependents. Psychol Addict Behav. 2013;27(1):62.CrossRefPubMed
73.
Christiansen P, Bloor JF. Individualised but not general alcohol Stroop predicts alcohol use. Drug Alcohol Depend. 2014;134:410–3.CrossRefPubMed
74.
Christiansen P, Mansfield R, Duckworth J, Field M, Jones A. Internal reliability of the alcohol-related visual probe task is increased by utilising personalised stimuli and eye-tracking. Drug Alcohol Depend. 2015;155:170–4.CrossRefPubMed
Metadata
Title
Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial
Authors
Marilisa Boffo
Ronny Willemen
Thomas Pronk
Reinout W. Wiers
Geert Dom
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2190-2

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