Cognitive Bias Modification in tobacco dependence using an Approach-Avoidance Task (CBM-AAT): A randomized controlled double blind intervention study
Final Report Abstract
Tobacco dependence is one of the most common mental disorders in Germany. It is associated with tremendous negative health and social consequences. Although the majority of individuals who smoke want to quit, only a minority achieves long-term abstinence (Mottillo et al., 2009). This paradox might partly be explained by studies showing that automatic processes, such as automatic approach biases towards substance-related stimuli, which are difficult to control voluntarily, play a central role in the maintenance of tobacco dependence. Therefore, training regimes aiming at a modification of dysfunctional automatic processes have been developed (so-called Cognitive Bias Modification [CBM]). In order to specifically change automatic approach biases towards substance-related stimuli, participants are, for example, presented with smoking-related and neutral images and instructed to push and pull a joystick. In CBM trainings, the instruction is chosen in such a way that the majority of the substace-related stimuli is associated with pushing and the majority of the neutral images (>80%) with pulling. Thereby, automatic approach biases towards substance-related stimuli should be reduced and positive effects on problem behavior should emerge. The combination of treatment-as-usual (TAU) with CBM trainings has substantially increased long-term abstinence rates (8-13%) in abstinent patients with alcohol dependence. The aim of the present randomized-controlled, double-blind trial was to investigate the efficacy and working mechanisms of TAU in combination with CBM in individuals with tobacco dependence. Thefinal sample comprised 351 participants. All participants received a one-day smoke-free intervention and an optional short telephone coaching seven days after the smoke-free intervention. Participants were randomized blockwise to one of three conditions: (1) TAU in combination with CBM, (2) TAU in combination with control training (Sham), (3) TAU only. All participants took part participated in assessment pre- and post-intervention as well as at 6- month follow-up. At follow-up, 17.7% of participants were abstinent, with no significant differences between groups. The results indicate that automatic approach biases are not a relevant maintaining factor in long-term tobacco dependence and in abstinence-motivated individuals. The findings indicate the need to investigate other processes, such as inhibitory abilities, and to better runderstand situational factors that influence the processing of smokingrelated stimuli.
Publications
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Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial. Trials, 23(1).
Wittekind, Charlotte E.; Takano, Keisuke; Sckopke, Philipp; Winkler, Markus H.; Werner, Gabriela G.; Ehring, Thomas & Rüther, Tobias
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Approach Bias Modification als Add-On in der Rauchentwöhnung: Eine randomisiert-kontrollierte Studie. Vortrag präsentiert auf dem 3. Deutschen Psychotherapiekongress
Wittekind, C. E.
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The effects of approach bias modification on cue reactivity to smoking-related stimuli in smokers: a randomized controlled fMRI study. Vortrag präsentiert auf dem 3. Deutschen Psychotherapiekongress
Motka, F.
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Cognitive Bias Modification as Add-On to the Treatment of Substance Use Disorders. The Sage Handbook of Addiction Psychology, 360-376. Sage Publications Ltd.
Wittekind, Charlotte E.; Rinck, Mike & Wiers, Reinout W.
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Approach Bias Modification as an Add-On to Smoking Cessation Treatment: A Randomized Controlled Trial. American Journal of Psychiatry.
Wittekind, Charlotte E.; Takano, Keisuke; Motka, Franziska; Winkler, Markus H.; Werner, Gabriela G.; Ehring, Thomas & Rüther, Tobias
