Katrijn Houben

Retraining automatic action-tendencies to approach alcohol in hazardous drinkers

AIMS The main aim of this study was to test whether automatic action-tendencies to approach alcohol can be modified, and whether this affects drinking behaviour. DESIGN AND PARTICIPANTS Forty-two hazardous drinkers were assigned randomly to a condition in which they were implicitly trained to avoid or to approach alcohol, using a training variety of the alcohol Approach Avoidance Test (AAT). Participants pushed or pulled a joystick in response to picture-format (landscape or portrait). The pictures depicted alcoholic or non-alcoholic drinks. Participants in the avoid-alcohol condition pushed most alcoholic and pulled most non-alcoholic drinks. For participants in the approach-alcohol condition these contingencies were reversed. After the implicit training, participants performed a taste test, including beers and soft drinks. Automatic action tendencies at post-test were assessed with the AAT, including both trained and untrained pictures, and with a different test (Implicit Association Test, IAT). We further tested effects on subjective craving. RESULTS Action tendencies for alcohol changed in accordance with training condition, with the largest effects in the clinically relevant avoid-alcohol condition. These effects occurred outside subjective awareness and generalized to new pictures in the AAT and to an entirely different test using words, rather than pictures (IAT). In relatively heavy drinking participants who demonstrated changed action tendencies in accordance with their training condition, effects were found on drinking behaviour, with participants in the approach-alcohol condition drinking more alcohol than participants in the avoid-alcohol condition. No effect was found on subjective craving. CONCLUSIONS Retraining automatic processes may help to regain control over addictive impulses, which points to new treatment possibilities.

Getting a Grip on Drinking Behavior: Training Working Memory to Reduce Alcohol Abuse

Alcohol abuse disrupts core executive functions, including working memory (WM)—the ability to maintain and manipulate goal-relevant information. When executive functions like WM are weakened, drinking behavior gets out of control and is guided more strongly by automatic impulses. This study investigated whether training WM restores control over drinking behavior. Forty-eight problem drinkers performed WM training tasks or control tasks during 25 sessions over at least 25 days. Before and after training, we measured WM and drinking behavior. Training WM improved WM and reduced alcohol intake for more than 1 month after the training. Further, the indirect effect of training on alcohol use through improved WM was moderated by participants’ levels of automatic impulses: Increased WM reduced alcohol consumption in participants with relatively strong automatic preferences for alcohol. These findings are consistent with the theoretical framework and demonstrate that training WM may be an effective strategy to reduce alcohol use by increasing control over automatic impulses to drink alcohol.

Control yourself or just eat what you like? Weight gain over a year is predicted by an interactive effect of response inhibition and implicit preference for snack foods.

OBJECTIVE Previous research showed a strong relation between response inhibition, overeating and overweight. It was shown that people with ineffective response inhibition are more susceptible to the temptations of palatable food, eat more and are more often overweight or obese. In addition the results of several studies suggest that what needs to be inhibited may be an affect-driven motivation for food. In the present longitudinal study, we therefore investigated the interplay of response inhibition and implicit preferences for snack foods in predicting weight gain. DESIGN In a sample of predominantly normal weight undergraduate female students, implicit preference for food, response inhibition, and body mass index (BMI) were measured. After 1 year, BMI was measured again. MAIN OUTCOME MEASURES Weight gain of the participants over a 1-year period. RESULTS AND CONCLUSIONS The results strongly confirmed our expectations: participants with strong implicit preferences for snack foods and low inhibitory capacity gained the most weight. These findings imply that ineffective response inhibition may render people vulnerable to excessive or impulsive behavior in general, but that the manifestation thereof is determined by domain-specific preferences or needs.

Resisting temptation: Decreasing alcohol-related affect and drinking behavior by training response inhibition

According to dual-process models, excessive alcohol use emerges when response inhibition ability is insufficient to inhibit automatic impulses to drink alcohol. This study examined whether strengthening response inhibition for alcohol-related cues decreases alcohol intake. Fifty-two heavy drinking students were randomly assigned to one of two conditions: In the beer/no-go condition, participants performed a go/no-go task that consistently paired alcohol-related stimuli with a stopping response, to increase response inhibition for alcohol-related stimuli. In the beer/go condition, in contrast, participants were always required to respond to alcohol-related stimuli during the go/no-go task. Before and after the go/no-go manipulation, we measured weekly alcohol intake and implicit attitudes toward alcohol. In addition, we measured alcohol consumption during a taste test immediately after the go/no-go manipulation. Following the manipulation, participants in the beer/no-go condition demonstrated significantly increased negative implicit attitudes toward alcohol, and a significant reduction in weekly alcohol intake, while participants in the beer/go condition showed a non-significant increase in implicit positive attitudes toward alcohol and a significant increase in weekly alcohol intake. This study demonstrates that repeatedly stopping prepotent responses toward alcohol-related stimuli can be an effective strategy to reduce excessive alcohol use.

Training inhibitory control. A recipe for resisting sweet temptations.

When inhibitory control is lacking, people are more prone to indulge in high calorie food. This research examined whether training to inhibit food-related responses renders one less susceptible to temptations of high calorie food. Trait chocolate lovers were divided into three conditions: participants either consistently inhibited responding to chocolate stimuli (chocolate/no-go condition), consistently responded to chocolate stimuli (chocolate/go condition), or responded to chocolate stimuli only during half the trials (control condition). Chocolate consumption was measured following the manipulation with a taste test. Chocolate consumption did not differ between the control condition and the chocolate/go condition, and increased as a function of dietary restraint in both conditions. In the chocolate/no-go condition, however, chocolate consumption was significantly reduced, and higher levels of dietary restraint were associated with decreased chocolate intake. These findings demonstrate that repeatedly practicing inhibitory control over food-related responses can help people regain control over the consumption of high calorie food.

Response inhibition moderates the relationship between implicit associations and drinking behavior

BACKGROUND Contemporary dual-process models of alcohol abuse propose that alcohol abuse develops because of dysfunctions in the impulsive system, which generates automatic impulses to drink alcohol, and disruptions in the reflective system, which becomes unable to inhibit the influence of these automatic impulses. Based on these insights, this study investigated whether individual differences in the ability of the reflective system to exert response inhibition moderate the relationship between automatic cognitive processes and drinking behavior. Specifically, it was examined whether the interaction between implicit alcohol-related associations and response inhibition predicted drinking behavior. METHODS Seventy-one university students completed the study online via the Internet. Implicit alcohol associations with positive affect and with arousal were assessed with variants of the Implicit Association Test. Response inhibition was measured using the original Stroop task. Participants also reported their weekly alcohol use and alcohol-related problems. RESULTS As predicted, implicit associations were unrelated to drinking behavior when response inhibition was high. In contrast, when response inhibition was low, stronger implicit associations between alcohol and positive affect predicted increased alcohol use and alcohol-related problems. CONCLUSIONS These findings indicate that the relationship between automatic cognitive processes, originating in the impulsive system, and drinking behavior depends on individual differences in response inhibition exerted by the reflective system. As prolonged alcohol abuse is known to impair response inhibition, alcohol abusers may benefit from interventions that increase response inhibition, thereby restoring inhibitory control over automatic impulses.

Overcoming the urge to splurge: Influencing eating behavior by manipulating inhibitory control

BACKGROUND AND OBJECTIVES When inhibitory control is lacking, people are more prone to indulge in high calorie food. This research examined whether increasing or decreasing inhibitory control influences food intake in opposite directions. METHODS In this study, baseline inhibitory control ability was measured with the Stop Signal Task. Next, participants performed a modified Stop Signal Task with three within-subjects conditions: One type of high calorie food was always paired with a stop signal (inhibition manipulation), while another type of high calorie food was never presented with a stop signal (impulsivity manipulation). In the control condition, high calorie food was presented with a stop signal on half the trials. Following the manipulation, intake of the three food products that were used in the manipulation was measured during a taste test. RESULTS Participants with low inhibitory control abilities consumed more of the control food compared to participants with high inhibitory control abilities. However, the inhibition manipulation decreased food consumption in participants with low levels of inhibitory control to the same level of food intake as that of participants with high levels of inhibitory control. Conversely, the impulsivity manipulation increased food intake in participants with high levels of inhibitory control to the level of consumption of participants with low levels of inhibitory control. CONCLUSIONS These findings demonstrate the causal role of inhibition in eating behavior and suggest that strengthening inhibitory control can help people regain control over the consumption of high calorie food.

Beer à no-go: learning to stop responding to alcohol cues reduces alcohol intake via reduced affective associations rather than increased response inhibition

AIMS   Previous research has shown that consistently not responding to alcohol-related stimuli in a go/no-go training procedure reduces drinking behaviour. This study aimed to examine further the mechanisms underlying this go/no-go training effect. DESIGN, SETTING AND PARTICIPANTS   Fifty-seven heavy drinkers were assigned randomly to two training conditions: in the beer/no-go condition, alcohol-related stimuli were always paired with a stopping response, while in the beer/go condition participants always responded to alcohol-related stimuli. Participants were tested individually in a laboratory at Maastricht University. MEASUREMENTS   Weekly alcohol intake, implicit attitudes towards beer, approach-avoidance action tendencies towards beer and response inhibition were measured before and after the training. FINDINGS   Results showed a significant reduction in both implicit attitudes (P = 0.03) and alcohol intake (P = 0.02) in the beer/no-go condition, but not in the beer/go condition. There were no significant training effects on action tendencies or response inhibition. CONCLUSIONS   Repeatedly stopping pre-potent responses towards alcohol-related stimuli reduces excessive alcohol use via a devaluation of alcohol-related stimuli rather than via increased inhibitory control over alcohol-related responses.

Learning to dislike alcohol: conditioning negative implicit attitudes toward alcohol and its effect on drinking behavior.

RationaleSince implicit attitudes toward alcohol play an important role in drinking behavior, a possible way to obtain a behavioral change is changing these implicit attitudes.ObjectivesThis study examined whether a change in implicit attitudes and in drinking behavior can be achieved via evaluative conditioning.MethodsParticipants were randomly assigned to an experimental condition and a control condition. In the experimental condition, participants were subjected to an evaluative conditioning procedure that consistently pairs alcohol-related cues with negative stimuli. In the control condition, alcohol-related cues were consistently paired with neutral stimuli during the evaluative conditioning phase. Implicit attitudes, explicit attitudes, and drinking behavior were measured before and after the evaluative conditioning phase.ResultsFollowing the evaluative conditioning procedure, participants in the experimental condition showed stronger negative implicit attitudes toward alcohol and consumed less alcohol compared to participants in the control condition. However, this effect was only found when the evaluative conditioning task paired alcohol-related cues with general negative pictures, but not when using pictures of frowning faces.ConclusionsThese results demonstrate that evaluative conditioning can effectively change implicit attitudes toward alcohol and also suggest that this procedure can be used to change drinking behavior. Hence, evaluative conditioning may be a useful new intervention tool to combat alcohol misuse.

Implicitly positive about alcohol? Implicit positive associations predict drinking behavior

Research using unipolar Implicit Association Tests (IATs) demonstrated that positive but not negative implicit alcohol associations are related to drinking behavior. However, the relative nature of the IAT with respect to target concepts (i.e., alcohol vs. soft drinks) obscures the interpretation of IAT scores and their relationship to behavior. Here, results with unipolar alcohol vs. soft drinks IATs were compared to results with unipolar Single Target IATs (ST-IAT) for alcohol alone. As expected, positive implicit alcohol associations assessed with both the alcohol-soft drinks IAT and the alcohol ST-IAT were related to alcohol use. In contrast, negative implicit associations with alcohol, whether they were assessed with alcohol-soft drinks IAT or the alcohol ST-IAT, showed no relationship with drinking behavior. Importantly, the alcohol-soft drinks IAT also predicted alcohol use above the variance explained by explicit alcohol-related cognitions, demonstrating that positive implicit associations with alcohol predict unique variance in drinking behavior.