Mike Rinck

Retraining Automatic Action Tendencies Changes Alcoholic Patients’ Approach Bias for Alcohol and Improves Treatment Outcome

This study tested the effects of a new cognitive-bias modification (CBM) intervention that targeted an approach bias for alcohol in 214 alcoholic inpatients. Patients were assigned to one of two experimental conditions, in which they were explicitly or implicitly trained to make avoidance movements (pushing a joystick) in response to alcohol pictures, or to one of two control conditions, in which they received no training or sham training. Four brief sessions of experimental CBM preceded regular inpatient treatment. In the experimental conditions only, patients’ approach bias changed into an avoidance bias for alcohol. This effect generalized to untrained pictures in the task used in the CBM and to an Implicit Association Test, in which alcohol and soft-drink words were categorized with approach and avoidance words. Patients in the experimental conditions showed better treatment outcomes a year later. These findings indicate that a short intervention can change alcoholics’ automatic approach bias for alcohol and may improve treatment outcome.

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.

Relatively strong automatic appetitive action-tendencies in male carriers of the OPRM1 G-allele

This study investigated whether automatic approach action tendencies for alcohol‐related stimuli were associated with variation in the mu‐opioid receptor gene (OPRM1), previously related to rewarding effects of alcohol and craving. An adapted approach avoidance task was used, in which participants pulled or pushed a joystick in reaction to the format of a picture shown on the computer screen (e.g. pull landscape pictures and push portrait pictures). Picture size on the screen changed upon joystick movement, so that upon a pull movement picture size increased (creating a sense of approach) and upon a push movement picture size decreased (avoidance). Participants reacted to four categories of pictures: alcohol‐related, other appetitive, general positive and general negative. The sample consisted of 84 heavy drinking young men without a g‐allele in the A118G (or A355G) single nucleotide polymorphism of the OPRM1 gene and 24 heavy drinking young men with at least one g‐allele. Heavy drinking carriers of a g‐allele showed relatively strong automatic approach tendencies for alcohol (approach bias). Unexpectedly, they also showed an approach bias for other appetitive stimuli. No approach bias was found for general positive or negative stimuli. These results suggest that automatic approach tendencies in response to appetitive stimuli could play a role in the etiology of addictive behaviors and related disorders. Further research is needed to investigate the specificity of this approach bias and possible gender differences.

Emotional and Temporal Aspects of Situation Model Processing during Text Comprehension: An Event-Related fMRI Study

Language comprehension in everyday life requires the continuous integration of prior discourse context and general world knowledge with the current utterance or sentence. In the neurolinguistic literature, these so-called situation model building processes have been ascribed to the prefrontal cortex or to the right hemisphere. In this study, we use whole-head event-related fMRI to directly map the neural correlates of narrative comprehension in context. While being scanned using a spin-echo sequence, 20 participants listened to 32 short stories, half of which contained globally inconsistent information. The inconsistencies concerned either temporal or chronological information or the emotional status of the protagonist. Hearing an inconsistent word elicited activation in the right anterior temporal lobe. The comparison of different information aspects revealed activation in the left precuneus and a bilateral frontoparietal network for chronological information. Emotional information elicited activation in the ventromedial prefrontal cortex and the extended amygdaloid complex. In addition, the integration of inconsistent emotional information engaged the dorsal frontomedial cortex (Brodmanns area 8/9), whereas the integration of inconsistent temporal information required the lateral prefrontal cortex bilaterally. These results indicate that listening to stories can elicit activation reflecting content-specific processes. Furthermore, updating of the situation model is not a unitary process but it also depends on the particular requirements of the text. The right hemisphere contributes to language processing in context, but equally important are the left medial and bilateral prefrontal cortices.

Spider fearful individuals attend to threat, then quickly avoid it: Evidence from eye movements

According to cognitive models of anxiety, anxiety patients exhibit an early reflexive attentional bias toward threat stimuli, which may be followed by intentional avoidance of these stimuli. To determine the time course of attentional vigilance and avoidance, the authors conducted an eye-tracking study in which 22 highly spider fearful participants (SFs) and 23 nonanxious control participants (NACs) studied groups of 4 pictures (spider, butterfly, dog, and cat). The authors found that the very first fixation was on a spider picture more often in SFs than in NACs. However, SFs quickly moved their eyes away from the spider they had fixated first, yielding shorter gaze durations than NACs. Afterward, SFs exhibited shorter gaze durations on spiders than NACs for the rest of the 1-min presentation time. This early reflexive attentional bias toward threat followed by avoidance of threat may explain earlier failures to find attentional biases in anxiety.

The emotional Stroop effect in anxiety disorders: General emotionality or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

Approach bias modification in alcohol dependence: Do clinical effects replicate and for whom does it work best?

BACKGROUND Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation. METHODS 509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected. RESULTS The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM. CONCLUSIONS CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism.

A Comparison of attentional biases and memory biases in social phobia and major depression

Cognitive processes play an important role in the etiology and maintenance of anxiety and depression. Current theories differ, however, in their predictions regarding the occurrence of attentional biases and memory biases in depression and anxiety. To allow for a systematic comparison of disorders and cognitive processes, 117 women (35 with generalized social phobia, 27 with major depression, and 55 healthy controls) participated in a test of visual attention (visual search), an explicit memory test (free recall), and an implicit memory test (anagram solving). Both clinical groups exhibited attentional biases for disorder-related words, whereas only depressed participants showed clear evidence of explicit and implicit memory biases. The implications of these results for competing theories are discussed.

Emotion simulation during language comprehension

We report a novel finding on the relation of emotion and language. Covert manipulation of emotional facial posture interacts with sentence valence when measuring the amount of time to judge valence (Experiment 1) and sensibility (Experiment 2) of the sentence. In each case, an emotion-sentence compatibility effect is found: Judgment times are faster when facial posture and sentence valence match than when they mismatch. We interpret the finding using a simulation account; that is, emotional systems contribute to language comprehension much as they do in social interaction. Because the effect was not observed on a lexical decision task using emotion-laden words (Experiment 3), we suggest that the emotion simulation affects comprehension processes beyond initial lexical access.

Speeded detection and increased distraction in fear of spiders: evidence from eye movements.

Anxiety patients exhibit attentional biases toward threat, which have often been demonstrated as increased distractibility by threatening stimuli. In contrast, speeded detection of threat has rarely been shown. Therefore, the authors studied both phenomena in 3 versions of a visual search task while eye movements were recorded continuously. Spider-fearful individuals and nonanxious control participants participated in a target search task, an odd-one-out search task, and a category search task. Evidence for disorder-specific increased distraction by threat was found in all tasks, whereas speeded threat detection did not occur in the target search task. The implications of these findings for cognitive theories of anxiety are discussed, particularly in relation to the concept of disengagement from threat.