Article

Luck, come here! Automatic approach tendencies toward gambling cues in moderate‐to‐high risk gamblers

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  • Ubisoft Halifax
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Abstract

Background and aims: Similar to substance addictions, reward-related cognitive motivational processes, such as selective attention and positive memory biases, have been found in disordered gambling. Despite findings that individuals with substance use problems are biased to approach substance-related cues automatically, no study has yet focused on automatic approach tendencies for motivationally salient gambling cues in problem gamblers. We tested if moderate- to high-risk gamblers show a gambling approach bias and whether this bias was related prospectively to gambling behaviour and problems. Design: Cross-sectional assessment study evaluating the concurrent and longitudinal correlates of gambling approach bias in moderate- to high-risk gamblers compared with non-problem gamblers. Setting: Online study throughout the Netherlands. Participants: Twenty-six non-treatment-seeking moderate- to high-risk gamblers and 26 non-problem gamblers community-recruited via the internet. Measurements: Two online assessment sessions 6 months apart, including self-report measures of gambling problems and behaviour (frequency, duration and expenditure) and the gambling approach avoidance task, with stimuli tailored to individual gambling habits. Findings: Relative to non-problem gamblers, moderate- to high-risk gamblers revealed a stronger approach bias towards gambling-related stimuli than neutral stimuli (P = 0.03). Gambling approach bias was correlated positively with past-month gambling expenditure at baseline (P = 0.03) and with monthly frequency of gambling at follow-up (P = 0.02). In multiple hierarchical regressions, baseline gambling approach bias predicted monthly frequency positively (P = 0.03) and total duration of gambling episodes (P = 0.01) 6 months later, but not gambling problems or expenditure. Conclusions: In the Netherlands, relative to non-problem gamblers, moderate- to high-risk gamblers appear to have a stronger tendency to approach rather than to avoid gambling-related pictures compared with neutral ones. This gambling approach bias is associated concurrently with past-month gambling expenditure and duration of gambling and has been found to predict persistence in gambling behaviour over time.

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... This study received a quality assessment rating of 81.8% (see Table 1). Boffo et al. (2018) adapted the approach avoidance task developed by Rinck and Becker (2007) in their research into fear of spiders. The task requires participants to either approach ("pull") or avoid ("push") neutral and target stimuli using a joystick or keyboard keys, appearing to reflect attentional bias at orientation of attention. ...
... The task requires participants to either approach ("pull") or avoid ("push") neutral and target stimuli using a joystick or keyboard keys, appearing to reflect attentional bias at orientation of attention. Boffo et al. (2018) adapted this task to examine attentional bias in problem gamblers using gambling-related and neutral pictorial stimuli in a sample of moderate to highrisk gamblers (n = 22) and non-problem gamblers (n = 26). Approach bias scores were calculated by subtracting median reaction times in each stimulus category for both approach and avoid trials, where a faster 'pull' response to gambling stimuli relative to neutral stimuli indicates a stronger approach tendency. ...
... The reviewed studies provide evidence for attentional bias at both orientation and maintenance of attention, with eight studies producing effects relevant to attention orientation (Boffo et al., 2018;Boyer & Dickerson, 2003;Brevers et al., 2011b;Ciccarelli et al., 2016aCiccarelli et al., , 2016bCiccarelli et al., , 2020McCusker & Gettings, 1997;Molde et al., 2010) and seven reporting attentional bias at the maintenance level (Diskin & Hodgins, 1999;Wölfling et al., 2011;Hudson, 2016;Ciccarelli et al., 2019;McGrath et al., 2021;Vizcaino et al., 2012;Kim et al., 2021Kim et al., , 2022. The study by Brevers et al. (2011a) concluded that effects indicated attentional bias at both orientation and maintenance of attention. ...
Article
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A large body of previous research has provided support for the role of attentional bias as a maintaining factor in addiction. This systematic review aimed to investigate the extent and nature of attentional bias as a phenomenon which exists within problem gamblers. Studies were identified through searches of three databases (MedLine, PSYCHINFO, and Web of Science) and examination of the reference lists of the final studies meeting criteria for inclusion. The scope of the review included empirical studies making experimental comparisons of problem gamblers and non-problem gamblers across a range of attentional paradigms. A comparison of effect sizes was conducted across studies comparing problem to non-problem gamblers within and between attention paradigms. Twenty-two studies were reviewed systematically across ten experimental paradigms. Attentional bias was demonstrated in 16 of the 22 studies, with attentional bias effects varying across paradigms. Quality assessment revealed two main limitations across studies: lack of a priori power analysis, and failure to control for gambling frequency as a possible confounding variable. Findings support the role of attentional bias as a potential maintaining factor in problem gambling behaviour, in line with evidence for substance addiction. Recommendations for future studies are outlined alongside a discussion of clinical implications.
... Evidence for approach bias tendencies to underly automatic behavioural impulses towards seeking out gambling activities in the presence of appetitive salient cues was first shown by Boffo et al. (2018) in a Dutch sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers demonstrated stronger approach tendencies towards gambling-related stimuli compared with neutral ones. ...
... Each session included (1) self-report measures of gambling behaviour (frequency, duration, and expenditure), (2) self-report assessment of problem gambling severity (PGSI), and (3) a gambling approach-avoidance task, utilising culturally relevant stimuli tailored to individual gambling habits. However, our study failed to replicate Boffo et al. (2018) findings in a Canadian sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers did not exhibit greater approach bias tendencies towards gambling-related stimuli compared to neutral stimuli. ...
... Research in other addictive behaviours has demonstrated how biased approach tendencies distinctively contribute to dysregulated substance (mis)use, predicting the increase in prospective consumption (e.g., in problematic use of alcohol and cannabis; Cousijn et al., 2011;Fleming & Bartholow, 2014;Sharbanee et al., 2013). However, in the field of gambling research, so far, only one published study has investigated approach bias to motivationally salient gambling cues and whether the hypothesized approach bias predicts problematic gambling behaviour (Boffo et al., 2018). 1 In a Dutch sample, Boffo et al. (2018) compared gambling approach bias in non-treatment-seeking moderate-to-high-risk gamblers vs. nonproblematic gamblers. Utilising a gambling variant of the Approach Avoidance Task (G-AAT; Wiers et al., 2009) to evaluate differential responding speed to appetitive, gambling-related vs neutral, nongambling-related cues, results showed that moderate-to-high-risk gamblers displayed a stronger approach bias to gambling-related stimuli in comparison to non-problematic gamblers. ...
Article
Evidence for approach bias tendencies to underly automatic behavioural impulses towards seeking out gambling activities in the presence of appetitive salient cues was first shown by Boffo et al. (2018) in a Dutch sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers demonstrated stronger approach tendencies towards gambling-related stimuli compared with neutral ones. Moreover, gambling approach bias was associated with past-month gambling behaviour and predictive of gambling activity persistence over time. The current study aimed to replicate these findings within a Canadian sample evaluating the concurrent and longitudinal correlates of gambling approach bias. The study was conducted online, available throughout Canada. Twenty-seven non-treatment-seeking moderate-to-high-risk gamblers and 26 non-problem gamblers community-recruited via multiple channels (i.e., internet and newspaper advertisements, land-based flyers, and university recruitment portals). Participants completed two online assessment sessions 6-months apart. Each session included (1) self-report measures of gambling behaviour (frequency, duration, and expenditure), (2) self-report assessment of problem gambling severity (PGSI), and (3) a gambling approach-avoidance task, utilising culturally relevant stimuli tailored to individual gambling habits. However, our study failed to replicate Boffo et al. (2018) findings in a Canadian sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers did not exhibit greater approach bias tendencies towards gambling-related stimuli compared to neutral stimuli. Moreover, gambling approach bias was not predictive of prospective gambling behaviour (frequency, duration, or expenditure) or severity of gambling problems. Reported results do not provide evidence for approach tendencies contributing to problematic gambling behaviour in a Canadian sample of moderate-to-high-risk gamblers compared to non-problematic gambler controls. Further replications on the topic are needed. Future research should evaluate approach tendencies within the gambling context, considering the potential impact of task reliability to assess approach bias in light of individual gambling modality preferences.
... A first set of studies has been recently conducted to examine the role of gamblingrelated approach bias in Canadian and Dutch problem and non-problem gamblers, using an adapted version of the AAT with gambling stimuli tailored to participants' gambling preferences [100,101]. Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. ...
... A first set of studies has been recently conducted to examine the role of gamblingrelated approach bias in Canadian and Dutch problem and non-problem gamblers, using an adapted version of the AAT with gambling stimuli tailored to participants' gambling preferences [100,101]. Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. ...
... Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. Even though not yet replicated, these results are consistent with findings in other addictive behaviors and support the hypothesis that automatic approach tendencies also play a role in problematic gambling behavior. ...
... A first set of studies has been recently conducted to examine the role of gamblingrelated approach bias in Canadian and Dutch problem and non-problem gamblers, using an adapted version of the AAT with gambling stimuli tailored to participants' gambling preferences [100,101]. Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. ...
... A first set of studies has been recently conducted to examine the role of gamblingrelated approach bias in Canadian and Dutch problem and non-problem gamblers, using an adapted version of the AAT with gambling stimuli tailored to participants' gambling preferences [100,101]. Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. ...
... Results demonstrated the presence of approach bias towards gambling cues amongst Dutch gamblers with moderate-to-high severity of gambling problems, compared to non-problem gamblers [101], but not for Canadian problem gamblers [100]. Moreover, gambling approach bias predicted frequency and duration of prospective gambling episodes, over and above baseline neutral approach bias and gambling frequency and duration [101]. Even though not yet replicated, these results are consistent with findings in other addictive behaviors and support the hypothesis that automatic approach tendencies also play a role in problematic gambling behavior. ...
Chapter
Excessive gambling behavior is a complex psychopathological phenomenon, characterized by the interaction of multiple etiological factors and by a very heterogeneous symptomatological expression. To date, there are no existing evidence-based “best practice” treatment standards for gambling disorder. Healthcare providers and clinicians are further challenged by the difficulty in reaching out to individuals suffering from gambling problems. Despite a surge of empirical studies on various therapeutic approaches addressing disordered gambling, there is an urgent need for the development of suitable and cost-effective helping tools. This chapter presents a narrative overview of recent advances in the development of and research on innovative treatment approaches and treatment modalities for gambling problems, ranging from training interventions based on addiction models, such as Cognitive Bias Modification and general cognitive training programs; neuromodulation techniques, and employment of modern digital technology to promote large-scale support services and overcome treatment barriers, to personalization of existing interventions to individual and culture-based characteristics and preferences, and integration of multiple methods. Each section of this chapter presents existing preliminary evidence for such novel treatment approaches in the domain of disordered gambling and, when not available, results in the broader field of addictive behaviors. Altogether, these novel venues of research on gambling interventions share the goal of enhancing therapeutic effects and overcoming barriers and limitations to existing treatment programs by meeting the heterogeneous needs and demands of this peculiar clinical population.
... Based on such research, exploring the possibility of deploying CBM training as a PG intervention to reduce or perhaps even reverse such gambling-related biases (as has been successfully done in alcohol use disorders, see Wiers et al., 2023 for a review) is a worthwhile undertaking. CBM training generally consists of adapted cognitive bias assessment tasks, such as the visual probe task (VPT;MacLeod et al., 2002) or approach-avoidance task (AAT; Boffo et al., 2018), where a stimulus-response contingency is added to train participants to learn a new, more beneficial response towards gambling cues (i.e., shift attention away from or avoid gambling-related cues). Interventions using CBM training have been shown to be moderately effective in reducing symptomatology across psychopathologies, including addiction Gladwin et al., 2017), anxiety (Krebs et al., 2018) and food disorders (Fodor et al., 2017). ...
... Secondary outcomes were attentional bias for gambling stimuli (VPT-assessment version; MacLeod et al., 2002) and approach bias for gambling stimuli (AAT-assessment version; Boffo et al., 2018;Rinck & Becker, 2007). A relative attentional bias score was computed by subtracting the median response time (RT) for gambling trials (cued by gambling-related stimuli) from the median RT for neutral trials (cued by neutral stimuli) (Wen et al., 2020). ...
Article
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Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants’ motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.
... However, the AAT has yet to be investigated as an intervention tool in SP. The AAT addiction literature has documented the presence of an approach bias toward salient stimuli for those who engage in cannabis use (Cousijn, Goudriaan & Wiers, 2011), alcohol use (Wiers, Rinck, Dictus & Van den Wildenberg, 2009), cigarette smoking (Machulska, Zlomuzica, Adolph, Rinck & Margraf, 2015) and high-risk gambling (Boffo et al., 2018). Cousijn et al. (2011) showed that approach bias towards cannabis stimuli predicted increased cannabis use at 6-month follow up. ...
... Cousijn et al. (2011) showed that approach bias towards cannabis stimuli predicted increased cannabis use at 6-month follow up. In addition, Boffo et al. (2018) found that gambling approach bias predicted both past and future gambling persistence over time. As a training tool, the AAT has shown promising results for other addictions like alcohol use and cigarette smoking (Heuer et al., 2007;Klein et al., 2011;Wittekind et al., 2015). ...
Article
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Background and aims Pathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response. Method Forty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli). Results Results of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups. Discussion Our preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.
... Positive implicit associations have notably been found among alcoholic patients (Barkby et al. 2012), cigarette smokers (Payne et al. 2007;Woud et al. 2016), cannabis users (Cousijn et al. 2011), cocaine users (Wiers et al. 2007b), heroin users , problem gamblers , and problem video gamers (Yen et al. 2011). Similarly, approach and avoidance automatic tendencies have been found in alcohol dependence (Barkby et al. 2012;Field et al. 2008), nicotine dependence (Mogg et al. 2005), cannabis use (Beraha et al. 2013), and problem gambling (Boffo et al. 2018). ...
... As an illustration, it was found that, via this task, hazardous drinkers were faster to pull than to push the joystick in response to alcohol pictures ). Likewise, automatic approach tendencies were positively associated with past-month expenditures and gambling frequency among problem gamblers (Boffo et al. 2018). ...
Article
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Decision-making impairments play a pivotal role in the emergence and maintenance of addictive disorders. However, a sound conceptualization of decision making as an umbrella construct, encompassing its cognitive, affective, motivational, and physiological subcomponents, is still lacking, preventing an efficient evaluation of the heterogeneity of decision-making impairments and the development of tailored treatment. This paper thus unfolds the various processes involved in decision making by adopting a critical approach of prominent dual- or triadic-process models, which postulate that decision making is influenced by the interplay of impulsive-automatic, reflective-controlled, and interoceptive processes. Our approach also focuses on social cognition processes, which play a pivotal role in decision making and addictive disorders but were largely ignored in previous dual- or triadic-process models. We propose here a theoretical framework in which a range of coordinated processes are first identified on the basis of their theoretical and clinical relevance. Each selected process is then defined before reviewing available results underlining its role in addictive disorders (i.e., substance use, gambling, and gaming disorders). Laboratory tasks for measuring each process are also proposed, initiating a preliminary process-based decision-making assessment battery. This original approach may offer an especially informative view of the constitutive features of decision-making impairments in addiction. As prior research has implicated these features as risk factors for the development and maintenance of addictive disorders, our processual approach sets the scene for novel and transdiagnostic experimental and applied research avenues.
... With participants' explicit attention focused on the format of an image (i.e., portrait or landscape), the implicit bias can be measured through calculating the difference between approach (i.e., pulling/arm flexion) and avoidance (i.e., pushing/arm extension) movements during trials with a specific stimulus category. The AAT is effective in assessing implicit approach biases for various stimuli, including alcohol [23], cannabis [24], gambling [31], sexual [32,33], and condom stimuli [33]. ...
Article
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Alcohol and cannabis are the first and second most used substances among adolescents. Adolescence is a period of considerable development, making the adolescent brain particularly vulnerable to negative effects of alcohol and cannabis use. Developing and testing interventions that target both alcohol and cannabis use during adolescence are vital to decreasing costly consequences. Biases in cognitive processing of drug-related stimuli play an important role in the development and maintenance of problematic substance use. The Approach-Avoidance Task (AAT) is a computerized program, effective in assessing implicit approach biases for both alcohol and cannabis, in which participants make approach or avoidance movements in response to an irrelevant feature of an image presented on a screen (e.g., push when in portrait, pull when in landscape). A modified version of the AAT is also used as an approach bias modification (ApBM) intervention, to retrain participants’ implicit biases toward or away from stimuli by presenting the target stimuli predominantly in one format (e.g., push or pull). Despite research demonstrating the effectiveness of AAT interventions to reduce problematic alcohol and cannabis use, there is a dearth of research examining this intervention among adolescents. This protocol paper describes a NIDA-funded randomized control trial (RCT) to evaluate an integrated mobile ApBM intervention to target co-occurring alcohol and cannabis use among treatment-seeking adolescents. Outcomes will be measured from pre-treatment through a three-month follow-up. The sampling procedures, assessment protocol, description of the intervention, and planned statistical approaches to evaluating outcomes are detailed. Clinical and research implications of this work are also discussed.
... Yet in the past decade, increasing neuroimaging evidence has appeared that some people with behavioral addictions show a pattern of cue-triggered mesolimbic hyperreactivity and sensitized "wanting" similar to that seen in people with drug addiction. This is manifested psychologically by an attentional bias toward the relevant cues and more intense urges or craving to approach and pursue the target of the behavioral addiction than experienced by nonaddicted individuals who recreationally pursue the same end (Boffo et al. 2018). People with behavioral addictions also show greater mesolimbic activations triggered by their addiction-related cues in neuroimaging studies relative to other reward cues or to activations triggered by the same cues in other people without the behavioral addiction. ...
Article
The incentive-sensitization theory (IST) of addiction was first published in 1993, proposing that ( a ) brain mesolimbic dopamine systems mediate incentive motivation (“wanting”) for addictive drugs and other rewards, but not their hedonic impact (liking) when consumed; and ( b ) some individuals are vulnerable to drug-induced long-lasting sensitization of mesolimbic systems, which selectively amplifies their “wanting” for drugs without increasing their liking of the same drugs. Here we describe the origins of IST and evaluate its status 30 years on. We compare IST to other theories of addiction, including opponent-process theories, habit theories of addiction, and prefrontal cortical dysfunction theories of impaired impulse control. We also address critiques of IST that have been raised over the years, such as whether craving is important in addiction and whether addiction can ever be characterized as compulsive. Finally, we discuss several contemporary phenomena, including the potential role of incentive sensitization in behavioral addictions, the emergence of addiction-like dopamine dysregulation syndrome in medicated Parkinson's patients, the role of attentional capture and approach tendencies, and the role of uncertainty in incentive motivation.
... In the field of gambling studies, the term 'habit' is often used colloquially to refer to recurrent or frequent patterns of gambling involvement. Recent studies have begun to characterize habit formation in gambling (Boffo et al., 2018;Dickerson, 1993;Griffiths, In models of problem gambling, habit is presently an underspecified construct, compared to its role in contemporary, neuroscience-oriented models of drug addiction. For example, Everitt and Robbins (2005) hypothesized that habit formation is a key process in the gradual loss of control over drug seeking behaviors, in which initially 'goaldirected' drug taking progressively transitions to automatic and stimulus-driven behavior. ...
Article
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Habit formation is a key process in contemporary models of addictive behaviors but has received limited attention in the context of gambling and problem gambling. Methods for examining habit formation and expression in relation to gambling are also lacking. In this study, 60 participants with no prior slot machine experience attended three sessions spaced 6–8 days apart, during which they played a short 200-spin session on a realistic simulation of a modern multi-line slot machine. Behavioral data were analyzed to characterize habit formation within and between sessions. Fixed-effects regressions, integrating trial- and session-level effects, assessed predictors of gambling speed (spin initiation latencies) and betting rigidity (the likelihood of switching the bet amount), as two putative markers of habit formation. Participants gambled faster and showed less variability in betting strategy as they accumulated experience in the number of trials and sessions gambled. Simultaneously, as the number of sessions gambled increased, participants showed a more pronounced tendency to slow their betting after larger wins (i.e. the post-reinforcement pause increased from session 1 to session 3). Our methods provide a basis for future research to examine habits in the context of slot machine gambling.
... As motor approach behaviour towards conditioned reward cues directly reflects the motivation to engage or have the reward [11], the AAT allows to measure wanting implicitly. Researchers have previously employed modified versions of this task to investigate changes in implicit wanting associated with alcohol misuse [28,29], problem gambling [30] and food rewards [31,32]. Yet, we are currently aware of only one study that has utilized this paradigm to investigate problematic SNS use. ...
Article
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Despite growing concerns about the addictive potential of social networking sites (SNSs), little is known about the precise neural, cognitive, and emotional processes underpinning compulsive SNS behaviours, such as excessive checking of SNSs. Recent evidence points to the important role of reward in SNS behaviours and one avenue to examine reward processes related to SNSs is the use of behavioural paradigms that allow for the measurement of implicit motivational responses, such as the approach avoidance task (AAT). The AAT has been successfully utilised to capture changes in unconscious reward processes in substance use disorders and other behavioural addictions, with faster approach reactions to addiction-related stimuli reflecting increased wanting/urges to have/consume the reward. In the present study 411 young adults completed an online Visual Approach/Avoidance by the Self Task (VAAST) with social media and control logos as well as other subjective (explicit) measures of reward experience related to SNSs. Our results showed that across participants SNS logos elicited strong approach reactions (compared to control stimuli) and that stronger SNS approach tendencies predicted more frequent SNS checking. Importantly, increased approach motivation was not associated with more problematic use. However, both checking frequency and problematic use were related to alterations of explicit reward processing, including the subjective experience of SNS urges or wanting. We conclude that changes in automatic approach motivation towards SNS stimuli are common in most SNS users, which suggests that implicit imbuement of social media with reward has become pervasive among young adults. Problematic SNS use however may be more reliably indicated by changes in explicit reward processing, such as subjective wanting.
... In such situations, counteracting an almost automatic action seems to require additional cognitive resources (Asci, Braem, Park, Boehler, & Krebs, 2019), which is reminiscent of overriding a prepotent response in classic conflict tasks such as the Stroop task, Simon task, and the Eriksen flankers task (for review see Ridderinkhof, Forstmann, Wylie, Burle, & van den Wildenberg, 2011). Strikingly, in extreme cases, individuals may not be able to regulate inherent valence-action mappings, leading to maladaptive behavioral patterns such as overeating and pathological gambling, but also phobias (Boffo et al., 2018;Heuer, Rinck, & Becker, 2007;Veenstra & de Jong, 2010). These examples highlight the relevance of better understanding the neurocognitive mechanisms that underlie valence-triggered response biases and how they can be abolished. ...
Article
Incentive-valence signals have a large impact on our actions in everyday life. While it is intuitive (and most often beneficial) to approach positive and avoid negative stimuli, these prepotent response tendencies can also be maladaptive, as exemplified by clinical conditions such as overeating or pathological gambling. We have recently shown that targets associated with monetary incentives can trigger such valence-action biases (target condition), and that these are absent when valence and action information are provided by advance cues (cue condition). Here, we explored the neural correlates underlying the abolition of the behavioral bias in this condition using fMRI. Specifically, we tested in how far valence and action information are integrated at all in the cue condition (where no behavioral biases are observed), assessing activity at the moment of the cue (mainly preparation) and the target (mainly implementation). The cue-locked data was dominated by main effects of valence with increased activity for incentive versus no-incentive cues in a network including anterior insula, premotor cortex, (mostly ventral) striatum (voxel-wise analysis), and across five predefined regions of interest (ROI analysis). Only one region, the anterior cingulate cortex, featured a valence-action interaction, with increased activity for win-approach compared to no-incentive-approach cues. The target-locked data revealed a different interaction pattern with increased activity in loss-approach as compared to win-approach targets in the cerebellum (voxel-wise) and across all ROIs. For comparison, the uncued target condition (target-locked data only) featured valence and action main effects (incentive > no-incentive targets; approach > avoid targets), but no interactions. The results resonate with the common observations that performance benefits after incentive-valence cues are promoted by increased preparatory control. Moreover, there is support for the idea that valence and action information are integrated according to an evolutionary benefit (cue-locked), requiring additional neural resources to implement non-intuitive valence-action mappings (target-locked).
... However, all items targeting expenditures were rated low among the expert stakeholders in the Delphi, with some Delphi stakeholders even arguing against including expenditures in the GDIT.Gambling expenditures have been investigated in several studies (e.g.,Blaszczynski, Ladouceur, Goulet, & Savard, 2006;Williams, Volberg, Stevens, Williams, & Arthur, 2017;Wood & Williams, 2007) showing a lack of correspondence between self-reported gambling expenditures and actual revenue. Measuring expenditures in gambling research is complicated, as gamblers may not be able to remember or estimate their gambling expenditures accurately.Other possible sources of self-report biases among gamblers could be positive memory bias (not thinking about or reporting losses)(Boffo et al., 2018), or not fully understanding instructions on how to estimate theoretical constructs such as net expenditure or net losses. These issues, related to reporting gambling expenditures, were emphasized by several participants in the "think aloud" interviews and by many Delphi stakeholders. ...
Article
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Objectives Diverse instruments are used to measure problem gambling and Gambling Disorder intervention outcomes. The 2004 Banff consensus agreement proposed necessary features for reporting gambling treatment efficacy. To address the challenge of including these features in a single instrument, a process was initiated to develop the Gambling Disorder Identification Test (GDIT), as an instrument analogous to the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Methods Gambling experts from 10 countries participated in an international two‐round Delphi (n = 61; n = 30), rating 30 items proposed for inclusion in the GDIT. Gambling researchers and clinicians from several countries participated in three consensus meetings (n = 10; n = 4; n = 3). User feedback was obtained from individuals with experience of problem gambling (n = 12) and from treatment‐seekers with Gambling Disorder (n = 8). Results Ten items fulfilled Delphi consensus criteria for inclusion in the GDIT (M ≥ 7 on a scale of 1–9 in the second round). Item‐related issues were addressed, and four more items were added to conform to the Banff agreement recommendations, yielding a final draft version of the GDIT with 14 items in three domains: gambling behavior, gambling symptoms and negative consequences. Conclusions This study established preliminary construct and face validity for the GDIT.
... Utilizing different samples and procedures, a substantial body of empirical literature has demonstrated that disordered gamblers exhibited enhanced attentional processing towards gambling cues than non-disordered gamblers. For instance, they show more pronounced Stroop effect towards gambling than neutral words (Molde et al., 2010), take longer to react to non-relevant stimuli during a gambling session (Diskin and Hodgins, 1999), commit more errors when performing an inhibition task in gambling-related trials (van Holst et al., 2012), show poor accuracy in identifying rotations of target images when preceded by gambling distractors (Hudson et al., 2017), and have automatic action tendencies towards gambling cues (Boffo et al., 2018). Furthermore, there is growing empirical evidence that biased attention toward gambling stimuli among gamblers reflects https://doi.org/10.1016/j.jad.2020.03.144 ...
Article
Background: Previous research has emphasized the importance of attentional bias in the maintenance of both adult and adolescent disordered gambling. There is a substantial body of empirical evidence demonstrating facilitated attention and difficulty in disengagement from gambling stimuli among disordered gamblers, but no study has ever experimentally investigated the association between attentional bias and risk-taking behavior in gambling. The aim of the present study was to examine the interrelationship between attentional bias for gambling stimuli, risk-taking attitude, and severity of gambling involvement. Methods: The present study recruited 70 male adults from gambling venues to participate in the experiment. Gambling severity, attentional bias, and risk-taking were assessed utilizing the South Oaks Gambling Screen, the Modified Posner Task, and the Balloon Analogue Risk Task, respectively. Results: Disordered gamblers showed greater readiness to detect gambling stimuli and took more risks than non-disordered gamblers. Regression analysis showed that being of a young age, automatic facilitated attention for gambling cues, and risk-proneness significantly predicted problem gambling. Additionally, a path analysis was performed to test if automatic facilitated attention towards gambling was on the path from risk-taking to gambling severity, or if risk-taking mediated the impact of facilitation biases on gambling severity. The results indicated that attentional bias predicted gambling severity both directly and indirectly via risk-taking. Limitations: The modest sample size and the absence of female gamblers limited the generalizability of the results. Conclusions: The present findings are compatible with the view that an automatic detection of gambling stimuli is responsible for greater riskiness that, in turn, fosters gambling problems.
... In accordance with findings suggesting issues in impulse control, Boyer and Dickerson have shown that poker machine gamblers with low levels of control over their gambling behavior display a stronger attentional bias for gambling related words compared to players with high levels of control over their gambling behavior (Boyer and Dickerson, 2003). Similarly, Boffo and colleagues recently showed that moderate-to high-risk gamblers exhibit a greater approach bias towards gambling-related stimuli than non-problem gamblers, and that this tendency to approach gambling cues was also positively correlated with past-month gambling expenditure, and with monthly gambling frequency (Boffo et al., 2017). Importantly, this tendency to approach gambling cues was also correlated with the total duration of gambling episodes seen at a follow-up 6 months later, suggesting that the degree of attentional bias may predict the intensity of gambling behavior. ...
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Sign-tracking behavior in Pavlovian autoshaping is known to be a relevant index of the incentive salience attributed to reward-related cues. Evidence has accumulated to suggest that animals that exhibit a sign-tracker phenotype are especially vulnerable to addiction and relapse due to their proneness to attribute incentive salience to drug cues, and their relatively weak cognitive and attentional control over their behavior. Interestingly, sign-tracking is also influenced by reward uncertainty in a way that may promote gambling disorder. Research indicates that reward uncertainty sensitizes sign-tracking responses and favors the development of a sign-tracker phenotype, compatible with the conditioned attractiveness of lights and sounds in casinos for problem gamblers. The study of attentional biases in humans (an effect akin to sign-tracking in animals) leads to similar observations, notably that the propensity to develop attraction for conditioned stimuli (CSs) is predictive of addictive behavior. Here we review the literature on drug addiction and gambling disorder, highlighting the similarities between studies of sign-tracking and attentional biases.
... Attention biases refer to the preferential allocation of attentional processes towards substance-related cues, 5 whereas approach biases refer to the automated tendencies for individuals to seek out and reach for substance-related stimuli. 8 To date, the advances in experimental psychology have led to there being both direct and indirect measures of attention biases, in order to ascertain whether an individual has any underlying attentional biases. Indirect measures, such as the Stroop task 9 and the Visual Probe task, are typically used. ...
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Introduction Advances in experimental psychology has highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. While prior research has documented the effectiveness of cognitive bias modification, such interventions tend to be highly repetitive and individuals lack motivation to train over time. Participatory action research methods have been more widely applied in psychiatry to help design interventions that are of relevant to key stakeholders and end users. This study aimed to involve both healthcare professionals and patients in the joint codesign of a gamified mobile attention bias modification intervention. Methods and analysis The participatory design research method adopted is that of a use-oriented design approach, in the form of a future workshop. 20 participants, comprising 10 healthcare professionals, 5 inpatients and 5 outpatients will be recruited to participate in three separate codesign workshops. In the first phase of the workshop, the participants share their critique of an attention bias modification intervention. In the second phase of the workshop, participants are asked to brainstorm features. The participants are also shown gamification approaches and are asked to consider if gaming elements could enhance the existing application. In the last phase, the participants are asked to sketch a new prototype. Ethics and dissemination Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (approval number 2018/01363). The findings arising from this study will be disseminated by means of conferences and publications.
... Applying this hypothesis to gambling disorder, craving, acting in tandem with attentional bias, increases the gambling-related stimuli's salience, which, in turn, steers attention and its biases. The automatic processing of these stimuli hampers the detection of others (Kastner et al., 1998) and drives gambling behaviors (Boffo et al., 2018), contributing to the severity of addiction Berridge, 1993, 2008). ...
Article
Background: Studies investigating attentional biases in gambling have observed that problem gamblers' attention is biased toward gambling cues. Despite the increase of gambling among adolescents, to date, no study has ever examined the role of attentional bias in adolescent gambling, as well as the relationships between adolescent gambling severity, craving, and alcohol use. Methods: The present study comprised 87 adolescent participants. Based on South Oaks Gambling Screen Revised for Adolescents (SOGS-RA) scores, participants were assigned to non-problem or problem gamblers groups. Participants performed a modified Posner Task (with cue presentation times at 100 and 500 ms) to assess attentional biases. Following the experiment, participants completed the Gambling Craving Scale (GACS) and the Alcohol Use Disorders Identification Test (AUDIT). Results: Compared to non-problem gamblers, problem gamblers displayed facilitation bias for gambling cues at 500 ms and reported higher levels of craving and alcohol consumption. Results also indicated that alcohol use correlated with facilitation bias. Limitations: The recruitment of a predominantly male sample and the use of an indirect measure of attentional bias may have affected the findings concerning attentional processes. Conclusions: The present study provides the first empirical evidence of attentional processes in adolescent gambling, and confirms the role of attentional biases, craving, and alcohol use being associated factors in adolescent problem gambling. The results of the present study stress the importance of attentional biases in the initial stages of problem gambling and suggest the need for clinical interventions aimed at reducing attentional bias before they became automatic. Overall, the present study stressed the role of attentional bias as both facilitator and a consequence of gambling involvement.
... In order to measure behavioral tendencies implicitly, an indirect instruction is used such that the direction of movement (i.e., pull versus push) depends on a non-affective dimension (Rinck and Becker, 2007). A recent study provides first evidence that moderate-to-high-risk gambling is also associated with an approach bias for gambling-related stimuli (Boffo et al., 2018). It was found that non-treatment seeking moderate-to-high-risk gamblers showed a stronger approach bias for gambling-related compared to neutral stimuli, whereas no differences emerged in non-problem gamblers. ...
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There is evidence that training addicted participants to implicitly avoid disorder-related stimuli by using a training version of the Approach-Avoidance Task (AAT) results in reduced substance consumption (i.e., Approach Bias Modification [AppBM]). The aim of the present web-based study was to investigate the feasibility and effectiveness of AppBM in reducing gambling-related symptoms. A self-selected sample of participants with problem/pathological slot-machine gambling completed an online survey and received either AppBM or Sham training (final N = 131). Attrition during study participation was high (66%). In both conditions slot-machine related and neutral pictures were presented. Within the AppBM condition all slot-machine related pictures had to be pushed and all neutral pictures had to be pulled, whereas in the Sham condition the contingency was 50:50. Eight weeks after baseline, participants were re-assessed. Both groups showed a similar reduction in gambling-related symptoms. Findings are at odds with the hypothesis claiming that only contingency trainings yield beneficial effects. However, it cannot be ruled out that effects result from other factors unrelated to training such as expectancy effects. We think this study holds valuable information how to conduct larger trials in the future and may prove helpful to improve training and its delivery.
... In order to measure behavioral tendencies implicitly, an indirect instruction is used such that the direction of movement (i.e., pull versus push) depends on a non-affective dimension (Rinck and Becker, 2007). A recent study provides first evidence that moderate-to-high-risk gambling is also associated with an approach bias for gambling-related stimuli (Boffo et al., 2018). It was found that non-treatment seeking moderate-to-high-risk gamblers showed a stronger approach bias for gambling-related compared to neutral stimuli, whereas no differences emerged in non-problem gamblers. ...
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Biases in information processing are attributed an important role in the maintenance of tobacco dependence. As these biases are not sufficiently taken into account in current treatments, the aim of the present study was to investigate whether clinical outcome can be improved by combining treatment-as-usual (TAU) with Approach-Avoidance Modification Training (AAMT). A two group parallel (1:1) randomized-controlled single-blind study with adult smokers (N = 105) was conducted (DRKS00011406). Participants received three sessions of TAU and either six sessions of AAMT or Sham training. During AAMT, participants were trained to implicitly avoid all smoking-related and to approach all smoking-unrelated pictures, while the contingency was 50:50 in Sham training. Participants were assessed after the intervention and 6 months later. Primary outcome was daily cigarette consumption at follow-up. Participants receiving TAU + AAMT did not show a significantly greater reduction of daily cigarette consumption at follow-up compared to TAU + Sham (per-protocol: 95% CI: -2.56–4.89, p =.608; intention-to-treat: 95% CI: -3.11–2.96, p =.968). Using an implicit AAMT (vs. Sham) as an add-on to TAU did not improve clinical outcome. However, no consistent evidence for a change of bias was found. It is important for future research to explore the effectiveness of optimized training versions (e.g., explicit instructions). Pre-registration: German Clinical Trials Register (DRKS00011406).
Chapter
In this chapter, the theoretical background of (digital) cognitive behavioral therapy (CBT) is presented, along with cognitive bias modification (CBM), a novel set of interventions in which cognitive processes involved in a disorder are directly targeted. Next, the effectiveness of digital CBT and CBM for common mental health disorders (depression, anxiety disorders, and substance use disorders, SUDs) is evaluated based on recent meta-analyses and supplemented with recent studies. Based on the reviewed literature, there is a reasonably strong evidence base for the effectiveness of digital CBT interventions for depression, anxiety, and SUDs. The evidence base for CBM interventions depends on the type of intervention and disorder. There is accumulating evidence that CBM training targeting interpretations reduces anxiety, but there is less evidence for its effects on depression. The evidence for emotional symptom reduction after CBM targeting attention is inconsistent. In SUD, there is accumulating evidence for increased abstinence after supplementing CBT treatment for alcohol use disorder for one type of CBM: approach bias modification, and preliminary, less consistent evidence for other types. Therefore, it is concluded that based on the currently available evidence, CBM could be a useful add-on to digital CBT in the clinical treatment of common mental health disorders.
Chapter
In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.KeywordsAddictionAlcohol use disorderApproach biasApproach bias retrainingCognitive-bias modificationCognitive trainingMindfulnessTreatmentWorking memory training
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Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson’s disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.
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Objectives: In terms of dual process models, behaviour can be conceived of as the outcome of an interplay between reflective, top-down and impulsive, bottom-up processes. Behaviour change interventions may benefit from targeting both types of processes in a coherent way. One approach to this, in the context of reducing hazardous drinking, is to combine imagery involving real-life situations involving alcohol with the simple actions involved in Approach Bias Modification (ApBM), a form of Cognitive Bias Modification. Design: We developed and tested a version of this Imagery-enhanced Approach Bias Modification (IApBM) in an experimental design, with two independent factors: imagery versus control and ApBM versus control training components (N = 139). Methods: An effect of integrating the training factors was hypothesized on the alcohol-approach bias of an alcohol Approach-Avoidance Task. Further exploratory analyses were performed for the bias on alcohol-related Single Attribute Implicit Association Tests and on alcohol-related questionnaires. Finally, the psychometric properties of an imagery interference effect during training were explored. Results: Results showed no benefit of the training and in fact suggested a negative interaction in which combining the training components appeared to block reductions in craving effected by each in isolation. The reliability of the imagery-related interference effect was high and the effect was correlated with alcohol-related scales. Conclusions: In conclusion, it appears that interference between training components decreases their individual effects when combining imagery and ApBM in the current way. The imagery-related interference effects that could be measured during training conditions may be useful as an implicit measure of automatic processes underlying hazardous drinking.
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Background Although previous studies have investigated the role of attentional bias in gambling, the inconsistent findings and the paucity of research require further investigations, as well as the examination of the interrelationships between attentional bias, subjective craving, and gambling severity. Methods The present study comprised 80 male gamblers, aged between 18 and 64 years. Participants carried out a modified version of the Posner Task to assess attentional bias and completed the South Oaks Gambling Screen (SOGS) and the Gambling Craving Scale (GACS) to assess the severity of gambling involvement and the subjective gambling-related craving, respectively. Results Regression analyses showed that craving and facilitation bias at 500 ms are significant predictors of gambling severity. The path analysis indicated that craving predicted gambling severity not only directly, but also indirectly via attentional bias for gambling stimuli. Limitations The recruitment of male participants and the not-matched gambling stimuli to the preferred gambling activity limit the present results. Conclusions The present findings shed light on the interrelationships between craving, attentional bias, and problem gambling, demonstrating that craving is indirectly associated with problem gambling via attentional bias: higher levels of craving make gamblers more responsive to gambling cues, leading to attentional bias, which, in turn, motivate gamblers to bet, contributing to problematic gambling.
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Estimating the reliability of cognitive task datasets is commonly done via split-half methods. We review four methods that differ in how the trials are split into parts: a first-second half split, an odd-even trial split, a permutated split, and a Monte Carlo-based split. Additionally, each splitting method could be combined with stratification by task design. These methods are reviewed in terms of the degree to which they are confounded with four effects that may occur in cognitive tasks: effects of time, task design, trial sampling, and non-linear scoring. Based on the theoretical review, we recommend Monte Carlo splitting (possibly in combination with stratification by task design) as being the most robust method with respect to the four confounds considered. Next, we estimated the reliabilities of the main outcome variables from four cognitive task datasets, each (typically) scored with a different non-linear algorithm, by systematically applying each splitting method. Differences between methods were interpreted in terms of confounding effects inflating or attenuating reliability estimates. For three task datasets, our findings were consistent with our model of confounding effects. Evidence for confounding effects was strong for time and task design and weak for non-linear scoring. When confounding effects occurred, they attenuated reliability estimates. For one task dataset, findings were inconsistent with our model but they may offer indicators for assessing whether a split-half reliability estimate is appropriate. Additionally, we make suggestions on further research of reliability estimation, supported by a compendium R package that implements each of the splitting methods reviewed here.
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Background and Objectives Addictive behaviors are gaining recognition in the clinical community, leading to more attention for the effects of problematic porn use. As many addictive behaviors are characterized by automatically activated approach-tendencies for disorder-relevant stimuli, we tested whether such tendencies are also present for erotic images and whether these are related to problematic porn use. Methods Measuring approach-bias for erotic photographs, sixty-two healthy heterosexual and bisexual men completed both a relevant-feature and an irrelevant-feature approach-avoidance task (AAT). Half of participants operated a joystick as response device, the other half a keyboard. We recorded participants’ number of weekly porn-viewing sessions and symptoms of problematic porn use. Results The irrelevant-feature AAT produced unreliable results and was not analyzed further. In the relevant-feature AAT, participants had an overall approach-bias towards erotic stimuli. Porn use frequency, but not problematic porn use, was associated with with greater erotic approach-bias. This relationship was stronger when measured with a joystick than with a keyboard. Limitations Our design did not allow to test the causal direction of the relationship between porn use and approach-bias, and our results cannot be generalized to women, non-heterosexual men, and clinical populations. Conclusions Similar to other addictive behaviors and substances, we found a positive relation between porn use and approach-bias. Future studies using the relevant-feature AAT will likely benefit from using the joystick rather than the keyboard.
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In a post-scarcity world, energy intake and excesses therein are mediated by psychological mechanisms, such as implicit inclinations to approach certain foods. We investigated how food deprivation, calorie content and individual food preferences affect this approach bias. Sixty women performed a touchscreen-based approach-avoidance task featuring a wide range of food items, once while satiated and once while food-deprived for 15 h. We found an overall approach bias towards food that was not influenced by food deprivation or calorie density of the food items. Instead, we found that approach bias related to the participants’ (lack of) desire to eat specific food items, and to a lesser extent to how much their general desire to eat changed due to food deprivation. Links with food preference were selective to trials in which foods had to be approached, and were absent in trials in which foods had to be avoided, pointing to selectivity to appetitive brain systems and clarifying the nature of the bias. Approach bias was unrelated to overall state or trait food craving. We conclude approach bias for appetitive stimuli may primarily express itself as speeded approach rather than slowed avoidance. Additionally, our results show there is merit in personalizing stimulus selection for approach bias measurement and retraining, as approach bias was concordant with individual food preferences, rather than objective calorie content.
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This study aimed to explore approach bias among individuals with the tendency of having a smartphone addiction. There were 183 male and female students who completed surveys that measured their level of addiction. The smartphone addiction and non-adddiction groups each comprised 27 participants. The approach-avoidance task (AAT) was administered to measure the avoidance and approach reaction time. The smartphone addiction group showed a higher tendency of having an approach bias towards smartphone-related stimulus than the non-addiction group, while no difference was found in the group of neutral stimulus. In addiction, the level of smartphone cravings and addiction predicted the level of approach bias towards smartphone-relevant stimulus. This study suggests the prevalence of approach bias in the smartphone addiction group through the AAT. Clinical implications, limitations of the study, and suggestions for future research are discussed.
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We systematically review the literature on approach-avoidance (AA) tendencies in mental disorders, including 97 empirical studies. Most evidence for the role of biased AA tendencies was found in addictive disorders: The presence of an approach bias (ApB) for substance related stimuli in subclinical populations can be a risk factor for increased future substance use, and AA modification training given as an add-on to standard treatment has the potential to reduce intake and relapse rates reliably. In depression, reduced approach of positive stimuli and reduced avoidance of negative stimuli have been found, and modification procedures seem to have clinical potential. In anxiety disorders, an avoidance bias (AvB) for threat-related stimuli has been found frequently, but modification studies did not yield any clinical effects. In eating disorder a lack of food preferences in anorexia nervosa may be present, but relations between AA measures and clinical (outcome) measures were not established. In other disorders, the evidence was limited due to a low number of published studies. Several methodological problems are discussed: It is often difficult to compare studies to each other, control groups and control stimuli are frequently missing, and many studies suffer from insufficient statistical power due to small samples. We finally give suggestions for future research on biased AA tendencies in psychopathology.
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Purpose of Review Automatic approach–avoidance tendencies drive excessive intake of drugs and unhealthy food. Dual-process models of behaviour propose that strong approach biases predict excessive intake when reflective processes are weak. Consistent with theory, early findings indicated that approach biases predicted excessive use of drugs, including alcohol and tobacco. Given that reviews on approach bias for appetitive substances are lacking, the current review aimed to synthesise the recent findings on automatic approach biases across three of the most commonly assessed substances: alcohol, food and tobacco. Recent Findings The findings suggest that approach biases exist for a range of substances, are mostly stronger in clinical samples than healthy controls and predict consumption behaviour, albeit under certain conditions. Summary Approach biases for appetitive substances are related to excessive consumption in line with theoretical premises. Further longitudinal research is needed, particularly in the domains of tobacco and food, to determine the prediction of consumption of these substances over time. Nevertheless, the findings highlight a continued need for approach bias modification techniques aimed at changing this underlying mechanism.
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This study tested the effectiveness of a cognitive bias modification (CBM) intervention to simultaneously reduce approach biases toward alcohol and increase approach biases toward condoms among high-risk young adults. Participants (N = 102) were randomly assigned to either a training condition or a sham-training condition. Participants in the training condition were trained to make avoidance movements away from alcohol stimuli and approach movements toward condom stimuli over four training sessions. Approach biases and behavior were assessed at pretest, posttest, and 3-month follow-up. Approach biases changed for both stimulus categories in accordance with training condition. Condom behavior and attitudes also changed as a function of training condition such that participants in the training condition reported fewer instances of condom nonuse and more positive attitudes toward condoms at a 3-month follow-up. Participants in both conditions had significant reductions in alcohol consumption following the intervention and did not differ by training condition.
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The current study aimed to examine the relationship between implicit memory associations, gambling involvement, and problem gambling in a large representative group of Canadian adults. The sample consisted of 3078 (48.1% males, mean age 43.93, SD = 15.82) adult online panelists from across Canada that included 388 problem and pathological gamblers. Memory associations were assessed using a 10-item measure of word associations and a 10-item measure of behavioural associations. Gambling involvement was assessed via self-report of involvement, and problem gambling was assessed using the Problem and Pathological Gambling Measure (PPGM). Significant associations were found between measures of memory associations and both level of gambling involvement and problem gambling, with the magnitude of the correlations ranging from 0.262 to 0.388. Behavioural associations tended to have a stronger relationship with gambling involvement and problem gambling than word associations. The results of this study suggest that implicit associations may have utility in the assessment of problem gambling.
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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. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2190-2) contains supplementary material, which is available to authorized users.
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Disordered gambling is characterized by persistent and problematic gambling, leading to impairment or distress, which may be exacerbated by vigilance to gambling cues in the environment. Yet, questions regarding the specific attentional biases present in gamblers remain unresolved. In the current study, we used a rapid serial visual presentation paradigm to examine attentional orienting and maintenance/ disengagement for gambling stimuli, relative to emotional and neutral stimuli, in high-and low-risk gamblers (N = 57). High-risk gamblers showed attentional biases for gambling stimuli, relative to other distractors, and these biases were observed at the level of attentional maintenance/disengagement. Low-risk gamblers showed some evidence of non-specific attentional biases (to negative and gambling pictures). Low-risk, but not high-risk, gamblers demonstrated sustained biases for negative items and facilitated disengagement from positive items. Findings highlight differences in attentional processes between high-and low-risk gamblers and point to sustained biases as worthy targets for clinical interventions. Future work should assess the malleability of gambling biases in high-risk gamblers and determine whether altering attention to gambling items influences gambling behaviour. Résumé Le jeu compulsif est caractérisé par des comportements liés au jeu qui sont problé-matiques et persistants, et qui entraînent une détresse ou une incapacité à fonctionner pouvant être exacerbées par l'attention accordée aux signaux associés au jeu dans
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Background Attentional biases have been recognized as factors responsible for the maintenance of gambling problems. To date, no study has ever assessed the attentional biases among problem gamblers that have discontinued gambling (e.g., abstinent gamblers in treatment). Methods The sample consisted of 75 participants comprising three groups: non-problem gamblers, problem gamblers, and abstinent pathological gamblers undergoing treatment. The groups were discriminated using South Oaks Gambling Screen scores, with the exception of the abstinent pathological gamblers that already had a DSM-5 diagnosis for gambling disorder. Participants carried out a modified Posner Task for the assessment of attentional bias for gambling stimuli and completed the Depression Anxiety Stress Scale and the Gambling Craving Scale. Results Abstinent pathological gamblers showed an avoidance bias in the maintenance of attention, whereas problem gamblers exhibited a facilitation in detecting gambling stimuli. No biases were detected in non-problem gamblers. The results also demonstrated that compared to the other groups, abstinent pathological gamblers showed high emotional stress and problem gamblers reported a higher level of craving. Limitations The sample size limits the generalizability of results. Conclusions The present study demonstrated that attentional biases affect the maintenance and the discontinuation of gambling activities, and that the subjective feeling of craving for gambling may facilitate problem gamblers’ attention towards gambling stimuli.
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Models distinguishing two types of different processes or "systems" are prominent and widespread in many fields of psychological science. However, they recently have been substantially criticized and challenged. In this chapter, we focus on so-called dual-process or dual -system models that differentiate between more automatic (often "hot" emotional-affective) versus more controlled (often "cold" cognitive -deliberative) processes. We start out with an attempt to describe and clarify different terminologies, including a clarification of the temperature metaphor of "hotness versus coldness." We then propose to ground and decompose the notion of "hot ness" in emotion-relevant basic biological processes of the autonomic nervous system and incentive salience. Extending the scope, we then focus on two types of dual-process or dual-system models, discussing both their strengths as well as shortcomings. Finally, we suggest a diagnosis of the current state of affairs and propose possibly more fruitful directions for future research and theory-forming. As part of this, we briefly describe our R3 model, a novel model of reflectivity that here serves as a proof-of-principle thought-experiment to address several shortcomings of existing dual -process and dual-system models.
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Background: From a cognitive perspective, attentional biases are deemed as factors responsible in the onset and development of gambling disorder. However, knowledge relating to attentional processes in gambling is scarce and studies to date have reported contrasting results. Moreover, no study has ever examined which component and what type of bias are involved in attentional bias in gambling. Methods: In the present study, 108 Italian participants, equally divided into problem and non-problem gamblers, were administered a modified Posner Task, an attentional paradigm in which – through the manipulation of stimuli presentation time – it is possible to measure both initial orienting and maintenance of attention. In addition to the experimental task, participants completed self-report measures involving (i) craving (Gambling Craving Scale), (ii) depression, anxiety and stress (Depression Anxiety Stress Scale) and (iii) emotional dysregulation (Difficulties in Emotion Regulation Scale). Results: Analyses revealed facilitation in detecting gambling-related stimuli at the encoding level in problem gamblers but not in non-problem gamblers. Compared to non-problem gamblers, problem gamblers also reported higher levels of craving, emotional dysregulation, and negative mood states. Furthermore, all measures correlated with the gambling severity. Limitations: The use of indirect measure of attentional bias could be less accurate compared to direct measures. Conclusions: The facilitation in detecting gambling-related stimuli in problem gamblers and the correlation between subjective craving and facilitation bias suggests that attentional bias could not be due to a conditioning process but that motivational factors such as craving could induce addicted-related seeking behaviors.
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The field of gambling research has advanced rapidly in recent years with the sophistication of the research mirroring the complexity of this public health concern. This is an exciting time for gambling research. Psychology, genetics, neurobiology, and treatment have joined forces to address not only gambling but also the universal theme of what gambling represents: conflicting motivations that drive behavior. This new book gathers important recent research in the field.
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Outcome expectancies are the positive or negative effects that individuals anticipate may occur from engaging in a given behaviour. Although explicit outcome expectancies have been found to play an important role in gambling, research has yet to assess the role of implicit outcome expectancies in gambling. In two studies, we investigated whether implicit and explicit positive gambling outcome expectancies were independent predictors of gambling behaviour (i.e. amount of time spent and money risked gambling; Study 1) and problem gambling severity (Study 2). In both studies, implicit positive gambling outcome expectancies were assessed by having regular gamblers (N ¼ 58 in Study 1; N ¼ 96 in Study 2) complete a gambling outcome expectancy reaction time (RT) task. A self-report measure of positive gambling outcome expectancies was used to assess participants’ explicit positive gambling outcome expectancies. Both the RT task and self-report measure of positive gambling outcome expectancies significantly contributed unique as well as shared variance in the prediction of self-reported gambling behaviour (Study 1) and problem gambling severity (Study 2). Findings from the current research point to the importance of using both direct and indirect assessment modes when examining the role of outcome expectancies in gambling.
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Studies of gambling starting before adulthood in the general population are either cross-sectional, based on the stability of these behaviors between 2 time points, or cover a short developmental period. The present study aimed at investigating the developmental trajectories of gambling problems across 3 key periods of development, mid-adolescence, early adulthood, and age 30, in a mixed-gender cohort from the general population. Using a semiparametric mixture model, trajectories were computed based on self-reports collected at ages 15 (N = 1,882), 22 (N = 1,785), and 30 (N = 1,358). Two distinct trajectories were identified: 1 trajectory including males and females who were unlikely to have experienced gambling problems across the 15-year period, and 1 trajectory including participants likely to have experienced at least 1 problem over the last 12 months at each time of assessment. Participants following a high trajectory were predominantly male, participated frequently in 3 to 4 different gambling activities, and were more likely to report substance use and problems related to their alcohol and drug consumption at age 30. Thus, gambling problems in the general population are already observable at age 15 in a small group of individuals, who maintain some level of these problems through early adulthood, before moderately but significantly desisting by age 30, while also experiencing other addictive behaviors and related problems. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Addiction research has hypothesised that automatic and reflective cognitive processes play an important role in the onset and maintenance of alcohol (ab)use, wherein automatic reactions to drug-related cues steer the drug user towards consuming before reflective processes can get over and steer towards a different behavioural response. These automatic processes include the tendency to attend and approach alcohol cues. These biases may be trained away from alcohol via computerised cognitive bias modification (CBM). The present protocol describes the design of a double-blind randomised controlled trial (RCT) testing the effectiveness of attentional bias and approach bias re-training with a 2×2 factorial design, alongside a brief motivational support (MS) program. Participants (n = 120) are adult alcohol dependent outpatients, recruited from a public health service for addiction in Italy, who have been abstinent for at least two months, and with a main diagnosis of alcohol dependence disorder. Participants are randomly assigned to one of four experimental conditions and complete 11 sessions of training after a baseline assessment. The MS takes place before each training session. Post-intervention and three-month follow-up assessments examine the change in clinical outcome variables and attentional and approach biases (measured with the Visual Probe Task and the Approach-Avoidance Task, respectively). Alcohol approach-avoidance implicit memory associations (measured with the Brief Implicit Association Test) are also evaluated at pre- and post-intervention to explore generalisation effects. Primary outcome measure is relapse rate at follow-up. Secondary outcome measures include change in cognitive biases, in alcohol-related implicit memory associations, and in the clinical variables assessed. An exploratory analysis is also planned to detect interaction effects between the CBM modules and possible moderators (interference control capacity, gender, age, number of previous detoxifications) and mediators (change in cognitive bias) of the primary outcome measure. This RCT is the first to test the effectiveness of a combined CBM intervention alongside motivational support in alcohol-dependent outpatients. The results of this study can be extremely valuable for future research in the optimisation of CBM treatment for alcohol addiction. Current Controlled Trials ISRCTN01005959 (registration date: 24 October 2013).
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Objective: In alcohol-dependent patients, alcohol cues evoke increased activation in mesolimbic brain areas, such as the nucleus accumbens and the amygdala. Moreover, patients show an alcohol approach bias, a tendency to more quickly approach than avoid alcohol cues. Cognitive bias modification training, which aims to retrain approach biases, has been shown to reduce alcohol craving and relapse rates. The authors investigated effects of this training on cue reactivity in alcohol-dependent patients. Method: In a double-blind randomized design, 32 abstinent alcohol-dependent patients received either bias modification training or sham training. Both trainings consisted of six sessions of the joystick approach-avoidance task; the bias modification training entailed pushing away 90% of alcohol cues and 10% of soft drink cues, whereas this ratio was 50/50 in the sham training. Alcohol cue reactivity was measured with functional MRI before and after training. Results: Before training, alcohol cue-evoked activation was observed in the amygdala bilaterally, as well as in the right nucleus accumbens, although here it fell short of significance. Activation in the amygdala correlated with craving and arousal ratings of alcohol stimuli; correlations in the nucleus accumbens again fell short of significance. After training, the bias modification group showed greater reductions in cue-evoked activation in the amygdala bilaterally and in behavioral arousal ratings of alcohol pictures, compared with the sham training group. Decreases in right amygdala activity correlated with decreases in craving in the bias modification but not the sham training group. Conclusions: These findings provide evidence that cognitive bias modification affects alcohol cue-induced mesolimbic brain activity. Reductions in neural reactivity may be a key underlying mechanism of the therapeutic effectiveness of this training.
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Approach Avoidance tasks measure approach bias, a behavioral tendency to be faster at approaching rather than avoiding drug cues. Approach bias has been measured in a number of different drug-using populations and there is evidence to suggest that approach bias measurements correlate with drug use. Little is known, however, about the motivational mechanisms underlying the approach bias. In the current study we assessed whether the approach bias to cigarettes was immediately sensitive to changes in the incentive value of smoking. We examined the change from baseline in a participant group, after half the group had been given the opportunity to smoke. Specifically, we examined whether the approach bias has the characteristics of a cue-elicited behavior or is flexibly modulated by current desire. Results showed that while the baseline approach-bias score in deprived cigarette smokers correlated with craving, smoking a cigarette led to reduced craving but an increased approach bias score. We discuss a possible account of these findings in terms of an ideomotor outcome-response priming mechanism.
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This paper examines the major factors in the psychology of lottery gambling (including instant scratchcard lotteries and video lottery terminals) and argues that success is due to a number of simple and inter‐related factors. Part of the popularity of lotteries is that they offer a low cost chance of winning a very large jackpot prize, i.e. without the huge jackpot very few people would play. However, there are other important maintenance factors including: (i) successful advertising and television coverage; (ii) a general ignorance of probability theory; (iii) entrapment; (iv) manufacturing credibility; and (v) use of heuristics (e.g. illusion of control, flexible attributions, hindsight bias, availability bias, representativeness bias). The paper also argues that some types of lottery game (i.e. instant scratchcards and video lottery terminals) can stimulate excessive and problematic Play.
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The past decade has witnessed a surge in research on training paradigms aimed at directly influencing cognitive processes in addiction and other psychopathology. Broadly, two avenues have been explored: In the first, the aim was to change maladaptive cognitive motivational biases (cognitive bias modification); in the second, the aim was to increase general control processes (e.g., working memory capacity). These approaches are consistent with a dual-process perspective in which psychopathology is related to a combination of disorder-specific impulsive processes and weak general abilities to control these impulses in view of reflective longer-term considerations. After reviewing the evidence for dual-process models in addiction, we discuss a number of critical issues, along with suggestions for further research. We argue that theoretical advancement, along with a better understanding of the underlying neurocognitive processes, is crucial for adequately responding to recent criticisms on dual-process models and for optimizing training paradigms for use in clinical practice.
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In the study of addiction, attentional bias refers to the observation that substance-related cues tend to capture the attention of experienced substance users. Attentional bias is a cognitive intermediate in the conditioned association between drug-related cues, craving, and relapse. Numerous studies have documented the existence of attentional bias for cues associated with substances. By contrast, few studies have investigated attentional bias in individuals with pathological gambling (PG) or problematic gambling. In this study, we sought to assess attentional bias at the level of maintenance of attention in a sample of pathological gamblers. Twenty-three pathological gamblers and 21 healthy volunteers performed the Visual Probe Task to compare attentional bias with gambling-related cues between individuals with PG and healthy volunteers. The measured of attentional bias was based on their reaction times (RTs) to probes replacing neutral and gambling-related cues (images). Second, we examined the correlation between PG severity and degree of attentional bias among individuals with PG. Results show that pathological gamblers, but not healthy volunteers, had attentional bias for gambling-related cues with exposure times that assess maintenance of attention. There was no correlation between PG severity and degree of attentional bias. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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To assess whether alcohol-related biases in selective-attention and action tendency uniquely or concurrently predict the ability to regulate alcohol consumption. Two groups of undergraduate social drinkers (total n = 55) who differed in their ability to regulate their alcohol consumption completed a novel Selective-Attention/Action-Tendency Task (SA/ATT), which assessed separately alcohol-related biases in selective attention and action tendency. University of Western Australia, Australia. Dysregulated drinking was operationalized as a self-reported high level of alcohol consumption on the Alcohol Consumption Questionnaire, and a high desire to reduce consumption on the Brief Readiness to Change Algorithm. Selective attention and action tendency were assessed using the SA/ATT, working memory was assessed using the operation-span task and participant characteristics were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results indicated that (i) there was no significant association between alcohol-related biases in selective attention and action tendency, r = 0.16, P = 0.274, and (ii) biases towards alcohol, in both selective attention, β = 1.01, odds ratio = 2.74, P = 0.022, and action tendency, β = 1.24, odds ratio = 3.45, P = 0.015, predicted independent variance in dysregulated-drinker status. Biases in selective attention and action tendency appear to be distinct mechanisms that contribute independently to difficulty regulating alcohol consumption. Treatment components that could be combined to target both mechanisms could enhance treatment outcomes for alcohol-use disorders.
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Rationale: Drug-addicted individuals show automatic approach tendencies towards drug-related cues, i.e., an approach bias (ApB). Nevertheless, little is known about ApB in tobacco smokers and about the presence of ApB after smoking abstinence. Objectives: We investigated ApB to smoking cues in heavy tobacco smokers versus never-smokers and studied its relation to smoking characteristics and craving. Second, we compared ApBs of heavy smokers with biases of abstinent heavy smokers. Method: A group of current heavy smokers (n = 24), ex-smokers who were abstinent for at least 5 years (n = 20), and never-smokers (n = 20) took part in the experiment. An indirect smoking approach avoidance task was performed, in which participants were required to respond to pictures of smoking and neutral cues by pulling (approach) or pushing (avoid) on a joystick, according to the content-irrelevant format of the picture (landscape or portrait). Craving scores were examined using the Questionnaire of Smoking Urges. Results: Heavy smokers showed an ApB for smoking cues compared to ex-smokers and never-smokers, which correlated positively to craving scores. There were no group differences in ApB scores for ex-smokers and never-smokers. Conclusion: These results suggest that ApBs for smoking cues are present in heavy smokers and decrease after long-term successful smoking cessation.
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The current research examined whether the presentation of gambling-related cues facilitates the activation of gambling outcome expectancies using both reaction time (RT) and self-report modes of assessment. Gambling outcome expectancies were assessed by having regular casino or online gamblers (N = 58) complete an outcome expectancy RT task, as well as a self-report measure of gambling outcome expectancies, both before and after exposure to one of two randomly assigned cue conditions (i.e., casino or control video). Consistent with hypotheses, participants exposed to gambling-related cues (i.e., casino cue video condition) responded faster to positive outcome expectancy words preceded by gambling prime relative to non-gambling prime pictures on the post-cue RT task. Similarly, participants in the casino cue video condition self-reported significantly stronger positive gambling outcome expectancies than those in the control cue video condition following cue exposure. Activation of negative gambling outcome expectancies was not observed on either the RT task or self-report measure. The results indicate that exposure to gambling cues activates both implicit and explicit positive gambling outcome expectancies among regular gamblers.
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Pictorial stimuli were presented in a Stroop task paradigm that enabled the recording of attentional bias. The sample comprised 33 pathological slot machine gamblers (PG) and 22 control participants. The design of the study had one between-subjects factor – Group (PGs vs control), and two within-subject factors: (1) Stimulus meaning (win-related gambling stimuli vs neutral stimuli) and (2) Exposure (subliminal vs supraliminal). The results supported the notion that the PG group had an attentional bias towards visual win-related gambling stimuli compared with the control group. Furthermore, the degree of attentional bias among the PG group was moderately negatively correlated with net loss in the week before testing. One possible treatment implication of the findings is to include in-vivo exposure sessions as a supplement to cognitive behavioural therapy for gambling. Future studies could also include non-win gambling-related stimuli and should also comprise non-pathological regular gamblers as an additional control group.
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Drug-related cues can elicit approach responses in drug users. However, no relevant research has ever concerned heroin abusers. In the present study, we investigated whether the abstinent heroin abusers demonstrated special behavioural tendencies to approach or avoid the drug-related stimuli compared with neutral stimuli. Twenty-two male abstinent heroin abusers (AH) and 20 healthy males (NC) were tested by a Pull/Push Task. Participants pulled (approach response) or pushed (avoidance response) a lever in response to the content of stimulus pictures (i.e. heroin-related versus neutral). The approach and avoidance scores were therefore calculated based on response times and directions to reflect their behavioural tendencies. Relative to the NC individuals, the AH individuals demonstrated significantly heightened tendencies to approach ("pull") the heroin-related stimuli in comparison with the neutral stimuli, while their tendencies to avoid ("push") the heroin-related stimuli were marginally blunted, reflecting a special bias for AH individuals to behaviourally approach, and simultaneously resist to avoid, heroin-related cues.
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Pathological gambling (PG) has recently been considered as a "behavioral" or nonsubstance addiction. A comparison of the characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs. This review was conducted to compare and contrast research findings in PG and SUDs pertaining to neurocognitive tasks, brain function, and neurochemistry, with a focus on impulsivity and compulsivity. Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances. Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies.
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We present a brief overview of the incentive sensitization theory of addiction. This posits that addiction is caused primarily by drug-induced sensitization in the brain mesocorticolimbic systems that attribute incentive salience to reward-associated stimuli. If rendered hypersensitive, these systems cause pathological incentive motivation ('wanting') for drugs. We address some current questions including: what is the role of learning in incentive sensitization and addiction? Does incentive sensitization occur in human addicts? Is the development of addiction-like behaviour in animals associated with sensitization? What is the best way to model addiction symptoms using animal models? And, finally, what are the roles of affective pleasure or withdrawal in addiction?
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There is a wealth of evidence showing enhanced attention toward drug-related information (i.e., attentional bias) in substance abusers. However, little is known about attentional bias in deregulated behaviors without substance use such as abnormal gambling. This study examined whether problem gamblers (PrG, as assessed through self-reported gambling-related craving and gambling dependence severity) exhibit attentional bias for gambling-related cues. Forty PrG and 35 control participants performed a change detection task using the flicker paradigm, in which two images differing in only one aspect are repeatedly flashed on the screen until the participant is able to report the changing item. In our study, the changing item was either neutral or related to gambling. Eye movements were recorded, which made it possible to measure both initial orienting of attention as well as its maintenance on gambling information. Direct (eye-movements) and indirect (change in detection latency) measures of attention in individuals with problematic gambling behaviors suggested the occurrence of both engagement and of maintenance attentional biases toward gambling-related visual cues. Compared to nonproblematic gamblers, PrG exhibited (a) faster reaction times to gambling-cues as compared to neutral cues, (b) higher percentage of initial saccades directed toward gambling pictures, and (c) an increased fixation duration and fixation count on gambling pictures. In the PrG group, measures of gambling-related attentional bias were not associated with craving for gambling and gambling dependence severity. Theoretical and clinical implications of these results are discussed.
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Repeated drug exposure can lead to an approach-bias, i.e. the relatively automatically triggered tendencies to approach rather that avoid drug-related stimuli. Our main aim was to study this approach-bias in heavy cannabis users with the newly developed cannabis Approach Avoidance Task (cannabis-AAT) and to investigate the predictive relationship between an approach-bias for cannabis-related materials and levels of cannabis use, craving, and the course of cannabis use. DESIGN, SETTINGS AND PARTICIPANTS: Cross-sectional assessment and six-month follow-up in 32 heavy cannabis users and 39 non-using controls. Approach and avoidance action-tendencies towards cannabis and neutral images were assessed with the cannabis AAT. During the AAT, participants pulled or pushed a joystick in response to image orientation. To generate additional sense of approach or avoidance, pulling the joystick increased picture size while pushing decreased it. Craving was measured pre- and post-test with the multi-factorial Marijuana Craving Questionnaire (MCQ). Cannabis use frequencies and levels of dependence were measured at baseline and after a six-month follow-up. Heavy cannabis users demonstrated an approach-bias for cannabis images, as compared to controls. The approach-bias predicted changes in cannabis use at six-month follow-up. The pre-test MCQ emotionality and expectancy factor were associated negatively with the approach-bias. No effects were found on levels of cannabis dependence. Heavy cannabis users with a strong approach-bias for cannabis are more likely to increase their cannabis use. This approach-bias could be used as a predictor of the course of cannabis use to identify individuals at risk from increasing cannabis use.
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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.
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Research on implicit cognition and addiction has expanded greatly during the past decade. This research area provides new ways to understand why people engage in behaviors that they know are harmful or counterproductive in the long run. Implicit cognition takes a different view from traditional cognitive approaches to addiction by assuming that behavior is often not a result of a reflective decision that takes into account the pros and cons known by the individual. Instead of a cognitive algebra integrating many cognitions relevant to choice, implicit cognition assumes that the influential cognitions are the ones that are spontaneously activated during critical decision points. This selective review highlights many of the consistent findings supporting predictive effects of implicit cognition on substance use and abuse in adolescents and adults; reveals a recent integration with dual-process models; outlines the rapid evolution of different measurement tools; and introduces new routes for intervention.
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In 3 experiments, the authors tested the assumption that perceived movements toward a person trigger the approach system and thereby facilitate the processing of positive affective concepts, whereas perceived movements away from a person trigger the avoidance system and thereby facilitate the processing of negative affective concepts. In the 1st study, participants categorized positive words more quickly than negative words while flexing the arm and negative words more quickly than positive words while extending the arm. The 2nd study revealed that positive words were categorized more rapidly than negative words if viewers had the impression that they were moving toward the computer screen, whereas negative words were categorized faster if viewers had the impression that they were moving away from the screen. These findings were replicated in Experiment 3 using a lexical decision task instead of an adjective evaluation task.
Chapter
A comprehensive review of research examining intermediary mechanisms to understand the link between genetic variation and addiction liability. Although there is scientific consensus that genetic factors play a substantial role in an individual's vulnerability to drug or alcohol addiction, specific genetic variables linked to risk or resilience remain elusive. Understanding how genetic factors contribute to addiction may require focusing on intermediary mechanisms, or intermediate phenotypes, that connect genetic variation and risk for addiction. This book offers a comprehensive review of this mechanistic-centered approach and the most promising intermediate phenotypes identified in empirical research. The contributors first consider the most established findings in the field, including variability in drug metabolism, brain electrophysiological profiles, and subjective reactions to direct drug effects; they go on to review highly promising areas such as expectancies, attentional processing, and behavioral economic variables; and finally, they investigate more exploratory approaches, including the differential susceptibility hypothesis and epigenetic modifications. Taken together, the chapters offer a macro-level testing of the hypothesis that these alternative, mechanistic phenotypes can advance the understanding of genetic influences on addiction. The book will be of interest to researchers and practitioners in a range of disciplines, including behavioral genetics, psychology, pharmacology, neuroscience, and sociology. Contributors John Acker, Steven R.H. Beach, Gene H. Brody, Angela D. Bryan, Megan J. Chenoweth, Danielle M. Dick, Eske D. Derks, Mary-Anne Enoch, Meg Gerrard, Frederick X. Gibbons, Thomas E. Gladwin, Mark S. Goldman, Marcus Heilig, Kent E. Hutchison, Hollis C. Karoly, Steven M. Kogan, Man Kit Lei, Susan Luczak, James MacKillop, Renee E. Magnan, Leah M. Mayo, Marcus R. Munafò, Daria Orlowska, Abraham A. Palmer, Danielle Pandika, Clarissa C. Parker, Robert A. Philibert, Lara A. Ray, Richard R. Reich, Ronald L. Simons, Courtney J. Stevens, Rachel E. Thayer, Rachel F. Tyndale, Tamara L. Wall, Reinout W. Wiers, Michael Windle, Harriet de Wit
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Outcome expectancies (OEs), or beliefs about the consequences of engaging in a particular behaviour, are important predictors of addictive behaviours. In Study 1 of the present work, we assessed whether memory associations between gambling and positive outcomes are related to excessive and problem gambling. The Gambling Behaviour Outcome Association Task (G-BOAT) was administered to a sample of 96 community-recruited gamblers. On the G-BOAT, participants responded to a list of positive outcome phrases with the first two behaviours that came to mind. Those with more problematic gambling (as measured on the Problem Gambling Severity Index) and greater gambling involvement (as measured by time and money spent gambling on the Gambling Timeline Followback) responded to positive outcome phrases on the G-BOAT with more gambling-related responses. In Study 2, we administered G-BOAT to a community-recruited sample of 61 gamblers, who also completed a computerized reaction time measure of implicit gambling OEs, an explicit self-report measure of gambling OEs, and a measure of gambling frequency. Consistent with Strack and Deutch’s (2004) reflective-impulsive model, memory associations on the G-BOAT and positive OE scores on the explicit Gambling Expectancy Questionnaire each predicted unique variance in frequency of gambling behaviour. These studies are among the first to demonstrate the important role of memory associations in excessive and problem gambling. © 2016, Centre for Addiction and Mental Health. All rights reserved.
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Disordered gambling is characterized by persistent and problematic gambling, leading to impairment or distress, which may be exacerbated by vigilance to gambling cues in the environment. Yet, questions regarding the specific attentional biases present in gamblers remain unresolved. In the current study, we used a rapid serial visual presentation paradigm to examine attentional orienting and maintenance/disengagement for gambling stimuli, relative to emotional and neutral stimuli, in high- and low-risk gamblers (N = 57). High-risk gamblers showed attentional biases for gambling stimuli, relative to other distractors, and these biases were observed at the level of attentional maintenance/disengagement. Low-risk gamblers showed some evidence of non-specific attentional biases (to negative and gambling pictures). Low-risk, but not high-risk, gamblers demonstrated sustained biases for negative items and facilitated disengagement from positive items. Findings highlight differences in attentional processes between high- and low-risk gamblers and point to sustained biases as worthy targets for clinical interventions. Future work should assess the malleability of gambling biases in high-risk gamblers and determine whether altering attention to gambling items influences gambling behaviour.Le jeu compulsif est caractérisé par des comportements liés au jeu qui sont problématiques et persistants, et qui entraînent une détresse ou une incapacité à fonctionner pouvant être exacerbées par l’attention accordée aux signaux associés au jeu dans l’environnement. Pourtant, les questions relatives à la présence d’un biais attentionnel spécifique chez les joueurs demeurent sans réponses. La présente étude a utilisé un modèle de présentation visuelle sérielle rapide (Rapid Serial Visual Presentation [RSVP]) afin d’examiner l’orientation de l’attention et le maintien ou le décrochage de celle-ci en présence de stimuli liés au jeu par rapport à des stimuli neutres et chargés émotivement chez des joueurs à faible risque et à haut risque (N = 57). Un biais attentionnel pour les stimuli liés au jeu pouvant aller jusqu’au maintien ou au décrochage de l’attention a été observé chez les joueurs à haut risque, par rapport aux autres éléments de distraction. Les données sur les joueurs à faible risque indiquent quant à elles la présence d’un biais attentionnel non spécifique (pour les images de jeu et négatives). Un biais attentionnel soutenu pour les éléments négatifs facilitant le décrochage de l’attention à des éléments positifs a été observé chez les joueurs à faible risque, mais non chez ceux à haut risque. Les résultats de l’étude mettent d’une part en évidence les différences entre le processus attentionnel des joueurs à haut risque et celui des joueurs à faible risque, et indiquent d’autre part que les biais attentionnels soutenus peuvent constituer les cibles d’intervention cliniques efficaces. Une prochaine étude devra évaluer la malléabilité du biais attentionnel pour le jeu des joueurs à haut risque et déterminer si une modification de l’attention accordée aux éléments liés au jeu peut influencer les comportements associés au jeu.
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Background: Addiction is characterized by compulsive drug seeking and substance use, yet many individuals break free of these patterns and change their behavior. Traditional candidate predictors of behavior change/persistence rely on self-reports of factors such as readiness to change. However, explicit measures only characterize top-down influences on behavior. The incentive sensitization model of addition suggests that more implicit, automatic processes, such as the tendency to approach substance cues, play a major role in behavior. Methods: We examined implicit alcohol approach and avoidance tendencies using a reaction time (RT) task in a sample of problem drinkers with alcohol use disorder (AUD) seeking to reduce heavy drinking. We measured alcohol approach and avoidance tendencies at baseline and at outcome, 12 weeks later. We asked whether alcohol approach and avoidance tendencies (i) changed over time, (ii) related to current drinking, and (iii) predicted changes in drinking from baseline to outcome. Results: Approach and avoidance tendencies did not significantly change over time, nor did they correlate with current drinking, but these tendencies at baseline did predict drinking weeks later. Faster alcohol approach was associated with greater overall drinking at outcome, and faster alcohol avoidance predicted fewer drinking days per week at outcome. Exploratory analyses examined the relationship between approach and avoidance and traditional explicit measures including appraisals of alcohol and motivation to change. Implicit approach tendencies were largely distinct from explicit measures, and approach and avoidance tendencies explained unique variance in outcome drinking. Conclusions: The current findings suggest that implicit alcohol approach and avoidance tendencies assessed via a simple reaction time task can predict relative changes in drinking weeks later. Given that many explicit measures typically used in treatment studies fail to predict who will change, approach and avoidance tendencies are promising candidates to understand individual differences in treatment responses.
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In light of the upcoming eleventh edition of the International Classification of Diseases (ICD-11), the question arises as to the most appropriate classification of 'Pathological Gambling' ('PG'). Some academic opinion favors leaving PG in the 'Impulse Control Disorder' ('ICD') category, as in ICD-10, whereas others argue that new data especially from the neurobiological area favor allocating it to the category of 'Substance-related and Addictive Disorders' ('SADs'), following the decision in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders. The current review examines important findings in relation to PG, with the aim of enabling a well-informed decision to be made with respect to the classification of PG as a SAD or ICD in ICD-11. Particular attention is given to cognitive deficits and underlying neurobiological mechanisms that play a role in SADs and ICDs. These processes are impulsivity, compulsivity, reward/punishment processing and decision-making. In summary, the strongest arguments for subsuming PG under a larger SAD category relate to the existence of similar diagnostic characteristics; the high co-morbidity rates between the disorders; their common core features including reward-related aspects (positive reinforcement: behaviors are pleasurable at the beginning which is not the case for ICDs); the findings that the same brain structures are involved in PG and SADs, including the ventral striatum. Research on compulsivity suggests a relationship with PG and SAD, particularly in later stages of the disorders. Although research is limited for ICDs, current data do not support continuing to classify PG as an ICD.
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The motivation to seek out and consume rewards has evolutionarily been driven by the urge to fulfill physiological needs. However in a modern society dominated more by plenty than scarcity, we tend to think of motivation as fueled by the search for pleasure. Here, we argue that two separate but interconnected sub-cortical and unconscious processes direct motivation: " wanting " and " liking. " These two psychological and neuronal processes and their related brain structures typically work together, but can become dissociated, particularly in cases of addiction. In drug addiction, for example, repeated consumption of addictive drugs sensitizes the mesolimbic dopamine system, the primary component of the " wanting " system, resulting in excessive " wanting " for drugs and their cues. This sensitizing process is long-lasting and occurs independently of the " liking " system, which typically remains unchanged or may develop a blunted pleasure response to the drug. The result is excessive drug-taking despite minimal pleasure and intense cue-triggered craving that may promote relapse long after detoxification. Here, we describe the roles of " liking " and " wanting " in general motivation and review recent evidence for a dissociation of " liking " and " wanting " in drug addiction, known as the incentive sensitization theory (Robinson and Berridge 1993). We also make the case that sensitization of the " wanting " system and the resulting disso-ciation of " liking " and " wanting " occurs in both gambling disorder and food addiction.
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In the current study, we investigated whether the internal reliability of the visual probe task measure of attentional bias for substance-related cues could be improved by incorporating eye-tracking methods and personalised stimuli. Sixty social drinkers completed two visual probe tasks: one with a broad range of different alcohol pictures, the other containing only images of the participants' preferred drink. Attentional bias was inferred from manual reaction times to probes replacing the pictures, and from the duration of eye movement fixations towards the pictures (gaze dwell time). Internal reliability was highest for personalised (versus general) alcohol stimuli, and for eye-tracking (versus manual reaction time) measures of attentional bias. The internal reliability of both reaction time (α=.73) and gaze dwell time measures (α=.76) of attentional bias for personalised alcohol stimuli was acceptable. Internal reliability of indices of attentional bias for general alcohol stimuli was inferior, although better for the gaze dwell time (α=.51) compared to the reaction time measure (α=.19). Attentional bias towards personalised stimuli was larger than bias to general stimuli, but only for the reaction time measure. There were no statistically significant associations between measures of attentional bias and alcohol consumption or craving. Adopting personalised stimuli and eye movement monitoring significantly improves the internal reliability of the alcohol-related visual probe task. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Article
The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical symptoms and underlying neurobiology. We examine the relevance of this theory for Gambling Disorder and point to predictions for future studies. The theory promises a significant contribution to the understanding of behavioral addiction and opens new avenues for treatment.
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Extensive recent research has begun to unravel the more implicit or automatic cognitive mechanisms in addiction. This effort has increased our understanding of some of the perplexing characteristics of addictive behaviors. The problem, often, is not that substance abusers do not understand that the disadvantages of continued use outweigh the advantages; rather, they have difficulty resisting their automatically triggered impulses to use their substance of abuse. Existing interventions may help to moderate these impulses. In addition, new techniques aimed at directly modifying implicit cognitive processes in substance abuse are being developed.
Article
An approach bias for alcohol stimuli (i.e. faster approach than avoidance reactions) might facilitate relapses in alcohol dependence. Neurobiological models suggest hypersensitivity in the reward system [inter alia nucleus accumbens and orbitofrontal cortex (OFC)] to cause pathologically enhanced approach impulses towards alcohol stimuli. At the same time, in alcohol dependence, these structures are only insufficiently controlled by a hypoactive dorsolateral prefrontal cortex (DLPFC). The present study investigated the cortical aspects of this model with functional near-infrared spectroscopy in 21 alcohol-dependent in-patients and 21 healthy controls (HC; comparable in age, gender and education) during performance of the Approach-Avoidance Task (AAT) for the first time. Complementing previous findings, in reaction times (RTs), patients showed stronger approach preferences for alcohol than non-alcohol stimuli. For non-alcohol stimuli, patients even displayed avoidance preferences. The reversed pattern was found in HC. Group differences in activity of the OFC were identical to those in RTs, revealing patients to assign higher subjective value to approaching alcohol stimuli. In both groups, regulatory activity in the right DLPFC was stronger during avoiding than approaching alcohol pictures. Probable awareness of the behavioural hypotheses due to explicit task instructions and patients' deficient prefrontal function might account for this equally aligned pattern. Results are discussed with regard to recent findings revealing a reduced behavioural approach bias and risk for relapse by applying a retraining version of the AAT. Functional measurements might serve as a method for monitoring the corresponding neurobiological changes and-possibly-predicting the success of such a training.
Article
Wishful thinking (WT)—defined as predicting a more favorable outcome for a preferred team—was investigated in soccer stadia and betting stations in Israel. High levels of WT were found in all contexts investigated. As hypothesized, the intensity of WT varied between contexts as a function of the “legitimacy” of emotionalism and subjectivity, and within each context as a function of self-defined levels of fanhood and preference. An explicit instruction to be objective did not reduce WT in predicting game outcomes. Paid betting forms represented an ecologically valid voluntary behavior most contradictory of wishful thinking, since bettors are strongly motivated to be objective and impartial. The results showed that fans could not overcome their wishful thinking, betting emotionally and against their financial interest.
Article
This study examined the association between automatic processes and drinking behavior in relation to individual differences in response inhibition in young adolescents who had just started drinking. It was hypothesized that strong automatic behavioral tendencies toward alcohol-related stimuli (alcohol-approach bias) were associated with higher levels of alcohol use, especially amongst adolescents with relatively weak inhibition skills. To test this hypothesis structural equation analyses (standard error of mean) were performed using a zero inflated Poisson (ZIP) model. A well-known problem in studying risk behavior is the low incidence rate resulting in a zero dominated distribution. A ZIP-model accounts for non-normality of the data. Adolescents were selected from secondary Special Education schools (a risk group for the development of substance use problems). Participants were 374 adolescents (mean age of M = 13.6 years). Adolescents completed the alcohol Approach Avoidance Task (a-AAT), the Stroop Colour Naming Task (Stroop) and a questionnaire that assessed alcohol use. The ZIP-model established stronger alcohol-approach tendencies for adolescent drinkers (P < 0.01) and the interaction revealed a stronger effect of alcohol-approach tendencies on alcohol use in the absence of good inhibition skills (P < 0.05). Automatically-activated cognitive processes are associated with the drinking behavior of young, at-risk adolescents. It appears that alcohol-approach tendencies are formed shortly after the initiation of drinking and particularly affect the drinking behavior of adolescents with relatively weak inhibition skills. Implications for the prevention of problem drinking in adolescents are discussed.
Article
A recent paper published in Drug and alcohol dependence (Ataya et al., 2012) is the first systematic attempt to establish the internal reliability of measures of substance-related attentional bias, and it makes an important and long overdue contribution to this topic. The authors reported that the reliability of attentional bias indices derived from the visual probe task was very poor, and while the attentional bias index from the Stroop was a little better, it fell some way short of being acceptable, as α>0.70 in only two of six studies in which the task was used. In this commentary, we speculate on some of the factors that might have contributed to the poor reliability of the tasks, and how task reliability might be improved in future studies.
Article
Although there is considerable information concerning the attentional biases in psychoactive substance use and misuse, much less is known about the contribution of attentional processing in problem gambling. The aim of this study was to examine whether problem gamblers (PrG) exhibit attentional bias at the level of the encoding processing stage. Forty PrG and 35 controls participated in an attentional blink (AB) paradigm in which they were required to identify both gambling and neutral words that appeared in a rapid serial visual presentation. Explicit motivation (e.g., intrinsic/arousal, extrinsic, amotivation) toward the gambling cues was recorded. A diminished AB effect for gambling-related words compared to neutral targets was identified in PrG. In contrast, AB was similar when either gambling-related or neutral words were presented to controls. Furthermore, there was a significant positive correlation between the reduced AB for gambling-related words and the sub-score of intrinsic/arousal motivation to gamble in PrG. Such findings suggest that the PrG group exhibits an enhanced ability to process gambling-related information, which is associated with their desire to gamble for arousal reasons. Theoretical and clinical implications of these results are discussed.
Article
This paper explores the way in which emotions are causal determinants of action. It argues that emotional events, as appraised by the individual, elicit changes in motive states (called states of action readiness), which in turn may (or may not) cause action. Actions can be elicited automatically, without prior intention (called impulsive actions), or intentionally. Impulsive actions reflect the simplest and biologically most general form in which emotions can cause action, since they require no reflection, no foresight, and no planning. Impulsive actions are determined conjointly by the nature of action readiness, the affordances perceived in the eliciting event as appraised, and the individual's action repertoire. Those actions from one's repertoire are performed that both match the perceived affordances and the aim of the state of action readiness.
Article
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.
Article
The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Article
Researchers in thinking and reasoning have proposed recently that there are two distinct cognitive systems underlying reasoning. System 1 is old in evolutionary terms and shared with other animals: it comprises a set of autonomous subsystems that include both innate input modules and domain-specific knowledge acquired by a domain-general learning mechanism. System 2 is evolutionarily recent and distinctively human: it permits abstract reasoning and hypothetical thinking, but is constrained by working memory capacity and correlated with measures of general intelligence. These theories essentially posit two minds in one brain with a range of experimental psychological evidence showing that the two systems compete for control of our inferences and actions.
Article
Here I argue that addicted people become unable to make drug-use choices on the basis of long-term outcome, and I propose a neural framework that explains this myopia for future consequences. I suggest that addiction is the product of an imbalance between two separate, but interacting, neural systems that control decision making: an impulsive, amygdala system for signaling pain or pleasure of immediate prospects, and a reflective, prefrontal cortex system for signaling pain or pleasure of future prospects. After an individual learns social rules, the reflective system controls the impulsive system via several mechanisms. However, this control is not absolute; hyperactivity within the impulsive system can override the reflective system. I propose that drugs can trigger bottom-up, involuntary signals originating from the amygdala that modulate, bias or even hijack the goal-driven cognitive resources that are needed for the normal operation of the reflective system and for exercising the willpower to resist drugs.
Article
We examined attitudes towards spiders by employing an Approach-Avoidance Task, in which participants respond to pictures by pulling a joystick towards themselves or by pushing it away from themselves. For spider fearfuls, this stimulus-response assignment is either compatible (push spiders away) or incompatible (pull spiders closer). Specific compatibility effects were found: compared to non-anxious controls and control pictures, highly spider fearful participants responded to spider pictures more quickly by pushing than by pulling, even when picture contents was task-irrelevant. Moreover, compatibility effects predicted fear-related behavior independently of questionnaires. Potential applications, extensions, and limitations of the findings are discussed.