A randomized controlled trial of Web-based Attentional Bias Modification to help smokers quit.

OBJECTIVE To assess the efficacy of a multiple-sessions Web-based Attentional Bias Modification (ABM) self-help intervention in 434 smokers who made a quit-attempt. METHOD Respondents were randomized to receive 6 sessions of ABM- or placebo-training in a period of 2 weeks. Smoking-related cognitions (e.g., self-efficacy and intention to quit) and cognitive biases (i.e., attentional and approach bias) for smoking-cues were assessed before training (pretest). Primary outcome-variable was continued abstinence, 6 months after baseline. Bias reduction at the posttraining assessment was the secondary outcome. A 2 × 2 mixed analysis of variance (ANOVA) and logistic regression analyses were conducted using the whole sample (N = 434) as well as subsamples of light to moderate smokers (<15 cigarettes, N = 115) and heavy smokers (15 or more cigarettes, N = 319). Conservative analyses (coding drop-outs as smokers) as well as complete case analyses were conducted. RESULTS The ABM training had no significant effect regarding bias reduction and no behavioral effects in the whole sample of smokers. Subsample analyses revealed a significant positive effect on continued abstinence in heavy smokers only (complete case analyses: odds ratio [OR] = 3.15; p = .02; confidence interval [CI] = 1.24-7.99; conservative analyses: OR = 2.49; p = .02; CI = 1.13-5.48). CONCLUSION Web-based ABM training is ineffective in fostering cognitive bias reduction and continued smoking abstinence. However, the positive effects in heavy smokers-as indicated by exploratory subsample analyses-warrant further research into the potential of multiple sessions ABM training to foster continued smoking abstinence in heavy smokers who make a quit-attempt. (PsycINFO Database Record

[1]  R. Wiers,et al.  Cognitive Bias Modification for adolescents with substance use problems--Can serious games help? , 2015, Journal of behavior therapy and experimental psychiatry.

[2]  R. Wiers,et al.  Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study , 2015, The American journal of drug and alcohol abuse.

[3]  K. Fagerström,et al.  Time to First Use Among Daily Smokers and Smokeless Tobacco Users. , 2015, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[4]  S. Shiffman,et al.  Lack of attentional retraining effects in cigarette smokers attempting cessation: a proof of concept double-blind randomised controlled trial. , 2015, Drug and alcohol dependence.

[5]  A. Fritzsche,et al.  The approach-avoidance task as an online intervention in cigarette smoking: a pilot study. , 2015, Journal of behavior therapy and experimental psychiatry.

[6]  L. Bizarro,et al.  Attentional bias modification in smokers trying to quit: a longitudinal study about the effects of number of sessions. , 2014, Journal of substance abuse treatment.

[7]  Andrew J Waters,et al.  Attentional retraining administered in the field reduces smokers' attentional bias and craving. , 2014, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  G. Andersson,et al.  Moderation and mediation of the effect of attention training in social anxiety disorder. , 2014, Behaviour research and therapy.

[9]  R. Wiers,et al.  The Effect of Approach/Avoidance Training on Alcohol Consumption Is Mediated by Change in Alcohol Action Tendency , 2014, PloS one.

[10]  Colin MacLeod,et al.  Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification , 2014, BMC Psychiatry.

[11]  R. Wiers,et al.  Alcohol-related biases in selective attention and action tendency make distinct contributions to dysregulated drinking behaviour. , 2013, Addiction.

[12]  J. Boettcher,et al.  Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues , 2013, PloS one.

[13]  B. Hommel,et al.  Motivational Mechanisms and Outcome Expectancies Underlying the Approach Bias toward Addictive Substances , 2012, Front. Psychology.

[14]  C. Beard,et al.  Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. , 2012, Behavioural and cognitive psychotherapy.

[15]  J. Boettcher,et al.  Internet-Based Attention Training for Social Anxiety: A Randomized Controlled Trial , 2012, Cognitive Therapy and Research.

[16]  Reinout W Wiers,et al.  Preventing smoking relapse via web-based computer-tailored feedback: a randomized controlled trial , 2014 .

[17]  G. Andersson,et al.  Internet-delivered attention bias modification training in individuals with social anxiety disorder - a double blind randomized controlled trial , 2012, BMC Psychiatry.

[18]  R. Wiers,et al.  Retraining Automatic Action Tendencies Changes Alcoholic Patients’ Approach Bias for Alcohol and Improves Treatment Outcome , 2011, Psychological science.

[19]  J. Oldham.  Absence of evidence. , 2011, Journal of psychiatric practice.

[20]  M. Otto,et al.  Attentional bias and craving in smokers: the impact of a single attentional training session. , 2010, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[21]  Iosief Abraha,et al.  Modified intention to treat reporting in randomised controlled trials: systematic review , 2010, BMJ : British Medical Journal.

[22]  Reinout W Wiers,et al.  Clinical effectiveness of attentional bias modification training in abstinent alcoholic patients. , 2010, Drug and alcohol dependence.

[23]  M. Fillmore,et al.  The effect of image complexity on attentional bias towards alcohol-related images in adult drinkers. , 2010, Addiction.

[24]  S. Glantz,et al.  Health Effects of Light and Intermittent Smoking: A Review , 2010, Circulation.

[25]  Hein de Vries,et al.  Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months. , 2009, Health education research.

[26]  Matt Field,et al.  Attentional bias modification in tobacco smokers. , 2009, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[27]  Javad Salehi Fadardi,et al.  Reversing the sequence: reducing alcohol consumption by overcoming alcohol attentional bias. , 2009, Drug and alcohol dependence.

[28]  R. Wiers,et al.  Relatively strong automatic appetitive action‐tendencies in male carriers of the OPRM1 G‐allele , 2009, Genes, brain, and behavior.

[29]  C. Beard,et al.  Attention modification program in individuals with generalized anxiety disorder. , 2009, Journal of abnormal psychology.

[30]  J. Buckner,et al.  Attention training for generalized social anxiety disorder. , 2009, Journal of abnormal psychology.

[31]  C. Husten,et al.  State-specific smoking-attributable mortality and years of potential life lost--United States, 2000-2004. , 2009, MMWR. Morbidity and mortality weekly report.

[32]  Ute Leonards,et al.  Attentional bias training and cue reactivity in cigarette smokers. , 2008, Addiction.

[33]  K. Berridge,et al.  The incentive sensitization theory of addiction: some current issues , 2008, Philosophical Transactions of the Royal Society B: Biological Sciences.

[34]  Donald W Hine,et al.  Implicit cognition and substance use: a meta-analysis. , 2008, Addictive behaviors.

[35]  M. Field,et al.  Attentional bias in addictive behaviors: a review of its development, causes, and consequences. , 2008, Drug and alcohol dependence.

[36]  M. Field,et al.  Rapid approach responses to alcohol cues in heavy drinkers. , 2008, Journal of behavior therapy and experimental psychiatry.

[37]  R. Wiers,et al.  Effects of a low dose of alcohol on cognitive biases and craving in heavy drinkers , 2007, Psychopharmacology.

[38]  C. Vandelanotte,et al.  Website-delivered physical activity interventions a review of the literature. , 2007, American journal of preventive medicine.

[39]  G. Bühringer.  Handbook of Implicit Cognition and Addiction , 2007 .

[40]  Matt Field,et al.  Experimental manipulation of attentional biases in heavy drinkers: do the effects generalise? , 2007, Psychopharmacology.

[41]  Reinout W Wiers,et al.  Attentional re-training decreases attentional bias in heavy drinkers without generalization. , 2007, Addiction.

[42]  Jerry L. Grenard,et al.  Automatic and controlled processes and the development of addictive behaviors in adolescents: A review and a model , 2007, Pharmacology Biochemistry and Behavior.

[43]  G. Eysenbach.  The Law of Attrition Revisited – Author’s Reply , 2006, Journal of Medical Internet Research.

[44]  H. de Vries,et al.  Predictors of smoking relapse in a sample of Dutch adult smokers; the roles of gender and action plans. , 2006, Addictive behaviors.

[45]  T. Palfai,et al.  The search for new ways to change implicit alcohol-related cognitions in heavy drinkers. , 2006, Alcoholism, clinical and experimental research.

[46]  R. Shegog,et al.  A review of computer and Internet-based interventions for smoking behavior. , 2006, Addictive behaviors.

[47]  S. Schmukle.  Unreliability of the dot probe task , 2005 .

[48]  A. Bechara.  Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective , 2005, Nature Neuroscience.

[49]  G. Eysenbach.  The Law of Attrition , 2005, Journal of medical Internet research.

[50]  Jean-François Etter,et al.  Comparing the Efficacy of Two Internet-Based, Computer-Tailored Smoking Cessation Programs: A Randomized Trial , 2005, Journal of medical Internet research.

[51]  K. Mogg,et al.  Attentional and approach biases for smoking cues in smokers: an investigation of competing theoretical views of addiction , 2005, Psychopharmacology.

[52]  F. Strack,et al.  Reflective and Impulsive Determinants of Social Behavior , 2004, Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc.

[53]  K. Mogg,et al.  Attentional biases for alcohol cues in heavy and light social drinkers: the roles of initial orienting and maintained attention , 2004, Psychopharmacology.

[54]  Marion F Zabinski,et al.  Computer and Internet applications for psychological treatment: update for clinicians. , 2004, Journal of clinical psychology.

[55]  V. Gebski,et al.  Inclusion of patients in clinical trial analysis: the intention‐to‐treat principle , 2003, The Medical journal of Australia.

[56]  Andrew J Waters,et al.  Attentional shifts to smoking cues in smokers. , 2003, Addiction.

[57]  Brian A. Nosek,et al.  Understanding and using the implicit association test: I. An improved scoring algorithm. , 2003, Journal of personality and social psychology.

[58]  R. Borland,et al.  Residual outcome expectations and relapse in ex-smokers. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[59]  Matt Field,et al.  Eye movements to smoking-related pictures in smokers: relationship between attentional biases and implicit and explicit measures of stimulus valence. , 2003, Addiction.

[60]  Lee Hogarth,et al.  Attentional orienting towards smoking-related stimuli , 2003, Behavioural pharmacology.

[61]  C. MacLeod,et al.  Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. , 2002, Journal of abnormal psychology.

[62]  Karin Mogg,et al.  Selective processing of smoking-related cues in smokers: manipulation of deprivation level and comparison of three measures of processing bias , 2002, Journal of psychopharmacology.

[63]  W. Velicer,et al.  Biochemical verification of tobacco use and cessation. , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[64]  T. Duka,et al.  Attentional bias associated with alcohol cues: differences between heavy and occasional social drinkers , 2001, Psychopharmacology.

[65]  Frank Baeyens,et al.  On the generality of the affective Simon effect , 2001 .

[66]  Hein de Vries,et al.  Self-efficacy expectations with regard to different tasks in smoking cessation , 2000 .

[67]  S. Hollis,et al.  What is meant by intention to treat analysis? Survey of published randomised controlled trials , 1999, BMJ.

[68]  M. Wakefield,et al.  The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. , 1999, Preventive medicine.

[69]  J Brug,et al.  The application and impact of computer-generated personalized nutrition education: a review of the literature. , 1999, Patient education and counseling.

[70]  M J Campbell,et al.  Choosing between randomised and non-randomised studies: a systematic review , 1998, BMJ.

[71]  P. Pini.  Addiction , 1996, The Lancet.

[72]  L. Kozlowski,et al.  The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. , 1991, British journal of addiction.

[73]  L. Kozlowski,et al.  Nicotine addiction and its assessment. , 1990, Ear, nose, & throat journal.

[74]  C. MacLeod,et al.  Attentional bias in emotional disorders. , 1986, Journal of abnormal psychology.

[75]  Mijke Rhemtulla,et al.  Alcohol cognitive bias modification training for problem drinkers over the web. , 2015, Addictive behaviors.

[76]  Reinout W. Wiers,et al.  Should We Train Alcohol-Dependent Patients to Avoid Alcohol? , 2013, Front. Psychiatry.

[77]  R. West,et al.  Relapse prevention interventions for smoking cessation. , 2009, The Cochrane database of systematic reviews.

[78]  Terry F. Pechacek,et al.  Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. , 2008, MMWR. Morbidity and mortality weekly report.

[79]  Roland Deutsch,et al.  Reflective and impulsive determinants of addictive behavior , 2006 .

[80]  Javad Salehi Fadardi,et al.  The addiction-stroop test: Theoretical considerations and procedural recommendations. , 2006, Psychological bulletin.

[81]  R. West,et al.  Relapse prevention interventions for smoking cessation. , 2005, The Cochrane database of systematic reviews.

[82]  Josue P. Keely,et al.  Shape of the relapse curve and long-term abstinence among untreated smokers. , 2004, Addiction.

[83]  Josue P. Keely,et al.  Measures of abstinence in clinical trials: issues and recommendations. , 2003, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[84]  R. Wiers,et al.  Developmental Cognitive Neuroscience Approach Bias Modification in Alcohol Dependence: Do Clinical Effects Replicate and for Whom Does It Work Best? , 2022 .