Corinde E Wiers1, Christine Stelzel, Thomas E Gladwin, Soyoung Q Park, Steffen Pawelczack, Christiane K Gawron, Heiner Stuke, Andreas Heinz, Reinout W Wiers, Mike Rinck, Johannes Lindenmeyer, Henrik Walter, Felix Bermpohl. 1. From the Department of Psychiatry and Psychotherapy and the Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin; the Berlin School of Mind and Brain and the Department of Psychology, Humboldt Universität zu Berlin; the Department of Education and Psychology, Freie Universität Berlin; the Addiction, Development, and Psychopathology Lab, Department of Psychology, University of Amsterdam, Amsterdam; the Department of Psychology, University of Lübeck, Lübeck, Germany; the Salus Klinik, Lindow, Germany; the Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands; and Chemnitz University of Technology, Chemnitz, Germany.
Abstract
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 eitherbias 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.
RCT Entities:
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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