Salus Clinic, Lindow, Germany.
Dev Cogn Neurosci. 2013 Apr;4:38-51. doi: 10.1016/j.dcn.2012.11.002. Epub 2012 Nov 14.
Alcoholism is a progressive neurocognitive developmental disorder. Recent evidence shows that computerized training interventions (Cognitive Bias Modification, CBM) can reverse some of these maladaptively changed neurocognitive processes. A first clinical study of a CBM, called alcohol-avoidance training, found that trained alcoholic patients showed less relapse at one-year follow-up than control patients. The present study tested the replication of this result, and questions about mediation and moderation.
509 alcohol-dependent patients received treatment as usual (primarily Cognitive Behavior Therapy) inpatient treatment. Before and after treatment, the implicit approach bias was measured with the Alcohol Approach-Avoidance Task. Half of the patients were randomly assigned to CBM, the other half received treatment as usual only. Background variables, psychopathology and executive control were tested as possible moderating variables of CBM. One year after treatment, follow-up data about relapse were collected.
The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up. Change in alcohol-approach bias mediated this effect. Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM.
CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism.
酗酒是一种进行性的神经认知发育障碍。最近的证据表明，计算机化训练干预（认知偏差修正，CBM）可以逆转一些适应不良的神经认知过程。一项关于 CBM 的首次临床研究，即酒精回避训练，发现经过训练的酗酒患者在一年的随访中复发率低于对照组患者。本研究检验了这一结果的复制，并对中介和调节问题进行了探讨。
509 名酒精依赖患者接受了常规治疗（主要是认知行为疗法）住院治疗。在治疗前后，使用酒精趋近回避任务测量了内隐趋近偏差。一半的患者被随机分配到 CBM 组，另一半仅接受常规治疗。背景变量、精神病理学和执行控制被测试为 CBM 的可能调节变量。治疗一年后，收集了关于复发的随访数据。
接受 CBM 的组发展出了酒精回避行为，并在一年的随访中报告了显著较低的复发率。酒精趋近偏差的变化中介了这一效应。调节分析表明，年龄较大的患者和测试前有强烈趋近偏差的患者从 CBM 中获益最大。
CBM 是治疗酒精成瘾的一种很有前途的附加治疗方法，可能会抵消长期酗酒带来的一些适应不良的神经认知影响。
