Addiction, Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands.
Amsterdam Brain and Cognition (ABC), University of Amsterdam, The Netherlands.
Addict Biol. 2017 Nov;22(6):1632-1640. doi: 10.1111/adb.12463. Epub 2016 Oct 27.
Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects.
两项研究表明，在酒精接近偏见再训练（一种认知偏见修正（CBM）形式）后，临床结果有所改善。我们研究了经颅直流电刺激（tDCS）是否可以增强 CBM 的效果。tDCS 是一种神经调节技术，可以增加神经可塑性，并且之前已被发现可以减少渴望。100 名酒精依赖住院患者（91 名用于分析）以双盲平行设计随机分为三组实验组。实验组在接受背外侧前额叶皮层（DLPFC）2 mA 阳极 tDCS 的同时接受了四次 CBM 治疗。有两个对照组：一个在训练期间接受假刺激，另一个在不同时间接受主动刺激。治疗结果为戒断持续时间（主要结果）和 3 个月和 12 个月后的复发，以及渴望和接近偏见（次要结果）。随着时间的推移，渴望和接近偏见评分下降；与实验条件没有显著交互作用。三个月后戒断持续时间没有影响（χ2（2）= 3.53，p = 0.77）。然而，当纳入相关预测因子时，对一年后复发率的逻辑回归（临床标准的标准结果，但未预先注册）显示出一种趋势；仅在 CBM 期间接受主动刺激的条件下，复发率低于接受假刺激的条件（B = 1.52，S.E. = 0.836，p = 0.07，无预测因子：p = 0.19）。没有发现 tDCS 对 CBM 增强作用的有力证据。然而，在事后分析中，tDCS 与 CBM 联合使用在治疗结果上显示出有希望的趋势。讨论了重要的局限性，需要进行复制以找到更可靠的效果。
