LMU Munich, Department of Psychology, Clinical Psychology and Psychotherapy, Germany.
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany.
Behav Res Ther. 2019 Mar;114:35-43. doi: 10.1016/j.brat.2018.12.004. Epub 2018 Dec 6.
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).
信息处理偏差在维持烟草依赖中起着重要作用。由于目前的治疗方法没有充分考虑到这些偏差，本研究旨在探讨通过将常规治疗（TAU）与趋近回避修正训练（AAMT）相结合，是否可以改善临床疗效。一项针对成年吸烟者（N=105）的两臂平行（1:1）随机对照单盲研究（DRKS00011406）进行了。参与者接受了三次 TAU 治疗，要么接受了六次 AAMT 治疗，要么接受了假训练。在 AAMT 中，参与者被训练以隐含地回避所有与吸烟相关的图片，并接近所有与吸烟无关的图片，而在假训练中，两者的比例为 50:50。干预后和 6 个月后对参与者进行了评估。主要结局是随访时的每日吸烟量。与 TAU+Sham 相比，接受 TAU+AAMT 的参与者在随访时每日吸烟量的减少没有显著差异（意向治疗：95%CI：-3.11-2.96，p=0.968）。使用趋近回避修正训练（vs. 假训练）作为 TAU 的附加治疗并没有改善临床疗效。然而，没有发现偏见改变的一致证据。未来的研究需要探索优化后的训练版本（如明确的指导）的有效性。预先注册：德国临床试验注册处（DRKS00011406）。
