Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands.
Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands.
JMIR Mhealth Uhealth. 2020 Apr 14;8(4):e16217. doi: 10.2196/16217.
Alcohol use is associated with an automatic tendency to approach alcohol, and the retraining of this tendency (cognitive bias modification [CBM]) shows therapeutic promise in clinical settings. To improve access to training and to enhance participant engagement, a mobile version of alcohol avoidance training was developed.
The aims of this pilot study were to assess (1) adherence to a mobile health (mHealth) app; (2) changes in weekly alcohol use from before to after training; and (3) user experience with regard to the mHealth app.
A self-selected nonclinical sample of 1082 participants, who were experiencing problems associated with alcohol, signed up to use the alcohol avoidance training app Breindebaas for 3 weeks with at least two training sessions per week. In each training session, 100 pictures (50 of alcoholic beverages and 50 of nonalcoholic beverages) were presented consecutively in a random order at the center of a touchscreen. Alcoholic beverages were swiped upward (away from the body), whereas nonalcoholic beverages were swiped downward (toward the body). During approach responses, the picture size increased to mimic an approach movement, and conversely, during avoidance responses, the picture size decreased to mimic avoidance. At baseline, we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy, and craving. After 3 weeks, 37.89% (410/1082) of the participants (posttest responders) completed an online questionnaire evaluating adherence, alcohol consumption, and user satisfaction. Three months later, 19.03% (206/1082) of the participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption.
The 410 posttest responders were older, were more commonly female, and had a higher education as compared with posttest dropouts. Among those who completed the study, 79.0% (324/410) were considered adherent as they completed four or more sessions, whereas 58.0% (238/410) performed the advised six or more training sessions. The study identified a significant reduction in alcohol consumption of 7.8 units per week after 3 weeks (95% CI 6.2-9.4, P<.001; n=410) and another reduction of 6.2 units at 3 months for follow-up responders (95% CI 3.7-8.7, P<.001; n=206). Posttest responders provided positive feedback regarding the fast-working, simple, and user-friendly design of the app. Almost half of the posttest responders reported gaining more control over their alcohol use. The repetitious and nonpersonalized nature of the intervention was suggested as a point for improvement.
This is one of the first studies to employ alcohol avoidance training in a mobile app for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted.
饮酒与趋近酒精的自动倾向有关，而这种倾向的再训练（认知偏差修正[CBM]）在临床环境中显示出治疗潜力。为了提高培训的可及性并增强参与者的参与度，开发了一种移动版的酒精回避训练应用程序。
本试点研究旨在评估：（1）移动健康（mHealth）应用程序的依从性；（2）从培训前到培训后每周饮酒量的变化；（3）mHealth 应用程序的用户体验。
1082 名自选中的非临床参与者，他们正在经历与酒精相关的问题，使用 Breindebaas 酒精回避训练应用程序 3 周，每周至少进行两次训练。在每次训练中，会连续在触摸屏中央呈现 100 张图片（50 张含酒精饮料和 50 张不含酒精饮料）。含酒精饮料向上滑动（远离身体），而不含酒精饮料向下滑动（朝向身体）。在趋近反应时，图片大小会增加以模拟趋近运动，反之，在回避反应时，图片大小会减小以模拟回避运动。在基线时，我们评估了社会人口特征、饮酒量、与酒精相关的问题、其他物质的使用、自我效能感和渴求感。3 周后，37.89%（410/1082）的参与者（posttest responders）完成了一份在线问卷，评估了依从性、饮酒量和用户满意度。三个月后，19.03%（206/1082）的参与者（follow-up responders）填写了一份随访问卷，检查了依从性和饮酒量。
410 名 posttest responders 年龄较大，更多为女性，教育程度较高，与 posttest dropout 相比。在完成研究的参与者中，79.0%（324/410）被认为是依从性的，因为他们完成了四节或更多课程，而 58.0%（238/410）完成了建议的六节或更多培训课程。研究发现，3 周后每周的饮酒量减少了 7.8 个单位（95%CI 6.2-9.4，P<.001；n=410），3 个月后随访应答者的饮酒量又减少了 6.2 个单位（95%CI 3.7-8.7，P<.001；n=206）。posttest responders 对应用程序快速、简单和用户友好的设计提供了积极的反馈。近一半的 posttest responders 表示对自己的饮酒行为有了更多的控制。干预措施的重复和非个性化被认为是需要改进的一点。
这是首次在移动应用程序中使用酒精回避训练来治疗问题饮酒者的研究之一。初步结果表明，移动 CBM 应用程序满足了问题饮酒者的需求，并可能有助于减少饮酒量。在对照研究中复制这些发现是有必要的。
