Wirtz Janina, Moritz Steffen, Gehlenborg Josefine, Ascone Leonie, Kühn Simone
University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Neuroplasticity Working Group, Martinistr. 52, 20246 Hamburg, Germany.
University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Clinical Neuropsychology Working Group, Martinistr. 52, 20246 Hamburg, Germany.
Addict Behav. 2022 Dec;135:107429. doi: 10.1016/j.addbeh.2022.107429. Epub 2022 Jul 16.
Imaginal retraining, a type of approach-bias-modification performed in one's own imagination, is effective in reducing alcohol craving in problem drinkers. This study aims to segregate three main components of the original technique and compare their effectiveness in reducing craving and alcohol consumption.
The study was conducted online. Interested individuals wishing to reduce their alcohol consumption underwent a baseline assessment (T0), whereby a total of N = 200 included participants were randomly assigned to one of four study arms. There were three active groups receiving different training manuals: psychoeducation + advice only (PE), PE + a simplified motor in-sensu AAT instruction (AAT0), and the 'enriched' original imaginal retraining technique (including the components PE + enhanced movements + an embodied cognition/ emotion induction instruction) (AAT+), vs. a wait-list control (WLC). Participants in the three active arms were instructed to train twice a day (10 mins. each) over the course of four weeks, whereafter a post-test was conducted (T1). A follow-up took place one month later (T2). Repeated measures ANOVAs were computed to test for differential changes of the four groups over time (group*time interaction effects) concerning craving and alcohol consumption. Both per-protocol and intention-to-treat analyses (PPA, ITTA) were conducted.
In both PPA and ITTA, significant group*time interaction effects were identified, whereby false-discovery-rate corrected post-hoc tests revealed that AAT0 most consistently reduced craving with stability towards follow-up. Results concerning alcohol consumption (g ethanol) were inconsistent.
This study demonstrates that a simplified version of the imaginal retraining technique yields consistent results concerning craving reduction. This may hint towards the central importance of the core element of retraining: a movement of pushing (imagined) alcoholic beverages away. Possibly, more complex forms of imaginal retraining need further instruction than a written manual, such as instructive videos.
想象再训练是一种在个人想象中进行的认知偏差矫正方法，对减少问题饮酒者的酒精渴望有效。本研究旨在分离原始技术的三个主要组成部分，并比较它们在减少渴望和酒精消费方面的有效性。
本研究通过在线方式进行。希望减少酒精消费的感兴趣个体接受基线评估（T0），共有N = 200名纳入研究的参与者被随机分配到四个研究组之一。有三个干预组接受不同的训练手册：仅心理教育+建议（PE）、PE + 简化的运动内感觉酒精成瘾治疗指令（AAT0），以及“强化”的原始想象再训练技术（包括PE + 强化动作 + 具身认知/情绪诱导指令）（AAT+），与一个等待列表对照组（WLC）进行比较。三个干预组的参与者被指示在四周内每天训练两次（每次10分钟），之后进行后测（T1）。一个月后进行随访（T2）。计算重复测量方差分析以测试四组在渴望和酒精消费方面随时间的差异变化（组*时间交互效应）。进行了符合方案分析和意向性分析（PPA，ITTA）。
在PPA和ITTA中，均发现了显著的组*时间交互效应，经错误发现率校正的事后检验显示，AAT0在减少渴望方面最为一致，且对随访具有稳定性。关于酒精消费（乙醇克数）的结果不一致。
本研究表明，想象再训练技术的简化版本在减少渴望方面产生了一致的结果。这可能暗示了再训练核心要素的重要性：将（想象中的）酒精饮料推开的动作。可能，比书面手册更复杂的想象再训练形式需要进一步的指导，如指导性视频。
