Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department for Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.
Neuropsychobiology. 2022;81(5):387-402. doi: 10.1159/000526805. Epub 2022 Nov 18.
Positively conditioned Pavlovian cues tend to promote approach and negative cues promote withdrawal in a Pavlovian-to-instrumental transfer (PIT) paradigm, and the strength of this PIT effect was associated with the subsequent relapse risk in alcohol-dependent (AD) patients. When investigating the effect of alcohol-related background cues, instrumental approach behavior was inhibited in subsequent abstainers but not relapsers. An automatic approach bias towards alcohol can be modified using a cognitive bias modification (CBM) intervention, which has previously been shown to reduce the relapse risk in AD patients. Here we examined the effects of such CBM training on PIT effects and explored its effect on the relapse risk in detoxified AD patients.
N = 81 recently detoxified AD patients performed non-drug-related and drug-related PIT tasks before and after CBM versus placebo training. In addition, an alcohol approach/avoidance task (aAAT) was performed before and after the training to assess the alcohol approach bias. Patients were followed up for 6 months.
A stronger alcohol approach bias as well as a stronger non-drug-related PIT effect predicted relapse status in AD patients. No significant difference regarding relapse status or the number of heavy drinking days was found when comparing the CBM training group versus the placebo group. Moreover, there was no significant modulation effect of CBM training on any PIT effect or the aAAT.
A higher alcohol approach bias in the aAAT and a stronger non-drug-related PIT effect both predicted relapse in AD patients, while treatment outcome was not associated with the drug-related PIT effect. Unlike expected, CBM training did not significantly interact with the non-drug-related or the drug-related PIT effects or the alcohol approach bias.
在条件性 Pavlovian 线索范式中，正性条件化的 Pavlovian 线索往往会促进趋近行为，而负性条件化的 Pavlovian 线索则会促进回避行为，这种 Pavlovian 到工具性的转移（PIT）效应的强度与酒精依赖（AD）患者的后续复发风险相关。在研究与酒精相关的背景线索的影响时，对于随后的戒酒者，工具性趋近行为受到抑制，但对于复发者则没有受到抑制。使用认知偏差修正（CBM）干预可以改变对酒精的自动趋近偏向，此前的研究表明，这种干预可以降低 AD 患者的复发风险。在这里，我们研究了这种 CBM 训练对 PIT 效应的影响，并探讨了其对已戒毒的 AD 患者复发风险的影响。
81 名最近戒毒的 AD 患者在接受 CBM 或安慰剂训练前后进行了非药物相关和药物相关的 PIT 任务。此外，在训练前后还进行了酒精趋近/回避任务（aAAT），以评估对酒精的趋近偏向。对患者进行了 6 个月的随访。
更强的酒精趋近偏向以及更强的非药物相关 PIT 效应可以预测 AD 患者的复发状态。在比较 CBM 训练组与安慰剂组时，在复发状态或重度饮酒天数方面没有发现显著差异。此外，CBM 训练对任何 PIT 效应或 aAAT 均没有显著的调节作用。
在 aAAT 中，酒精趋近偏向越高，非药物相关的 PIT 效应越强，都可以预测 AD 患者的复发，而治疗结果与药物相关的 PIT 效应无关。与预期相反的是，CBM 训练并没有显著影响非药物相关或药物相关的 PIT 效应或酒精趋近偏向。
