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      Recent Advances in Attention Bias Modification for Substance Addictions

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          Abstract

          Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological trials that have appeared to date have produced mixed results, which has clinical implications. Developments in Internet and mobile technologies have transformed how attention bias modification is currently being achieved. There remains great potential for further research that examines the efficacy of technology-aided attention bias interventions.

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          Most cited references 27

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          Cognitive bias modification: A review of meta-analyses.

          Cognitive bias modification (CBM) is a novel, but controversial intervention with considerable divergence amongst conclusions in individual studies and reviews. This systematic review synthesizes meta-analyses of CBM to determine whether CBM is effective, and what parameters most reliably evoke the process of CBM.
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            The Effectiveness of Cognitive Bias Modification Interventions for Substance Addictions: A Meta-Analysis

            Background and Aims Cognitive bias modification (CBM) interventions, presumably targeting automatic processes, are considered particularly promising for addictions. We conducted a meta-analysis examining randomized controlled trials (RCTs) of CBM for substance addiction outcomes. Methods Studies were identified through systematic searches in bibliographical databases. We included RCTs of CBM interventions, alone or in combination with other treatments, for any type of addiction. We examined trial risk of bias, publication bias and possible moderators. Effects sizes were computed for post-test and follow-up, using a random-effects model. We grouped outcome measures and reported results for addiction (all related measures), craving and cognitive bias. Results We identified 25 trials, 18 for alcohol problems, and 7 for smoking. At post-test, there was no significant effect of CBM for addiction, g = 0.08 (95% CI -0.02 to 0.18) or craving, g = 0.05 (95% CI -0.06 to 0.16), but there was a significant, moderate effect on cognitive bias, g = 0.60 (95% CI 0.39 to 0.79). Results were similar for alcohol and smoking outcomes taken separately. Follow-up addiction outcomes were reported in 7 trials, resulting in a small but significant effect of CBM, g = 0.18 (95% CI 0.03 to 0.32). Results for addiction and craving did not differ by substance type, sample type, delivery setting, bias targeted or number of sessions. Risk of bias was high or uncertain in most trials, for most criteria considered. Meta-regression analyses revealed significant inverse relationships between risk of bias and effect sizes for addiction outcomes and craving. The relationship between cognitive bias and respectively addiction ESs was not significant. There was consistent evidence of publication bias in the form of funnel plot asymmetry. Conclusions Our results cast serious doubts on the clinical utility of CBM interventions for addiction problems, but sounder methodological trials are necessary before this issue can be settled. We found no indication that positive effects on biases translate into effects on addiction outcomes.
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              The clinical relevance of attentional bias in substance use disorders.

              Individuals with substance use disorders typically show an "attentional bias" for substance-related cues: Those cues are able to grab and hold the attention, in preference to other cues in the environment. We discuss the theoretical context for this work before reviewing the measurement of attentional bias, and its relationship to motivational state and relapse to substance use after a period of abstinence. Finally, we discuss the implications of this research for the treatment of substance use disorders. We conclude that attentional bias is associated with subjective craving, and that moment-by-moment fluctuations in attentional bias may precede relapse to substance use. The evidence regarding the predictive relationship between attentional bias assessed in treatment contexts and subsequent relapse is inconsistent. Furthermore, there is currently insufficient evidence to endorse attentional bias modification as a treatment for substance use disorders. Clinical implications and suggestions for future research are highlighted.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                04 April 2018
                April 2018
                : 15
                : 4
                Affiliations
                [1 ]National Addictions Management Service, Institute of Mental Health, Singapore 539747, Singapore; song_guo@ 123456imh.com.sg
                [2 ]Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 66308232, Singapore; h.e.smith@ 123456ntu.edu.sg
                [3 ]National Healthcare Group, National Psychiatry Residency Program, Singapore 539747, Singapore; yingjiangbo@ 123456gmail.com
                [4 ]Department of Developmental Psychiatry, Institute of Mental Health, Singapore 539747, Singapore; daniel_fung@ 123456imh.com.sg
                Author notes
                [* ]Correspondence: melvynzhangweibin@ 123456gmail.com ; Tel.: +65-389-2504
                Article
                ijerph-15-00676
                10.3390/ijerph15040676
                5923718
                29617325
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Perspective

                Public health

                m-health, attention bias, attention bias modification, substance abuse, addiction, e-health

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