Journal of Consulting and Clinical Psychology

Stice, Eric; Jansen, Anita

doi: 10.1037/ccp0000371pmid: 30507222

Kofler, Michael J.; Sarver, Dustin E.; Austin, Kristin E.; Schaefer, Hillary S.; Holland, Elizabeth; Aduen, Paula A.; Wells, Erica L.; Soto, Elia F.; Irwin, Lauren N.; Schatschneider, Christopher; Lonigan, Christopher J.

doi: 10.1037/ccp0000308pmid: 30507223

Objective: Working memory deficits have been linked experimentally and developmentally with attention-deficit/hyperactivity disorder (ADHD)-related symptoms/impairments. Unfortunately, substantial evidence indicates that extant working memory training programs fail to improve these symptoms/impairments. We hypothesized that this discrepancy may reflect insufficient targeting, such that extant protocols do not adequately engage the specific working memory components linked with the disorder’s behavioral/functional impairments. Method: The current study describes the development, empirical basis, and initial testing of central executive training (CET) relative to gold-standard behavioral parent training (BPT). Children with ADHD ages 8–13 (M = 10.43, SD = 1.59; 21 girls; 76% Caucasian/non-Hispanic) were treated using BPT (n = 27) or CET (n = 27). Detailed data analytic plans for the pre/post design were preregistered. Primary outcomes included phonological and visuospatial working memory, and secondary outcomes included actigraphy during working memory testing and two distal far-transfer tasks. Multiple feasibility/acceptability measures were included. Results: The BPT and CET samples did not differ on any pretreatment characteristics. CET was rated as highly acceptable by children and was equivalent to BPT in terms of feasibility/acceptability as evidenced by parent-reported high satisfaction, low barriers to participation, and large ADHD symptom reductions. CET was superior to BPT for improving working memory (Group × Time d = 1.06) as hypothesized. CET was also superior to BPT for reducing actigraph-measured hyperactivity during visuospatial working memory testing and both distal far-transfer tasks (Group × Time d = 0.74). Conclusions: Results provide strong support for continued testing of CET and, if replicated, would support recent hypotheses that next-generation ADHD cognitive training protocols may overcome current limitations via improved targeting.

Chen, Zhang; Veling, Harm; de Vries, Stijn P.; Bijvank, Bas Olde; Janssen, Ignace M. C.; Dijksterhuis, Ap; Holland, Rob W.

doi: 10.1037/ccp0000320pmid: 30507224

Objective: Not responding to appetitive food items in the go/no-go training has been shown to reduce the evaluation of these items in normal-weight university students. In this preregistered study, we administered an identical go/no-go training in both morbidly obese individuals and normal-weight university students, to assess whether findings from laboratory studies on go/no-go training performed in university environments can be translated to clinical settings. Method: Obese individuals (N = 59, 14 males, Mage = 46.10, MBMI = 44.49) and university students (N = 58, 15 males, Mage = 23.21, MBMI = 22.64) were trained to consistently respond to certain food items (go) and withhold responses to other items (no-go). Evaluations of the go and no-go items, along with items not used in the training (untrained), were measured both before and after the training. Results: Before the training, evaluations of go, no-go and untrained items were matched; after the training, go items were evaluated more positively than no-go (p = .031 and p = .002 in obese and normal-weight individuals) and untrained items (p = .003 in normal-weight individuals). Only relatively hungry participants rated no-go items as less attractive than both go and untrained items (no-go devaluation effect). More important, effects of the training on food evaluation did not differ between the two participant groups. Conclusions: Obese and normal-weight individuals showed similar responsivity to the go/no-go training on food evaluation, suggesting that insights from laboratory studies may be translated to clinical settings to develop effective interventions to regulate food intake.

Jones, Andrew; McGrath, Elly; Robinson, Eric; Houben, Katrijn; Nederkoorn, Chantal; Field, Matt

doi: 10.1037/ccp0000312pmid: 30507225

Objective: We conducted a randomized controlled trial to compare the effects of three types of Internet-delivered Inhibitory Control Training (ICT) with each other and with an active control intervention on alcohol consumption in a community sample of problem drinkers. Method: Two hundred and 46 heavy drinkers, who were motivated to reduce their alcohol consumption (mean age 41.32, 130 female) self-monitored their alcohol consumption for 1 week before being randomized to receive 1 of 3 variants of ICT (Associative No-Go, Associative Stop Signal, General Inhibition) or an active control. Participants then completed up to 14 ICT/control sessions on the Internet over a 4-week period, while regularly recording their alcohol consumption. Results: There were significant reductions in alcohol consumption across all groups over the 4-week training period (main effect of time, F(2, 402) = 77.12, p < .01, ηp2 = .28, BF10 > 99), however there were no differences between ICT groups, or between ICT groups and the active control group (Group × Time interaction, F(6, 402) = 1.10, p = .36, ηp2 = .02, BF10 = 0.03). Contrary to hypotheses, there were no changes in general inhibitory control, the disinhibiting effects of alcohol cues, or alcohol affective associations after ICT. Conclusions: In this study, which attempted to translate findings from proof-of-concept laboratory studies into a viable behavior change intervention, we found that multiple sessions of ICT delivered over the Internet did not help heavy drinkers to reduce their alcohol consumption beyond nonspecific effects associated with taking part in a trial.

Rinck, Mike; Wiers, Reinout W.; Becker, Eni S.; Lindenmeyer, Johannes

doi: 10.1037/ccp0000321pmid: 30507226

Objective: Alcohol-dependent patients show attentional and approach biases for alcohol-related stimuli. Computerized cognitive bias modification (CBM) programs aim to retrain these biases and reduce relapse rates as add-ons to treatment. Retraining of alcohol-approach tendencies has already yielded significant reductions of relapse rates in previous studies, and retraining of biased attention toward alcohol is promising approach. The current large-scale randomized controlled trial compared the clinical effects of these training methods—separately and in combination—to those of sham training methods and a no-training control, as an add-on to regular treatment. Methods: Participants were 1,405 alcohol-dependent patients of an inpatient rehabilitation clinic. In addition to regular treatment, patients were randomized to receive 6 sessions of approach-bias retraining, 6 sessions of attention-bias retraining, 3 sessions of each of these CBM training varieties, 6 sessions of variants of sham training, or no training. Effects of the training methods were evaluated by measuring treatment success at 1-year follow-up. Results: Primary outcome: The 3 active training conditions yielded higher success rates at 1-year follow-up than sham training or no training (8.4%, on average). Secondary results (available for half of the sample): Both varieties of CBM had only small effects on the targeted biases (significant only for the combined training). Moreover, neither significant mediation of the clinical effect by the change in trained bias nor significant moderation of the clinical effect was found. Conclusions: Both alcohol-avoidance training and alcohol-attention training increased success rates effectively, as did the combination of both methods. Future studies should test ways to increase training effectiveness further.

Hirsch, Colette R.; Krahé, Charlotte; Whyte, Jessica; Loizou, Sofia; Bridge, Livia; Norton, Sam; Mathews, Andrew

doi: 10.1037/ccp0000310pmid: 30507227

Objective: Repetitive negative thinking (RNT) for example, worry in generalized anxiety disorder (GAD) and rumination in depression, is often targeted during psychological treatments. To test the hypothesis that negative interpretation bias contributes to worry and rumination, we assessed the effects of inducing more positive interpretations in reducing RNT. Method: Volunteers diagnosed with GAD (66) or depression (65) were randomly allocated to one of two versions of cognitive bias modification for interpretation (CBM-I), either with or without RNT priming prior to training, or a control condition, each involving 10 Internet-delivered sessions. Outcome measures of interpretation bias, a behavioral RNT task and self-reported worry, rumination, anxiety and depression were obtained at baseline, after home-based training and at 1-month follow-up (self-report questionnaires only). Results: CBM-I training, across diagnostic groups, promoted a more positive interpretation bias and led to reductions in worry, rumination, and depressive symptoms, which were maintained at follow-up. Anxiety symptoms were reduced only in the GAD group at follow-up. There were no differences between CBM-I versions; brief priming of RNT did not influence CBM-I effectiveness. Level of interpretation bias post training partially mediated the effects of CBM-I on follow-up questionnaire scores. Conclusions: In contrast to some recent failures to demonstrate improvements following Internet-delivered CBM, we found that self-reported RNT and negative mood were reduced by CBM-I. This is consistent with a causal role for negative interpretation bias in both worry and rumination, suggesting a useful role for CBM-I within treatments for anxiety and depression.

Price, Rebecca B.; Cummings, Logan; Gilchrist, Danielle; Graur, Simona; Banihashemi, Layla; Kuo, Susan S.; Siegle, Greg J.

doi: 10.1037/ccp0000309pmid: 30507228

Objective: Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information. Method: Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat. Results: Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy. Conclusions: Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse).

Glashouwer, Klaske A.; Neimeijer, Renate A. M.; de Koning, Marlies L.; Vestjens, Michiel; Martijn, Carolien

doi: 10.1037/ccp0000311pmid: 30507229

Objective: The aim was to investigate whether a computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical sample under less controlled circumstances. Method: Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which participants had to click on pictures of their own and other people’s bodies. Their own pictures were systematically followed by portraits of friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with an Implicit Association Test. Results: In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on implicit associations regarding self-attractiveness. Conclusions: These findings do not support the use of evaluative conditioning in its present form as an intervention for adolescents in clinical practice.

Avishai, Aya; Oldham, Mary; Kellett, Stephen; Sheeran, Paschal

doi: 10.1037/ccp0000341pmid: 30507230

Objective: A substantial proportion of psychotherapeutic treatments are prematurely terminated because the client discontinues attendance. Interventions have been developed to reduce premature termination, but these are only moderately effective and often place considerable burden on clients and services. This research evaluated a brief, low-cost self-regulation intervention (i.e., implementation intentions) designed to sustain attendance at a group psychoeducation program. Method: Clients (N = 82) who had been referred for a psychological intervention due to anxiety or depression were sent a questionnaire concerning their views of attendance. Participants were randomly assigned to form an implementation intention as part of the questionnaire or not (controls). Attendance was then monitored over the 5 scheduled sessions of an evidence-based psychoeducational intervention. Results: Intention-to-treat analyses indicated that forming implementation intentions led to attendance at a greater number of sessions (M = 2.84 vs. 1.62), p < .01, and higher rates of completing the full course of treatment compared to controls (35% vs. 11%), p < .02. Conclusions: An intervention rooted in basic research on the psychology of action increased and sustained attendance at a mental health service.

Dvorak, Robert D.; Troop-Gordon, Wendy; Stevenson, Brittany L.; Kramer, Matthew P.; Wilborn, Dexter; Leary, Angelina V.

doi: 10.1037/ccp0000347pmid: 30507231

Objective: Normative feedback remains an effective approach to reducing alcohol use among college students. However, this approach is difficult to extend to protective behavioral strategies (PBS), which are proximal to alcohol-related problems. Deviance regulation theory (DRT) is a social psychology theory that posits individuals engage in behaviors to standout out in positive ways or avoid standing out in negative ways. The current study tests a DRT-based randomized control trial. Method: College student drinkers (n = 130) reported on PBS norm frequency, alcohol use, and PBS use. They were then randomly assigned to receive a positive message about PBS users, a negative message about non-PBS users, or a control. They reported on weekly PBS use, alcohol use, and alcohol problems for 10 weeks. Results: Consistent with DRT, there were immediate postintervention effects on PBS use for individuals who believed PBS was uncommon and who also received a positive message. This remained stable across time. There was significant growth in PBS use among individuals who received a negative message and who believed PBS use was common. The intervention was not directly associated with alcohol use or problems. However, PBS use was associated with average alcohol use and lower weekly and global alcohol problems. Conclusions: This study shows that a DRT intervention may increase PBS use. This may translate into lower alcohol use and fewer alcohol-related problems. The results also identify conditions under which positive and negative messages are indicated.