Accepted for/Published in: JMIR Formative Research
Date Submitted: Jan 25, 2023
Date Accepted: Jun 9, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Anxiety, drinking and habitual thinking: Feasibility, acceptability and preliminary efficacy of a web-based cognitive bias modification program for young people with social anxiety and hazardous alcohol use
ABSTRACT
Background:
Interpretation Bias Modification (IBM) and Approach Bias Modification (ApBM) cognitive re-training interventions can be efficacious adjunctive treatments for improving social anxiety or alcohol use problems. However, previous trials have not examined the combination of these interventions among a young, comorbid sample.
Objective:
This study describes the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (‘Re-Train Your Brain’), when delivered in conjunction with treatment as usual (TAU).
Methods:
The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (18-30 years) with co-occurring social anxiety and hazardous alcohol use were individually randomized to receive: (i) the ‘integrated’ Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU; n=35); (ii) the ‘alternating’ Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (n=32); or (iii) TAU only (n=33). Primary outcomes included feasibility (consent, follow-up rates, withdrawals, treatment adherence, adverse events) and acceptability (system usability, client satisfaction, training format preference). Secondary efficacy outcomes included changes in cognitive biases (interpretation, alcohol approach, and comorbid social anxiety and alcohol interpretation biases), social anxiety symptoms, and alcohol use (e.g., average drinks per day, hazardous drinking, severity of alcohol dependence, alcohol craving). Assessments were conducted at baseline, post-intervention (6-weeks post-baseline), and 12-weeks post-baseline. Descriptive statistics and linear and logistic regressions were conducted for primary outcomes, while intention-to-treat multi-level mixed effects analysis for repeated measures were performed for secondary outcomes, and reported with their corresponding effect sizes.
Results:
Both Re-Train Your Brain program formats were feasible and acceptable to young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only on anxiety interpretation biases (at 6-week follow-up; d=0.80 and d=0.89) and comorbid interpretation biases (at 12-week follow-up; d=1.53 and d=1.67). Additionally, the alternating group reported large improvements over control on generalised social anxiety symptoms (at 12-week follow-up; d=0.83) and alcohol cravings (at 6-week follow-up; d=0.81). There were null effects on all other variables, and no differences between the two intervention groups on efficacy outcomes.
Conclusions:
Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low cost, and non-labour-intensive adjunct intervention for targeting interpretation and comorbidity biases, as well as generalised anxiety and alcohol-related outcomes in the real world. Clinical Trial: Australian New Zealand Clinical Trials Registry (ACTRN12620001273976)
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