Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 15, 2025
Date Accepted: Aug 4, 2026
Warning: This is an author submission that is not peer-reviewed or edited.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.
Smartphone-based approach-avoidance bias modification for alcohol stimuli: Proof of concept study
ABSTRACT
Background:
Targeting automatic approach tendencies toward alcohol-related stimuli has been shown to significantly reduce relapse rates in patients with alcohol use disorder (AUD) when used as an add-on to inpatient treatment. Traditional AAT trainings require clinical settings and stationary devices. To expand accessibility, a mobile application was tested that allows the training to be conducted outside clinical environments while capturing actual motor parameters such as acceleration.
Objective:
Three proof-of-concept studies assessed the feasibility, split-half reliability, and sensitivity of the mobile AAT app.
Methods:
Study 1 tested technical stability and measurement reliability in 26 university students across six home-based sessions. Study 2 examined approach-avoidance tendencies in 15 inpatients with AUD. Study 3 tested 28 soccer fans to determine the presence and modifiability of alcohol-related approach biases after three or six training sessions.
Results:
The app demonstrated high technical stability, usability, and measurement reliability in Study 1. In Study 2, patients showed faster reaction times when pushing away alcohol images (avoidance tendency, p < .001) and greater acceleration when pulling them toward (approach tendency, p < .001). In Study 3, participants exhibited an initial avoidance bias correlated with higher AUDIT-C scores (p = .006). Training effects were observed as faster and stronger avoidance responses after repeated sessions (p = .015; p = .037), with greater effects following more sessions.
Conclusions:
The mobile AAT app appears technically feasible and behaviorally effective in modifying alcohol-related automatic tendencies. Future randomized controlled trials should evaluate its potential for prevention and early-intervention in non-clinical populations.
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