title: A clinical trial with combined transcranial direct current stimulation and alcohol approach bias retraining.
abstract: Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects.
authors: Addiction, Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands.|Amsterdam Brain and Cognition (ABC), University of Amsterdam, The Netherlands.
authors: Tess E
authors: http://orcid.org/0000-0001-7717-3418
authors: TE
authors: den Uyl
authors: Addiction, Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands.|Research Centre-Military Mental Health, Ministry of Defense, The Netherlands.
authors: Thomas E
authors: TE
authors: Gladwin
authors: Behavioural Science Institute, Radboud University Nijmegen, The Netherlands.
authors: Mike
authors: M
authors: Rinck
authors: Salus Klinik, Germany.
authors: Johannes
authors: J
authors: Lindenmeyer
authors: Addiction, Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, The Netherlands.|Amsterdam Brain and Cognition (ABC), University of Amsterdam, The Netherlands.
authors: Reinout W
authors: RW
authors: Wiers
mesh_terms: D000437:Alcoholism / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D066249:Craving; D004311:Double-Blind Method; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: CBM; alcoholism; tDCS