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ABSTRACTThe present study examined approach-avoidance, attentional and evaluation biases in Hair Pulling Disorder (HPD). Although none of the tasks showed indications of biased action tendencies in response to hair pulling-related pictures, or biased attention for hair pulling-related words, we found that patients were slower to react to hair pulling-related stimuli than to neutral stimuli. This slowing down may indicate that patients are ambivalent towards hair pulling. This “ambivalence” positively correlated with HPD symptom severity, but only on one of the three severity measures we assessed. Concerning action tendencies towards hair pulling-related words, patients were, however, faster to react to hair pulling-related words when compared to words related to resisting hair pulling. Future research is needed to disentangle this ambivalent response pattern in HPD.

To examine the applicability of an alcohol‐avoidance training procedure in patients with alcohol dependence and alcohol‐induced neurocognitive disorders (NDs), we trained 2 groups that differed in the degree of cognitive impairment: One group fulfilled the DSM‐5 criteria for alcohol‐induced mild ND, and 1 group was diagnosed with Korsakoff's syndrome (KS) (alcohol‐induced major ND, confabulatory/amnesic subtype; DSM‐5). The intervention is assumed to match the preserved cognitive capacity for implicit learning in both groups. Fifty‐one inpatients with a mild ND and 54 inpatients with KS were trained. Six training sessions (including pre‐ and posttests) of a computerized implicit alcohol approach‐avoidance task were applied. Neurocognitive variables were available from the standard assessment procedure of the clinic. Training of alcohol‐avoidance tendencies is feasible in a population with alcohol‐related NDs. The alcohol‐approach bias decreased for both groups in each session. Better learning results over time were obtained in participants with a larger baseline alcohol‐approach tendency. Learning effects were positively related to age and implicit (nondeclarative) memory functioning. No relation between training effects and executive or explicit memory functions was found. Training of an alcohol‐avoidance tendency can be successfully applied in patients with alcohol dependence including those with alcohol‐induced NDs. Our results show that alcohol‐avoidance training indeed depends on more implicit processes: Learning effects are related to implicit and not to explicit memory functioning, and not to executive functioning. Session‐to‐session training effects indicate that patients with alcohol‐related neurocognitive disorders (including Korsakoff's syndrome) can also be trained, opening up the research field of cognitive bias modification procedures to patient populations with psychopathology‐related neurocognitive disorders.

Abstract.Aim:Alcohol dependency is characterized by alcohol-related interpretation biases (IBs): Individuals with high levels of alcohol consumption generate more alcohol-related than alcohol-unrelated interpretations in response to ambiguous alcohol-related cues. However, a response bias could be an alternative account, meaning that individuals with high levels of alcohol consumption generate more alcohol-related IBs because of a greater baseline tendency to endorse alcohol-related responses. Methods:To test this alternative explanation, the present study employed a homograph-priming task, reliability of which was also examined. The sample included 577 clinically diagnosed alcohol-dependent inpatients and 61 control inpatients. Participants completed a homograph priming task (primes: homographs with and without an alcohol-related meaning, target words: alcohol and soft drinks) before commencing their behavioral cognitive treatment at a rehabilitation clinic. Results:Contrary to our expectations, we did not find an enhanced priming effect in alcohol-dependent inpatients. Moreover, there was no correlation between the priming score and levels of harmful drinking (AUDIT scores). Conclusions:The data provide limited support for the existence of alcohol-related IBs, possibly because of the low reliability of the priming task, the features of the task, and the study’s design.

Abstract.Background:In recent years, new neurocognitive explanatory approaches such as dual-process theories offer significant progress in understanding long-term relapse in substance use disorders. Based on such explanatory concepts stemming from basic research, novel methods of intervention have been deduced which focus on directly changing cognitive biases. The efficacy of these Cognitive Bias Modification (CBM) concepts has been evaluated in a growing number of studies in the context of different substance use and addictive disorders. By now, there are also first findings for using CBM in the context of smoking. Objectives:To evaluate the empirical evidence, whether CBM qualifies i) for reducing attentional or approach bias towards smoking-related cues, ii) for effectively reducing the high relapse rates in smoking cessation, iii) for the reduction of smoking behaviour and iv) craving. Methods:The systematic evidence search has been carried out in clinical databases (Cochrane Library, PsycArticles, PSYNDEX, PsycINFO, Medline) as well as via manual reverse search. Finally, 12 studies have been identified which met the inclusion criteria (RCT, CBM interventions for smokers; outcomes: change in attentional or approach bias, craving, number of cigarettes smoked, abstinence). Results:Despite the heterogeneity of the studies in terms of sample selection, realisation of interventions and methodological aspects, the findings collectively indicate that different forms and ‘dosages’ of CBM interventions can influence attentional or approach bias in smokers. Also, positive effects on craving and motivation to quit could be detected. Effects on smoking behaviour are inconsistent and often statistically non-significant. First online applications showed encouraging results. Discussion:The results concerning the efficacy of CBM in smoking cessation are still rudimentary and inconsistent. However, a large portion of the studies was not conducted under naturalistic conditions, but rather in laboratories with non-treatment seekers or participants partially motivated to quit. Despite these limitations, the findings can be evaluated as encouraging. The results suggest that CBM will be implemented in routine care as an adjunct intervention within a behavioural therapy-oriented cessation programme. However, specific studies which assess the efficacy of CBM as a component for relapse prevention in smoking cessation intervention in routine care are still lacking.

Abstract.Aims:This study examined whether alcohol-related interpretation biases (IBs) can be reduced by means of cognitive bias modification – interpretation (CBM-I) training. Also, the training’s generalization effects and the moderating role of executive control (EC) were examined. Methods:Participants were 98 young hazardous drinkers. Half of the participants were trained to interpret ambiguous alcohol-related scenarios in an alcohol-unrelated way (neutral CBM-I), the other half completed alcohol-related ambiguous open-ended scenarios (control CBM-I). Alcohol-related IBs were assessed with open-ended ambiguous alcohol-related scenarios, completed by participants. The completions were coded by participants (self-coding) and by two independent coders (conservatively and liberally). Results:Neutral CBM-I, compared to control CBM-I, did not decrease alcohol-related IBs for the conservative and self-coding. For the liberal coding, both groups showed a decrease in alcohol-related IBs pre to post training. Moreover, there were no group differences in interpreting ambiguous, alcohol-related pictures during a signal-detection task. At the behavioral level, there was no reduction in alcohol use for either group at one week follow-up. Finally, EC did not moderate training effects. Conclusions:Although CBM-I effects were largely absent; the findings emphasize that more research into the working mechanisms of alcohol CBM-I is needed to test its potential in the context of hazardous drinking.

The present research aimed to replicate and extend findings of Huijding, Muris, Lester, Field, and Joosse (2011), investigating whether symbolic approach–avoidance responses can induce implicit and explicit evaluation biases. Faces with a neutral expression were shown on a computer screen, and participants were instructed to repeatedly move a manikin towards some faces (approach) and away from other faces (avoidance). An affective priming task and a face rating task were used to assess training-compatible differences in implicit and explicit face evaluations, respectively. Results showed that the manikin training was successful: The priming task revealed more positive implicit evaluations of approached than avoided faces, and approached faces were rated more positively than avoided ones in the face rating task. These findings replicate those of Huijding and colleagues by demonstrating training effects on explicit evaluations, and they extend them by demonstrating effects on implicit evaluations.

A growing body of evidence shows that the prolonged execution of approach movements towards stimuli and avoidance movements away from them affects their evaluation. However, there has been no systematic investigation of such training effects. Therefore, the present study compared approach-avoidance training effects on various valenced representations of one neutral (Experiment 1, N= 85), angry (Experiment 2, N= 87), or smiling facial expressions (Experiment 3, N= 89). The face stimuli were shown on a computer screen, and by means of a joystick, participants pulled half of the faces closer (positive approach movement), and pushed the other half away (negative avoidance movement). Only implicit evaluations of neutral-expression were affected by the training procedure. The boundary conditions of such approach-avoidance training effects are discussed.

Prior research has shown that depressive symptoms are associated with an enhanced attention toward negative stimuli and difficulty of disengaging attention from negative stimuli. The current study was an extension of a 2005 study by Koster and colleagues. A different stimulus presentation time and word set were used. The whole range of depressive symptoms was included in this sample instead of creating dichotomized groups. The Exogenous Cueing Task with negative, positive, and neutral cues was administered to 85 female undergraduate university students. Participants completed the Beck's Depression Inventory-II–NL questionnaire to measure self-reported depression. Contrary to previous findings, depressive symptoms were related to a facilitated rather than impaired attentional disengagement from negative stimuli. An explanation for the discrepancy with findings from Koster, et al.may be the different stimulus presentation time (1,000 msec. instead of 500 or 1,500 msec).

Anxiety disorders are characterized by biased implicit threat associations, which can be measured by indirect reaction time tasks. These tasks might provide a useful tool in the assessment of individual diagnoses and therapeutic changes. However, sufficient psychometric properties of the applied tasks are a prerequisite for these applications. Therefore, we comparatively investigated the reliability and validity of an Extrinsic Affective Simon Task (EAST), an Approach-Avoidance Task (AAT), and an Affective Priming Task (APT) by presenting the same tasks twice within 1 week. Data show retest reliabilities of around r= .42 for the EAST, r= .35 for the AAT, and r= .63 for the APT. Internal consistencies varied between .44 and .49 for the EAST, .66 and .70 for the AAT, and .53 and .76 for the APT. Validity correlations with self-report questionnaires ranged between r= .43 and r= .59, being lowest for the EAST and highest for the AAT. We argue that while these instruments might not be applicable to individual diagnostics yet, they are sufficiently reliable and valid to be used in the assessment of group differences.

In two experiments, we investigated how repetition priming--a type of implicit memory--may be used to improve recall of the layout of digits on push-button telephones and calculators--an explicit memory task. In Experiment 1, participants were able to use repetition priming by pretending to dial a well-known telephone number in order to recall the telephone layout of digits, improving encoding of the number and preparation of the corresponding motor program. In contrast, no facilitative effect of known numbers on encoding and preparation was found for the calculator layout. Experiment 2 showed that the priming advantage of the telephone layout is not due to a general inadequacy of the calculator layout: Experimentally induced semantic repetition priming and motor repetition priming were observed for both the telephone layout and the calculator layout.

Selective attention in patients after an attempted suicide was investigated to find out whether a specific attentional bias for suicide-related materials exists and to clarify the possible role of emotions in the bias. Thirty-one patients who had previously attempted to commit suicide and 31 control participants took part in a modified Stroop task. The suicidal patients took significantly longer to name the colors of suicide-related words compared with other words, whereas color naming times of the control participants did not differ for suicide-related, neutral, positive, or negative words. Therefore, the attentional bias exhibited by suicidal patients was highly specific. There was no relation between the bias and measures of anxiety, depression, or hopelessness, whereas suicidal ideation correlated significantly with the attentional bias.

Zusammenfassung.Ausgehend von der konstruktivistischen Sicht des Textverstehens wurde in 2 Experimenten überprüft, ob Leserinnen und Leser Orts- und Zeitangaben, die für die Protagonistenziele unterschiedlich relevant sind, problemlösend und damit strategischverarbeiten können. Die Ziele der Protagonisten waren unterschiedlich klar definiert. Die beiden Experimente, bestehend aus Lese- und Testteil sowie Fragenheft, unterschieden sich durch die Plazierung des Fragenheftes, das einmal nach jeder einzelnen Geschichte und einmal erst am Ende das gesamten Leseteils dargeboten wurde. Die Ergebnisse beider Experimente ergaben, daß Leserinnen und Leser nicht nur in der Lage sind, Orts- und Zeitangaben in narrativen Texten strategisch einzusetzen, sondern daß sie dies auch von sich aus tun. Diese Aufmerksamkeitsfokussierung spiegelte sich in den Lesezeiten jedoch nur uneinheitlich wider. Im Testteil ergab sich ein klarer Nachteil für das Behalten zeitlicher gegenüber räumlicher Information, obgleich zuvor im Fragenheft beide gleichermaßen korrekt als lösungsrelevant identifiziert worden waren.

Zusammenfassung.Mit zwei Experimenten wurde untersucht, ob in natürlicheren Texten beschriebene Veränderungen von räumlichen Gegebenheiten während des Lesens in ein Situationsmodell integriert werden und wie sich räumliche Veränderungen auf die Verfügbarkeit von Textinhalten auswirken. In beiden Experimenten lernten die Probanden zunächst den Grundriß eines Gebäudes mit den Raumnamen sowie den in den Räumen enthaltenen Objekten kennen. Innerhalb einer längeren Rahmenhandlung wurde sodann beschrieben, wie das Gebäude zweimal umgebaut wird, indem Wände ein- und ausgebaut werden. Nach jedem Umbau lasen die Probanden mehrere Episoden, die in dem Gebäude spielten. Dabei wurden sowohl die Repräsentation der Umbauten als auch die Verfügbarkeit der gelernten Objekte durch die Lesezeiten kritischer Sätze getestet. Beide Experimente zeigten, daß Leser die Veränderungen der räumlichen Gegebenheiten in ihrem Situationsmodell repräsentieren und diese Veränderungen bei der Repräsentation von Bewegungen der Hauptpersonen beachten. Ein konsistenter Distanzeffekt, d. h. eine Abhängigkeit der Objektverfügbarkeit von der räumlichen Distanz zwischen Objekt und Protagonist, wurde hingegen nicht gefunden.

Heavy users and addicted individuals have shown to develop an approach action tendency – or approach bias – toward stimuli related to the substance of interest. Emerging evidence points to approach bias retraining (ABR) as an effective aid for the treatment of addictive behaviors. The current study seeks to extend this work by testing, in a pilot study, whether standard smoking cessation treatment involving cognitive-behavioral therapy (CBT) and nicotine replacement therapy can be augmented by ABR. To this end, we will randomly assign 100 adult smokers to either ABR-augmented treatment or placebo-augmented treatment and compare the two conditions on short-term and long-term abstinence rates. The hope is that the findings of this study can inform treatment development for adult smokers.

BackgroundAvoidance of stimuli that are associated with the traumatic event is a key feature of posttraumatic stress disorder (PTSD). Thus far, studies on the role of avoidance in the development and maintenance of PTSD focused primarily on strategic or explicit avoidance. However, patients may also show implicit avoidance behavior, which may remain even when explicit avoidance is reduced.ObjectivesThe present pilot study was designed to test the hypothesis that PTSD patients show implicit avoidance of threatening, trauma-related stimuli. In addition, it was tested whether this avoidance behavior also occurs for other stimuli.MethodsThe Approach-Avoidance Task was used as an indirect measure of avoidance. Participants were 16 women suffering from PTSD who had experienced a sexual trauma, and 23 healthy non-traumatized women. Using a joystick, they pulled pictures closer to themselves or pushed them away. The pictures varied in content, being either high-threat sexual, non-threat sexual, high-threat accident, or positive.ResultsCompared to control participants, PTSD patients avoided high-threat sexual pictures, and the degree of avoidance was predicted by self-reported arousal level. Moreover, PTSD patients with high levels of self-reported explicit avoidance, depressive symptoms, and PTSD symptom severity also avoided high-threat accident pictures.ConclusionsThese findings point to the possible importance of threat value instead of trauma-relatedness in explaining implicit avoidance. The results are discussed in light of cognitive-behavioral models of PTSD, and clinical implications are suggested.