Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data
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Cognitive Bias Modification (CBM) refers to a family of interventions targeting substance-related cognitive biases, which have been found to play a role in the maintenance of addictive behaviors. In this study, we conducted a Bayesian meta-analysis of individual patient data from studies investigating the effects of CBM as a behavior change intervention for the treatment of alcohol and tobacco use disorders, in individuals aware of the behavior change goal of the studies. Main outcomes included reduction in the targeted cognitive biases after the intervention and in substance use or relapse rate at the short-to-long term follow-up. Additional moderators, both at the study-level (type of addiction and CBM training) and at the participant-level (amount of completed training trials, severity of substance use), were progressively included in a series of hierarchical mixed-effects models. We included 14 studies involving 2435 participants. CBM appeared to have a small effect on cognitive bias (0.23, 95% credible interval = 0.06-0.41) and relapse rate (-0.27, 95% credible interval = -0.68 - 0.22), but not on reduction of substance use. Increased training practice showed a paradoxical moderation effect on relapse, with a relatively lower chance of relapse in the control condition with increased practice, compared to the training condition. All effects were associated with extremely wide 95% credible intervals, which indicate the absence of enough evidence in favor or against a reliable effect of CBM on cognitive bias and relapse rate in alcohol and tobacco use disorders. Besides the need for a larger body of evidence, research on the topic would benefit from a stronger adherence to the current methodological standards in randomized controlled trial design and the systematic investigation of shared protocols of CBM.
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Evidence for the efficacy of ApBM for nonclinical samples is inconclusive.
“Although the evidence for the efficacy of ApBM for nonclinical samples is inconclusive (Boffo et al., 2019; Cristea et al., 2015; Wiers et al., 2018)”
From Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study (2020) · cites this paper as Boffo et al., 2019
The Discussion concludes that evidence is insufficient to establish whether CBM is effective as a behavior-change intervention. But the Methods distinguish those studies from proof-of-principle studies in nonclinical participants, and the Results say the included participants had a substance-use diagnosis or consumption patterns indicative of abuse. The paper therefore supports the uncertainty, but not an ApBM-specific conclusion for nonclinical samples. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCBM's efficacy among nonclinical samples is inconsistent.
“While CBM's efficacy among nonclinical samples is inconsistent (Boffo et al., 2019; Cristea et al., 2015; Wiers et al., 2018), there are particularly promising findings in clinical contexts as clients are motivated to change their thoughts and behavior (Wiers et al., 2018).”
From Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study (2020) · cites this paper as Boffo et al., 2019
The Discussion (page unavailable) describes evidence for CBM as a behavior-change intervention as limited and inconsistent. But that conclusion concerns the selected behavior-change studies, some of which involved students; it does not establish that efficacy specifically among nonclinical samples is inconsistent. The Introduction distinguishes nonclinical proof-of-principle studies from studies designed to assess therapeutic efficacy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Boffo, M., Zerhouni, O., Gronau, Q. F., van Beek, R. J. J., Nikolaou, K., Marsman, M., & Wiers, R. W.
- Affiliations
- University of Amsterdam (NL)
- Université Paris Nanterre (FR)
- University of Sussex (GB)
- Corresponding author
- Boffo, Marilisa
- Wiers, Reinout W.
- ORCID
- Venue
- Neuropsychology Review
- Published
- 2019-01-14
- Volume
- 29
- Issue
- 1
- Pages
- 52-78
- ISSN
- 1040-7308 (ISSN-L)
- 1573-6660
- PMC
- PMC6499757
- OpenAlex
- W2909620162
- Cited by
- 146
- References
- 83
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 21 · 2023: 15 · 2022: 20 · 2021: 23 · 2020: 24 · 2019: 16
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neuropsychology Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- HAL (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- University of Amsterdam
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- cognitive bias modification, alcoholism, tobacco use disorder, relapse, substance use reduction, cognitive biases, behaviour change interventions, training trials, addiction treatment
- MeSH terms
- Alcoholism, Bayes Theorem, Humans, Tobacco Use Disorder, Cognitive Behavioral Therapy, Behavior, Addictive, Treatment Outcome
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