Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study (Preprint)
Authors: Prior Katrina , Salemink Elske , Piggott Monique , Manning Victoria , Wiers Reinout W , Teachman Bethany A , Teesson Maree , Baillie Andrew J , Mahoney Alison , McLellan Lauren , Newton Nicola C , Stapinski Lexine A 
Published: February 2023

BACKGROUND

Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample.

OBJECTIVE

This study aims to describe 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 (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” <i>Re-Train Your Brain</i> program, where each session included <i>both</i> IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” <i>Re-Train Your Brain</i> program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline.

RESULTS

Both <i>Re-Train Your Brain</i> program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen <i>d</i>=0.80 and Cohen <i>d</i>=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen <i>d</i>=1.53 and Cohen <i>d</i>=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen <i>d</i>=0.83) and alcohol cravings (at the 6-week follow-up; Cohen <i>d</i>=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes.

CONCLUSIONS

Should these findings be replicated in a larger randomized controlled trial, <i>Re-Train Your Brain</i> has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world.

CLINICALTRIAL

Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131

INTERNATIONAL REGISTERED REPORT

RR2-10.2196/28667