What is the current evidence for the effectiveness of cognitive bias modification in addiction? A review, recent and large RCT and Bayesian meta-analysis

There is plenty of evidence that different cognitive biases are related to addiction. On average, individuals diagnosed with substance use disorders spontaneously activate (mainly positive) memory associations, and show an attentional bias, as well as an approach tendency towards substance-relevant cues. However, these associations do not prove that cognitive biases play a causal role in the persistence and maintenance of addiction. To prove causality, experimental manipulations are necessary, and therefore CBM procedures were developed. After causality was found in so-called “proof-of-principal (PoP)” studies with ‘healthy’ participants (often students who participated because of their course credits rather than a wish to change behavior), the first clinical RCT’s were conducted.

In this talk, the effectiveness of CBM in addiction is reviewed based on a review, a large clinical RCT (N > 1400), and a Bayesian meta-analyses.

PoP-studies are able to successfully manipulate biases, which might also result in a short-term change of behavior. When CBM is added to treatment as usual, clinical RCTs show a long-term effect on abstinence of around 10%. However, there seems to be no difference between CBM and sham-training when CBM is tested as a stand-alone intervention: all participants show a reduction in substance use (main effect of time).
To conclude, CBM appears to be an effective add-on intervention for alcohol use disorder. For other substance use disorders more research is needed. Further, there are several ways to better incorporate CBM in current treatment.