Investigating mediators and moderators of the alcohol priming effect

Acute doses of alcohol can increase subsequent craving and alcohol consumption. This ‘alcohol priming effect’ may be an important determinant of both relapse among alcohol-dependent individuals, and binge drinking behaviours among social drinkers. This thesis aimed to investigate potential mediators and moderators of the alcohol priming effect. Current models have proposed alcohol-induced impairments of inhibitory control to underlie the alcohol priming effect (Field et al, 2010). However, there is currently inconclusive evidence for this claim. The overarching aim of this thesis was to, therefore, clarify the extent to which acute alcohol consumption indirectly affects subsequent consumption via these impairments. Each experimental study included a measure of inhibitory control (a stop-signal task), administration of alcohol and a measure of ad libitum alcohol consumption. This data was then synthesised in chapter 7. Overall, there was no effect of alcohol on inhibitory control and, therefore, inhibitory impairments did not mediate alcohol priming. This thesis also investigated two potential novel moderators of the alcohol priming effect; the role of beliefs about alcohol’s acute effects (chapter 6) and the effect of social influences (chapters 3, 4 and 5). Belief’s regarding the effects of alcohol were not found to affect ad lib alcohol consumption but did affect alcohol-induced impairments of inhibitory control. In addition, the alcohol priming effect had little effect on drinking when in the presence of others. Notably, alcohol consumption was increased in the presence of others relative to when alone (chapter 4) and when exposed to a heavy, relative to a light, drinking friend (chapter 5) regardless of whether a priming dose had been consumed. In addition, the association between self-reported peer and personal alcohol consumption was moderated by urgency (one facet of impulsivity) but only when drinking induced disinhibition was low (chapter 3). Overall these findings suggest the importance of the alcohol priming effect as a determinant of binge drinking is minimal. Furthermore, these findings suggest that the effect of alcohol on inhibition is exaggerated in the current literature. Previous findings may have been influenced by individual beliefs regarding the acute effect of alcohol. Other people’s drinking does; however, appear to exert a consistent effect on personal alcohol consumption. Models of alcohol priming require considerable adjustment in light of these findings

A meta-analytic investigation of the role of reward on inhibitory control

Contemporary theories predict that inhibitory control (IC) can be improved when rewards are available for successfully inhibiting. In non-clinical samples empirical research has demonstrated some support; however, “null” findings have also been published. The aim of this meta-analysis was to clarify the magnitude of the effect of reward on IC and identify potential moderators. A total of 73 articles (contributing k = 80 studies) were identified from PubMed, PsycInfo, and Scopus, published between 1997 and 2020, using a systematic search strategy. A random effects meta-analysis was performed on effect sizes generated from IC tasks, which included rewarded and non-rewarded inhibition trials. Moderator analyses were conducted on clinical samples (vs “healthy controls”), task type (go/no-go vs stop signal vs Flanker vs Simon vs Stroop vs Anti-saccade), reward type (monetary vs points vs other), and age (adults vs children). The prospect of reward for successful inhibition significantly improved IC (SMD = 0.429, 95% CI = 0.288, 0.570, I2 = 96.7%) compared with no reward conditions/groups. This finding was robust against influential cases and outliers. The significant effect was present across all IC tasks. There was no evidence of the effect moderated by type of reward, age, or clinical samples. Moderator analyses did not resolve the considerable heterogeneity. The findings suggest that IC is a transient state that fluctuates in response to motivations driven by reward. Future research might examine the potential of improving IC through rewards as a behavioural intervention

The effect of beliefs about alcohol's acute effects on alcohol priming and alcohol-induced impairments of inhibitory control

Acute alcohol administration can lead to a loss of control over drinking. Several models argue that this ‘alcohol priming effect’ is mediated by the effect of alcohol on inhibitory control. Alternatively, beliefs about how alcohol affects behavioural regulation may also underlie alcohol priming and alcohol-induced inhibitory impairments. Here two studies examine the extent to which the alcohol priming effect and inhibitory impairments are moderated by beliefs regarding the effects of alcohol on the ability to control behaviour. In study 1, following a priming drink (placebo or .5g/kg of alcohol), participants were provided with bogus feedback regarding their performance on a measure of inhibitory control (stop-signal task; SST) suggesting that they had high or average self-control. However, the bogus feedback manipulation was not successful. In study 2, before a SST, participants were exposed to a neutral or experimental message suggesting acute doses of alcohol reduce the urge to drink and consumed a priming drink and this manipulation was successful. In both studies craving was assessed throughout and a bogus taste test which measured ad libitum drinking was completed. Results suggest no effect of beliefs on craving or ad lib consumption within either study. However, within study 2, participants exposed to the experimental message displayed evidence of alcohol-induced impairments of inhibitory control, while those exposed to the neutral message did not. These findings do not suggest beliefs about the effects of alcohol moderate the alcohol priming effect but do suggest beliefs may, in part, underlie the effect of alcohol on inhibitory control

Statistics anxiety and predictions of exam performance in UK psychology students

Background Statistics anxiety is common among social science students. Despite much evidence examining statistics anxiety and test performance, little research has explored the role of student self-prediction on test performance in a higher education setting. Objective The purpose of this study was to investigate the relationship between statistics anxiety and both students’ self-prediction of their future exam performance and actual test performance on a formal statistics assessment at undergraduate level in psychology students in the UK. Method Using a cross-sectional design, two hundred and two students were required to complete Statistics Anxiety Rating Scales, the Mathematical Prerequisites for Psychometrics Scale, and provided self-predicted test performance scores. Test performance data was obtained from a formal statistics assessment. Results As predicted, we demonstrated statistics test anxiety to be negatively associated with self-predicted performance. Additionally, we found statistics anxiety was positively associated with test performance. Conclusion The findings highlight the complex relationship between statistics anxiety and test performance, suggesting there may be an optimal level of anxiety for performance in statistics assessments. Implications The results we report have implications for psychology research methods and statistics instructors who may wish to incorporate the findings into statistics instruction modules in order to assuage high levels of statistics anxiety and foster student well-being

The impact of alcohol priming on craving and motivation to drink: a meta-analysis.

Background & Aims: An initial dose of alcohol can motivate - or prime - further drinking and may precipitate (re)lapse and bingeing. Lab-based studies have investigated the alcohol priming effect. However, heterogeneity in designs has resulted in some inconsistent findings. The aims of this meta-analysis were to i) determine the pooled effect size for motivation to drink following priming, measured by alcohol consumption and craving, and ii) to examine whether design characteristics influenced any priming effect. Design: Literature searches of PsycINFO, PubMed and Scopus in October 2020 (updated October 2021) identified lab-based alcohol priming studies which assessed effect of priming on motivation to drink. Setting: Laboratory-based. Participants: Adult, alcohol users. Measurements: A tailored risk-of-bias tool assessed quality of lab-based studies. Random effects meta-analyses were computed on outcome data from 38 studies comparing the effect of a priming dose of alcohol against control on subsequent alcohol consumption/self-reported craving. Study characteristics that might have affected outcomes were design type (within/between-participant), dose of prime, time of motivation assessment, type of control drink (placebo alcohol/soft drink). Findings: A small-to-moderate effect of alcohol, relative to control, on subsequent alcohol consumption (SMD = .336 [95% CI: .171, .500) and craving (SMD = .431 [95% CI: .306, .555]). Aspects of study design differentially affected consumption and craving. The size of the priming dose had no effect on consumption, but larger doses were sometimes associated with greater craving (with craving generally following the blood alcohol curve). Alcohol priming effects for consumption, but not craving, were smaller when compared to a placebo, relative to soft drink, control. Conclusions: Lab-based alcohol priming studies are a valid paradigm from which to investigate the impact of acute intoxication on alcohol motivation. However, designs are needed which assess the impact of acute consumption on motivation to drink in more varied and realistic ways

A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned

Background: Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care. Methods: We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA. Results: From 1st May–1st September 2013, nine patients with an EMS suspected diagnosis of TIA had the TIA diagnosis later confirmed by a specialist from five participating sites. This recruitment rate is comparable to stroke trials in the EMS setting. Bureaucratic obstacles and duplication of approval processes across participating sites took 13 months to resolve before recruitment commenced. Due to the initial difficulty in recruitment, a substantial amendment was approved to modify inclusion criteria, allowing patients with atrial fibrillation and/or taking anticoagulant therapy to participate in the study. Conclusions: It is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting

Longitudinal associations with alcohol consumption during the first COVID-19 lockdown: Associations with mood, drinking motives, context of drinking, and mental health

Background: Coronavirus (COVID-19) resulted in lockdown measures in the UK, which has impacted alcohol use. Alcohol is often used as a coping mechanism and there are public health concerns regarding excessive consumption due to the pandemic. We aimed to longitudinally assess drinking behaviors, and associated factors, during the first UK government-mandated lockdown. Methods: An online survey was distributed through social media (8th April 2020, onwards). Fortnightly follow up surveys were emailed to participants. The primary outcome measure was ‘weekly unit consumption’ and data was collected on a range of potentially related factors: demographics, factors relating to COVID-19 (e.g., health, work status), drinking motives, context of drinking, drinking intentions, mood, depression and anxiety. Findings: A total of 539 self-selected participants completed the baseline survey, with 186 completing at least 3 follow up surveys for multilevel modelling analysis. Personal coping motives, anxiety, drinking at home alone, and drinking at home with others were positively associated with alcohol consumption during lockdown. The following baseline measures also predicted increased consumption: male gender, lower education, and higher AUDIT scores (based on behavior prior to lockdown). Findings were consistent when utilizing an inverse probability weight to account for predictors of attrition (female, younger age, higher baseline AUDIT scores). Conclusions: Those already drinking at hazardous levels were more likely to increase their consumption, as were those who were drinking to cope. As we recover from the pandemic, there is a need for widespread alcohol support, and certain groups may need targeted support

Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial.

BACKGROUND: Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. METHODS: In this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544. FINDINGS: Between Jan 16, 2015, and May 31, 2017, we randomly assigned 368 patients to receive CBT plus standardised medical care (n=186) or standardised medical care alone (n=182); of whom 313 had primary outcome data at 12 months (156 [84%] of 186 patients in the CBT plus standardised medical care group and 157 [86%] of 182 patients in the standardised medical care group). At 12 months, no significant difference in monthly dissociative seizure frequency was identified between the groups (median 4 seizures [IQR 0-20] in the CBT plus standardised medical care group vs 7 seizures [1-35] in the standardised medical care group; estimated incidence rate ratio [IRR] 0·78 [95% CI 0·56-1·09]; p=0·144). Dissociative seizures were rated as less bothersome in the CBT plus standardised medical care group than the standardised medical care group (estimated mean difference -0·53 [95% CI -0·97 to -0·08]; p=0·020). The CBT plus standardised medical care group had a longer period of dissociative seizure freedom in the previous 6 months (estimated IRR 1·64 [95% CI 1·22 to 2·20]; p=0·001), reported better health-related quality of life on the EuroQoL-5 Dimensions-5 Level Health Today visual analogue scale (estimated mean difference 6·16 [95% CI 1·48 to 10·84]; p=0·010), less impairment in psychosocial functioning on the Work and Social Adjustment Scale (estimated mean difference -4·12 [95% CI -6·35 to -1·89]; p<0·001), less overall psychological distress than the standardised medical care group on the Clinical Outcomes in Routine Evaluation-10 scale (estimated mean difference -1·65 [95% CI -2·96 to -0·35]; p=0·013), and fewer somatic symptoms on the modified Patient Health Questionnaire-15 scale (estimated mean difference -1·67 [95% CI -2·90 to -0·44]; p=0·008). Clinical improvement at 12 months was greater in the CBT plus standardised medical care group than the standardised medical care alone group as reported by patients (estimated mean difference 0·66 [95% CI 0·26 to 1·04]; p=0·001) and by clinicians (estimated mean difference 0·47 [95% CI 0·21 to 0·73]; p<0·001), and the CBT plus standardised medical care group had greater satisfaction with treatment than did the standardised medical care group (estimated mean difference 0·90 [95% CI 0·48 to 1·31]; p<0·001). No significant differences in patient-reported seizure severity (estimated mean difference -0·11 [95% CI -0·50 to 0·29]; p=0·593) or seizure freedom in the last 3 months of the study (estimated odds ratio [OR] 1·77 [95% CI 0·93 to 3·37]; p=0·083) were identified between the groups. Furthermore, no significant differences were identified in the proportion of patients who had a more than 50% reduction in dissociative seizure frequency compared with baseline (OR 1·27 [95% CI 0·80 to 2·02]; p=0·313). Additionally, the 12-item Short Form survey-version 2 scores (estimated mean difference for the Physical Component Summary score 1·78 [95% CI -0·37 to 3·92]; p=0·105; estimated mean difference for the Mental Component Summary score 2·22 [95% CI -0·30 to 4·75]; p=0·084), the Generalised Anxiety Disorder-7 scale score (estimated mean difference -1·09 [95% CI -2·27 to 0·09]; p=0·069), and the Patient Health Questionnaire-9 scale depression score (estimated mean difference -1·10 [95% CI -2·41 to 0·21]; p=0·099) did not differ significantly between groups. Changes in dissociative seizures (rated by others) could not be assessed due to insufficient data. During the 12-month period, the number of adverse events was similar between the groups: 57 (31%) of 186 participants in the CBT plus standardised medical care group reported 97 adverse events and 53 (29%) of 182 participants in the standardised medical care group reported 79 adverse events. INTERPRETATION: CBT plus standardised medical care had no statistically significant advantage compared with standardised medical care alone for the reduction of monthly seizures. However, improvements were observed in a number of clinically relevant secondary outcomes following CBT plus standardised medical care when compared with standardised medical care alone. Thus, adults with dissociative seizures might benefit from the addition of dissociative seizure-specific CBT to specialist care from neurologists and psychiatrists. Future work is needed to identify patients who would benefit most from a dissociative seizure-specific CBT approach. FUNDING: National Institute for Health Research, Health Technology Assessment programme

Barriers and facilitators to self-management of asthma in adolescents:an interview study to inform development of a novel intervention

BACKGROUND AND OBJECTIVE: Despite literature that spans twenty years describing the barriers to asthma self-management in adolescents, successful, clinically-based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self-management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals. METHODS: Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12-18 years, 14 healthcare professionals, and 12 parents. Focus groups and interviews were audio-recorded and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis. RESULTS: Adolescents', parents', and healthcare professionals' views were summarised into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy, and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self-management and our results provide further validation for previous studies. CONCLUSION AND CLINICAL RELEVANCE: Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self-manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two-way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilise to empower adolescents to improve their asthma self-management. This article is protected by copyright. All rights reserved