Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design, Setting and Participants: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. Findings: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Conclusions: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.Medical Research Future Fund (MRFF) MRF1141214National Health and Medical Research Council (NHMRC) of Australia GNT200946

Evaluación neuropsicológica en adicciones: guía clínica

The aim of this article is to provide rommendations for neuropsychological assessment in the con­text of addiction treatment. I propose key basic guidelines to conduct neuropsychological as­sessment in two contexts: (1) profiling of cognitive sequela as­sociated  with substance use; (2) prediction of treat­ment otcomes, in terms of retention and ad­herence to addiction treatment, and risk of relapse. I also discuss novel therapeutic approaches spurred by a neuropsychological understanding of substance use disorders. These recommendations are aimed to fos­ter the transition between neuroscientific discovery and clinical translation, by providing basic guidelines to incorporate neuropsychological tools in clinical practice with addicted clients. ResumenEl objetivo de este artículo de opinión es proporcionar pautas para la evaluación neuropsicológica en el contexto terapéutico de las adicciones. Se proponen guías básicas para la evaluación neuropsicológica en dos contextos: (1) la determinación de los perfiles neuropsicológicos de usuarios consumidores de drogas; (2) la predicción de los resultados del tratamiento de las adicciones, en términos de retención y adherencia a las recomendaciones terapéuticas y de riesgo de recaídas en el consumo. Se describen también nuevas aproximaciones terapéuticas derivadas de una comprensión neuropsicológica de los trastornos por uso de sustancias. Las pautas recogidas en este artículo pretenden servir para facilitar la transición entre el descubrimiento científico y la implementación asistencial, proporcionando guías básicas para incorporar estas herramientas en la práctica clínica con pacientes drogodependientes.AbstractThe aim of this article is to provide rommendations for neuropsychological assessment in the con­text of addiction treatment. I propose key basic guidelines to conduct neuropsychological as­sessment in two contexts: (1) profiling of cognitive sequela as­sociated  with substance use; (2) prediction of treat­ment otcomes, in terms of retention and ad­herence to addiction treatment, and risk of relapse. I also discuss novel therapeutic approaches spurred by a neuropsychological understanding of substance use disorders. These recommendations are aimed to fos­ter the transition between neuroscientific discovery and clinical translation, by providing basic guidelines to incorporate neuropsychological tools in clinical practice with addicted clients.

Knowing What to Respond in the Future Does Not Cancel the Influence of Past Events

Everyday tasks seldom involve isolate actions but sequences of them. We can see whether previous actions influence the current one by exploring the response time to controlled sequences of stimuli. Specifically, depending on the response-stimulus temporal interval (RSI), different mechanisms have been proposed to explain sequential effects in two-choice serial response tasks. Whereas an automatic facilitation mechanism is thought to produce a benefit for response repetitions at short RSIs, subjective expectancies are considered to replace the automatic facilitation at longer RSIs, producing a cost-benefit pattern: repetitions are faster after other repetitions but they are slower after alternations. However, there is not direct evidence showing the impact of subjective expectancies on sequential effects. By using a fixed sequence, the results of the reported experiment showed that the repetition effect was enhanced in participants who acquired complete knowledge of the order. Nevertheless, a similar cost-benefit pattern was observed in all participants and in all learning blocks. Therefore, results of the experiment suggest that sequential effects, including the cost-benefit pattern, are the consequence of automatic mechanisms which operate independently of (and simultaneously with) explicit knowledge of the sequence or other subjective expectancies

The evidential value of research on cognitive training to change food-related biases and unhealthy eating behavior: A systematic review and p-curve analysis

Cognitive bias modification (CBM), which retrains implicit biases towards unhealthy foods, has been proposed as a promising adjunct to improve the efficacy of weight loss interventions. We conducted a systematic review of research on three CBM approaches (i.e., cue-specific inhibitory control, approach bias modification, and attentional bias modification) for reducing unhealthy eating biases and behavior. We performed a p-curve analysis to determine the evidential value of this research; this method is optimally suited to clarify whether published results reflect true effects or false positives due to publication and reporting biases. When considering all CBM approaches, our results suggested that the findings of CBM trials targeting unhealthy eating are unlikely to be false positives. However, only research on attentional bias modification reached acceptable levels of power. These results suggest that CBM interventions may be an effective strategy to enhance the efficacy of weight loss interventions. However, there is room for improvement in the methodological standards of this area of research, especially increasing the statistical power can help to fully clarify the clinical potential of CBM, and determine the role of potential moderatorsConsejería de Educación e Investigación, Grant/Award Numbers: 2016-T1/SOC-1395, 2020-5A/SOC-19723; Spanish Ministry of Science and Innovation, Grant/Award Numbers: PSI2017-85159-P, Ref. FJC2018-036047-

Impulsivity and body fat accumulation are linked to cortical and subcortical brain volumes among adolescents and adults

Obesity is associated not only with metabolic and physical health conditions, but with individual variations in cognition and brain health. This study examined the association between body fat (an index of excess weight severity), impulsivity (a vulnerability factor for obesity), and brain structure among adolescents and adults across the body mass index (BMI) spectrum. We used 3D T1 weighted anatomic magnetic resonance imaging scans to map the association between body fat and volumes in regions associated with obesity and impulsivity. Participants were 127 individuals (BMI: 18–40 kg/m2; M = 25.69 ± 5.15), aged 14 to 45 years (M = 24.79 ± 9.60; female = 64). Body fat was measured with bioelectric impendence technology, while impulsivity was measured with the UPPS-P Impulsive Behaviour Scale. Results showed that higher body fat was associated with larger cerebellar white matter, medial orbitofrontal cortex (OFC), and nucleus accumbens volume, although the latter finding was specific to adolescents. The relationship between body fat and medial OFC volume was moderated by impulsivity. Elevated impulsivity was also associated with smaller amygdala and larger frontal pole volumes. Our findings link vulnerability and severity markers of obesity with neuroanatomical measures of frontal, limbic and cerebellar structures, and unravel specific links between body fat and striatal volume in adolescence

Distortion and Signal Loss in Medial Temporal Lobe

Background: The medial temporal lobe (MTL) contains subregions that are subject to severe distortion and signal loss in functional MRI. Air/tissue and bone/tissue interfaces in the vicinity of the MTL distort the local magnetic field due to differences in magnetic susceptibility. Fast image acquisition and thin slices can reduce the amount of distortion and signal loss, but at the cost of image signal-to-noise ratio (SNR). Methodology/Principal Findings: In this paper, we quantify the severity of distortion and signal loss in MTL subregions for three different echo planar imaging (EPI) acquisitions at 3 Tesla: a conventional moderate-resolution EPI (36363 mm), a conventional high-resolution EPI (1.561.562 mm), and a zoomed high-resolution EPI. We also demonstrate the advantage of reversing the phase encode direction to control the direction of distortion and to maximize efficacy of distortion compensation during data post-processing. With the high-resolution zoomed acquisition, distortion is not significant and signal loss is present only in the most anterior regions of the parahippocampal gyrus. Furthermore, we find that the severity of signal loss is variable across subjects, with some subjects showing negligible loss and others showing more dramatic loss. Conclusions/Significance: Although both distortion and signal loss are minimized in a zoomed field of view acquisition with thin slices, this improvement in accuracy comes at the cost of reduced SNR. We quantify this trade-off between distortion and SNR in order to provide a decision tree for design of high-resolution experiments investigating the functio

Exploring Empathic Space: Correlates of Perspective Transformation Ability and Biases in Spatial Attention

Separate lines of research have noted recruitment of parietal cortex during tasks involving visuo-spatial processes and empathy. To explore the relationship between these two functions, a self-other perspective transformation task and a task of spatial attention (line bisection) were administered to 40 healthy participants (19 women). Performance on these tasks was examined in relation to self-reported empathy. Rightward biases in line bisection correlated positively with trait-level self-reported empathic concern, suggesting a left hemisphere mediation of this prosocial personality trait. Unexpectedly, speed of perspective taking in the self-other transformation task correlated negatively with empathic concern, but only in women, which we interpret in light of gender differences in empathy and strategies for egocentric mental transformations. Together, the findings partially support the commonalities in visuo-spatial attention, perspective-taking and empathy. More broadly, they shed additional light on the relationship between basic cognitive functions and complex social constructs

Impaired Decoding of Fear and Disgust Predicts Utilitarian Moral Judgment in Alcohol-Dependent Individuals

The definitive version is available at www3.interscience.wiley.comBackground: Recent studies of moral reasoning in patients with alcohol use disorders have indicated a “utilitarian” bias, whereby patients are more likely to endorse emotionally aversive actions in favor of aggregate welfare (e.g., throwing a dying person into the sea to keep a lifeboat of survivors afloat). Here, we investigate the underlying psychological and neuropsychological processes. Methods: Alcohol-dependent individuals (n = 31) and healthy comparison participants (n = 34) completed a validated moral judgment task, as well as measures of impulsivity, mood symptoms (anxiety and depression), and emotional face recognition. Results: Alcohol-dependent individuals were more likely to endorse utilitarian choices in personal moral dilemmas compared with controls and rated these choices as less difficult to make. Hierarchical regression models showed that poorer decoding of fear and disgust significantly predicted utilitarian biases in personal moral dilemmas, over and above alcohol consumption. Impulsivity and mood symptoms did not predict moral decisions. Conclusions: These findings suggest that impaired fear and disgust decoding contributes to utilitarian moral decision-making in alcohol-dependent individuals.This work is supported by the “Red de Trastornos Adictivos”, RETICS Program, Instituto de Salud Carlos III, Spanish Ministry of Health (PI: AVG) and the Junta de Andaluc ıa under the Research Project P07.HUM 03089 (PI: MPG). MCP is funded by FPU predoctoral research grant (AP 2008-01848) from Spanish Ministry of Education and Science

The Relationship between Visual-Spatial and Auditory-Verbal Working Memory Span in Senegalese and Ugandan Children

BACKGROUND: Using the Kaufman Assessment Battery for Children (K-ABC) Conant et al. (1999) observed that visual and auditory working memory (WM) span were independent in both younger and older children from DR Congo, but related in older American children and in Lao children. The present study evaluated whether visual and auditory WM span were independent in Ugandan and Senegalese children. METHOD: In a linear regression analysis we used visual (Spatial Memory, Hand Movements) and auditory (Number Recall) WM along with education and physical development (weight/height) as predictors. The predicted variable in this analysis was Word Order, which is a verbal memory task that has both visual and auditory memory components. RESULTS: Both the younger (<8.5 yrs) and older (>8.5 yrs) Ugandan children had auditory memory span (Number Recall) that was strongly predictive of Word Order performance. For both the younger and older groups of Senegalese children, only visual WM span (Spatial Memory) was strongly predictive of Word Order. Number Recall was not significantly predictive of Word Order in either age group. CONCLUSIONS: It is possible that greater literacy from more schooling for the Ugandan age groups mediated their greater degree of interdependence between auditory and verbal WM. Our findings support those of Conant et al., who observed in their cross-cultural comparisons that stronger education seemed to enhance the dominance of the phonological-auditory processing loop for WM

The Cognitive Drivers of Compulsive Eating Behavior

Compulsivity is a central feature of obsessive-compulsive and addictive disorders, which share considerable overlap with excessive eating in terms of repetitive behavior despite negative consequences. Excessive eating behavior is characteristic of several eating-related conditions, including eating disorders [bulimia nervosa (BN), binge eating disorder (BED)], obesity, and food addiction (FA). Compulsivity is proposed to be driven by four distinct cognitive components, namely, contingency-related cognitive flexibility, task/attentional set-shifting, attentional bias/disengagement and habit learning. However, it is unclear whether repetitive behavior in eating-related conditions is underpinned by deficits in these cognitive components. The current mini-review synthesizes the available evidence for performance on compulsivity-related cognitive tasks for each cognitive domain among populations with excessive eating behavior. In three of the four cognitive domains, i.e., set-shifting, attentional bias and habit learning, findings were mixed. Evidence more strongly pointed towards impaired contingency-related cognitive flexibility only in obesity and attentional bias/disengagement deficits only in obesity and BED. Overall, the findings of the reviewed studies support the idea that compulsivity-related cognitive deficits are common across a spectrum of eating-related conditions, although evidence was inconsistent or lacking for some disorders. We discuss the theoretical and practical importance of these results, and their implications for our understanding of compulsivity in eating-related conditions