1.  dilemma@liverpool.ac.uk @lisa_dil
How do we control an unsuitable tendency? The effects of Cue Avoidance Training and Inhibitory Control Training on alcohol consumption in the laboratory.
Lisa C. G. Di Lemma 
Prof. Matt Field 
@lisa_dil

2. Background
Appetitive cues elicit automatic cognitive processing biases.
Can these be means of promoting
behavioural change?

3. Cognitive Bias Modification (CBM) literature
Allom, Mullan, & Hagger, 2015; Wiers et al. 2010, 2011, 2013; Eberl et al., 2012; Veling et al. 2011, 2014; Van Konnigsbruggen et al.,

4. Cue Avoidance training (CAT; Wiers et al., 2010)
Modifies their motivational appetitive tendencies.

5. CAT (Wiers et al., 2010) Portrait format Landscape format
Ap. Potrait and avoid Landscape
Portrait format
Landscape format

6. CAT (Wiers et al., 2010)
Results from the implementation of the CAT, on 42 hazardous drinking students, revealed that alcohol approach tendencies changed into avoidance tendencies in the avoid-alcohol training group, and that these resulted in reductions in alcohol consumption in the lab (Wiers et al., 2010). Results which were replicated in subsequent clinical studies on alcohol dependent patients, showing that CAT improves treatment outcome

7. Inhibitory Control Training (ICT; see Jones et al., 2016)
Inhibition of motor response when alcohol cues are presented
Measuring the successful inhibition of a motor response when prompted by a stimuli (Stop or Non-Go trials) in a context which requires a rapid predominant response

8. ICT (Houben et al., 2012) f X

9. ICT
Overall, findings are consistent between appetite and addiction literature.   

10. However... Stimuli devaluation
Which particular type of cognitive training is effective
Which mechanisms underpin these training effects
Stimuli devaluation
Behavioural-Stimulus Interaction (BSI) theory (Veling et al., 2008)
Houben et al. (2012)
Veling et al. (2013)
Wessel et al. (2015)
Wies et al. (2010)
Our research is needed in order to clarify the mechanisms underlying these training effects.

11. The present study... Repeated measure between-subject design:
CAT vs ICT.
Repeated measure between-subject design:
testing if both types of training would be equally effective in reducing alcohol consumption in the laboratory;
investigating if trainings will lead to changes in automatic alcohol positive evaluations.

12. Participants Heavy drinking young adults (N = 120) Inclusion criteria:
aged between 18 and 25;
individuals regularly consuming alcohol over the recommended government’s limits;
fluency in English;
normal or corrected to normal vision.
no family history of alcohol dependence;
Current BAC = zero.

13. Participants were randomly assigned to one of 4 conditions:
Methods
Participants were randomly assigned to one of 4 conditions:
CAT;
“Sham” CAT (control = 50% contingency);
ICT;
“Sham” ICT (control = 50% contingency).
Participants completed either one of the trainings. Both interventions were contrasted with appropriate control conditions (‘sham training’).
bogus Taste-Test (a measure of the motivation to drink alcohol).

14. Protocol
Before and after the training condition, participants completed a pictorial alcohol valenced IAT (Houben et al., 2012), followed by a bogus Taste-Test (a measure of the motivation to drink alcohol) and some questionnaires.
The Time Line Follow Back (Sobbel & Sobbel, 1992)
The Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993)
The TRI is a measure of drinking restraint
Contemplation Ladder
The RCQ is a 12-item instrument for measuring the "stage of change" reached by an excessive drinker of alcohol.
1 hour 40 min.

15. Implicit Association Task (IAT; Houben et al., 2012)
Measures the strength of implicit associations towards alcohol

16. Results
Consumption
Alcohol and Soda consumption calculated as a % of the total volume of each type of fluid available for training groups after receiving the manipulation.
Training effects on alcohol consumption were replicated in the laboratory (Allom et al., 2015; Wiers et al. 2010),

17. Results
IAT (D scores)
No significant change in automatic valenced alcohol associations from pre-test to post-test, due to training condition (Fs < 1.78, ps > .19).
Findings which are consistent with our meta-analysis (Jones, et al. 2016).
Jones et al., 2016: indicating that these devaluation effects on stimuli seem NOT to be robust.
The sample held positive associations towards alcohol both at pre-test t(119) = 4.41, p = .00 and post-test t(119) = 6.48, p = .00 (effect size r = .03).

18. Perhaps... during training individuals are learning...
Signal detection;
New associations between the stimuli, the response and/or the category (Verbruggen, et al., 2014; Chiu and Aron; 2015).
Suggesting that training outcome may arise from a complex interaction of different factors and future research should investigate these alternative hypothesis.

19. Limitations VS Strengths
Population;
Single blinded;
Long experiment;
Taste-test demands effects.
Measured awareness;
Use of Sham trainings (50:50 contingency) for the control conditions;
Use of booster training trials
First study comparing training-effectiveness of these two types of interventions.

20. Discussion Clinical potential of these brief interventions
CAT or ICT seem to be equally effective (Allom et al., 2015; Wiers et al )
Mechanism underling these training still remain to be specified!
Future directions:
Neuropsychological correlates;
Long-term effects and effectiveness in a real word setting, across various patient categories.
A) Bowley et al. 2013; Korucuoglu et al., 2014; Petit et al., 2014; Spierer et al. 2013; Wiers et al., 2014
B) Boffo et al., 2015; Eberl et al., 2012; Jones et al., 2014

21. Thank you for your attention!
Di Lemma L.C.G. & Field M. (in press) Cue Avoidance Training and Inhibitory Control Training for the reduction of alcohol consumption in the laboratory: a comparison of effectiveness and investigation of their mechanisms of action 
@lisa_dil

24. Secondary measures Awareness;
Differences in alcohol-related cognitive biases over time;
Analysis of tasks error rates
Trainings generalisation effects to novel stimuli (not used during training blocks; Wiers et al. 2010).