Cognitive bias modification as a web-based intervention for problem drinkers: A randomized controlled trial with a factorial design

Objective: Previous studies have shown that Cognitive Bias Modification (CBM) can decrease cognitive biases implicated in the maintenance of problem drinking. However, it is still unclear what the individual and combined effects of multiple CBM interventions are when delivered as an e-health intervention. The current study therefore investigated the effects of web-based modification of attention bias, selective inhibition, and approach bias in a 2 (attentional bias modification: intervention/placebo) x 2 (selective inhibition training: intervention/placebo) x 2 (approach bias modification: intervention/placebo) double-blind, randomized controlled trial in self-identified problem drinkers. Method: Self-identified problem drinkers were randomly assigned to one of the eight CBM conditions. All participants first completed a personalized feedback intervention before completing 12 CBM sessions over six weeks. Cognitive biases were assessed with trained and untrained tasks at pre- and post-test and alcohol use was additionally measured three and six months later. Results: 427 self-identified problem drinkers (M_age = 51.2 years, SD_age = 8.69) were included. Results showed that alcohol use decreased over time, but the reductions in drinking did not differ between CBM conditions. There was little evidence that CBM changed cognitive biases. It should however be noted that some bias measures showed inadequate reliability. Conclusions: The results indicate that in problem drinkers, web-based CBM does not add to the effects of a brief motivational intervention to reduce alcohol use over time. Findings may be due to unsuccessful bias modification. Future studies need to delineate moderators of effectiveness and investigate new and promising inference-based CBM-variations.