Re-Train Your Brain: Online intervention tackles co-occurring alcohol misuse and social anxiety in young adults

Clinical testing of an online cognitive training intervention for co-occurring alcohol misuse and social anxiety will soon be underway, following successful evaluation of a demo program in young adults. In a study reported in Alcoholism: Clinical and Experimental Research, researchers assessed the demo’s acceptability and ease-of-use among service providers and target users in Sydney, Australia, with the feedback used to develop and refine the full program.

When alcohol misuse and an anxiety disorder co-occur, each can fuel and impede recovery from the other in a ‘feed-forward’, perpetuating cycle. Relapse after treatment for alcohol use disorder, for example, is particularly common among those who also have anxiety. Partly responsible are automatic, subconscious brain processes affecting anxious thoughts and the tendency to drink, resulting in implicit, subconscious biases that are difficult to override. Some problem drinkers exhibit ‘approach bias’, where they are implicitly drawn towards alcohol, whereas people with anxiety often show ‘interpretation bias’, which is a tendency to interpret information negatively – for example, that a yawn from a conversation partner indicates boredom.

Innovative training procedures known as cognitive bias modifications (CBM) have been developed to tackle these subconscious processes, via repeated practice on a cognitive task. Approach bias modification (ApBM), for example, seeks to train a tendency to avoid (rather than approach) alcohol by having patients repeatedly push away images of alcohol on a computer screen. Another procedure, interpretation bias modification (IBM), aims to reduce anxiety symptoms by training patients to resolve ambiguity within hypothetical social scenarios in a positive or neutral (instead of negative) way. Both approaches have shown promising effects on cognitive biases and anxiety/alcohol symptoms when delivered alongside standard treatment, but to date have largely been examined separately from each other. Given the vicious reinforcing cycle of alcohol misuse and anxiety, it is possible that combining ApBM and IBM could have multiplicative effects.

Feedback on a demo online version of a hybrid ApBM+IBM program, called ‘Re-Train Your Brain’, was sought from 14 service providers and 15 young adults with hazardous alcohol use and social anxiety. The program was well-received and deemed acceptable for the target age-group, and was rated highly for quality and ease of use. Improvements to design and implementation were suggested, which should enhance patient adherence to the intervention. For example, participants raised the need to clearly convey the rationale for the approach at the start of treatment to increase user buy-in and engagement.

Young adulthood is a critical period of vulnerability for onset of both alcohol misuse and anxiety disorders, and use of a hybrid ApBM+IBM intervention alongside existing treatment may prevent chronic and entrenched problems from developing. The feedback gained reflects positively on the acceptability of this intervention for young adults with co-occurring hazardous alcohol use and social anxiety, and the suggested improvements have been implemented into the full program. The next stage will be a pilot feasibility study, followed by a larger clinical trial to evaluate the efficacy of the program in reducing cognitive biases, alcohol use and social anxiety.

Acceptability and co-development of an online cognitive bias modification intervention for emerging adults with hazardous alcohol use and social anxiety: A mixed methods study. K. Prior, E. Salemink, R.W. Wiers, B.A. Teachman, M. Piggott; N.C. Newton, M. Teesson, A.J. Baillie, S. Campbell, L.A Stapinski (pages xxx).

ACER-20-4371.R1