good migrations brief ryan _eabct 2012
DESCRIPTION
Summary of clinical psychological impact of recent cognitive neuroscience findings with regard to addiction.TRANSCRIPT
Good Migrations? Translating experimental psychology paradigms into
clinical applications
Paper presented at European Association of Cognitive and Behavioural therapies, Geneva, 30th August 2012
New developments
• Recognition that information is processed at different levels
• Realisation that addictive behaviour is intransigent
• Findings that diverse treatments lead to broadly similar outcomes: component processes are unclear
The promise
Experimental psychology findings have illuminated hitherto dark territory:
Core cognitive processing in addiction occurs in advance of, or outside of, consciousness. Accordingly, insight is limited.
Attention is crucial for both starting and ending behavioural sequences e.g. action slips. The very transient attentional capture of motivational cues can trigger drug seeking and taking.
Understanding facets of automaticity
• Certain tasks can be carried out in the absence of awareness e.g. walking down a familiar pathway
• An action may be initiated without deliberate attention or awareness – e.g. sipping from a glass of water or picking peanuts from a bowl
• Situations where attention is automatically drawn to something – e.g. the sudden appearance of a face at a window;
• In cognitive psychology where actions or tasks are deemed automatic if they do not appear to interfere with other tasks i.e. are not constrained by limited capacity.
(Norman & Shallice, 2001)
Facet of
impulsivity
Experimental
paradigm
“Real-world”
example
Potential
remedial
procedures
Behavioural
inhibition
Go no-go task/ Stop
signal task.
Suppressing
appetitive or
acquisitive
behaviour.
Practising self
restraint; training
in modifying
implicit approach
tendencies.
Attentional lapses
and biases
Slower reaction to
visual cues over
longer time intervals;
preferential
processing of
addiction relevant
stimuli.
“Action – slips”
leading to default
responses,
temporarily
“forgetting” goal is
abstinence;
distraction by
addiction related
cues
Cognitive bias
reversal; goal
maintenance
strategies such
as rehearsal;
aerobic exercise.
Brain training
focusing on
sustaining
attention.
Impaired
(impulsive)
decision-making
Delay discounting
task
Prioritising
immediate
gratification via drug
ingestion; devaluing
longer term benefits
of restraint
Brain training
with the aim of
increasing
working memory
capacity
especially
prospective
memory; aerobic
exercise.
“I’m still amazed that I carry on doing something when I don’t even like it”.
Themes applied
Importance of goal maintenance
Importance of identifying alternative goals and pursuing these in a systematic manner.
Rehearsal
Repetition
Reinforcement
Reversal
+
=
+
Temptation….
• “I found myself on my bike like I was possessed, cycling along the road where the house I used to go to [to buy cocaine] what am I doing? This is dangerous; this feels almost nostalgic”.
Feedback from a cognitive neuroscience perspective
• “You have done really well with your recovery programme so far. What happened to the weekend is unfortunately a common occurrence when we try to overcome in addiction to a drug like cocaine. What seems to happen is that while the rational and sensible part of you fully recognises the need to abstain, another part of you, let's say the more impulsive or emotional parts of your brain, still has not got the “quit” message. This is not a particularly clever part of your brain but what it lacks in intellect it makes up for in persistence!
• If you're feeling tired or stressed, which I know you were because of your forthcoming job interview, your impulsive brain can take advantage and get in the driving seat. What I suggest we do next in the session is a debrief about what was happening with you before you found yourself on the way to the crack house....”
Cycle of pre-occupation
Attentional bias
Contents of
Working memory
Attentional bias
Attribution of incentive salience
“The road to recovery is paved with ……good rehearsals.”
• Successful execution of any task requires both controlled and automatic processing
• Treatment for addiction requires that automatic processes are recruited through practice, implementation intentions, programmed cue exposure and stimulus control.
• Robust practice has been shown to increase automatic inhibition of competing goals (Palfai, p 416, Wiers &
Stacey 2006)
The Future:Neuro-Cognitive Behaviour Therapy?
• Emphasis both on remediation of cognitive deficits and reversal of cognitive biases.
• Focus on goal maintenance and working memory mechanisms.
• Prioritises cognitive control strategies.
