The primary aim of this study is to investigate the effect of a computer-based WMT on executive functioning (and especially WM performance) in a clinical sample of alcohol dependent subjects. Secondly, we will examine if an improvement in WM is…
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Verslaving (alcohol)
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
We are interested in the difference in performance of our participants on the
three timepoints (pretest, posttest and follow-up)
- Working memory performance (visuospatial working memory taak, backward digit
span, letter span taak)
- Automatic preferences for alcohol (Implicit Association Test)
See section 7.1.1 of the research protocol for an elaborated
desciption/information.
Secondary outcome
- Alcohol use and relapse (Time Line Follow Back Questionnaire)
- Working memory (equal, but not trained task)
- Executive functioning (Stroop task, Concept Shifting Test, Letter Digit
Coding Test)
- Control (Mastery questionnaire)
- Approach/avoidance of alcohol (Approach and Avoidance of Alcohol
Questionnaire)
- Craving (Visual analogue scale)
- Motivation to change drinking behavior questionnaire
- Self-efficacy questionnaire
- Intelligence (Groninger Intelligence Test)
- Memory (verbal learning test)
- Psychological wellbeing (Symptom Check List 90 )
- Completement of the working memory training
- Number of excluded subejcts/ drop outs
See section 7.1.2 en 7.1.3 of the research protocol for an elaborated
desciption/information.
Background summary
Alcohol abuse causes disruptions in the human cognitive domain. For instance
planning, attention, inhibition of inappropriate actions and working memory are
affected by long-term alcohol abuse. It has been shown that an impairment of
the aforementioned executive functions may result in maladaptive behaviour. For
instance, drinking behaviour can get out of control, due to the fact that
automatic impulses may not be suppressed appropriately. Working memory forms/is
the basis for learning, planning, organizing, staying focused, control of
impulses and reasoning.
Study objective
The primary aim of this study is to investigate the effect of a computer-based
WMT on executive functioning (and especially WM performance) in a clinical
sample of alcohol dependent subjects. Secondly, we will examine if an
improvement in WM is related to improved control over drinking behaviour (e.g.
the amount of consumed alcohol beverages and alcohol cravings). Thirdly, we are
interested whether this improvement in cognitive functioning is additional to
the effect of the regular treatment, especially in the long run.
Hypotheses:
1.WM performance will be improved in the experimental group (training
condition) after WMT in comparison with the two control groups (control
condition).
2.Alcohol cravings and automatic preferences (impulses) for alcohol will be
reduced in the experimental group after WMT in comparison with the two control
groups. This reduction is linked to the improvement in WM performance.
3.Chronic heavy drinkers, participants with relatively strong automatic
preferences for alcohol, will profit the most from this WMT in comparison with
participants who have lower automatic preferences for alcohol. Their WM
performance will improve and there will be less alcohol cravings, less
automatic preferences (impulses) for alcohol and a lower relapse rate.
4.The (possible) improvement in cognitive functioning after WMT will be
additional to the effect of the regular treatment.
Study design
We will use a double-blind randomized trial. The study will have a 3x4
split-plot design (with time-point as within subject factor and group (working
memory training versus active control condition/passive control condition) as
between subjects factor). Before and after training, we will measure working
memory performance and drinking behaviour. After 3 months, a follow-up
measurement will take place. A neuropsychological assessment (measurement of
intelligence and cognitive functioning) will be surveyed by the researchers at
pre-test.
Intervention
WMT is an intervention that is used to strengthen executive functions
(Klingberg, 2010). It is found that WMT is highly relevant for reducing
clinical symptoms and to improve WM capacity and other cognitive abilities in a
variety of clinical samples (Beck et al., 2010; Borella et al., 2010; Klingberg
et al., 2005; Houben, Wiers & Jansen, 2011).
The WMT used in the present study is based on the exact same tasks used in the
study of Houben, Wiers and Jansen (2011) and the results of this study were
promising. The participants in this study showed an improvement in WM
performance after WMT. Their WMT was based on the ideas, tasks and studies of
Klingberg and associates (e.g. 2002). The daily exercises are designed to train
both the visuo-spatial and verbal WM. All participants (in both the training
and control conditions) will be tested during the WMT on three kind of WM
tests: the visuospatial WM span task, the backwards digit span task, and the
letter span task (based on Klingberg et al., 2002). All three tasks consist of
30 trials.
•Visuospatial WM task: during this task, a certain number of squares in a 4x4
grid changed in colour on the computer screen. Participants have to reproduce
this sequence by clicking on the squares that have changed colour in the
correct order using the computer mouse.
•Backward digit span: during this task, a sequence of numbers will be presented
on the computer screen. Participants have to reproduce this sequence in
reversed order, using either the computer mouse or the number keys on the
keyboard.
•Letter span task: during this task, a sequence of letters will be presented on
the computer screen in a circle. One of the positions in this circle is the be
indicated and participants have to reproduce the corresponding letter using the
keyboard.
In the training condition (participants in the experimental group (group 3)),
the difficulty level of all three WM tasks will be automatically adjusted on a
trial-by-trial basis. Initially, each task involved sequences of three items.
The length of the sequences will increase and decrease according to
participants* performance. When participants correctly reproduce the sequences
on two consecutive trials, one item will be added to the sequence on the next
trial. When participants are not able to correctly reproduce the sequences on
two consecutive trials, the sequence in the next trial will contain one item
fewer. In the control condition (participants in group 2), the difficulty level
of the WM tasks will not be adjusted, remaining at the initial, easy level
throughout each task (i.e., three items in each sequence).
Study burden and risks
The risk of participating in this study are considered minimal. The working
memory training and questionnaires are non-invasive and scarecely stressful.
When taken into consideration that the participants have to be mental competent
to give informed consent and the the risks of participating in this study are
minimal, we feel that the burden of approximately 40 minutes for 25 consecutive
days are justified, in order to gain more insight in the relationship between
working memory and automatic preferences for alcohol.
P.O. Box 5800
6202 AZ Maastricht
NL
P.O. Box 5800
6202 AZ Maastricht
NL
Listed location countries
Age
Inclusion criteria
Alcohol dependence: diagnosed according to criteria DSM IV (American Psychiatric Association, 2000);Participants will be screened with the Alcohol Use Disorder Identification Test (AUDIT; Saunders et al.1993), and are only allowed to participate when they score 8 or higher on the AUDIT (i.e., the cut-off score for hazardous drinking; Saunders et al. 1993). ;Age over 18 years;A minimum of 4 years of formal schooling and no history of mental retardation;Native Dutch speaker;Mental competency to give informed consent. Mental competency as defined by the Dutch law (WGBO: Wet of Geneeskundige Behandel Overeenkomst) is determined by the medical specialist (e.g. psychiatrist) based on the patient*s health record, observations and conversation with the regular therapist. If necessary, the psychiatrist will have a short conversation with the patient. The concerning psychiatrists are: Dr. Michael Wellner, Dr. Robert Hilse, Dr. Claudia Decker and Dr. An Joos. They are all employees of Addiction Care of the Mondriaan Zorggroep.;Participants must have access (preferable at their own home) to a computer with an internet connection.
Exclusion criteria
AUDIT score lower than 8 (the cut-off score for hazardous drinking; Saunders et al. 1993);History of acquired brain injury (e.g. cerebral contusion, cerebrovascular accident);Participants who show signs of poor compliance (e.g. not completing a session in time and session loss) and/or poor response on the questionnaires will be excluded from the experiment by the researchers. ;Polydrug users are excluded from the study when their primary drug (core addiction) is different than alcohol. Possible polydrug use will be registered.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
In other registers
| Register | ID |
|---|---|
| Other | Identificatienummer is aangevraagd op www.trialregister.nl; wordt verwacht binnen 4 weken. |
| CCMO | NL38350.068.11 |
| OMON | NL-OMON26354 |