Drug Stroop: Mechanisms of response to computerized cognitive behavioral therapy for cocaine dependence in a randomized clinical trial. (1st February 2018)

• Record Type: Journal Article
• Authors: DeVito, Elise E.; Kiluk, Brian D.; Nich, Charla; Mouratidis, Maria; Carroll, Kathleen M.
• Is Part Of: Drug and alcohol dependence. Volume 183(2018)
• Page Start: 162
• Page End: 168
• Publication Date: 2018-02-01
• Subjects: Cocaine -- Cognitive behavioral therapy (CBT) -- Drug Stroop -- Emotional Stroop -- Cognitive control -- Attentional bias -- Psychotherapy; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2017.10.022
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Computer based cognitive behavioral therapy (CBT4CBT) versus treatment as usual Randomized Controlled Trial (RCT). Participants were methadone-maintained, seeking treatment for cocaine-use disorders. Reduced (i.e., improved) Drug Stroop effect observed at post- versus pre-treatment. Greater reductions in Drug Stroop effect correlated with more CBT4CBT engagement. More reduction in Drug Stroop effect with longer within-treatment cocaine abstinence. Abstract: Background: Poor performance on Drug Stroop tasks, which could indicate attentional bias to drug-related cues, craving, poor cognitive control (including poor response inhibition), has been associated with substance use severity, treatment retention and substance use treatment outcomes. Cognitive Behavioral Therapy (CBT) focuses on training in appraisal and coping strategies, including strategies to minimize the negative impact of triggers and coping with drug-cue-induced craving. One mechanism of action of CBT may be the strengthening of cognitive control processes and reduction of attentional bias to drug-related stimuli. Methods: Methadone-maintained individuals with cocaine-use disorders, participating in a randomized controlled trial of treatment as usual (TAU) versus TAU plus access to computer-based CBT (CBT4CBT), completed a computerized Drug Stroop task at pre- and post-treatment. Analyses determined whether attentional bias toward drug-related stimuli changed differentially by treatment group or cocaine use outcomes across the treatment period and whether engagement in components of CBT4CBT or TAU treatment related to changes in attentional bias toward drug-related stimuli at post- versus pre-treatment. Results: Participants achieving a longer duration of cocaine abstinence during treatment (3+ weeks) showed greater reductions in Drug Stroop Effect than those with shorter maximum continuous abstinence. Reductions in Drug Stroop Effect across treatment were associated with greater engagement with CBT4CBT-specific treatment components, but not TAU-specific treatment components. Conclusions: Reduction in attentional bias to drug-related cues and craving and/or improved executive cognitive control and response inhibition may contribute to the mechanism of action of CBT4CBT.