Supplementary Material for: Automatic Approach Behaviors in Alcohol Dependence: Does a Cognitive Bias Modification Training Affect Pavlovian-to-Instrumental Transfer Effects?

<b><i>Introduction:</i></b> Positively conditioned Pavlovian cues tend to promote approach and negative cues promote withdrawal in a Pavlovian-to-instrumental transfer (PIT) paradigm, and the strength of this PIT effect was associated with the subsequent relapse risk in alcohol-dependent (AD) patients. When investigating the effect of alcohol-related background cues, instrumental approach behavior was inhibited in subsequent abstainers but not relapsers. An automatic approach bias towards alcohol can be modified using a cognitive bias modification (CBM) intervention, which has previously been shown to reduce the relapse risk in AD patients. Here we examined the effects of such CBM training on PIT effects and explored its effect on the relapse risk in detoxified AD patients. <b><i>Methods:</i></b> <i>N</i> = 81 recently detoxified AD patients performed non-drug-related and drug-related PIT tasks before and after CBM versus placebo training. In addition, an alcohol approach/avoidance task (aAAT) was performed before and after the training to assess the alcohol approach bias. Patients were followed up for 6 months. <b><i>Results:</i></b> A stronger alcohol approach bias as well as a stronger non-drug-related PIT effect predicted relapse status in AD patients. No significant difference regarding relapse status or the number of heavy drinking days was found when comparing the CBM training group versus the placebo group. Moreover, there was no significant modulation effect of CBM training on any PIT effect or the aAAT. <b><i>Conclusion:</i></b> A higher alcohol approach bias in the aAAT and a stronger non-drug-related PIT effect both predicted relapse in AD patients, while treatment outcome was not associated with the drug-related PIT effect. Unlike expected, CBM training did not significantly interact with the non-drug-related or the drug-related PIT effects or the alcohol approach bias.

<b><i>引言：</i></b> 在巴甫洛夫工具性转移（Pavlovian-to-instrumental transfer, PIT）范式中，经正性条件化的巴甫洛夫线索通常会促发趋近行为，负性线索则引发退缩行为；且该PIT效应的强度与酒精依赖（alcohol-dependent, AD）患者后续的复发风险密切相关。在探究酒精相关背景线索的作用时，后续保持戒断的患者的工具性趋近行为受到抑制，而复吸患者则无此现象。针对酒精的自动趋近偏差可通过认知偏差矫正（cognitive bias modification, CBM）干预手段进行调整，既往研究已证实该手段可降低AD患者的复发风险。本研究旨在探究此类CBM训练对PIT效应的影响，并探讨其对戒酒康复后AD患者复发风险的作用。<b><i>方法：</i></b> 本研究共纳入81名近期完成戒酒脱毒的AD患者，受试者在接受CBM训练与安慰剂训练前后，分别完成了非药物相关与药物相关的PIT任务。此外，受试者在训练前后均完成酒精趋近/回避任务（alcohol approach/avoidance task, aAAT），以评估其酒精趋近偏差。对所有患者进行为期6个月的随访。<b><i>结果：</i></b> 更强的酒精趋近偏差与更强的非药物相关PIT效应，均可预测AD患者的复发状态。CBM训练组与安慰剂组在复发状态或重度饮酒天数上均无显著差异。此外，CBM训练对各类PIT效应及aAAT均无显著调节作用。<b><i>结论：</i></b> aAAT测试中更高的酒精趋近偏差，以及更强的非药物相关PIT效应，均可预测AD患者的复发情况，而治疗结局与药物相关PIT效应无关联。与预期不符的是，CBM训练并未对非药物相关、药物相关PIT效应或酒精趋近偏差产生显著交互作用。