Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial.

BACKGROUND: Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. OBJECTIVE: This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. METHODS: In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. RESULTS: We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (ß=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (ß=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. CONCLUSIONS: The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476.

Geofencing in location-based behavioral research: Methodology, challenges, and implementation.

This manuscript presents a novel geofencing method in behavioral research. Geofencing, built upon geolocation technology, constitutes virtual fences around specific locations. Every time a participant crosses the virtual border around the geofenced area, an event can be triggered on a smartphone, e.g., the participant may be asked to complete a survey. The geofencing method can alleviate the problems of constant location tracking, such as recording sensitive geolocation information and battery drain. In scenarios where locations for geofencing are determined by participants (e.g., home, workplace), no location data need to be transferred to the researcher, so this method can ensure privacy and anonymity. Given the widespread use of smartphones and mobile Internet, geofencing has become a feasible tool in studying human behavior and cognition outside of the laboratory. The method can help advance theoretical and applied psychological science at a new frontier of context-aware research. At the same time, there is a lack of guidance on how and when geofencing can be applied in research. This manuscript aims to fill the gap and ease the adoption of the geofencing method. We describe the current challenges and implementations in geofencing and present three empirical studies in which we evaluated the geofencing method using the Samply application, a tool for mobile experience sampling research. The studies show that sensitivity and precision of geofencing were affected by the type of event, location radius, environment, operating system, and user behavior. Potential implications and recommendations for behavioral research are discussed.

Psychological well-being during the COVID-19 pandemic: Combining a web survey with experience sampling methodology.

COVID-19-related regulations have impacted the economy and people's well-being, highlighting the long-standing problem of inequality. This research explored how COVID-19-related restrictive policies, such as a lockdown or social distancing, affected people's well-being. In Study 1, a cross-sectional online survey (N = 685), we examined the associations between socio-economic characteristics, the number of resources, their relative change, people's stress levels, and their support of restrictive policies. We found that financial loss due to COVID-19, the number of children at home, and the intensity of restrictive measures were associated with higher stress by restrictive measures. The lower support for restrictive measures was observed among those who experienced financial loss due to COVID-19, had more children at home, less frequently accessed COVID-19-related information in the media, and did not perform self-isolation. Men were generally less supportive of restrictions than women, and the number of new COVID-19 cases was negatively related to the support. Lower stress and higher support for restrictive measures were positively associated with life satisfaction. In Study 2, an experience-sampling survey (Nparticipants = 46, Nresponses = 1112), the participants rated their well-being and level of available resources daily for one month. We observed that daily increases in well-being, characterized by higher life satisfaction and lower levels of stress and boredom, were positively associated with more social communication and being outdoors. In summary, the findings support the resource and demand framework, which states that people with access to resources can better cope with the demands of restrictive policies. Implications for policies and interventions to improve well-being are discussed.

Using computer-based habit versus chess-based cognitive remediation training as add-on therapy to modify the imbalance between habitual behavior and cognitive control in tobacco use disorder: protocol of a randomized controlled, fMRI study.

BACKGROUND: Although the vast majority of smokers are aware of the enormous preventable health hazards caused by smoking, only a small percentage of smokers manage to remain abstinent in the long term. One possible explanation for this discrepancy lies in the inflexibility of addictive behavior and associated disadvantageous decision-making. According to a dual-process theory of decision-making, two distinct decision systems can be identified. One slow deliberate system based on desirable expectations of outcome value described as goal-directed behavior and a fast reflexive system based on habitual instrumental behavior and driven by reinforcement experienced in the past. In the course of addiction development, an imbalance occurs between habitual behavior and goal-directed. The present study aims to investigate the modifiability of the balance between habitual and goal-directed behavior at the neurobiological and behavioral level in smokers using two different novel add-on therapies. We hypothesize that both interventions change the balance between goal-directed and habitual behavior, but by different mechanisms. Whereas a cognitive remediation treatment should directly improve cognitive control, in contrast an implicit priming task should affect the early processing and the emotional valence of smoking and smoking cues. METHODS: We will conduct a randomized controlled study in treatment-seeking individuals with tobacco use disorder applying either chess-based cognitive remediation training (N = 30) or implicit computer-based habit-modifying training (N = 30) as add on therapy compared to the standard smoking cessation group therapy (N = 30) only. We will address neurobiological and neuropsychological correlates associated with craving, reward devaluation, cue reactivity and attentional bias. In addition, various effects of treatment and prediction of treatment outcome will be examined using behavioral and neural measures. DISCUSSION: The present study will apply different examination methods such as functional magnetic resonance imaging, neuropsychological tests, and self-report before and after the interventions. This allows the identification of intervention-specific mechanisms and therefore potential neurobiology-based specific treatment targets for individuals with Tobacco Use Disorder. TRIAL REGISTRATION: Registered at clinicaltrials.gov/ct2/show/NCT03764969 (05 December 2018).

Open Lab: A web application for running and sharing online experiments.

Online experiments have become a popular way of collecting data in the social and behavioral sciences. However, the high technical hurdles of setting up a server may prevent researchers from starting them. Also, proprietary software may restrict a researcher's freedom to customize or share their study. Open Lab is a server-side application designed to host online surveys and experiments created using lab.js. Available online at https://open-lab.online , Open Lab offers a fast, secure, and transparent way to deploy studies; it handles uploading experiment scripts, customizing study design, managing the participant database, and working with the study results. Open Lab is integrated with the lab.js experiment builder ( https://lab.js.org/ ), a browser-based program which enables the creation of new studies from scratch or the use of templates. This paper compares Open Lab with other study deployment services, discusses how Open Lab contributes to open science practices, and provides a step-by-step guide for researchers.

A Smarter Way to Use Your Smartphone: An Intervention to Limit Smartphone-Related Distractions Reduces Hyperactivity but Not Inattention Symptoms.

INTRODUCTION: Smartphones are often helpful in our everyday lives. Yet, they also tend to interrupt us during other activities. It has been argued that such distractions contribute to attention-deficit/hyperactivity disorder-like symptoms. However, since there are mostly correlational studies, the causal nature of this relationship is unclear. Our aim was to test whether reducing smartphone-related distractions might have a beneficial effect on inattention and hyperactive symptoms. METHODS: We conducted a 1-week field experiment with 37 healthy undergraduates and quasi-randomly assigned them to an intervention or control group (CG). The intervention group was given theory-based specific instructions that aimed at reducing smartphone-related distractions, whereas the CG received no intervention. The outcomes of interest were inattention level, hyperactive symptoms, and working memory accuracy. RESULTS: Compared to those in the control condition, participants who limited their smartphone use showed considerable reductions in hyperactive symptoms after 1 week - particularly those who displayed high problematic smartphone use. However, there were no group differences regarding inattention symptoms and working memory accuracy. DISCUSSION: The results give a first hint that strategically reducing smartphone-related distractions via specific but simple use modifications can mitigate hyperactive symptoms. Especially people with problematic smartphone use seem to profit from such an intervention. Remaining questions and directions are discussed.

lab.js: A free, open, online study builder.

Web-based data collection is increasingly popular in both experimental and survey-based research because it is flexible, efficient, and location-independent. While dedicated software for laboratory-based experimentation and online surveys is commonplace, researchers looking to implement experiments in the browser have, heretofore, often had to manually construct their studies' content and logic using code. We introduce lab.js, a free, open-source experiment builder that makes it easy to build studies for both online and in-laboratory data collection. Through its visual interface, stimuli can be designed and combined into a study without programming, though studies' appearance and behavior can be fully customized using HTML, CSS, and JavaScript code if required. Presentation and response times are kept and measured with high accuracy and precision heretofore unmatched in browser-based studies. Experiments constructed with lab.js can be run directly on a local computer and published online with ease, with direct deployment to cloud hosting, export to web servers, and integration with popular data collection platforms. Studies can also be shared in an editable format, archived, re-used and adapted, enabling effortless, transparent replications, and thus facilitating open, cumulative science. The software is provided free of charge under an open-source license; further information, code, and extensive documentation are available from https://lab.js.org/ .

The influence of perceived stress and self-control on efficacy of repeated transcranial direct current stimulation in non-treatment-seeking smokers.

INTRODUCTION: Transcranial direct current stimulation (tDCS) has recently been raising interest in its therapeutic impact on tobacco use disorder. This study investigates the effects of repeated frontal tDCS (anode: F3, cathode: F4) on cigarette consumption, craving and executive functions. MATERIAL AND METHODS: In a randomized sham-controlled trial, 24 individuals received active (2.0 mA) and 20 individuals received sham stimulation (0.3 mA) for 20 min on five consecutive days. The participants indicated their tobacco cravings, answered questionnaires and completed neuropsychological tasks at various time points throughout the study. Carbon monoxide (CO) levels and the daily numbers of consumed cigarettes were recorded. RESULTS: Both intervention groups experienced a significant decrease in the daily number of smoked cigarettes, CO levels, and craving after the stimulation, however, there were no improvements in executive functions. These results did not differ significantly between both intervention groups. Additionally, in the active group, a higher level of perceived stress and a lower level of self-control were linked to a lower cigarette consumption, respectively a higher reduction of the level of CO. CONCLUSION: This study does not support the hypotheses that tDCS reduces cigarette consumption, attenuates substance craving, or improves executive functions beyond the placebo effect. Our subgroup analysis suggests that high levels of perceived stress and low self-control may be predictors for a successful reduction in cigarette consumption. Furthermore, the placebo effect might be rather high for light smokers, whereas heavy smokers seem to benefit more from the specific effects of tDCS. CLINICAL TRIAL REGISTRATION NUMBER: NCT03691805.

Samply: A user-friendly smartphone app and web-based means of scheduling and sending mobile notifications for experience-sampling research.

Undertaking an experience-sampling study via smartphones is complex. Scheduling and sending mobile notifications often requires the use of proprietary software that imposes limits on participants' operating systems (whether iOS or Android) or the types of questions that can be asked via the application. We have developed an open-source platform-Samply-which overcomes these limitations. Researchers can access the entire interface via a browser, manage studies, schedule and send notifications linking to online surveys or experiments created in any Internet-based service or software, and monitor participants' responses-all without the coding skills usually needed to program a native mobile application. Participants can download the Samply Research mobile application for free from Google Play or the App Store, join a specific study, receive notifications and web links to surveys or experiments, and track their involvement. The mobile application leverages the power of the React Native JavaScript library, which allows it to be rendered in the native code of Android and iOS mobile operating systems. We describe Samply, provide a step-by-step example of conducting an experience-sampling study, and present the results of two validation studies. Study 1 demonstrates how we improved the website's usability for researchers. Study 2 validates the mobile application's data recording ability by analyzing a survey's participation rate. The application's possible limitations and how mobile device settings might affect its reliability are discussed.

The training game SALIENCE for the therapy of alcohol use disorder.

The feasibility study was aimed to develop a web-based gaming tool for the therapy of alcohol use disorder to offer patients a cue-exposure-based extinction and decision training, enhanced with virtual reality. To increase the training effect, patients playfully experience situations that resemble critical real-life situations. For implementing the game, a combination of HTML5 and JavaScript was used. The application comes with an administrator interface, to allow editing the game content. Initially, we included 21 patients (Group 1), 18 suffering from alcohol use disorder and 3 using cannabis (18/3 male/female, mean age 39 ± 13 years). Considering the iterative process of a feasibility study, we developed the game design as suggested by participants of Group 1 and additionally included 11 novel participants (Group 2) (11 suffering from an alcohol use disorder, 7/4 male/female, mean age 46 ± 14 years). Basically, the game was very well received. Usability ratings were generally high, even in patients with little computer experience. Both groups rated the application as realistic, and would generally be willing to play it on a daily basis. Given that SALIENCE is inexpensive, easily available, and engaging, it might be a reasonable add-on intervention to the standard treatment of alcohol use disorder.

Noncompliance with online mood manipulations using film clips: how to detect and control for it.

The reliability of online mood manipulations is potentially undermined by participants' noncompliance behavior, e.g., skipping a part of the experiment or switching between web pages during the mood manipulation. The goal of the current research is to investigate (1) whether and how mood manipulations are threatened by noncompliance behavior, (2) whether it is confounded with the induced mood state as predicted by Affect Regulation Theory, and (3) what measures can be taken to control for the noncompliance. In two online-experiments, noncompliance behavior was assessed during the mood manipulation with movie clips by tracking interruptions of watching and page switches. The results support the affect regulation hypothesis demonstrating that people confronted with negative emotional content interrupted watching the video and switched between pages more often than people with positive content. Methodologically, this causes a threat to the internal validity of internet-based mood manipulation studies. To decrease the risk of noncompliance, the current study recommends to block skipping a part of the mood manipulation, detect page focus events and measure the time people stay on a page.

The effect of mood on integration of information in a multi-attribute decision task.

The exact effect of different moods on choosing strategies in multi-attribute decision tasks is yet unknown since previous work has found apparently contradicting results. Furthermore, different theoretical accounts lead to opposite expectations. While the "mood-as-information" theory states that a positive mood leads to heuristic processing of information and application of non-compensatory strategies, the "broaden-and-build" theory expects more non-compensatory decision-making in a negative mood. To test the predictions of those two theories, we conducted two experimental studies, in which both the mood and the type of information search were manipulated. The results rather support "mood-as-information" theory, so participants in the positive mood made non-compensatory choices more often than participants in the negative mood. The effect was only present in the open information board, where the information was presented simultaneously, but not in the closed Mouselab, where the information had to be searched in a sequential manner.

Heart echinococcosis: Current problems and surgical treatment.

We present historical, epidemiological, and statistical data on heart echinococcosis (also known as hydatid disease) and concomitant lesions of different organs, as well as a demonstration of its surgical management. The diagnosis of heart echinococcosis is based on review and identification of the cyst and we evaluate the various common diagnostic methods. Surgical treatment of patients with heart echinococcosis may require cardiopulmonary bypass or may be an off-pump procedure depending on the location of the cysts.  Finally, we present some additional techniques for prevention of recurrence.

High-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation as a treatment option in multiple sclerosis.

High-dose immunosuppressive therapy (HDIT) with autologous hematopoietic stem cell transplantation (auto-HSCT) is a new and promising approach to the treatment of multiple sclerosis (MS) patients because currently there are no effective treatment methods for this disease. In this article, we present results of a prospective clinical study of efficacy of HDIT + auto-HSCT in MS patients. The following treatment strategies were employed in the study: "early," "conventional," and "salvage/late" transplantation. Fifty patients with various types of MS were included in this study. No toxic deaths were reported among 50 MS patients; transplantation procedure was well-tolerated by the patients. The efficacy analysis was performed in 45 patients. Twenty-eight patients achieved an objective improvement of neurological symptoms, defined as at least 0.5-point decrease in the Expanded Disability Status Scale (EDSS) score as compared to the baseline and confirmed during 6 months, and 17 patients had disease stabilization (steady EDSS level as compared to the baseline and confirmed during 6 months). The progression-free survival at 6 years after HDIT + auto-HSCT was 72%. Magnetic resonance imaging data were available in 37 patients before transplantation showing disease activity in 43.3%. No active, new, or enlarging lesions were registered in patients without disease progression. In conclusion, HDIT + auto-HSCT suggests positive results in management of patients with different types of MS. Identification of treatment strategies based on the level of disability, namely "early," "conventional," and "salvage/late" transplantation, appears to be feasible to improve treatment outcomes.

Heart echinococcosis: current problems and surgical treatment.

We present some historical, epidemiological, statistical data for heart echinococcosis and concomitant lesions of different organs. The diagnosis of heart echinococcosis is based on revealing of the cyst and its identification with echinococcus. The value of different diagnostic methods is shown. A surgical procedure in patients with heart echinococcosis depends on the localization of the cysts (manipulations under cardiopulmonary bypass or off-pump procedure). We present some additional techniques for prophylaxis of recurrence.