A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial

Youwei Zhu, Haifeng Jiang, Hang Su, Na Zhong, Runji Li, Xiaotong Li, Tianzhen Chen, Haoye Tan, Jiang Du, Ding Xu, Huan Yan, Dawen Xu, Min Zhao, Youwei Zhu, Haifeng Jiang, Hang Su, Na Zhong, Runji Li, Xiaotong Li, Tianzhen Chen, Haoye Tan, Jiang Du, Ding Xu, Huan Yan, Dawen Xu, Min Zhao

Abstract

Background: Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy's feasibility when using mobile-based health technologies in supporting recovery from MUD in China.

Objective: The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD.

Methods: Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions.

Results: Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group×time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group.

Conclusions: The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy.

Trial registration: ClinicalTrials.gov NCT03318081; https://ichgcp.net/clinical-trials-registry/NCT03318081 (Archived by WebCite at https://ichgcp.net/clinical-trials-registry/NCT03318081).

Keywords: attention bias; cognitive function; impulse control; methamphetamine; methamphetamine use disorder; risk decision making.

Conflict of interest statement

Conflicts of Interest: None declared.

©Youwei Zhu, Haifeng Jiang, Hang Su, Na Zhong, Runji Li, Xiaotong Li, Tianzhen Chen, Haoye Tan, Jiang Du, Ding Xu, Huan Yan, Dawen Xu, Min Zhao. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018.

Figures

Figure 1
Figure 1
Methamphetamine-related attention bias modification task. Patients were asked to decide whether the meaning of the word in the left box was consistent with the color of the word on the right. The Chinese word printed in green on the left means “red,” whereas the phrase presented on the right means “smoking methamphetamine.”.
Figure 2
Figure 2
Methamphetamine-related attention control training. In situation 1, the border of the methamphetamine-related image was red, and the patients needed to push the “red” button. In situation 2, the border of the neutral picture was yellow, and the patients needed to push the “yellow” button as quickly as possible.
Figure 3
Figure 3
Methamphetamine-related working memory training task (N-back task). The previous Figure 2 is an example of 2-back task training. Patients in the CCAT group were asked to decide the whether the figure (both shape and color) on the right was consistent with the figure showing the previous two pictures while ignoring the methamphetamine-related picture on the left.
Figure 4
Figure 4
Memory matrix task. A few blue squares were shown for 3 seconds and then they disappeared and returned to the original color. Patients were told to indicate the squares that turned blue that were shown seconds before. An incorrect response resulted in a red cross, whereas a correct response resulted in a green checkmark.
Figure 5
Figure 5
CONSORT flowchart of the study. CCAT: computerized cognitive addiction therapy.
Figure 6
Figure 6
International Shopping List (ISL) scores before and after intervention. Verbal learning and memory function were evaluated by ISL; scores are total number of correct responses. Significant differences between the two groups (P<.001 are marked by the asterisk. ccat: computerized cognitive addiction therapy.>

Figure 7

Continuous Paired Association Learning (CPAL)…

Figure 7

Continuous Paired Association Learning (CPAL) scores before and after intervention. Spatial working memory…

Figure 7
Continuous Paired Association Learning (CPAL) scores before and after intervention. Spatial working memory functions were reflected through the total number of errors in the CPAL. Significant differences between the two groups (P=.01) are marked by the asterisk. CCAT: computerized cognitive addiction therapy.

Figure 8

Social emotional cognition (SEC) task…

Figure 8

Social emotional cognition (SEC) task scores before and after intervention. Social cognition was…

Figure 8
Social emotional cognition (SEC) task scores before and after intervention. Social cognition was evaluated by the SEC task; SEC scores were assessed by accuracy rate (the proportion of correct responses). Changes in SEC scores did not reach significant level in CCAT group (P=.56), whereas the accuracy rate decreased significantly in the control group (P=.02) as reflected by the asterisk. CCAT: computerized cognitive addiction therapy.

Figure 9

Discounting change ln(k) before and…

Figure 9

Discounting change ln(k) before and after computerized cognitive addiction therapy (CCAT) training. Change…

Figure 9
Discounting change ln(k) before and after computerized cognitive addiction therapy (CCAT) training. Change in discounting ln(k) for participants in CCAT and control groups, calculated as posttraining minus pretaining. Negative values indicate a decrease in discounting. The values 2, 7, 30, 90, 180, and 360 were delayed times in the delay discounting task.

Figure 10

Iowa Gambling Task (IGT) scores…

Figure 10

Iowa Gambling Task (IGT) scores after computerized cognitive addiction therapy (CCAT) or control…

Figure 10
Iowa Gambling Task (IGT) scores after computerized cognitive addiction therapy (CCAT) or control training. The IGT score was calculated through the number of cards from the disadvantageous decks (C and D) subtracted from the advantageous decks (A and B). A positive score reflects the individual had a tendency to make better decisions. The lines are means and the error bars are the standard deviation.
All figures (10)
Figure 7
Figure 7
Continuous Paired Association Learning (CPAL) scores before and after intervention. Spatial working memory functions were reflected through the total number of errors in the CPAL. Significant differences between the two groups (P=.01) are marked by the asterisk. CCAT: computerized cognitive addiction therapy.
Figure 8
Figure 8
Social emotional cognition (SEC) task scores before and after intervention. Social cognition was evaluated by the SEC task; SEC scores were assessed by accuracy rate (the proportion of correct responses). Changes in SEC scores did not reach significant level in CCAT group (P=.56), whereas the accuracy rate decreased significantly in the control group (P=.02) as reflected by the asterisk. CCAT: computerized cognitive addiction therapy.
Figure 9
Figure 9
Discounting change ln(k) before and after computerized cognitive addiction therapy (CCAT) training. Change in discounting ln(k) for participants in CCAT and control groups, calculated as posttraining minus pretaining. Negative values indicate a decrease in discounting. The values 2, 7, 30, 90, 180, and 360 were delayed times in the delay discounting task.
Figure 10
Figure 10
Iowa Gambling Task (IGT) scores after computerized cognitive addiction therapy (CCAT) or control training. The IGT score was calculated through the number of cards from the disadvantageous decks (C and D) subtracted from the advantageous decks (A and B). A positive score reflects the individual had a tendency to make better decisions. The lines are means and the error bars are the standard deviation.

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