Addition of cue exposure to cognitive-behaviour therapy for alcohol misuse: a randomized trial with dysphoric drinkers

Aim To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction ( emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric. Design Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE. Setting Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia. Participants People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded. Intervention Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance. Measurements Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression. Results Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions. Conclusions These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.

Conceptual distinctions among Carver and White's (1994) BAS scales: A reward-reactivity versus trait impulsivity perspective

The 'BIS/BAS scales' (Carver & White, 1994) is the most widely cited inventory for assessing Gray's (1982,1991) Reinforcement Sensitivity Theory (RST) of personality. A peculiarity of this instrument is its three-factor representation of Gray's Behavioural Activation System (BAS), which mediates reactions to reward. While the BAS was initially proposed as the causal basis of Impulsivity, recent arguments suggest that Impulsivity is related to but distinct from reward-reactivity. In this paper, two studies examined Carver and White's BAS scales in terms of factor structure, and convergent/divergent validity when predicting proxies of Impulsivity and reward-reactivity. Confirmatory Factor Analysis revealed structural distinctions between the three BAS scales, and multivariate regression suggested that two of the scales (Drive and Reward-Responsiveness) reflect key concepts of the BAS, while the third (Fun-Seeking) has a broader focus, being equally related to reward-reactivity and Impulsivity. (c) 2005 Elsevier Ltd. All rights reserved.