Browsing by Author "Bickel, Warren K."
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- Choice Bundling Increases Valuation of Delayed Losses More Than Gains in Cigarette SmokersStein, Jeffrey S.; Brown, Jeremiah M.; Tegge, Allison N.; Freitas-Lemos, Roberta; Koffarnus, Mikhail N.; Bickel, Warren K.; Madden, Gregory J. (Frontiers, 2022-01-13)Choice bundling, in which a single choice produces a series of repeating consequences over time, increases valuation of delayed monetary and non-monetary gains. Interventions derived from this manipulation may be an effective method for mitigating the elevated delay discounting rates observed in cigarette smokers. No prior work, however, has investigated whether the effects of choice bundling generalize to reward losses. In the present study, an online panel of cigarette smokers (N = 302), recruited using survey firms Ipsos and InnovateMR, completed assessments for either monetary gains or losses (randomly assigned). In Step 1, participants completed a delay-discounting task to establish Effective Delay 50 (ED50), or the delay required for an outcome to lose half of its value. In Step 2, participants completed three conditions of an adjusting-amount task, choosing between a smaller, sooner (SS) adjusting amount and a larger, later (LL) fixed amount. The bundle size (i.e., number of consequences) was manipulated across conditions, where a single choice produced either 1 (control), 3, or 9 consequences over time (ascending/descending order counterbalanced). The delay to the first LL amount in each condition, as well as the intervals between all additional SS and LL amounts (where applicable), were set to individual participants' ED50 values from Step 1 to control for differences in discounting of gains and losses. Results from Step 1 showed significantly higher ED50 values (i.e., less discounting) for losses compared to gains (p < 0.001). Results from Step 2 showed that choice bundling significantly increased valuation of both LL gains and losses (p < 0.001), although effects were significantly greater for losses (p < 0.01). Sensitivity analyses replicated these conclusions. Future research should examine the potential clinical utility of choice bundling, such as development of motivational interventions that emphasize both the bundled health gains associated with smoking cessation and the health losses associated with continued smoking.
- Choosing Money over Drugs: The Neural Underpinnings of Difficult Choice in Chronic Cocaine UsersWesley, Michael J.; Lohrenz, Terry; Koffarnus, Mikhail N.; McClure, Samuel M.; De La Garza, Richard II; Salas, Ramiro; Thompson-Lake, Daisy G. Y.; Newton, Thomas F.; Bickel, Warren K.; Montague, P. Read (Hindawi, 2014-08-14)Addiction is considered a disorder that drives individuals to choose drugs at the expense of healthier alternatives. However, chronic cocaine users (CCUs)who meet addiction criteria retain the ability to choose money in the presence of the opportunity to choose cocaine. The neural mechanisms that differentiate CCUs from non-cocaine using controls (Controls) while executing these preferred choices remain unknown. Thus, therapeutic strategies aimed at shifting preferences towards healthier alternatives remain somewhat uninformed. This study used BOLD neuroimaging to examine brain activity as fifty CCUs and Controls performed single- and cross-commodity intertemporal choice tasks for money and/or cocaine. Behavioral analyses revealed preferences for each commodity type. Imaging analyses revealed the brain activity that differentiated CCUs from Controls while choosing money over cocaine. We observed thatCCUs devalued future commodities more than Controls. Choices for money as opposed to cocaine correlated with greater activity in dorsal striatum of CCUs, compared to Controls. In addition, choices for future money as opposed to immediate cocaine engaged the left dorsolateral prefrontal cortex (DLPFC) of CCUs more than Controls. These data suggest that the ability of CCUs to execute choices away from cocaine relies on activity in the dorsal striatum and left DLPFC.
- Cognitive function following SARS-CoV-2 infection in a population-representative Canadian sampleHall, Peter A.; Meng, Gang; Hudson, Anna; Sakib, Mohammed N.; Hitchman, Sara C.; MacKillop, James; Bickel, Warren K.; Fong, Geoffrey T. (Elsevier, 2022-05-01)Background: SARS-CoV-2 infection is believed to adversely affect the brain, but the degree of impact on socially relevant cognitive functioning and decision-making is not well-studied, particularly among those less vulnerable to age-related mortality. The current study sought to determine whether infection status and COVID-19 symptom severity are associated with cognitive dysfunction among young and middled-aged adults in the general population, using self-reported lapses in executive control and a standardized decision-making task. Method: The survey sample comprised 1958 adults with a mean age of 37 years (SD = 10.4); 60.8% were female. Participants reported SARS-CoV-2 infection history and, among those reporting a prior infection, COVID-19 symptom severity. Primary outcomes were self-reported symptoms of cognitive dysfunction assessed via an abbreviated form of the Barkley Deficits in Executive Functioning Scale (BDEFS) and performance on a validated delay-discounting task. Results: Young and middle-aged adults with a positive SARS-CoV-2 infection history reported a significantly higher number of cognitive dysfunction symptoms (Madj = 1.89, SE = 0.08, CI: 1.74, 2.04; n = 175) than their non-infected counterparts (Madj = 1.63, SE = 0.08, CI: 1.47,1.80; n = 1599; β = 0.26, p = .001). Among those infected, there was a dose-response relationship between COVID-19 symptom severity and level of cognitive dysfunction reported, with moderate (β = 0.23, CI: 0.003–0.46) and very/extremely severe (β = 0.69, CI: 0.22–1.16) COVID-19 symptoms being associated with significantly greater cognitive dysfunction. These effects remained reliable and of similar magnitude after controlling for demographics, vaccination status, mitigation behavior frequency, and geographic region, and after removal of those who had been intubated during hospitalization. Very similar—and comparatively larger—effects were found for the delay-discounting task, and when using only PCR confirmed SARS-CoV-2 cases. Conclusions: Positive SARS-CoV-2 infection history and moderate or higher COVID-19 symptom severity are associated with significant symptoms of cognitive dysfunction and amplified delay discounting among young and middle-aged adults with no history of medically induced coma.
- A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparitiesBickel, Warren K.; Moody, Laura; Quisenberry, Amanda J.; Ramey, Craig T.; Sheffer, C.E. (Elsevier, 2014-07-06)We propose that executive dysfunction is an important component relating to the socio-economic status gradient of select health behaviors. We review and find evidence supporting an SES gradient associated with (1) negative health behaviors (e.g., obesity, excessive use of alcohol, tobacco and other substances), and (2) executive dysfunction. Moreover, the evidence supports that stress and insufficient cognitive resources contribute to executive dysfunction and that executive dysfunction is evident among individuals who smoke cigarettes, are obese, abuse alcohol, and use illicit drugs. Collectively these data support the dual system model of cognitive control, referred to here as the Competing Neurobehavioral Decision Systems hypothesis. The implications of these relationships for intervention and social justice considerations are discussed.
- Congruence of BOLD Response across Intertemporal Choice Conditions: Fictive and Real Money Gains and LossesBickel, Warren K.; Pitcock, Jeffery A.; Yi, Richard; Angtuaco, Edgardo J.C. (Society for Neuroscience, 2009-07-08)Intertemporal choice is predicated on the valuation of commodities with respect to delay until their receipt. Subjective value of a future outcome decreases, or is discounted, as a function of that delay (Bickel and Johnson, 2003). Although behavioral studies suggest no difference between the devaluation of real and fictive outcomes, no neuroimaging studies have investigated potential differences in the underlying deliberative process. Here, we compare behavioral and neural correlates of intertemporal valuation of real and hypothetical monetary gains as well as hypothetical losses, which have been posited to involve different mechanisms. Behavioral and neuroimaging sessions were conducted in which participants made intertemporal choice decisions in a gains condition using both real and hypothetical $100 money and in a loss condition using a fictive $100 money. Within-subject comparison of behavioral data revealed no significant difference between levels of discounting across the three conditions. Random-effects analysis of functional magnetic resonance imaging (fMRI) data of each of the three discounting conditions independently revealed significant signal change in limbic (anterior cingulate, striatum, posterior cingulate) and executive functioning areas (lateral prefrontal cortex), whereas a repeated-measures ANOVA failed to detect differences in signal change across the three discounting conditions after correcting for multiple comparisons. These data support a concordance between real and hypothetical conditions from delay-discounting studies and further suggest a congruence of the fMRI blood oxygen level-dependent signal across brain regions associated with the deliberative process of different forms of intertemporal choice.
- Cumulative Vulnerabilities: Substance Use in Adolescence and in RecoveryTomlinson, Devin Christine (Virginia Tech, 2023-07-27)Substance use and substance use disorders (SUDs) pose a significant health and economic concern in the United States. Conditions and comorbidities exist that are associated with substance use onset, continuation, and outcomes. In the theory of Reinforcer Pathology, we can categorize these conditions into vulnerabilities, or factors that may be associated with susceptibility to substance use onset and poorer outcomes in substance use recovery. The theory of vulnerabilities and reinforcer pathology is tested through three investigations. The first investigation sought to establish the relationship between cumulative vulnerabilities and adolescent substance use in a cross-sectional analysis. The second investigation evaluates the temporal relationship of cumulative vulnerabilities and substance use among adolescents. The final investigation establishes the relationship of cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, these reports suggest that the intersection and cumulation of vulnerabilities to substance use and substance use disorders are directly related to substance use outcomes. Future research and reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns.
- Delay Discounting, Reinforcing Value of Food, and Components of Metabolic HealthBellows, Abby Gail (Virginia Tech, 2018-07-02)Background: According to the Centers for Disease Control and Prevention (CDC), over one-third of US adults are obese. In order to assess causes of and treatments for obesity, researchers have evaluated a number of processes underlying health-related behaviors, one of which is delay discounting. Delay discounting is a cognitive process that describes the phenomenon by which individuals discount the value of a future reward compared to the value of an immediate reward. Researchers have associated delay discounting with drug addiction, alcoholism, and cigarette smoking. More recently, delay discounting has been studied with regards to health-related behaviors, such as body weight management, food intake, glucose control, and physical activity. While a number of studies have concluded that obese individuals tend to be greater discounters, the relationship between delay discounting and various health-related behaviors beyond smoking and drug use remains unclear. The purpose of this study is to evaluate the relationship between delay discounting and diet quality, glucose tolerance, physical activity, and fasting vs. non-fasting conditions. Methods: Sixty-five males (n=20) and females (n=45) were recruited for the present study. Participants completed two lab sessions: one under non-fasting conditions, and one under fasting conditions which involved measurements of body mass and composition, blood pressure, blood glucose, blood lipids, and health-related questionnaires. Delay discounting and food purchase tasks were completed at both visits. Participants were asked to complete a four-day food intake record and wear a physical activity monitor for four days. Results: Lower rates of discounting were found in those who consumed more total vegetables, and lower food reinforcement was observed in those who spent less time sedentary and more time physically active, had greater dietary Restraint, and had a lower resting heart rate. There were no significant differences between discounting rates and food reinforcement across fasting and non-fasting conditions.
- Delayed reward discounting and grit in men and women with and without obesityThomas, J. Graham; Seiden, Andrew; Koffarnus, Mikhail N.; Bickel, Warren K.; Wing, Rena R. (Wiley, 2015-08-15)Objective The objective of this study was to examine how sensitivity to short-term reward and longterm goal perseverance are related to body mass index (BMI; kgm²) in a large sample of men and women with and without obesity. Methods A total of 450 participants (56.2% male; 73.1% non-Hispanic White) with mean ± standard deviation age of 30.7 ± 10.4 years and BMI of 29.3 ± 8.2 completed online versions of the Delayed Reward Discounting task to measure sensitivity to short-term reward and the Grit Scale to measure long-term goal perseverance. Results In regression analysis, higher sensitivity to short-term reward (i.e. a preference for receiving smaller rewards after a shorter delay; b = 0.49, p = 0.016) and lower long-term goal perseverance (b = 1.26, p = 0.042) were independently associated with higher BMIs. Individuals with a favourable score on one measure were not ‘protected’ from the risk associated with an unfavourable score on the other measure. Conclusions An overvaluation of short-term reward (e.g. the taste of palatable food and the comfort of engaging in sedentary activities) and undervaluation of long-term health goals (e.g. achieving a healthy weight and avoiding obesity-related comorbidities) may contribute to excess weight. Additional research incorporating prospective experimental designs is needed to determine whether decision-making strategies can be targeted to improve weight management.
- A Developmental Cascade Model of Maltreatment, Delay Discounting, and Health Behaviors across Adolescence and Young AdulthoodPeviani, Kristin Marie (Virginia Tech, 2022-06-15)Maltreatment is a pervasive global problem known to have cascading consequences that persist long after exposure subsides (Masten and Cicchetti, 2010). Maltreatment is often co-occurring, involving exposure to multiple types. Cumulative maltreatment, or exposure to multiple types of neglect and abuse, is proposed to be of critical importance for developmental psychopathology. However, a cumulative approach to studying maltreatment provides little insight into the developmental processes whereby it exerts its effects on health. Thus, we employed both a cumulative approach and a multidimensional approach to facilitate our comprehensive understanding of maltreatment experiences related to behavioral development. Given the high prevalence of maltreatment, it is important to cultivate a greater understanding of the processes linking maltreatment and health and to identify developmental periods of vulnerability to its deleterious effects. The present study uses a longitudinal design and a multidimensional approach to examine the effects of maltreatment on delay discounting and health-promoting and health-demoting behaviors during adolescence and across the transition from adolescence to young adulthood. The study sample includes 167 adolescents (aged 13–14 at Time 1; 53% male) who participated across 5 time points over 6 years. At Time 5, adolescents provided retrospective reports of their exposure to maltreatment during adolescence across ages 13–18. Delay discounting, substance use, and body mass index (BMI) were assessed at each time point. We used a developmental cascade model with autoregressive, cross-lagged, and cross-sectional associations to examine the longitudinal multivariate change processes and indirect effects from maltreatment exposure during adolescence to delay discounting and health-promoting and health-demoting behaviors during adolescence and across the transition to young adulthood. Our results indicate that cumulative maltreatment affects health-demoting behavior via its effects on delay discounting and that maltreatment of omission but not commission drives this effect. Furthermore, the findings identify adolescents exposed to maltreatment of omission as being especially vulnerable to marijuana use via elevated delay discounting. Identifying mediating processes linking maltreatment exposure to health-promoting and health-demoting behaviors may be instrumental for preventing deleterious developmental cascades and interrupting related health problems during adolescence and across the transition from adolescence to young adulthood.
- Dissociation and other trauma symptomatology are linked to imbalance in the competing neurobehavioral decision systemsBasso, Julia C.; Satyal, Medha K.; McKee, Kevin L.; Lynn, Sarah; Gyamfi, Daphne; Bickel, Warren K. (Frontiers Media, 2024-01-31)Objective: Dissociation is a conscious state characterized by alterations in sensation and perception and is thought to arise from traumatic life experiences. Previous research has demonstrated that individuals with high levels of dissociation show impairments in cognitive-emotional processes. Therefore, using the Competing Neurobehavioral Decisions System (CNDS) theory, we used statistical modeling to examine whether dissociative experience and trauma symptoms are independently predicted by impulsivity, risk-seeking, affective state (i.e., anxiety, depression, stress, and negative affect), and trauma history. Method: In this cross-sectional study design, data were collected via Amazon Mechanical Turk from a total of n = 557 English-speaking participants in the United States. Using Qualtrics, participants answered a series of self-reported questionnaires and completed several neurocognitive tasks. Three independent multiple linear regression models were conducted to assess whether impulsivity, risk seeking, affective state, and trauma history predict depersonalization, trauma symptoms, and PTSD symptoms. Results: As hypothesized, we found that depersonalization and other trauma symptoms are associated with heightened impulsivity, increased risk-seeking, impaired affective states, and a history of traumatic experiences. Conclusion: We demonstrate that an imbalanced CNDS (i.e., hyperimpulsive/ hypoexecutive), as evidenced by decreased future valuation, increased risk seeking, and impaired affective states, predicts heightened depersonalization and other trauma and PTSD symptomatology. This is the first time that dissociation has been connected to delay discounting (i.e., the tendency to place more value on rewards received immediately compared to farther in the future). Interventions that positively impact areas of the CNDS, such as episodic future thinking or mindfulness meditation, may be a target to help decrease dissociative symptoms.
- Dosing parameters for the effects of high-frequency transcranial magnetic stimulation on smoking cessation: Study protocol for a randomized factorial sham-controlled clinical trialCarl, Ellen; Liskiewicz, Amylynn; Rivard, Cheryl; Alberico, Ronald; Belal, Ahmed; Mahoney, Martin C.; Quisenberry, Amanda J.; Bickel, Warren K.; Sheffer, Christine E. (Springer, 2020-05-01)Background: Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term benefits of quitting. Conceptual and empirical evidence supports continued investigation of high frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in reducing relapse and decreasing cigarette consumption. While this evidence is compelling, an optimal dosing strategy must be determined before a long-term efficacy trial can be conducted. The goal of this study is to determine a dosing strategy for 20 Hz rTMS that will produce the best long-term abstinence outcomes with the fewest undesirable effects. Methods: This is a fully crossed, double-blinded, sham-controlled, 3x2x2 randomized factorial study. The three factors are duration (stimulation days: 8, 12, and 16); intensity (900 or 1800 pulses per day); and sham control. Participants (n = 258) will consist of adults (18-65) who are motivated to quit smoking cigarettes and who will be followed for 6 months post-quit. Outcomes include latency to relapse, point prevalence abstinence rates, delay discounting rates, cognitive-behavioral skills acquisition, and multiple measures of potential undesirable effects that impact participant compliance. Discussion: This study integrates existing theoretical concepts and methodologies from neuropsychology, behavioral economics, brain stimulation, clinical psychology, and the evidence-based treatment of tobacco dependence in the development of a promising and innovative approach to treat tobacco dependence. This study will establish an optimal dosing regimen for efficacy testing. Findings are expected to have a significant influence on advancing this approach as well as informing future research on clinical approaches that combine rTMS with other evidence-based treatments for tobacco dependence and perhaps other addictions.
- The Effect of Episodic Future Thought on Delay Discounting, Outcome Expectancies, and Alcohol Use among Risky College DrinkersBanes, Kelsey E. (Virginia Tech, 2016-11-01)Positive, but distal consequences of reducing alcohol use among at-risk users may have little impact on behavior due to temporal discounting (Mazur, 1987), in which delayed rewards are devalued relative to more proximal rewards, even if such distal rewards actually provide considerably more value. Delay discounting may be manipulated using a variety of means, one of which involves utilizing prospective thinking about future autobiographical events and is termed Episodic Future Thinking (Atance and ONeill, 2001). Episodic future thinking (EFT) has been demonstrated in previous studies to be effective in reducing delay discounting relative to a variety of control conditions (Benoit, Gilbert, and Burgess, 2011; Daniel, Stanton, and Epstein, 2013a, 2013b; Lin and Epstein, 2014; Peters and Büchel, 2010) and recently among substance-abusing populations (Snider, LaConte, and Bickel, 2016; Stein et al., 2016). The present study examined EFT in a novel sample of at-risk alcohol users. Participants were randomized to EFT, episodic past thinking (EPT), or a control condition in which non-autobiographical events were recalled (CET). Immediately following intervention, results demonstrated significantly less discounting in EFT and EPT, relative to CET. At follow-up, EFT demonstrated significantly less temporal discounting and alcohol use, when compared to both EPT and CET. No differences among conditions in alcohol demand or alcohol use intentions were observed. The present study contributes a number of novel findings to the literature, most notably that engaging in EFT predicts reductions in alcohol use prospectively and that reductions in delay discounting associated with EFT persist at least a week later, without any additional intervention. Such findings suggest that EFT manipulations influence the valuation of future rewards. Additionally, findings support EFT as a useful supplement to existing empirically-supported treatments or a component of novel substance use disorder treatments.
- Episodic Future Thinking about Smoking-Related Illness: A Preliminary Investigation of Effects on Delay Discounting, Cigarette Craving, and Cigarette DemandRuhi-Williams, Perisa; King, Mary J.; Stein, Jeffrey S.; Bickel, Warren K. (MDPI, 2022-06-10)Cigarette smokers show excessive delay discounting (devaluation of delayed rewards), which may contribute to tobacco use disorder. Episodic future thinking (EFT), or mental simulation of future events, has been shown to reduce both delay discounting and laboratory smoking behavior. Traditionally, EFT involves vividly imagining positive future events. In this preliminary investigation, we examined the effects of EFT specifically about smoking-related illness (SRI) on delay discounting, cigarette craving, and behavioral economic demand for cigarettes. In a 2 (episodic thinking) × 2 (smoking-related illness) factorial design, we randomly assigned smokers from Amazon Mechanical Turk to one of two EFT groups: EFT alone or EFT + SRI; or one of two episodic “recent” thinking (ERT) control groups: ERT alone or ERT + SRI. Both EFT groups generated and imagined positive future events, while both ERT groups imagined real events from the recent past. Both EFT + SRI and ERT + SRI groups imagined these events while also experiencing SRI symptoms. Participants then completed assessments of delay discounting, cigarette craving, and measures of cigarette demand. We observed significant main effects on delay discounting of both EFT (reduced discounting) and SRI (increased discounting), as well as significant main effects of both EFT and SRI on cigarette craving (in both cases, reduced craving). No significant main effect of EFT was observed on cigarette demand measures, although we observed a main effect of SRI on quantity of demand when cigarettes were free (Q0) (reduced demand). In all analyses, we observed no significant EFT × SRT interactions, indicating that these variables operate independently of one another. These methods may be adapted for use in clinical treatment to aid in smoking cessation interventions.
- Estimating the Impact of Tobacco Parity and Harm Reduction Tax Proposals Using the Experimental Tobacco MarketplaceFreitas Lemos, Roberta; Keith, Diana R.; Tegge, Allison N.; Stein, Jeffrey S.; Cummings, Kenneth Michael; Bickel, Warren K. (MDPI, 2021-07-23)Taxes are a demonstrably effective method to suppress tobacco use. This study examined the effects of the tobacco parity (i.e., imposing taxes equally on all tobacco products) and the harm reduction (i.e., applying taxes in proportion to the products’ levels of harm) tax proposals on demand and substitution across products. A crowdsourced sample of cigarette smokers (n = 35) completed purchasing trials with increasing tax magnitudes across different tax tiers in the Experimental Tobacco Marketplace in a repeated-measures design. Products were placed in three tax tiers (high, medium, and no tax) according to each proposal’s goal. The results indicated that total nicotine (mg) purchased was not significantly different between the proposals, with higher taxes yielding lower demand. However, as taxes increased, the tobacco parity proposal decreased the purchasing of all tobacco products and increased the purchasing of medicinal nicotine (i.e., the no tax tier). Conversely, the harm reduction proposal resulted in greater purchases of electronic nicotine delivery systems and smokeless tobacco (i.e., the medium tax tier). These findings support tobacco taxation as a robust tool for suppressing purchasing and suggest that differential taxation in proportion to product risk would be an effective way to incentivize smokers to switch from smoked to unsmoked products. Further studies should investigate the unintended consequences of their implementation.
- Evidence of Executive Dysfunction in Co-occurring Substance Use Disorder and Major Depressive Disorder or Antisocial Personality DisorderMoody, Lara (Virginia Tech, 2014-09-12)Background and Aims: Executive dysfunction is pervasive in substance-dependent individuals (Verdejo-GarcÃa, Bechara, Recknor, & Perez-Garcia, 2006). As many as four-fifths of individuals in treatment for substance use disorders (SUDs) have co-existing lifetime psychopathology. Executive function deficits are tied to markers of decreased quality of life including increases in negative life events (Green, Kern, Braff, & Mintz, 2000), maladaptive social functioning (Kurtz, Moberg, Ragland, Gur, & Gur, 2005) and worsened treatment outcomes (Czuchry & Dansereau, 2003). Despite evidence of executive dysfunction across several mental disorders, few studies investigate how the co-occurrence of psychopathologies in SUDs impacts executive functioning. Methods: Here, we compare measures of executive function (i.e., the Iowa Gambling Test, Letter Number Sequencing Test, Stroop Test, Wisconsin Card Sorting Test, Continuous Performance Test, Towers Test, and Delay Discounting Test) in individuals with a) substance use disorder, b) substance use disorder and co-occurring major depressive disorder, c) substance use disorder and co-occurring antisocial personality disorder, d) substance use disorder and co-occurring major depressive disorder and antisocial personality disorder and e) no substance use disorder or co-occurring psychopathology. Results: Regression models of respective executive function measure outcomes as a function of education, income, age, and group membership indicated that the Delay Discounting Test and Continuous Performance Test were the only significant overall models (F(4, 313) = 12.699, p < 0.001 and F(4, 307) = 2.659, p = 0.033, respectively). Conclusions: Overall the Delay Discounting Test and Continuous Performance Test were the most sensitive to differences between substance use and psychopathology profiles assessed.
- Future Thinking Priming Especially Effective at Modifying Delay Discounting Rates among Cigarette SmokersShevorykin, Alina; Bickel, Warren K.; Carl, Ellen; Sheffer, Christine E. (MDPI, 2021-08-18)Background: Tobacco use remains one of the world’s greatest preventable causes of death and disease. While most smokers want to quit, few are successful, highlighting a need for novel therapeutic approaches to support cessation efforts. Lower delay discounting (DD) rates are associated with increased smoking cessation success. Future thinking priming (FTP) reliably reduces DD rates in large populations. Smokers consistently discount more than nonsmokers, and evidence suggests that changes in DD rates are rate dependent. This study examined whether smoking status moderated the effect of FTP on DD rates and, if so, if the moderation effect could be attributed to differences in baseline rates of DD. Methods: Moderation analysis was conducted to determine whether the effect of FTP, versus neutral priming (NP), on DD differed among smokers and nonsmokers. Results: Smoking status moderated the effect of condition (FTP vs. NP) on post-intervention DD scores (b = −0.2919, p = 0.0124) and DD change scores (b = −0.2975, p = 0.0130). There was no evidence of rate dependence effects in the current sample. Conclusions: FTP had a greater effect on decreasing DD rates among smokers than nonsmokers. FTP is effective and simple to administer, which makes it a promising therapeutic approach for aiding smoking cessation.
- Imagine to Remember: An Episodic Future Thinking Intervention to Improve Medication Adherence in Patients with Type 2 DiabetesEpstein, Leonard H.; Jimenez-Knight, Tatiana; Honan, Anna M.; Paluch, Rocco A.; Bickel, Warren K. (Dove Medical Press, 2022-01-01)Purpose: Medication nonadherence is prevalent in diabetic populations, with “forgetting” a commonly cited reason. This issue of forgetfulness is due, in part, to a failure of prospective memory (PM). Episodic future thinking (EFT) has been shown to improve PM but has not been used to improve medication adherence. Patients and Methods: The current study used a multiple baseline design (N = 4) to test the effects of EFT on medication non-adherence for four patients with a diagnosis of type 2 diabetes or prediabetes, with comorbid high blood pressure or high cholesterol. Medication adherence was objectively measured over 15 weeks using medication event monitoring systems. Results: Results of visual analysis showed medication adherence was reliably improved, confirmed by mixed model analysis of variance (p < 0.001), with significant differences from baseline to treatment (Tau <0.05) for 3 of 4 participants. Improvements in two measures of PM (effect size (ES) = 0.73, 0.80) and delay discounting (ES = 1.20) were observed. Conclusion: This study provides a feasible way to improve medication adherence in patients with prediabetes or type 2 diabetes.
- Imagining the Future to Reshape the Past: A Path to Combine Cue Extinction and Memory Reconsolidation With Episodic Foresight for Addiction TreatmentRafei, Parnian; Rezapour, Tara; Bickel, Warren K.; Ekhtiari, Hamed (Frontiers, 2021-07-21)Continuous maladaptive drug-related memories that are resistant to extinction and cause drug-seeking behaviors to be triggered are known to be one of the hallmarks of drug addiction (1). These drug-related memories are salient, strong, and persistent due to chronic maladaptive consolidation processes. Due to the salient content of drug-related memories formed during drug-taking behaviors, certain stimuli (e.g., peers, locations, paraphernalia) become encoded with reward contingencies associated with drugs. As a result of this learning processing, drug-paired stimuli acquire incentive motivational properties that change them into salient cues (2). According to Pavlovian conditioning, consequent exposure to these stimuli (Henceforth called drug cues) activates the original memories and evokes craving. This enhanced retrieval co-occurs with the activation of limbic cortico-striatal pathways involved in reward processing (3). A serious question in addiction neuroscience is whether these memories could be actively erased/reshaped in favor of the recovery process. Different research groups suggested various treatment strategies during the last decade to modulate these memories. Here in this short opinion paper, we propose a novel framework titled “Cue-induced Retrieval and Reconsolidation with Episodic Foresight” (CIREF) that aims to combine three different cognitive interventions, i.e., cue-exposure, memory reconsolidation, and episodic future thinking, to reshape these maladaptive drug-related memories toward more adaptive memories to support addiction recovery.
- The Impact of Pain on Key Outcomes in Opioid Use Disorder RecoveryCraft III, William Hugh (Virginia Tech, 2023-07-24)Opioid misuse and addiction constitute a significant public health challenge in the 21st century, with opioids involved in the majority of drug overdose deaths since 1999. A vigorously researched area that contributes substantially to the opioid misuse and addiction challenge is pain. The impact of pain, however, on important health outcomes for individuals in recovery from opioid use is less well understood. The effects of pain on substance use and mental health outcomes was investigated among individuals in recovery from opioid use disorder. Two studies are reported. First, the relationships between pain status and severity on substance use, treatment utilization, and mental health outcomes (e.g., depressive symptoms) was characterized cross-sectionally. Second, subgroups of OUD recovery defined by depression, opioid withdrawal, and pain were identified. Relationships between recovery subgroups, OUD symptoms, remission, opioid use, and quality of life were assessed. Finally, transitions among subgroups across 4 years of recovery were characterized. The present findings support pain as a key dimension of opioid use disorder recovery, highlighting the distinction between acute and chronic pain, the dynamic nature of opioid use disorder recovery, and emphasizing the necessity of integrating pain into opioid use disorder treatment.
- The influence and manipulation of resting-state brain networks in alcohol use disorderMyslowski, Jeremy Edward (Virginia Tech, 2024-01-25)Alcohol use disorder is common, and treatments are currently inadequate. Some of the acute effects of alcohol on the brain, such as altering the decision-making and future thinking capacities, mirror the effects of chronic alcohol use. Therefore, interventions that can address these shortcomings may be useful for reducing the negative effects of alcohol use disorder in combination with other therapies. The signature of those interventions may also be evident in the signature of large-scale, dynamic brain networks, which can show whether an intervention is effective. One such intervention is episodic future thinking, which has been shown to reduce delay discounting and orient people toward pro-social, long-term outcomes. To better understand decision making in high-risk individuals, we examined delay discounting in an adolescent population. When the decision-making faculties were challenged with difficult choices, adolescents made decisions inconsistent with their predicted preference, complemented by increased brain activity in the central executive network and salience network. Using these results and the hypothesis that the default mode network would be implicated in future thinking and intertemporal choice, we examined the neural effects of a brief behavioral intervention, episodic future thinking, that seeks to address these impairments. We showed that episodic future thinking has both acute and longer-lasting effects on consequential brain networks at rest and during delay discounting compared to a control episodic thinking condition in alcohol use disorder. Our failure to show group differences in default mode network prompted us to scrutinize it more carefully, from a position where we could measure the ability to self-regulate the network rather than its resting-state tendency. We implemented a real-time fMRI experiment to test the degree to which people along the alcohol use severity spectrum can self-regulate this network. Our results showed that default mode network suppression is impaired as alcohol use disorder severity increases. In the process, we showed that direct examination of resting-state networks with these methods will provide more information than measuring them at rest alone. We also characterized the default mode network along the real-time fMRI pipeline to show the whole-brain spatial pattern of regions associated and unassociated with the network. Our results indicate that resting-state brain networks are important markers for outcomes in alcohol use disorder and that they can be manipulated under experimental conditions, potentially to the benefit of the afflicted individual.
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