Periodic Reporting for period 4 - Self-Control (Take control!Towards novel training regimes enhancing inhibition and impulse control in health and psychiatric disease)
Reporting period: 2021-02-01 to 2022-01-31
Imagine you are on a diet, and you are painfully aware that another piece of that delicious chocolate cake is waiting for you in the refrigerator. Do you go and get it, or not? Although our environment is full of temptations, we have mechanisms for resisting them. To reach your long-term goal of losing weight, you may be able to resist that mouth-watering temptation and keep from opening the refrigerator. The ability to postpone immediate gratification – also known as self-control, inhibition, self-regulation, or willpower – is extremely valuable. It is important in the context of addiction (e.g. to alcohol or nicotine), impaired emotion regulation (e.g. borderline personality disorder), and eating disorders (e.g. obesity), where the ability to control impulses is oftentimes disturbed. These disorders, which are highly debilitating for the individual, also impose considerable social and economic costs.
Research has shown that the prefrontal cortex, in particular the right inferior frontal gyrus, of the brain is the key to self-control. Later in life, the ability to inhibit responses wanes, accompanied by a natural decrease in the volume of the prefrontal cortex. The present research aims to show that there are ways to strengthen this part of the brain and therewith enhance the ability to resist the urge to go the refrigerator, light a cigarette, or open a bottle of whiskey.
In a first study on older adults we were able to demonstrate that a custom-made video game played on a day-to-day basis over a period of two months can increase self-control. We were able to show that the training that we developed increases the thickness of right inferior frontal gyrus, a subpart of the prefrontal cortex, and train the ability to inhibit prepotent responses in an untrained task. This finding is remarkable in two ways, first that we find brain structural growth in a population above the age of 60 years, where neural plasticity has often been called into question and second that self-control can actually be trained, since this has frequently been doubted in the scientific community.
The overall goal of this ERC starting grant was to develop and optimize this promising self-control training and investigate its effectiveness in real-life self-regulation problems in the healthy population (dieting and quitting to smoke) as well as in patients suffering from alcohol addiction. We evaluated other training approaches that have been proven successful in addiction such as trainings using the so-called approach-avoidance task (AAT). In this task addicted individuals have been shown to be faster in pulling pictures to themselves that relate to their addiction and slower in pushing them away. We have developed a so called “in sensu” AAT (imaginal retraining), a variant of the AAT where the approach and avoidance is accomplished mentally by means of imagination. In the studies that we performed this imaginal approach has proved to be successful in terms of reducing alcohol consumption and craving for alcohol. Moreover, we demonstrated positive effects on craving for high-caloric foods in obese women and in smokers. The effects in smokers were demonstrated to persist in a 1 year follow up. In order to communicate this new “in sensu” AAT we created a video instruction: https://clinical-neuropsychology.de/retraining_download/.
Furthermore, we developed a virtual reality(VR)-based AAT training that we are currently still gathering evidence with.
Our hope is that these digital training interventions, which are relatively easy to implement, might be used to augment common psychotherapeutic approaches to addiction. But most importantly, these self-control training approaches can enable everyone to improve their capacity for self-regulation.
Research has shown that the prefrontal cortex, in particular the right inferior frontal gyrus, of the brain is the key to self-control. Later in life, the ability to inhibit responses wanes, accompanied by a natural decrease in the volume of the prefrontal cortex. The present research aims to show that there are ways to strengthen this part of the brain and therewith enhance the ability to resist the urge to go the refrigerator, light a cigarette, or open a bottle of whiskey.
In a first study on older adults we were able to demonstrate that a custom-made video game played on a day-to-day basis over a period of two months can increase self-control. We were able to show that the training that we developed increases the thickness of right inferior frontal gyrus, a subpart of the prefrontal cortex, and train the ability to inhibit prepotent responses in an untrained task. This finding is remarkable in two ways, first that we find brain structural growth in a population above the age of 60 years, where neural plasticity has often been called into question and second that self-control can actually be trained, since this has frequently been doubted in the scientific community.
The overall goal of this ERC starting grant was to develop and optimize this promising self-control training and investigate its effectiveness in real-life self-regulation problems in the healthy population (dieting and quitting to smoke) as well as in patients suffering from alcohol addiction. We evaluated other training approaches that have been proven successful in addiction such as trainings using the so-called approach-avoidance task (AAT). In this task addicted individuals have been shown to be faster in pulling pictures to themselves that relate to their addiction and slower in pushing them away. We have developed a so called “in sensu” AAT (imaginal retraining), a variant of the AAT where the approach and avoidance is accomplished mentally by means of imagination. In the studies that we performed this imaginal approach has proved to be successful in terms of reducing alcohol consumption and craving for alcohol. Moreover, we demonstrated positive effects on craving for high-caloric foods in obese women and in smokers. The effects in smokers were demonstrated to persist in a 1 year follow up. In order to communicate this new “in sensu” AAT we created a video instruction: https://clinical-neuropsychology.de/retraining_download/.
Furthermore, we developed a virtual reality(VR)-based AAT training that we are currently still gathering evidence with.
Our hope is that these digital training interventions, which are relatively easy to implement, might be used to augment common psychotherapeutic approaches to addiction. But most importantly, these self-control training approaches can enable everyone to improve their capacity for self-regulation.
We have conducted several studies in different addicted populations (alcohol-dependent patients, smokers, and gamblers) testing assumed working mechanisms of the approach-avoidance based training. In typical approach-avoidance trainings (AAT) participants are asked to push disease-related pictures away from themselves and pull non-disease-related pictures towards themselves. This has previously been shown to reduce relapse rates in alcohol dependent patients. We have not been particularly successful in replicating these effects, and therefore developed a new “in sensu” imaginal AAT variant.
The advantages of “in sensu” AAT compared to the classical computer-based AAT is, that (1) this approach does not require an external device and therefore can be exercised where and whenever needed, and (2) participants can work using their preferred object that they want to avoid (e.g. a particular brand) which will likely make the training more successful, and (3) the training involves an additional affective response.
Moreover we developed a virtual reality(VR) based AAT version in which patients are seated in a bar setting, a bar tender offers them drinks by placing them on the counter, and the patient’s task is to pull non-alcoholic bottles towards themselves and push alcoholic bottles away and throw them over the counter. Pilot data shows the success of this VR AAT version, however a randomized controlled study is still in the phase of data acquisition (Covid-19 related delay).
The advantages of “in sensu” AAT compared to the classical computer-based AAT is, that (1) this approach does not require an external device and therefore can be exercised where and whenever needed, and (2) participants can work using their preferred object that they want to avoid (e.g. a particular brand) which will likely make the training more successful, and (3) the training involves an additional affective response.
Moreover we developed a virtual reality(VR) based AAT version in which patients are seated in a bar setting, a bar tender offers them drinks by placing them on the counter, and the patient’s task is to pull non-alcoholic bottles towards themselves and push alcoholic bottles away and throw them over the counter. Pilot data shows the success of this VR AAT version, however a randomized controlled study is still in the phase of data acquisition (Covid-19 related delay).
We have developed, tested and started to disseminate a new self-control training variant, called „in sensu“ AAT. We have proven its utility in the domain of alcohol consumption (Moritz et al., 2019), craving for high-caloric foods in obese women (Moritz et al., 2019) and in smokers (Moritz et al., 2020). The training effects in smokers were even persistent in a 1 year follow-up assessment (Gehlenborg et al., 2021). Moreover, we did first steps in ordert o disentangle which elements of the procedure are most effective (Wirtz et al., 2021; Moritz, et al., 2021). To ease the process of communicating the new technique we created a video instruction that we are testing in an ongoing study.
The studies in which we implemented a virtual reality (VR) AAT also opened up a new arena of research in cognitive bias modification (Mellentin et al., 2020), which patients seem to enjoy. However, this approach affords more technical equipment and is therefore more inflexible to use.
We are currently making an effort to spread the word of the „in sensu“ AAT technique to enable the general population to use it for the idiosyncratic temptations they wish to refrain from, e.g. chocolate chip cookies, smoking. Taken together we hope that this research program helps individuals to enhance self-control, a virtue that is at the heart of human nature, and that humans have striven towards ever since Eve could not resist the apple from the forbidden tree.
The studies in which we implemented a virtual reality (VR) AAT also opened up a new arena of research in cognitive bias modification (Mellentin et al., 2020), which patients seem to enjoy. However, this approach affords more technical equipment and is therefore more inflexible to use.
We are currently making an effort to spread the word of the „in sensu“ AAT technique to enable the general population to use it for the idiosyncratic temptations they wish to refrain from, e.g. chocolate chip cookies, smoking. Taken together we hope that this research program helps individuals to enhance self-control, a virtue that is at the heart of human nature, and that humans have striven towards ever since Eve could not resist the apple from the forbidden tree.