Indeed, Drummond and others can point to a few significant effects in past cue-exposure treatment studies. However, those few effects cannot mitigate the fact that the majority of studies on the efficacy of cue-exposure do not find that this therapy is effective. The mixed pattern of effects across these studies is troublesome for two reasons.
Full Answer
What is cue exposure therapy (CET)?
Cue exposure therapy (CET) aims to reduce this cue reactivity by exposing abstinent drug users to conditioned drug-related stimuli while preventing their habitual response, i.e. drug use.
How does cue exposure improve self-efficacy?
When comparing standard treatment with standard plus cue exposure treatment, research tends to find that the inclusion of cue exposure increases the patient’s self-efficacy regarding their ability to resist substances in high-risk contexts.
Does a cue exposure intervention reduce neural activity in food-cue-reactivity regions?
A cue exposure intervention did not lead to a significantly stronger reduction in neural activity in brain regions related to food-cue-reactivity, in response to visual HC palatable food stimuli, as compared to the participants that received a lifestyle intervention.
What is cue reactivity and cue exposure during extinction?
Perhaps the most researched cognitive and behavioral treatment to have emerged from the cue reactivity literature is cue exposure during extinction; by removing the reward associated with a conditioned stimulus or an operant response, an organism eventually stops expecting, or responding for, the reward.
Is cue exposure therapy effective in overcoming addiction?
Cue Exposure Therapy (CET) is a behavioristic psychological approach to treating substance use disorders (SUD). Prior systematic reviews have found CET to be ineffective when targeting SUDs.
How does cue exposure work?
CET with a moderate drinking goal (CET-MDG) involves repeated sessions during which the client is exposed to cues designed to elicit desire for additional alcohol after the client has consumed a priming dose of one or more drinks.
What is exposure therapy based on?
Exposure therapy is a technique used by therapists to help people overcome fears and anxieties by breaking the pattern of fear and avoidance. It works by exposing you to a stimulus that causes fear in a safe environment. For example, a person with social anxiety may avoid going to crowded areas or parties.
What are the different theories of addiction?
There are several theories that model addiction: genetic theories, exposure theories (both biological and conditioning), and adaptation theories.
Is cue exposure therapy a CBT?
Cue-exposure, based on classical conditioning, is a well-validated form of CBT used in the treatment of fear-based problems (Foa & Kozak, 1986) and has the goal of extinguishing a learned response through repeated exposure to a conditioned stimulus in the absence of the consequence.
What is abstinence violation effect?
The abstinence violation effect can be defined as a tendency to continue to engage in a prohibited behavior following the violation of a personal goal to abstain.
What are the disadvantages of exposure therapy?
Exposure therapy can also have occasional drawbacks:Symptoms may return: Some patients may see their symptoms return over time. 3 This is especially likely if the treatment ended prematurely.Simulated conditions don't always reflect reality: The conditions in exposure therapy do not always reflect reality.
How difficult is exposure therapy?
According to Mark Pfeffer, director of the Panic and Anxiety Center in Chicago, IL, exposure therapy is difficult work that causes people to feel things they have worked hard to avoid. Because of this, if not implemented properly, exposure therapy's positive effects can wane.
How do you apply exposure therapy?
Make a list. Make a list of situations, places or objects that you fear. ... Build a Fear Ladder. Once you have made a list, arrange things from the least scary to the most scary. ... Facing fears (exposure) Starting with the situation that causes the least anxiety, repeatedly engage in.Practise. ... Reward brave behaviour.
What are the three main psychological theories of addiction?
There are psychodynamic, attachment theory, and self-medication perspectives about addiction to consider, as well. These psychological approaches suggest that a person uses drugs to fill a terrific void in their emotional lives or as a means of quieting voices of inner conflict.
What are the 4 theories of addiction?
Psychological theories There are a variety of psychological approaches to the explanation of drug dependence, including emphasis on learning and conditioning (behavioural models), cognitive theories, pre-existing behavioural tendencies (personality theories), and models of rational choice.
What are three theories of addiction?
The theories addressed here include: Negative Reinforcement-NR (“Pain Avoidance”) Positive Reinforcement-PR (“Pleasure Seeking”) Incentive Salience-IS (“Craving”)
What is cognitive behavioral intervention?
Another cognitive-behavioral intervention—cue exposure with response prevention —has been used to help clients who want to control their drinking, as well as those who want to abstain. The assumption underlying CET is that a variety of cues have been associated over time with craving for and excessive consumption of alcohol. As a result, cues paired with withdrawal and relief drinking can come to elicit a conditioned desire or craving when the experienced drinker is in the presence of those cues. These cues include, for example, seeing or imagining one's favorite alcohol beverage, experiencing certain emotional states, being in the presence of other problem drinkers, and attending social events such as parties. Locations where one buys or consumes alcohol, illicit drug use and cigarette smoking, and, of course, consumption of an alcoholic beverage, may also trigger craving and excessive drinking.
How effective are psychosocial interventions for MI?
Although medications have been very effective in reducing alcohol use, some psychosocial interventions have also been proven effective. Individuals with MI had a significant reduction in drinking days and an increase in abstinence rates when compared to subjects receiving educational treatment. 87 CM, group counseling (e.g., AA), cue exposure therapy, and relapse prevention are other treatment methods that have been proven efficacious for AUD especially when used alongside medications.
What is cue exposure therapy?
Cue Exposure Therapy (CET) is a behavioristic psychological approach to treating substance use disorders (SUD). Prior systematic reviews have found CET to be ineffective when targeting SUDs. The effect of this approach on alcohol use disorders (AUD) seems more promising at trial level but has yet to be systematically reviewed and quantitatively analyzed. Therefore, we aimed to examine the effectiveness of CET targeting AUD compared to active control conditions in a meta-analytic review. Following a systematic search of the literature, a total of seven controlled trials were identified. CET showed no to small additional effects on drinking intensity and drinking frequency, a small additional effect on total drinking score and a moderate additional effect on latency to relapse. Stratification and analysis of a-priori defined trial covariates revealed that CET may have an increased effect in the longer term, and that CET combined with urge-specific coping skills may be the better option for treating AUD than conventional CET. Also, CET may prove less effective when comparing it to cognitive behaviour therapy as opposed to other active control conditions. The overall quality of evidence was graded low due to high risk of bias, inconsistency, imprecision and suspected publication bias. Sounder methodological trials are needed to derive a firm conclusion about the effectiveness of CET for treating AUD.
How does VR technology help with CET?
VR technology simulates and enriches real-life situations by presenting a diverse range of stimuli to create a fully immersive experience. Multiple sensory inputs (auditory, olfactory, visual, and tactile) facilitate ecological validity and provide a better alternative to classical cue-exposure methods. Lee et al. (2007) suggested that VR technology adds effectiveness to CET because of its capacity to induce greater subjective and physiological craving, which in turn prompts the generalization of treatment effects to real world, daily life activities. VR-based assessment and treatment studies have provided benefits in many psychopathologies, particularly in anxiety disorders ( Maples-Keller, Bunnell, Kim, & Rothbaum, 2017; Meyerbröker & Emmelkamp, 2010 ), post-traumatic stress disorder ( Rothbaum et al., 2014) and fear of flying ( Maples-Keller et al., 2017 ), as well as in eating disorders ( Ferrer García & Gutiérrez Maldonado, 2012 ), pain management ( Malloy & Milling, 2010 ), and drug addiction ( Hone-Blanchet, Wensing, & Fecteau, 2014 ). In AUDs, VR has been used as: a) an assessment tool (to elicit craving); and b) a VR (exposure) therapy tool (to reduce craving), variously termed VR exposure [VRE], VR therapy [VRT], or VR exposure therapy [VRET]. VRETs have achieved good results for long-term effectiveness in other disorders: for example, a 12-month follow-up study of VRET in patients with fear of flying showed long-lasting benefits ( Rothbaum, Hodges, Anderson, Price, & Smith, 2002 ). Another study indicated that the beneficial effects of VRET on fear of flying persisted over a 3-year follow-up period ( Wiederhold & Wiederhold, 2003 ).
What is a CET with a moderate drinking goal?
CET with a moderate drinking goal (CET-MDG) involves repeated sessions during which the client is exposed to cues designed to elicit desire for additional alcohol after the client has consumed a priming dose of one or more drinks. In addition to the sight and smell of one's favorite beverage, cues can include photos or videos portraying other people drinking, verbal descriptions of likely drinking situations, and role-plays designed to provoke emotions that elicit craving. Each CET-MDG session typically involves two or three “cue exposure episodes,” with repeated assessment of craving, intoxication or self-efficacy, often combined with practice of coping skills to deal with one's desire to continue drinking. CET continues until the client reports that exposure to cues no longer provokes meaningful cravings. Throughout the therapy, clients are encouraged to engage and work through their cravings, instead of fearing, avoiding, or giving in to cravings.
What is the treatment for cannabis use?
Treatment of cannabis use involves both psychotherapy and pharmacologic therapy options. 97 A range of psychotherapy models for problematic cannabis use have been tested and proven efficacious, such as aversion therapy, brief intervention therapy, CBT, voucher therapy or CM, motivational enhancement therapy, community-based therapy, and family therapy. 97,98 Longer therapies have not proven to be more advantageous compared to more brief interventions for cannabis use. 97 This has also been shown in trials for cannabis use in individuals with psychosis, in which longer intervention trials were met with high rates of relapse and did not prove more efficacious compared to the brief interventions. 99 CM has been found to enhance outcomes in, for example, CBT in individuals with cannabis use disorder. 97,100 This method of CM has also been confirmed in individuals with diagnosed schizophrenia who use cannabis, allowing for prolonged abstinence. 101
How does CET-MDG work?
During the course of CET-MDG, the client learns that the desire to continue drinking, even after one has had a priming dose (that is, a moderate amount of alcohol), will dissipate with the passage of time (habituation) and the employment of various coping skills. Although cue exposure is based on classical conditioning, and presumably works by gradual extinction or de-conditioning of craving, cue exposure may also work by increasing a client's self-efficacy That is, CET-MDG may also increase a client's belief that he or she can successfully and repeatedly resist the temptation or craving to continue drinking past one's limits, even after consuming one or more drinks. For some clients, this realization is a powerful therapeutic experience.
What is the context of CET?
Another important confound to the data could be the context in which CET takes place. The CS-US association during drug taking happens in locations relevant to the patient (context A). CET is administered in a clinical setting (context B) and after this, the patient returns to their home/ drug taking environment (context A) and therefore the extinguished cues are vulnerable to context renewal (Bouton et al, 2006). One approach to address this is to administer CET in multiple contexts in hope that extinction learning generalises across context. Another approach has been to either give patients ‘homework’ where they practice cue-exposure in a home setting or to have cue exposure entirely take place in their everyday life. The results of these studies that have extinction occur in context A are promising ( Sitharthan et al, 1997).
What is the process of learning associations between stimuli and outcomes?
Pavlovian or classical conditioning is the process of learning associations between stimuli and outcomes. In regards to addiction, drugs are an unconditioned stimulus (US) that produce reliable biological and psychological unconditioned responses (URs). It is believed locations and stimuli that are present during drug use (e.g. sight and smell of drugs, glasses, syringes, friends etc) become conditioned stimuli (CSs) that can produce a conditioned response (CR) similar to that of URs. A CS’s capacity to produce a CR is believed to lead to motivational changes such as cravings which can trigger drug use and relapse ( Everitt and Robbins, 2016)
What are the discrepancies between CET and addiction?
The discrepancy of therapeutic gains of CET between addiction and other disorders could potentially be explained by one or more of the following: 1) flaws and limitations of the current CET literature, 2) the current CET procedure failing to accommodate important theoretical influences of addiction aetiology and relapse e.g. context renewal, and 3) individual differences in learning mechanisms between drug dependent and non-dependent individuals.
What is extinction in Pavlovian conditioning?
Extinction is a phenomenon within Pav lovian conditioning where the CS-US associative link weakens after repeated non-reinforced presentations of the CS. As a result the CS loses its capacity to produce a CR ( Bouton et al, 2006). It is important to understand that extinction entails new learning and not unlearning of the original CS-US association. Extinction has led to the theoretically promising Cue-Exposure Therapy (CET).
Does CET reduce cravings?
While some research has shown CET reduces cravings, increases the time to relapse and reduces the amount of drug use to a greater extent or at least equally to the comparison control treatment ( Drummond and Glautier, 1994; Niaura et al, 1999; McClernon et al, 2007; Franken et al, 1999), CET has never produced long-term, complete abstinence for drug-dependent patients. There are several important limitations that are consistent across the majority of CET research for all drug classes which could confound the results and mask potential benefits of CET. Firstly the sample sizes of these studies tend to be small and attrition rates tend to be high. Secondly, there is often a lack of control group or no appropriate control group. Thirdly, they often lack interoceptive stimuli (e.g. moods, drug states) and only utilise a limited number of exteroceptive stimuli. The exteroceptive stimuli used has sometimes been standardised and not idiosyncratic to the patient.
Is CET effective for anxiety?
anxiety disorders ( Norton and Price, 2007). Surprisingly, in contrast to this, CET has not thus far been demonstrated to be effective for treating addiction ( Conklin and Tiffany, 2002).
Is there a lack of control group?
Secondly, there is often a lack of control group or no appropriate control group. Thirdly, they often lack interoceptive stimuli (e.g. moods, drug states) and only utilise a limited number of exteroceptive stimuli. The exteroceptive stimuli used has sometimes been standardised and not idiosyncratic to the patient.
How does CET work?
CET helps to decondition, or un-learn, those behaviors, so that people respond differently in situations that were once high risk. As a client endures his exposure sessions, and learns to identify cues, verbalizes his body’s reactions to those cues, and practices new responses in those same old situations, CET changes the associations that people learned as they cycled through an addiction. -Kevin Murphy, Psy.D. Traditionally, Alcoholics Anonymous, healthcare providers and drug counselors have categorized addiction as a disease, arguing that an addiction is akin to an incurable medical condition like diabetes. A growing number of practitioners, however, posit that addiction manifests conditioned behaviors, not a medical disorder. CET helps to decondition, or un-learn, those behaviors, so that people respond differently in situations that were once high risk (e.g., a strained marriage, a high pressure job, living alone, etc.). As a client endures his exposure sessions, and learns to identify cues, verbalizes his body’s reactions to those cues, and practices new responses in those same old situations, CET changes the associations that people learned as they cycled through an addiction. CET enhances a client’s stress tolerance, so, in a high-risk situation, s/he responds instead of reacts to a cue, thinking through instead of acting on an urge to use.
What is CET in addiction?
CET serves to empower people to control their stress and urges to use, urges that tend to rule the day in the life of a so-called addict.
Is CET a treatment for anxiety?
Eventually, it’s predicted, CET will become as mainstream a practice in the field of chemical dependency as ET in the treatment of anxiety disorders. -Kevin Murphy, Psy.D. Building on that long track record, Cue Exposure Therapy (CET) borrows heavily from the format used in ET, but is specifically designed to treat the cravings that perpetuate substance use disorders. CET acts to de-sensitize the effect of triggers (the feel of a cold bottle, the sight of a sandwich baggie, etc.) that tend to prompt cravings. Research into CET is not nearly as robust as the literature that supports the efficacy of ET. Eventually, it’s predicted , CET will become as mainstream a practice in the field of chemical dependency as ET in the treatment of anxiety disorders.
When did exposure therapy start?
Exposure Therapy emerged in the 1950s as an intervention to treat panic-phobic disorders. Owing to the abundance of empirical support behind the intervention, Exposure Therapy (ET) has become a staple in the treatment of anxiety disorders.
What is cue exposure therapy?
Cue Exposure Therapy (CET) is a behavioristic psychological approach to treating substance use disorders (SUD). Prior systematic reviews have found CET to be ineffective when targeting SUDs. The effect of this approach on alcohol use disorders (AUD) seems more promising at trial level but has yet to …
Where is the 4Addictive Behaviors and Treatment Evaluation?
4Addictive Behaviors and Treatment Evaluation, Department of Psychiatry of the Academic Medical Center, Amsterdam, Netherlands. Electronic address: [email protected].