1 Temporary goals vs. alcohol cues: Assessing attentional priority in heavy drinkers
Malvika Godara Student ID: 10895450 Research Master Thesis
Department: Developmental Psychology
Supervisors: Prof. Reinout Wiers & Dr. Bram Van Bockstaele Second Assessor: Dr. Elske Salemink
Abstract
Alcohol use disorders, persevering patterns of excessive drinking, create a huge social and economic burden on the society. Attentional Bias (AB) for alcohol cues, automatic direction of attention, is a crucial factor in the development and maintenance of disordered alcohol use. Treatments incorporating attentional training have shown favorable initial results in reducing AB for alcohol cues, but the impact is not long-term and does not always generalize, pointing towards a need for improvement. Research in the domain of anxiety has shown that temporary goals, induced within task, can override attention for
threat. Attention to alcohol cues is thought to function, much like threat, in a bottom-up manner. Therefore, the current study investigated whether temporary goals take preference over alcohol cues in
the attentional system. Sixty heavy drinkers performed modified dot probe and flanker tasks designed to test spatial attention by presenting goal- and alcohol-relevant stimuli together. Dot probe results confirm that individuals display an AB towards goal-relevant stimuli in the presence of alcohol cues,
while flanker analyses revealed a greater interference effect of goal-relevant stimuli. These findings suggest that attention to alcohol cues is more malleable and situational, and can be used to improve the
3 Comparing attention deployment to temporary goal and alcohol cues in heavy drinkers
Alcohol use disorder (AUD), alcohol abuse and dependence, stems from persevering patterns of excessive drinking, and is associated with many physical and mental comorbidities, such as heart and liver diseases, anxiety disorders and suicidal ideation (Grant et al., 2004; Rehm, 2011). AUD is
typically characterized by heavy drinking, difficulty cutting down, engaging in risky situations such as unsafe sex, and usage resulting in physical and social problems for the individual and society
(American Psychiatric Association, 2013). AUD is among the most prevalent mental disorders globally (Grant et al., 2015; World Health Organization, 2015), with at least 23 million affected individuals in the European Union (EU) alone (Rehm et al., 2015). Moreover, the health, social and economic consequences associated with AUD beget a huge burden on the society; it is the costliest mental problem in the EU (Effertz & Mann, 2013). Therefore, it is important to understand the mechanisms through which AUD develops, and how the development of the disorder can be impeded.
Attentional bias (AB) for alcohol cues, i.e. the preferential deployment of attention to alcohol-related stimuli over other stimuli, has been suggested to play a causal role in the development and maintenance of AUD (Cox et al., 2006; Field & Cox, 2008; Franken, 2003; Wiers et al., 2014). Alcohol use is affected by an individual's expectancy of positive outcomes from usage, such as achieving social motives (Cooper et al., 1995; Cox & Klinger, 1988, 2004; Jones, Corbin, & Fromme, 2001; Kuntsche et al., 2005; Palfai & Weafer, 2006). Over time, the mental and physical state induced by the use of alcohol becomes an incentive itself which gets closely attached to goals, such as social motives, through the reward pathway in the brain (Kopetz et al., 2013). Consequently, previously neutral
environmental stimuli hinting at alcohol become motivationally important, such that all alcohol-related cues gain importance (Flagel et al., 2011; Wise, 2004). This induces an immediate deployment of attention, AB, towards alcohol cues. For example, Townshend and Duka (2001) tested AB for alcohol
cues by presenting occasional and heavy drinkers with alcohol-related and neutral stimuli in a dot probe paradigm. A pair of alcohol and a neutral picture appeared on the screen, and were replaced by a probe in place of either alcohol or neutral picture. Individuals responded to the location of probe by pressing one of two buttons. The heavy drinkers had faster RTs when probes followed alcohol pictures, displaying a greaterAB for alcohol stimuli, than occasional drinkers.
Recently, Attentional Bias Modification (ABM) for alcohol addiction has been developed which uses dot probe paradigm to reduce AB for alcohol cues (Schoenmakers et al., 2010). Individuals are presented two images, alcohol and soda(soft drinks/water), which are replaced by a probe in the location of soda image. Their task is to respond to the probe, which trains individuals to direct attention away from alcohol cues to soda pictures. In the control condition, individuals usually perform a
categorization task, wherein they are presented an image which they have to classify as alcohol or non-alcohol category. Reviews of ABM research have found that incorporating ABM in treatments for alcohol addiction leads to reduced AB for alcohol cues (Cox et al., 2014; Wiers et al., 2013). Despite initial favorable results, changes in AB caused by ABM do not seem to generalize always nor does ABM seem to have a significant long-term impact on AB (Field et al., 2007; Lopes et al., 2015). Therefore, it is important to investigate new avenues through which ABM can be improved as it is an inexpensive and easy-to-administer training (over web and mobile) which can be individualized without incurring major costs (Cox et al., 2014).
In the anxiety domain, researchers have been investigating AB for threat-related stimuli, and ABM is being utilized to reduce AB for threat cues with similar results as addiction literature (Lopes et al., 2015). Recent research in anxiety psychopathology has focused on temporary goals, goals induced within the span of the study/training, and AB for goal-related stimuli to override AB for threat (De
5 important source of attention deployment and any information irrelevant to these goals is filtered from the attention span (Allport, 1989; Corbetta & Shulman, 2002; Desimone & Duncan, 1995). For
example, the goal to react to a specific stimulus in order to win points leads to a shift of attention towards stimuli-related cues (Vogt, De Houwer & Moors, 2011). In a follow-up study, Vogt et al. (2013) examined whether temporary goals can override attention for threat. They employed the dot-probe paradigm to test for spatial attention by presenting dyads of goal-related, threat-related and neutral stimuli. Imbedded within the dot probe task, the goal task established the temporary goal by pressing a button every time a goal picture appeared. Points were awarded for every correct answer in the goal task, and the participants were instructed to collect a certain number of points in order to keep their motivation high and to keep the goal active. Vogt et al. (2013) found that attention was deployed to goal-relevant stimuli, thus canceling out the attentional bias for threatening stimuli (study 1), even in a highly anxious sample (study 2) and in the case of imminent threat (harsh sound) (study 3). These results suggest that incorporating temporary goals can shift the allocation of attention away from threat, even for highly anxious individuals. Given the similar bottom-up nature of AB for threat and alcohol cues (Van Bockstaele et al., 2014, Wiers et al., 2013), it is possible that, in a manner similar to threat, temporary goal cues might override attention for alcohol cues.
In the present study, we addressed the possibility that, in a manner similar to threatening cues, temporary goals would override attention for alcohol cues. In a sample of heavy-drinking students, we presented temporary goal stimuli together with alcohol-related stimuli, replicating the design of Vogt et al. (2013) in appetitive domain. We expected that alcohol-related stimuli would attract more attention than soda (neutral-related; soft drinks/water) stimuli, thereby displaying an attentional bias for alcohol cues. But when temporary goal- and alcohol-related stimuli are presented together, attention would be automatically directed to goal-related stimuli.
As an expansion of the study of Vogt et al. (2013), we induced temporary goals either actively (by pressing button upon presentation of goal-related stimuli; points awarded only for correct answers – see Vogt et al.) or passively (simply registering the presentation of goal-related stimuli; points awarded only for goal pictures). Our passive goal induction condition allowed us to control for
stimulus-response contingency of the temporary goals which the other stimuli (alcohol-related or soda-related) do not enjoy. In the Vogt et al. (2013) study, only goal-related stimuli required an action response, maybe giving them an advantage over the other presented stimuli as they did not require an imminent action response. We anticipated that temporary goals would exert stronger AB when formed by active response as opposed to passive response.
In addition to the dot probe paradigm, we also embedded the goal task in a modified flanker task (Nikolaou et al., 2013a; Nikolaou et al., 2013b). In the flanker task, individuals were presented with a soda-, temporary goal- or alcohol-related background picture superimposed with a row of five arrows. Their task was to respond to the direction of the central arrow, which was similar to (congruent) or different from (incongruent) the direction of flanking arrows. Slower responses to incongruent
arrows in comparison to congruent arrows indicated that the background image attracted more attention, interfering with the task at hand. We hypothesized that temporary goal-related backgrounds would result in the largest congruency effect, i.e. slower responses to incongruent arrows, followed by alcohol-related stimuli, and then soda-related stimuli. As in the dot probe task, we hypothesized that these effects would be more pronounced in the active than the passive goal condition.
Method Participants
7 (Alcohol Use Disorder Identification Test; Saunders et al., 1993). Participants were invited only if they scored 8 or higher on the questionnaire (MAUDIT = 12.25, SD = 3.89, 8 - 25), a score which has been suggested as a cut-off for hazardous drinking (Babor et al., 2001). Further, participants were accepted for the study only if they were 18 years or older, had no history of health problems or psychiatric disorders, were not pregnant, and had not consumed any alcohol or drugs within 6 hours of performing the study. All participants provided informed consent before the study, and were awarded either course credit or monetary compensation for their time.
Materials
The experiment was programmed using Inquisit 2.0 (Millisecond Software), and was implemented on a Dell Optiplex 9010 desktop computer. All stimuli were presented on a black background. The experiment was conducted at the Psychology Laboratory, Roeterseiland campus, University of Amsterdam.
Pictures
All alcohol1 and soda2 pictures were taken from the Amsterdam Beverage Picture Set (ABPS; Pronk et al., 2015). A neutral category, office supplies/stationery (e.g. pen, pencil, stapler) constituted temporary goals, and pictures were taken from the internet with each picture depicting a single object on a white background. Two sets of 15 different pictures were used; containing five pictures each of alcohol, soda and temporary goals. Five filler images used solely in the goal task were taken from the internet. Both the dot probe/goal and flanker/goal tasks tasks used distinct picture sets, and the sets were counterbalanced across tasks. Alcohol pictures were selected from ABPS based upon high scores for valence (M = 1.43, SD = 1.19), arousal (M = -1.99, SD = 1.47), and urge to drink (M = -0.42, SD =
1 SDC10889, SDC10903, SDC11635, SDC11488, SDC11574, SDC10705, SDC11184, SDC11349, SDC11485 and SDC11584 2 SDC10758, SDC10759, SDC11444, SDC11373, SDC11591, SDC10744, SDC10734, SDC11445, SDC11370 and SDC 11594
1.42). Soda pictures were selected from ABPS based upon high scores for valence (M = 1.43, SD = 1.19), arousal (M = -1.99, SD = 1.47), and urge to drink (M = 0.97, SD = 1.43). During the practice trials, random filler pictures obtained from the internet were used, and no pictures related to main experimental trials were presented.
Alcohol Use Disorder Identification Test
The Alcohol Use Disorder Identification Test (AUDIT) was used to identify and select only heavy drinkers (Saunders et al., 1993). The AUDIT has a test-retest reliability ranging between .80 – .88, and an internal consistency of 0.94 (De Meneses-Gaya et al., 2009). The Cronbach's alpha in our sample was .70.
Dot Probe/Goal Task
Each trial in the dot probe task began with a white fixation cross (5 mm high) in the center of the black screen, along with two white squares (10.5 cm wide X 10.5 cm high) to the left and right of the fixation point (see Figure 1). The center of the squares was 0.5 cm from the fixation cross, and the pictures and probes were presented within the squares. After 500ms, the white squares were replaced by two pictures (goal vs. alcohol, goal vs. neutral, alcohol vs. neutral) within the squares for 350ms. The pictures were replaced by the white squares for 20ms, followed by a probe (black square; 0.5 cm wide X 0.5 cm high) in either one of the squares. Responses to the probe required participants to press the 'A' key is the probe was in the left square, and the 'L' key if the probe was in
9 the right square. A trial ended if a response was registered or timed out 1500ms after the appearance of probe. There were a total of six trial types: goal versus alcohol (probe follows goal or alcohol), goal versus soda (probe follows goal or soda), and alcohol versus soda (probe follows alcohol or soda). Participants performed 240 trials of dot probe, and the six types of trials were presented 40 times each in a random order.
Each dot probe trial was followed by a goal task trial. Goal task trials began with a white
Figure 1: Description of the Dot probe/goal task. The dot probe task began with a fixation cross in the center with two white squares on either side. The next screen showed stimuli (alcohol, goal, neutral) in the two squares. This was followed by a probe which appeared in either of the two squares. Participants had to respond by pressing one of two keys on the keyboard. The goal task began with a screen with
a picture (goal-relevant or irrelevant). This was followed by a screen with a question mark wherein participants had to respond or only register if they saw a goal-relevant picture.
fixation cross (5mm high) in the center of the black screen. After 500ms, a goal or non-goal (alcohol, soda, filler) picture appeared (width X height) in the center of the screen for 250ms. The picture was replaced by a black screen for 10ms, immediately followed by a red question mark (8mm high) which remained on screen until response or time out. Participants had to respond to the goal-relevant stimulus by pressing spacebar (active condition) or registering the picture (passive condition), i.e. wait for trial to time out. Ten points were awarded: for pressing spacebar for goal pictures (active condition), and whenever the goal picture appeared on the screen during the goal task (passive condition). Each correct identification or registration was followed by feedback, “+10 points”. In the active condition, no points were awarded for pressing spacebar when non-goal picture appeared or for not pressing spacebar when goal picture appeared. For the passive condition, no points were awarded when a non-goal picture appeared on the screen. Incorrect identification immediately received the feedback, “Error”, for 200ms. To keep motivation high, participants were instructed to accrue a total of 1400 points by the end of the task. Goal task trials ended upon response or timed out 2000ms after onset of question mark.
Participants performed 240 trials of the goal task, and goal and non-goal trials were presented randomly. Flanker/Goal Task
Each trial in the flanker task began with a white square (10.5 cm wide X 10.5 cm high) in the center of the screen. After 100ms, a black fixation cross (5mm high) would appear in the center of the square. Both the white square and fixation cross were replaced after 500ms with a picture (10.5 cm wide X 10.5 cm high), goal, alcohol or soda, in the center of the screen. 10 ms later, a row of five arrows was superimposed on the center of the screen (each arrow 5mm high), with the picture in the background still visible. The row of arrows consisted of a central target arrow flanked by two arrows on either side, pointing in either the same direction as target arrow (congruent; <<<<< or >>>>>) or in
11 opposite direction (incongruent; <<><< or >><>>) (see Figure 2). Participants responded to the
direction of the target arrow by pressing the 'A' key if the arrow pointed left or the 'L' key if the arrow pointed right. A trial ended when a response was registered or timed out 1500ms after the presentation of arrows. The participants performed 240 trials of flanker task. Each flanker trial was followed by a goal task trial, and the flanker trials were presented in random order.
A goal task trial began with a fixation point, “GOAL TASK!”, (5mm high) in order to
differentiate it from flanker trials, since both had a single image on the screen. After 500ms, a picture (10.5 cm wide X 10.5 cm high) appeared on the screen, goal or non-goal (alcohol, soda or filler), for 250ms. The picture was replaced by a black screen for 10ms, followed by a red question mark (8mm
Figure 2: The figure depicts the type of trials that were presented during the flanker task. The trials differed based upon background picture (goal, alcohol, or neutral), and congruency (same vs. different direction of arrows). An example of a trial
high) which remained on screen until response or time out. The response and feedback procedure
remained the same as goal task in dot probe/goal task. Participants performed 240 trials of the goal task, and goal and non-goal trials were presented in a random order.
Procedure
The study was approved by the Ethics Review Board at the University of Amsterdam. The participants, first, completed the AUDIT questionnaire, based upon which they were invited to take part in the study. For the main experiment, participants performed two tasks: the dot probe/goal task and the flanker/goal task. The order in which the two tasks were performed was counterbalanced between participants.
Practice Phase
The instructions for the task were presented on the screen. For dot probe trials, participants were told to pay attention to the fixation cross, and respond to the location of probe as accurately and swiftly as possible. For the flanker trials, participants were told to pay attention to the fixation cross, and respond to the direction of the central arrow as accurately and swiftly as possible. For the goal trials, participants were told to respond to the question mark by pressing spacebar or registering the image. Instructions for the goal task emphasized accuracy and not speed. The dot probe/goal task practice phase included 3 blocks; 1 block with 10 dot probe trials only, 1 block with 10 goal task trials only, and 1 block with 10 dot probe trials and 10 goal task trials combined. The flanker/goal task practice phase included 2 blocks; 1 block with 10 flanker trials only, and 1 block with 10 flanker trials and 10 goal task trials combined.
Test Phase
13 office supplies. They were informed that every correct identification or registration will award them 10 points, and their goal was to collect 1400 points by the end of the dot probe/goal task, and 1400 points by the end of flanker/goal task. Even though both the tasks had only 60 goal picture trials each,
participants were asked to collect more in order to keep their motivation high until the end of the tasks. The dot probe/goal task was divided into two blocks of 240 trials each; 120 dot probe and 120 goal trials. Each of the six dot probe trial types was presented 40 times, reaching a total of 480 trials over two separate blocks. Similarly, the flanker/goal task was divided into two blocks of 240 trials each; 120 flanker and 120 goal trials. Each of six flanker trial types (3 background X 2 congruency levels) was presented at least 40 times, reaching a total of 480 trials over two separate blocks.
Results
Dot Probe Task
Performance on the goal task yielded few errors (99% mean accuracy). Incorrect trials on the dot probe were removed (overall mean accuracy = 89%), and data for one participant was removed because mean accuracy was at chance level (57% accuracy). First, RTs slower than 3 SDs (Moverall =
369.28, SD = 129.68) were considered outliers, and removed from further analysis. Next, individual mean and SD were calculated for every participant, and latencies greater than 3 SD from the individual means were deleted for every participant (15.5% of trials removed).
An Attentional Bias Index (ABI) was calculated by subtracting the mean RT of congruent trials from incongruent trials (Vogt et al., 2013). Dot probe trials were considered congruent when the probe followed the goal-relevant picture for goal-neutral and goal-alcohol trials, and when the probe followed the alcohol picture for alcohol-neutral trials. For example, ABI for goal-alcohol trials was obtained by subtracting the mean RT of trials where probe followed goal picture from the mean RT of trials where probe followed alcohol picture. A positive ABI score is indicative of attention towards specific stimuli,
whereas 0 indicates no attentional preference. A negative ABI score is indicative of attentional avoidance.
To test for significant differences in the dot probe ABI scores, a 2x3 repeated measures ANOVA was performed with Goal Group (active vs. passive) as a between-subjects factor, and Trial Type (goal-alcohol, goal-soda, alcohol-soda) as a within-subjects factor. We found significant main effects of Trial Type, F(2, 114) = 34.06, p < 0.001, and Goal Group, F(1, 57) = 23.25, p < 0.001. Most importantly, these main effects were qualified by the significant interaction between Trial Type and Goal Group, F(2, 114) = 5.290, p < 0.01. The group means show that the RTs are faster when probe follows goal-related stimuli, and this effect is more pronounced in the active than the passive goal
Figure 3: Mean Attentional Bias Index scores for the two goal group conditions of Dot Probe Task according to trial type: alcohol-soda, goal-soda, and goal-alcohol.
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Alcohol-Soda Goal-Soda Goal-Alcohol
Active 3.37 (19.52) 35.16 (26.17) 46.31 (26.47)
Passive -.12 (16.20) 13.22 (18.34) 18.73 (24.12)
Post hoc t-tests revealed no significant difference between the active and passive groups for the alcohol-neutral trials, indicating that individuals in the two groups had similar levels of AB towards alcohol cues. Significant independent samples t-test for goal-neutral trials suggested a significant difference between the active and passive groups, t(57) = 3.72, p < .001. Most importantly, and in line with our hypothesis, results for goal-alcohol trials indicated that the type of goal group made a
significant difference in the effect of trial type, t(57) = -4.18, p < .001. Flanker Task
Performance on the goal task yielded few errors (99% mean accuracy). Incorrect trials on the flanker task were removed (Overall mean accuracy = 93%), and data for one participant was removed because mean accuracy was at chance level (50% accuracy). First, RTs slower than 3 Sds from the mean (Moverall = 369.28, SD = 129.68) were considered outliers, and removed from further analysis.
Next, individual mean and standard deviation (SD) were calculated for every participant, and latencies greater than 3 SD from the individual means were deleted for every participant (14.5% of trials
removed).
ABI scores were calculated by subtracting the mean RT of congruent trials from the mean RT of incongruent trials. Flanker trials were considered congruent when all the arrows pointed in the same direction, and incongruent when the flanker arrows pointed in a different direction than the
target/center arrow, regardless of the background.
Table 1: Mean (Standard Deviation) for each trial type, alcohol-soda, soda and goal-alcohol, based upon goal group, active and passive.
To test for significant differences in the flanker ABI scores, a 2X3 repeated measures ANOVA was performed with Goal Group (active vs. passive) as a between-subjects factor, and Background (goal, soda, alcohol) as a within-subjects factor. We found no significant main effect of Background, F(2, 114) = 1.56, p = .214, or Goal Group, F < 1. This conveys that there were no significant
differences in ABIs based upon the type of background or the goal condition. Further, no significant interaction between Goal Group and Background, F < 1, suggesting that ABIs for different
backgrounds did not differ significantly based upon Goal Group. Exploratory Analysis
In addition to the conventional Flanker analysis (Nikolaou et al., 2013), we also conducted a test for interference effect of the different background types. The interference effect refers to the inability to disengage attention from arousing stimuli (Fox et al., 2001), leading to slower responses to task-relevant stimuli (De Houwer & Tibboel, 2010). We tested the hypothesis that the different
background types (goal, neutral, alcohol) created different interference effects, reflecting the participants' difficulty to disengage attention away from the images.
To test for interference effect, we obtained three interference scores: mean RTalcohol – mean
RTsoda (alcohol-soda), mean RTgoal – mean RTsoda (goal-soda), mean RTgoal – mean RTalcohol
(goal-alcohol). Using the interference scores, we conducted a 2x3 repeated measures ANOVA with Goal Group (active vs. passive) as the between-subjects factor, and Background Type as the within-subjects factor. This analysis yielded a significant main effect of Background Type, F(2, 114) = 4.50, p < 0.05
17
(see Figure 4), suggesting that there was a difference in RTs based upon the type of background. However, there was no significant main effect of Goal Group, F < 1.
We conducted post-hoc t-tests for goal-neutral, t(58) = 3.18, p < 0.01 (M = 8.83, SD = 21.61), goal-alcohol, t(58) = 3.13, p < 0.01 (M = 7.95, SD = 19.77), and alcohol-neutral, t(58) = 0.40, p > 0.05 (M = 0.88, SD = 16.80). The differences between the goal-oriented and alcohol background
interference scores show that individuals responded slower to goal background flanker trials. These results indicate that backgrounds with goal stimuli created greater amount of interference, i.e. individuals found it more difficult to disengage attention from goal pictures.
Discussion
In this study, we investigated if temporary goal stimuli can override AB for alcohol cues, by creating a temporary goal and using the dot probe and flanker tasks to test its effect on attention. The results from the dot probe task were in line with this hypothesis, showing that attention for temporary goal-related stimuli overrides attention for alcohol-related and neutral stimuli in a sample of heavy
drinkers. This AB for goal-relevant stimuli was stronger in the active than the passive condition. The conventional flanker analysis failed to find any significant results. To clarify if the
background images created an interference effect in RTs, we conducted an exploratory analysis for the interference effect. An interference effect is the inability to disengage attention from task-irrelevant stimuli to focus on the task at hand (Fox et al., 2001). The results were in line with our hypothesis and confirmed the pattern of findings displayed by dot probe; indicating an interference effect for
temporary goal-relevant stimuli. The findings demonstrate that the temporary goal stimuli created the greatest difficulty in disengagement of attention in comparison to alcohol-related and neutral stimuli.
There are two possible explanations for the absence of effect in conventional flanker analysis. First, the absence could be due to the very high cognitive load that the flanker task created for the participants, due to congruency changes and task-switching between flanker and goal trials. But since the high load existed in the dot probe task as well, wherein we found significant results, it cannot be the legitimate explanation for the non-existent effect in the flanker task. Second, It is possible that the modified flanker task is not an appropriate test for examination of spatial attention because Nikolaou et al. (2013) designed it solely for investigation of AB for alcohol cues, and not in the manner that we did. While a dot probe task tests for spatial allocation of attention, the flanker task is more capable of
examining whether a stimulus created an interference effect (Van Bockstaele et al., 2012). The purpose of the current study was to clarify how attention in heavy drinkers would be directed when goal- and alcohol-related stimuli are presented simultaneously. Our results indicate that attentional preference is given to goal-related stimuli, thus overriding the attention for alcohol cues in heavy drinkers. The results are in line with the findings from the anxiety literature (Vogt et al., 2013), and add to the extensive literature which demonstrates that temporary goals of an individual bias
19 Moreover, our results also have implications for the prevailing theories related to attentional bias in heavy drinkers for alcohol cues. The general view is that attention is directed automatically to alcohol cues in the environment, and is difficult to impede or divert towards other stimuli (Tifanny, 1990; Townshend & Duka, 2001). The results of our study, though, provide quite a different picture, suggesting that attention for alcohol is more malleable, such that AB for alcohol cues can take a backseat when presented with other emotionally salient stimuli. This implies that attention to alcohol cues may be more situational and less automatic.
Furthermore, the results of our study have implications for clinical treatments targeting cognitive retraining of heavy drinkers or alcohol-dependent individuals, specifically ABM. ABM presents pairs of alcohol and neutral pictures, followed by a probe in the place of the neutral picture always. By doing so, the task trains the individuals to direct attention away from alcohol stimuli to neutral stimuli (Schoenmakers et al., 2010). Applying the current results to ABM, individuals can be presented pairs of alcohol and goal-related images, followed by a probe in the location of the goal picture always. This will train the individuals to direct attention away from alcohol stimuli and towards goal-related stimuli . This could lead to a stronger attentional preference for goals and attentional avoidance for alcohol in heavy drinkers. This is possible because the motivational influence of goals is likely to be stronger than training people to attend to neutral stimuli (Kopetz et al., 2013; Moskowitz, 2002). The neutral stimuli do not have the emotional salience that the goal-related stimuli possess because neutral stimuli are not considered rewarding by individuals. When combined with treatment as usual, it could lead to greater time to relapse and quicker achievement of treatment goals as compared to standard ABM.
A major limitation of our study is that on goal-unrelated trials we were unable to detect a significant AB for alcohol stimuli. The non-significant findings for AB for alcohol cues can be
attributed to the high cognitive load imposed by the task. In addition to responding to the dot probe, participants had to keep their goal (press button or register) active constantly which can lead to considerable load on individual cognitive resources (Smith & Jonides, 1999). It has been found that high cognitive load can lead to inhibition of cognitive preference for alcohol-related stimuli (Nikolau et al., 2013a; Sharbanee et al., 2014). However, despite the cognitive load AB for goal-related stimuli was significantly detected. Therefore, it is possible the failure to find this effect could be due to the fact that the dot probe uses only pictures. It is likely that simply looking at alcohol pictures did not arouse the participants as much as the physical presence of alcohol might. While temporary goals were awarded and created an active presence, the alcohol stimuli used in the current study were simply a stand-in for actual presence or consumption of alcohol. It has been found that participants who were provided an alcohol prime (a low dose of alcohol) displayed a stronger AB for alcohol (Duka & Townshend, 2004; Schoenmakers et al., 2008). Future studies could use an alcohol sip prime, i.e. give participants a low dose of alcohol, before performing the dot probe task. This levels the playing field for goal-related and alcohol-related stimuli during the task, and is likely to lead to a stronger AB for alcohol cues. If
temporary goals are able to override AB for alcohol-related stimuli in the presence of sip-prime, the findings would unequivocally attest to the superior nature of temporary goals in attentional system compared to alcohol cues.
An interesting avenue for future research is to test whether reward- and loss-sensitivity play a role in the emotional salience of temporary goals. We created temporary goals solely by rewarding participants with points. This excluded the opportunity to investigate the effect of avoidance of negative events or stimuli. Individuals might value avoiding negative more than gaining positive, which might lead to stronger avoidance goals for such people. Further, it is possible that
avoidance-21 (Higgins, 1997). Future studies can investigate this by incorporating a separate goal condition, wherein participants have to focus on not losing points.
Furthermore, most people are motivated by their individual life goals which exert influence over their actions. Therefore, it is highly likely that when presented in comparison with alcohol cues, individually-motivating goal-relevant stimuli might show a greater attention capture than temporary goal stimuli. Further, utilizing individual long-term goals in ABM could lead to a stronger and more lasting effect of the training, and thereby improved treatment outcomes for addiction.
In a similar vein, the motivation model of drinking (Cooper et al., 1995) suggests that different individuals are motivated to drink due to four major reasons: to enhance affect, to reduce negative affect, to improve social facilitation, and to avoid social rejection. Since these goals drive drinking behavior, they attach motivational importance to alcohol-related stimuli which leads to the
development of an AB for alcohol cues . It would be interesting to examine if AB for alcohol persists when drinking is not motivationally important anymore, and is in contrast to long-term goals. For example, an individual who drinks to fit into a social group may have the goal of avoiding social rejection, which motivates him/her to drink. But if the social group does not value drinking anymore, i.e. the individual does not need to drink alcohol to be a part of the group, the motivational value of drinking ceases to exist. Therefore, if an individual is presented with alcohol-related stimuli and peer group-related stimuli (where the peer group does not value drinking), it is possible that the latter stimuli would attract more attention. The pattern of attentional deployment from this comparison would shed light on which group of the population holds which type of goals are most important.
The current study provides evidence for the idea that temporary goals attract more attention than alcohol cues. The results also point out that the AB for alcohol cues is more malleable and
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