Gamified Adaptive Approach Bias Modification: a Pilot RCT in Individuals with Methamphetamine Use History

BACKGROUNDCognitive bias modification (CBM) programs have shown promise in treating psychiatric conditions, but they can be perceived as boring and repetitive. Incorporating gamified designs and adaptive algorithms in CBM training may address this issue and enhance engagement and effectiveness. OBJECTIVETo gather preliminary data and assess the preliminary efficacy of an adaptive approach bias modification (A-ApBM) paradigm in reducing cue-induced craving in individuals with methamphetamine use history. METHODSA randomized controlled trial with three arms was conducted. Individuals aged 18-60 with methamphetamine dependence and at least one year of methamphetamine use were recruited from 12 community-based rehabilitation centers in Sichuan, China. Individuals with inability to fluently operate a smartphone and/or the presence of mental health conditions other than methamphetamine use disorder (MUD) were excluded. A-ApBM group engaged in ApBM training using a smartphone application for four weeks. A-ApBM used an adaptive algorithm to dynamically adjust the difficulty level based on individual performance. Cue-induced craving scores and relapse were assessed using a visual analog scale at baseline, post-intervention, and at week-16 follow-up. RESULTSA total of 136 participants were recruited and randomized: 48 were randomized to the A-ApBM group, 48 were randomized to the S-ApBM group, and 40 were randomized to the no-intervention control group. The A-ApBM group showed a significant reduction in cue-induced craving scores at post-intervention compared to baseline (Cohens d = 0.34, p < 0.01, 95% CI = [0.03,0.54]). The reduction remained significant at the week-16 follow-up (Cohens d = 0.40, p= 0.01, 95% CI = [0.18,0.57]). No significant changes were observed in the S-ApBM and control groups. CONCLUSIONThe adaptive ApBM paradigm with gamified designs and dynamic difficulty adjustments may be an effective intervention for reducing cue-induced craving in individuals with methamphetamine use history. This approach improves engagement and personalization, potentially enhancing the effectiveness of CBM programs. Further research is needed to validate these findings and explore the application of adaptive ApBM in other psychiatric conditions. TRIAL REGISTRATIONRegistered at clinicaltrials.gov (ID NCT05794438).