Assessment of Automatically Activated Approach–Avoidance Biases Across Appetitive Substances
- 100 Downloads
Purpose of Review
Automatic approach–avoidance tendencies drive excessive intake of drugs and unhealthy food. Dual-process models of behaviour propose that strong approach biases predict excessive intake when reflective processes are weak. Consistent with theory, early findings indicated that approach biases predicted excessive use of drugs, including alcohol and tobacco. Given that reviews on approach bias for appetitive substances are lacking, the current review aimed to synthesise the recent findings on automatic approach biases across three of the most commonly assessed substances: alcohol, food and tobacco.
The findings suggest that approach biases exist for a range of substances, are mostly stronger in clinical samples than healthy controls and predict consumption behaviour, albeit under certain conditions.
Approach biases for appetitive substances are related to excessive consumption in line with theoretical premises. Further longitudinal research is needed, particularly in the domains of tobacco and food, to determine the prediction of consumption of these substances over time. Nevertheless, the findings highlight a continued need for approach bias modification techniques aimed at changing this underlying mechanism.
KeywordsApproach–avoidance bias Action tendency Implicit cognition Alcohol Tobacco Food
The authors would like to thank Antonio Verdejo-Garcia for his helpful feedback on an earlier version of this paper.
RSCL was supported by funding from the National Health and Medical Research Council (No. 1162031).
Compliance with Ethical Standards
Conflict of Interest
Dr. Albertella has nothing to disclose.
Dr. Wiers has nothing to disclose.
Dr. Kakoschke has nothing to disclose.
Dr. Lee reports funding from the National Health & Medical Research Council (No. 1162031) during the conduct of the study. The funders had no input to the study design, data collection, or interpretation, writing of the report, or submission for publication.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 13.Wiers RW, Gladwin TE. Reflective and impulsive processes in addiction and the role of motivation. In: Deutsch R, Gawronski B, Hofmann W, editors. Reflective and impulsive determinants of human behavior. Abingdon: Routledge; 2017. p. 173–88.Google Scholar
- 14.Gladwin TE, Figner B. Hot cognition and dual systems: introduction, criticisms, and ways forward. In: Wilhelms E, Reyna VF, editors. Frontiers of cognitive psychology series: neuroeconomics, judgment and decision making. New York: Psycholoy Press; 2014. p. 157–80.Google Scholar
- 15.Wiers RW, Anderson KG, Van Bockstaele B, Salemink E, Hommel BE. Affect, dual-processing, developmental psychopathology, and health behaviors. In: Affective determinants of health behavior, vol. 16. Oxford: Oxford University Press; 2018. p. 158.Google Scholar
- 17.Rinck M, Becker ES. Approach and avoidance in fear of spiders. J Behav Ther Exp Psychiatry. 2007;38(2):105–20 https://linkinghub.elsevier.com/retrieve/pii/S0005791606000620.CrossRefGoogle Scholar
- 24.Wiers RW, Boffo M, Field M. What’s in a trial? On the importance of distinguishing between experimental lab studies and randomized controlled trials: the case of cognitive bias modification and alcohol use disorders. J Stud Alcohol Drugs. 2018;79(3):333–43 http://www.ncbi.nlm.nih.gov/pubmed/29885138.CrossRefGoogle Scholar
- 25.• Zhang MWB, Ying J, Wing T, Song G, Fung DSS, Smith HE. Cognitive biases in cannabis, opioid, and stimulant disorders: a systematic review. Front Psychiatry. 2018;9:376. https://doi.org/10.3389/fpsyt.2018.00376/full In this systematic review, the authors documented the existence of substance-specific attentional and approach biases across opioid, cannabis and stimulant use disorders.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Roefs A, Huijding J, Smulders FTY, Macleod CM, De Jong PJ, Wiers RW, et al. Implicit measures of association in psychopathology research. Psych Bull. 2011;137(1):149. http://eetonderzoek.nl/wp-content/uploads/2015/03/IJA29.pdf–93.CrossRefGoogle Scholar
- 30.van Duijvenbode N, Didden R, Korzilius HPLM, Engels RCME. The usefulness of implicit measures for the screening, assessment and treatment of problematic alcohol use in individuals with mild to borderline intellectual disability. Adv Neurodev Disord. 2017;1(1):42–51. https://doi.org/10.1007/s41252-016-0005-1.CrossRefGoogle Scholar
- 33.• Weckler H, Kong G, Larsen H, Cousijn J, Wiers RW, Krishnan-Sarin S. Impulsivity and approach tendencies towards cigarette stimuli: implications for cigarette smoking and cessation behaviors among youth. Exp Clin Psychopharmacol. 2017;25(5):363–72 This study shows that adolescent smokers with a stronger approach bias and higher levels of impulsivity increased the odds of being a smoker. CrossRefGoogle Scholar
- 34.Machulska A, Zlomuzica A, Adolph D, Rinck M, Margraf J. “A cigarette a day keeps the goodies away”: smokers show automatic approach tendencies for smoking—but not for food-related stimuli. PLoS One. 2015;10(2):e0116464. https://doi.org/10.1371/journal.pone.0116464.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Schmidt R, Sebert C, Kösling C, Grunwald M, Hilbert A, Hübner C, et al. Neuropsychological and neurophysiological indicators of general and food-specific impulsivity in children with overweight and obesity: a pilot study. Nutrients. 2018;10(12):1983 Available from: https://www.mdpi.com/2072-6643/10/12/1983.CrossRefGoogle Scholar
- 49.•• Martin Braunstein L, Kuerbis A, Ochsner K, Morgenstern J. Implicit alcohol approach and avoidance tendencies predict future drinking in problem drinkers. Alcohol Clin Exp Res. 2016;40(9):1945–52 http://www.ncbi.nlm.nih.gov/pubmed/27421061. This is an important longitudinal study showing that a stronger approach bias for alcohol cues predicts future drinking in problem drinkers with alcohol-use disorder.CrossRefGoogle Scholar
- 50.•• Field M, Di Lemma L, Christiansen P, Dickson J. Automatic avoidance tendencies for alcohol cues predict drinking after detoxification treatment in alcohol dependence. Psychol Addict Behav. 2017;31(2):171–9 An important longitudinal study showing that approach–avoidance biases for alcohol cues predict treatment responses among individuals with alcohol use disorder. CrossRefGoogle Scholar
- 52.Lindgren KP, Baldwin SA, Ramirez JJ, Olin CC, Peterson KP, Wiers RW, et al. Self-control, implicit alcohol associations, and the (lack of) prediction of consumption in an alcohol taste test with college student heavy episodic drinkers. PLoS One. 2019;14(1):e0209940. Available from. https://doi.org/10.1371/journal.pone.0209940.CrossRefPubMedPubMedCentralGoogle Scholar
- 55.• Wiers CE, Gladwin TE, Ludwig VU, Gröpper S, Stuke H, Gawron CK, et al. Comparing three cognitive biases for alcohol cues in alcohol dependence. Alcohol Alcohol. 2016;52(2):242–8 This paper was the first to investigate three conceptually distinct automatically activated cognitive biases for alcohol cues: attentional bias, approach–avoidance bias, and implicit alcohol-approach associations among patients with alcohol use disorder. Google Scholar
- 61.• Maas J, Woud ML, Keijsers GPJ, Rinck M, Becker ES, Wiers RW. The attraction of sugar: an association between body mass index and impaired avoidance of sweet snacks. J Exp Psychopathol. 2017;8(1):40–54. https://doi.org/10.5127/jep.052415 This human laboratory study showed that higher body mass index was related to impaired avoidance, but not increased approach, of sweet snacks on the AAT.CrossRefGoogle Scholar
- 66••.. Stautz K, Frings D, Albery IP, Moss AC, Marteau TM. Impact of alcohol-promoting and alcohol-warning advertisements on alcohol consumption, affect, and implicit cognition in heavy-drinking young adults: a laboratory-based randomized controlled trial. Br J Health Psychol. 2017;22(1):128–50. https://doi.org/10.1111/bjhp.12221 This is an important experimental laboratory study examining the effects of alcohol advertisements on approach bias and alcohol use in young adults. The results show that exposure to alcohol-promoting advertisements increased approach and reduced avoidance of alcohol on the AAT relative to exposure to non-alcohol advertisements.CrossRefPubMedGoogle Scholar
- 70.Jones A, Button E, Rose AK, Robinson E, Christiansen P, Di Lemma L, et al. The ad-libitum alcohol ‘taste test’: secondary analyses of potential confounds and construct validity. Psychopharmacology. 2016;233(5):917–24. Available from. https://doi.org/10.1007/s00213-015-4171-z.CrossRefPubMedGoogle Scholar
- 75.Mollen S, Holland RW, Ruiter RAC, Rimal RN, Kok G. When the frame fits the social picture: the effects of framed social norm messages on healthy and unhealthy food consumption. Communic Res. 2016;1:33.Google Scholar
- 80.•• Lender A, Meule A, Rinck M, Brockmeyer T, Blechert J. Measurement of food-related approach–avoidance biases: larger biases when food stimuli are task relevant. Appetite. 2018;125:42–7 This study is the first to show that approach bias for food-related cues is stronger when participants are instructed to respond to the content of the pictures rather than to a task irrelevant feature (e.g. the outline of the picture) measured using the AAT. CrossRefGoogle Scholar
- 81.Field M, Caren R, Fernie G, De Houwer J. Alcohol approach tendencies in heavy drinkers: comparison of effects in a relevant stimulus-response compatibility task and an approach/avoidance Simon task. Psychol Addict Behav. 2011;25(4):697–701. https://doi.org/10.1037/a0023285.CrossRefPubMedGoogle Scholar
- 86.Juergensen J, Leckfor C. Stop pushing me away: relative level of Facebook addiction is associated with implicit approach motivation for Facebook stimuli. Psychol Rep 2018;003329411879862. https://doi.org/10.1177/0033294118798624