Approach With Caution: A Pilot Randomised Controlled Trial of Approach Bias Modification for People Undergoing...

Less than one-quarter of people who attend residential rehabilitation for methamphetamine use disorder (MUD) remain abstinent for 1 year. Approach bias modification (ApBM), a cognitive training intervention, reduces relapse rates when delivered during residential rehabilitation for alcohol use disorder. However, there has been little research on ApBM for MUD.

Twenty-four patients with MUD attending four residential treatment services in Melbourne were randomised, between March 2020 and August 2024, to 6 sessions of either ApBM (n = 10) or sham-control training (n = 14). Safety was monitored during the intervention and acceptability was assessed at the end of training. A blinded researcher assessed methamphetamine use, craving, and dependence severity at follow-ups 1 and 3 months after discharge from residential treatment.

Three ApBM and five control participants experienced adverse psychological reactions to the training task, resulting in two ApBM and 1 control participants withdrawing. However, participants who completed training generally provided positive acceptability ratings (mean Endorsement and Discomfort Scale scores of 69.13 [SD = 10.93] in the ApBM group and 58.83 [SD = 13.41] in controls). Directions of differences in proportions reporting past-month abstinence at 1-month (ApBM: 5/7 [71%]; controls: 5/11 [46%]) and 3-month follow-ups (ApBM: 4/7 [57%]; controls: 3/9 [33%]) and continuous abstinence at 3-month follow-up (ApBM: 3/7 [43%]; controls: 2/11 [18%]) favoured ApBM; however, these differences did not approach significance in this very small sample. Craving and MUD severity outcomes also did not differ significantly between groups.

Further research on ApBM's efficacy for MUD may be warranted, but safety concerns suggest caution.

Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true.