HALL OF FAME MEGATHREAD

Brown et al (2002) reported that self-efficacy mediated the effectiveness of CBT on drug use outcomes, which Borrelli et al (1994) reported was due to the achievement of goal-setting that will occur in CBT. In a review of studies of the Twelve-Step program, Aase, Jason, and Robinson (2012) concluded that self-efficacy played a mediational role between participation in the twelve-step group and substance use outcome. However, research has also failed to find that self-efficacy is a predictor of treatment outcome, particularly for marijuana (see Stephens et al, 1995). In a review of studies of 12-step program participation among dually-diagnosed individuals, Aase, Jason and Robinson (2008) concluded that increased self-efficacy plays a mediational role between participation in dual-focus 12-step groups and substance use outcomes. Since dually-diagnosed individuals face considerable barriers to sobriety, the enhancement of self-efficacy was thought to be an important finding. Although, as noted above, Stephens et al. (1995) found that self-efficacy was a relatively strong predictor of post-treatment marijuana use, they reported that at best, self-efficacy only partially mediated the effects of treatment on marijuana use. In more recent research by that group, Lozano and Stephens (2010) found that self-efficacy did not mediate between client-set goals and either reduced drinking or achievement of goals. Maisto et al. (2000) also failed to find a mediating relationship at all: although self-efficacy did predict drinking outcomes, it did not mediate the effects of treatment or of coping skills. They recommended assessing coping and self-efficacy more frequently, over short periods that would more closely approximate real time.

Second, different tasks were used in our studies and the study by Spruyt et al. In their prediction study, Spruyt et al. used the relevant-feature R-SRC, while we used an irrelevant-feature alcohol Approach Avoidance Task to measure the approach bias (alcohol AAT; Wiers et al., 2009) and different varieties of the task to modify the bias. As pointed out by De Houwer (2003), relevant and irrelevant feature tasks are structurally different. Relevant-feature tasks are less implicit in the sense of indirect (participants receive instructions regarding the contents of the stimuli), but are generally more reliable (Field et al., 2011), although reasonably good reliability has also been reported for the AAT (Cousijn et al., 2011). Field et al. (2011) directly compared a relevant- to an irrelevant-feature version of the SRC, and found no correlation between the two measures (r = −0.05, p = 0.37, Field, personal communication). In our own first re-training study, we also used the relevant-feature approach-avoid Implicit Association Test (Ostafin and Palfai, 2006), and again this measure was entirely unrelated to the AAT (r = −0.01, p = 0.92). Hence, measuring an approach-bias with a relevant-feature task appears to be unrelated to measuring, and perhaps changing, an approach-bias with an irrelevant-feature task. It could at least theoretically be the case that the kind of avoidance associations as measured by a relevant-feature SRC cause an increased chance of relapse, while alcohol-avoidance associations retrained and assessed by an irrelevant-feature AAT decrease the chance of relapse. In conclusion, the evidence does not support the idea that the induction of an avoidance bias is likely to be harmful in alcoholic patients: the study of Spruyt et al. does not allow conclusions regarding causality, and a recent training study in fact showed that a relative increase in avoidance mediated the beneficial effects of avoidance training. We do, however, concur with Spruyt et al. that more research is needed regarding the assessment and modification of biases in action tendencies (Watson et al., 2012; Wiers et al., 2013), and other cognitive biases, such as attentional biases, where similar measurement issues arise (Ataya et al., 2012), and where training to avoid alcohol has also shown beneficial effects in alcoholic patients (Schoenmakers et al., 2010). Further, while our replication study showed that a decrease in approach-bias to alcohol stimuli mediates the clinical effect, one could still hypothesize that overly strong avoidance associations may be less desirable than, e.g., more moderate avoidance, a general reduction in salience, or attentional inhibition of distracting or “tempting” stimulus features. Such questions are clearly of potential clinical importance and more research is needed to determine the underlying mechanisms of these novel training interventions.

I don't think that's exactly surprising given the typical age-range of the people posting here...

/r/baseball Thread