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

IMPORTANCE Cognitive 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. OBJECTIVE To assess the efficacy of an adaptive approach bias modification (A-ApBM) paradigm with gamified designs and dynamic difficulty adjustments in reducing cue-induced craving in individuals with methamphetamine use history. DESIGN: Randomized controlled trial with three study groups: Adaptive ApBM (A-ApBM), Static ApBM (S-ApBM), and control. SETTING Twelve community-based rehabilitation centers in Sichuan, China. PARTICIPANTS Individuals aged 18-50 with methamphetamine dependence were randomized. INTERVENTION A-ApBM and S-ApBM groups 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, while S-ApBM had a static difficulty level. MAIN OUTCOMES AND MEASURES Cue-induced craving scores assessed using a visual analog scale at baseline, post-intervention, and at week-16 follow-up. RESULTS The A-ApBM group showed a significant reduction in cue-induced craving scores at post-intervention compared to baseline (p = 0.02). The reduction remained significant at the week-16 follow-up (p = 0.01). No significant changes were observed in the S-ApBM and control groups. CONCLUSION AND RELEVANCE The 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 REGISTRATION Registered at [clinicaltrials.gov][1] (ID [NCT05794438][2]). ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05794438 ### Funding Statement None ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the participating community rehabilitation centers in Sichuan, China and was in accordance with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of The Second Xiangya Hospital of Central South University (Approval Number: 2021-076). The trial was registered at clinicaltrials.gov ([NCT05794438][2]). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are not available [1]: http://clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05794438&atom=%2Fmedrxiv%2Fearly%2F2023%2F08%2F24%2F2023.08.22.22279466.atom