TY - JOUR
T1 - Acute impact of self-guided mental imagery on craving in cocaine use disorder
T2 - a mixed-methods analysis of a randomized controlled trial
AU - Lowry, Natalie
AU - Marsden, John
AU - Clydesdale, Bethany
AU - Eastwood, Brian
AU - Havelka, Eva Maria
AU - Goetz, Camille
N1 - Funding Information:
During the past 3 years, J.M. declares research grants to King's College London (KCL) from: (1) the National Institute for Health Research (NIHR) for a multi‐centre RCT of acamprosate for alcohol use disorder; (2) the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Mental Health Foundation Trust (SLaM) for a pilot RCT of novel cognitive therapy for cocaine use disorder and related studies; and (3) an unrestricted grant from Indivior to KCL and SLaM from Indivior for a multi‐centre, RCT of extended‐release injectable buprenorphine for OUD. He has part‐time employment as Senior Academic Adviser for the Alcohol, Drugs, Tobacco and Justice Division, Health Improvement, Public Health England. He is a clinical academic consultant for the US National Institute on Drug Abuse, Centre for Clinical Trials Network. He holds no stocks in any company. The other authors have no interests to declare.
Funding Information:
The study was funded by the National Institutes for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) and South London, and Maudsley NHS Trust and King's College London were the joint sponsors. They had no role in study design, data collection, analysis, interpretation or report writing. The views expressed are those of the authors and not necessarily those of the NIHR or BRC. We would like to thank our participants and we kindly acknowledge the support from our colleagues at Lorraine Hewitt House (South London and Maudsley NHS Trust) and Elka Giemza and her team at the National Institute for Health Research and Welcome Trust Clinical Research Facility at King's College Hospital, London. J.M. and B.E. would like to thank Dr Rachel Evans at the University of Bangor for advice on the statistical analysis plan. C.G. kindly acknowledges academic supervision from J.M. and Professor Sir John Strang at the Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
Funding Information:
The study was funded by the National Institutes for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) and South London, and Maudsley NHS Trust and King's College London were the joint sponsors. They had no role in study design, data collection, analysis, interpretation or report writing. The views expressed are those of the authors and not necessarily those of the NIHR or BRC. We would like to thank our participants and we kindly acknowledge the support from our colleagues at Lorraine Hewitt House (South London and Maudsley NHS Trust) and Elka Giemza and her team at the National Institute for Health Research and Welcome Trust Clinical Research Facility at King's College Hospital, London. J.M. and B.E. would like to thank Dr Rachel Evans at the University of Bangor for advice on the statistical analysis plan. C.G. kindly acknowledges academic supervision from J.M. and Professor Sir John Strang at the Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
Publisher Copyright:
© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Mental imagery manipulations are used to treat several psychological disorders, but their utility in treating cocaine use disorder (CUD) is unknown. Using prompted re-experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving. Design: A quantitative–qualitative ‘mixed-methods’ analysis of data collected for a randomized controlled trial that was stopped prematurely. Setting: UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory). Participants: Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study). Interventions: Personalized (3-minute) cue–exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5-minute, audio-recorded, self-guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re-experiences (positive image before initiation to cocaine use or a negative image of a ‘worst time’ adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD). Measurements: Task transcripts were rated for imagery detail using five dimensions using a six-point scale of imagery detail (ID) (total score = 0–25) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire—strengths version (CEQ–S11; score = 0–110) reported at baseline, arrival at the laboratory, and immediately after the cue–exposure and mental imagery tasks. Findings: A mixed-effects, longitudinal, restricted linear regression, with the past-positive imagery condition as referent, showed main effects of reduced craving after the imagery task (b = –29.2, 95% confidence interval (CI) = –45.3 to −13.1, P-value < 0.001) and increased craving for the future-negative task (b = 14.2, 95% CI = 0.1–28.4, P-value 0.049). There was a future-negative task by post-imagery craving interaction (b = 28.1, 95% CI = 0.1–56.1, P-value 0.049). A theory-driven, deductive/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self-care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self-criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (r = –0.32, 95% CI = –0.69 to 0.13 and r = 0.06, 95% CI = –0.58 to 0.53, respectively). Conclusion: In people with cocaine use disorder, after cue–exposure, a self-guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to.
AB - Mental imagery manipulations are used to treat several psychological disorders, but their utility in treating cocaine use disorder (CUD) is unknown. Using prompted re-experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving. Design: A quantitative–qualitative ‘mixed-methods’ analysis of data collected for a randomized controlled trial that was stopped prematurely. Setting: UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory). Participants: Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study). Interventions: Personalized (3-minute) cue–exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5-minute, audio-recorded, self-guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re-experiences (positive image before initiation to cocaine use or a negative image of a ‘worst time’ adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD). Measurements: Task transcripts were rated for imagery detail using five dimensions using a six-point scale of imagery detail (ID) (total score = 0–25) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire—strengths version (CEQ–S11; score = 0–110) reported at baseline, arrival at the laboratory, and immediately after the cue–exposure and mental imagery tasks. Findings: A mixed-effects, longitudinal, restricted linear regression, with the past-positive imagery condition as referent, showed main effects of reduced craving after the imagery task (b = –29.2, 95% confidence interval (CI) = –45.3 to −13.1, P-value < 0.001) and increased craving for the future-negative task (b = 14.2, 95% CI = 0.1–28.4, P-value 0.049). There was a future-negative task by post-imagery craving interaction (b = 28.1, 95% CI = 0.1–56.1, P-value 0.049). A theory-driven, deductive/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self-care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self-criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (r = –0.32, 95% CI = –0.69 to 0.13 and r = 0.06, 95% CI = –0.58 to 0.53, respectively). Conclusion: In people with cocaine use disorder, after cue–exposure, a self-guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to.
KW - cocaine use disorder
KW - cognitive behavioural therapy
KW - cognitive therapy
KW - craving
KW - cue–exposure
KW - mental imagery
UR - http://www.scopus.com/inward/record.url?scp=85099924227&partnerID=8YFLogxK
U2 - 10.1111/add.15405
DO - 10.1111/add.15405
M3 - Article
AN - SCOPUS:85099924227
SN - 0965-2140
VL - 116
SP - 2418
EP - 2430
JO - Addiction
JF - Addiction
IS - 9
ER -
