A clinical trial with combined transcranial direct current stimulation and alcohol approach bias retraining

Addict Biol. 2017 Nov;22(6):1632-1640. doi: 10.1111/adb.12463. Epub 2016 Oct 27.


Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase neuroplasticity and has previously been found to reduce craving. One hundred alcohol-dependent inpatients (91 used for analysis) were randomized into three experimental groups in a double-blind parallel design. The experimental group received four sessions of CBM while receiving 2 mA of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). There were two control groups: One received sham stimulation during training and one received active stimulation at a different moment. Treatment outcomes were abstinence duration (primary) and relapse after 3 and 12 months, craving and approach bias (secondary). Craving and approach bias scores decreased over time; there were no significant interactions with experimental condition. There was no effect on abstinence duration after three months (χ2(2) = 3.53, p = 0.77). However, a logistic regression on relapse rates after one year (standard outcome in the clinic, but not-preregistered) showed a trend when relevant predictors were included; relapse was lower in the condition receiving active stimulation during CBM only when comparing to sham stimulation (B = 1.52, S.E. = .836, p = .07, without predictors: p = .19). No strong evidence for a specific enhancement effect of tDCS on CBM was found. However, in a post-hoc analysis, tDCS combined with CBM showed a promising trend on treatment outcome. Important limitations are discussed, and replication is necessary to find more reliable effects.

Keywords: CBM; alcoholism; tDCS.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Alcoholism / physiopathology
  • Alcoholism / therapy*
  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy / methods
  • Craving
  • Double-Blind Method
  • Female
  • Germany
  • Humans
  • Male
  • Middle Aged
  • Prefrontal Cortex / physiopathology
  • Transcranial Direct Current Stimulation / methods*
  • Treatment Outcome