Chess_SUD: Neurobiological Mechanisms of Chess as an Add-On Treatment Against SUD

Sponsor

Central Institute of Mental Health, Mannheim (Other)

Overall Status

Recruiting

CT.gov ID

NCT04057534

Collaborator

(none)

Enrollment

Location

Arms

Anticipated Duration (Months)

3.3

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Neurobiological and neuropsychological approaches to investigate the potential mechanism of action of chess as an add-on therapy (chess based - cognitive remediation treatment, CB-CRT) to reduce cognitive deficits in individuals with alcohol use disorder (AUD) or tobacco use disorder (TUD).

Condition or Disease	Intervention/Treatment	Phase
Substance Use Disorders	Behavioral: Standard therapy for AUD plus Chess-based cognitive treatment Behavioral: Standard therapy for AUD Behavioral: Standard smoking cessation therapy for TUD plus Chess-based cognitive treatment Behavioral: Standard therapy for TUD	N/A

Detailed Description

The study aims to investigate the potential mechanism of action of chess as a "chess based - cognitive remediation treatment, CB-CRT" to reduce cognitive deficits in individuals with substance use disorder (SUD) seeking treatment using neurobiological and neuropsychological approaches. Furthermore, it will be assessed whether this chess intervention has a generalized positive effect on short-term abstinence. Interestingly, the functional domains and associated underlying neuronal networks observed to be affected in individuals with SUD overlap significantly with those that could be strengthened by chess-based cognitive training or formal chess. Specifically, strengthening of cortical control regions (dorsolateral prefrontal cortex, DLPFC) and brain areas relevant for decision-making (orbitofrontal cortex, OFC) could prevent future relapse. Therefore, chess as an add-on therapy to complement other standard treatments of SUD could lead to improved therapeutic outcomes.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

96 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Investigating Neurobiological Mechanisms of Chess as an Add-On Treatment Against Substance Use Disorder

Actual Study Start Date :

Apr 1, 2020

Anticipated Primary Completion Date :

Aug 31, 2022

Anticipated Study Completion Date :

Aug 31, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: CB-CRT AUD group experimental group AUD: patients receive standard clinical therapy and an add-on chess based - cognitive remediation treatment (CB-CRT)	Behavioral: Standard therapy for AUD plus Chess-based cognitive treatment Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine. Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.
Active Comparator: Control group AUD control group: patients with AUD receive standard clinical therapy	Behavioral: Standard therapy for AUD Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine.
Experimental: CB-CRT TUD group experimental group TUD: patients receive standard smoking cessation therapy and an add-on CB-CRT	Behavioral: Standard smoking cessation therapy for TUD plus Chess-based cognitive treatment Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smoking cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.
Active Comparator: Control group TUD control group: patients with TUD receive standard smoking cessation therapy	Behavioral: Standard therapy for TUD Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smokind cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week.

Outcome Measures

Primary Outcome Measures

change in neural alcohol cue-reactivity [2 time points: before and after 6 weeks chess-based cognitive training]
fMRI alcohol cue-reactivity task (Vollstädt-Klein et al. 2010)
change in neural tobacco cue-reactivity [2 time points: before and after 6 weeks chess-based cognitive training]
fMRI tobacco cue-reactivity task (Vollstädt-Klein et al. 2011)
change in neural correlates of inhibition [2 time points: before and after 6 weeks chess-based cognitive training]
fMRI stop-signal task (Whelan et al. 2012)
substance use (alcohol consumption and tabacco use) [3 months follow-up after the end of treatment]
self-report
change in neural working memory processes [2 time points: before and after 6 weeks chess-based cognitive training]
fMRI working memory task "N-back" (Charlet et al. 2014)
Change in working memory capacity [2 time points: before and after 6 weeks SCP]
working memory capacity measured by letter-number sequencing task of the [Wechsler Memory Scale (Kent 2013)]; raw values will be transformed to IQ-like scales (mean 100, SD 15); the higher the value, the higher the working memory capacity
Change in impulsivity [3 time points: before and after 6 weeks SCP plus after 3 months]
impulsivity measured with BIS scale [Barratt impulsiveness scale (Patton et al. 1995)];range 15-60; total score will be used; high values represent high impulsivity
Change in decision-making [2 time points: before and after 6 weeks SCP]
[Iowa Gambling Task (Bechara et al. 1994)]
Change in mental flexibility [2 time points: before and after 6 weeks SCP]
[Dimensional Change Card Sort (Zelazo et al. 2014)]
Change in attentional capacity [2 time points: before and after 6 weeks SCP]
[d2 Test of Attention (Brickenkamp 2002)].

Secondary Outcome Measures

change in functional connectivity within the salience network (SN) and executive control network (ECN) [2 time points: before and after 6 weeks therapy and chess-based cognitive training]
[measured with fMRI]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 65 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

severe alcohol (AUD) or tabacco use disorder (SUD) according to DSM-5
abstinence from alcohol for at least 72 hours (AUD)
sufficient ability to communicate with investigators and answer questions in both written and verbal format
ability to provide fully informed consent and to use self-rating scales
main diagnosis AUD: inpatient or outpatient treatment in our clinic
main diagnosis TUD: participation in 6 weeks smoking cessation treatment
Normal or corrected to normal vision
Signed consents for data security

Exclusion Criteria:

severe internal, neurological, and/or psychiatric comorbidities; other Axis I mental disorders other than TUD according to ICD-10 and DSM 5 (except for other substance use disorders - if AUD or TUD is still the main diagnosis -, ADHD, remitted depression, mild or moderate depression, adjustment disorder, generalized anxiety disorder, phobias, panic disorder or other mild or moderate personality disorders) in the last 12 months
Severe withdrawal symptoms (CIWA-Ar > 7; Sullivan et al. 1989)
alcohol intoxication (>0‰)
history of brain injury
severe cognitive impairments
common exclusion criteria for MRI (e.g. metal, claustrophobia, pregnancy)
suicidality or endangerment of others
positive Covid-19 screening