Development and testing of computerised cognitive behaviour intervention to address dysfunctional impulsivity in the nonclinical population

Professional Doctorate - Doctor of Clinical and Health Psychology (DCP)Scope: Individuals with high impulsivity levels place themselves and people around them at risk. For individuals who experience difficulties in effectively managing their impulsive behaviours, it may turn into a lifelong debilitating condition in both clinical and nonclinical populations. Impulsivity is a prominent feature of many psychiatric and developmental disorders: personality disorders (such as Borderline Personality Disorder [BPD]), eating disorders (such as bulimia), mood disorders (such as bipolar disorder [BD]) and substance addiction (such as drug addiction) Parry and Lindsay (2003). Impulsivity, alongside maladaptive coping strategies, hopelessness, cognitive rigidity, problem solving difficulties and hostility, is associated with deliberate self-harm and suicide attempts (Kumaraiah & Bhide, 2001). Impulsivity is considered to be a lifelong personality trait and a feature of many psychological problems and there seems to be a need to develop and test psychological interventions for this common mental health problem (Wells, Parboteeah, & Valacich, 2011). Therefore, developing an effective treatment program is important and will be of benefit not only to an individual but to a wider society (Grant & Kim, 2003). Purpose: Impulsivity is a prominent feature of many psychiatric and developmental disorders: personality disorders (e.g., Borderline Personality Disorder), eating disorders (e.g., Bulimia), Impulse Control Disorders (ICD) (e.g., Kleptomania), and substance addiction (Drug Addiction). Impulsivity has been associated with lower academic grades, higher aggression, interpersonal violence, impulsive shopping, and stealing in clinical and nonclinical population (Spinella, 2004). Impulsivity is related to the severity of gambling behaviours and is indicative of a future development of pathological gambling (Forbush et al., 2008). Additionally, impulsivity has been associated with self-injurious and suicidal behaviour (Klonsky & May, 2010). Individuals with high levels of impulsivity experience difficulties, such as emotional instability and cognitive distractibility, engaging in behaviours that often result in undesirable outcomes (Gay, Schmidt, & Van der Linden, 2011). Thus, they often feel powerless, weak and ashamed due to the lack of control over their impulsive behaviours (Grant & Kim, 2003). Additionally, such individuals often experience heightened anxiety, depressive moods, low self-esteem and increased stress associated with their impulsive behaviours (Grant & Kim, 2003). Therefore, developing an effective treatment program is important and will be of benefit not only to an individual but a wider society (Grant & Kim, 2003). Cognitive Behaviour therapy (CBT) is considered to be an effective intervention for impulse control disorders (Moeller & Dougherty, 2002). Treatment studies based on CBT interventions including covert sensitisation, imaginal desensitisation, aversion therapy, cognitive restructuring, relaxation training and relapse prevention were found to be effective in treatment of individuals diagnosed with kleptomania, compulsive buying, or pathological gambling (Hodgins & Peden, 2008). Mindfulness, as a therapeutic tool, has long been recognised as an effective intervention in emotional regulations and is considered to be a core component of a Mindfulness-Based Stress Reduction program and Dialectical-Behaviour Therapy (Peters, Erisman, Upton, Baer, & Roemer, 2011). Based on the current literature, we designed a computerised intervention program aimed at reducing dysfunctional impulsivity in a nonclinical sample. We expect to find a reduction in impulsivity, in particular: a decrease of impulsivity as measured by BIS-11; an increase in tolerance of delay as measured by Delay Discounting Task; and a reduction in cognitive distortions as measured by the Cognitive Distortion Scale (CDS). Methodology: Eligible participants were randomly assigned to an intervention group (IMP) and control group (SA). Participants were evaluated prior to initiating the computerised program, upon completion and during a follow up period on measures including: BIS-11; Cognitive Distortions Scale (CDS); and an online delay discounting task examining hypothetical monetary rewards. Indifference points were calculated and hyperbolic curves were fitted to the indifference points for both groups (IMP vs SA). The study is a mixed experimental design. The between-subject factor is the type of treatment. The within-subject factors are measures of impulsivity, cognitive distortions, social anxiety and delay discounting at time intervals (Pre-treatment, Post-treatment, and 2 weeks follow-up). Results: This study demonstrated that dysfunctional impulsivity in a nonclinical sample can be reduced with the help of computerised Cognitive Behaviour Therapy and Mindfulness intervention. In particular, results showed that increases in the tolerance of delay of gratification, reduction in Mind Reading, Shoulds, Confusing Needs and Wants, All-or-Nothing Thinking, Discounting Positives, Personalising, Regret Orientation, Short-term Thinking and Blaming cognitive distortions, as well as reduction in Non-Planning Impulsivity in the intervention group, were observed and sustained at a follow-up evaluation. General Conclusions and Implications: The results of this study highlight the value of an intervention program in addressing dysfunctional impulsivity and contributes to research in the area of decision making, self control, cognitive modification and cognitive therapy regarding the cognitive distortions associated with dysfunctional impulsivity. This is the first study to design and test computerised Cognitive Behaviour Therapy and Mindfulness intervention to address dysfunctional impulsivity in a nonclinical sample. Further research should be conducted to expand research in this area utilising larger sample sizes and to test this intervention program with the clinical population