1. What are behavioural and substance addictions?

Many people act impulsively on occasion, others engage in habits religiously, but what does addiction and the related concepts of impulsivity and compulsivity really mean? Broadly speaking, impulsivity is the failure to control a sudden urge to behave in a certain way that may cause harm to oneself or others. In contrast, compulsivity is the attempt to control these thoughts or behaviours through repetitive actions, typically adopted to avoid harm to oneself or others. Both are relevant to behavioural and substance addictions and involve changes in a range of brain functions, such as attention, perception, memory and other cognitive processes.

A greater understanding of these processes may lead to targeted treatment strategies for different psychiatric disorders that are characterized by impulsivity or compulsivity.

Which disorders are being studied?

Obsessive-compulsive disorder (OCD)

OCD is a chronic psychiatric disorder asso­ ciated with substantial impairment in work, social and family life. It is characterized by frequent intrusive thoughts (e.g. fear of contamination or concerns about symmetry and neatness) and/or rituals (e.g. repeated hand washing or arranging and checking). Currently, there is no single, proven cause of OCD. It is likely that both genetic and environmental factors are involved.

Trichotillomania (Hair-pulling disorder (HPD))

HPD is a psychiatric disorder characterized by repetitive pulling out of one’s hair, resulting in hair loss. Usually, there are repeated unsuccessful attempts to decrease or stop the pulling. The condition may lead to significant distress, reduced selfconfidence and poor self-esteem. It has been suggested that family dynamics may play a role in the development of this disorder. More recent work suggests a neurobiological basis to HPD.

Gambling disorder (GD)

GD is recognised as a behavioural addiction as it resembles substance addictions. It is characterized by the inability to resist gambling despite severe disruption to work, social and family life. Individuals with GD may continually chase their losses, hide their behaviour, tell lies about where they go, how much they spend or owe, accumulate debt or even resort to theft or fraud to continue gambling. There is no single known cause of GD, but there is evidence suggesting involvement of both genetic and environmental factors. Noticeably, there seems to be a predisposition for GD in individuals with a family history of substance addiction.

Methamphetamine (“Tik”) use disorder (MUD)

“Tik” is highly addictive and one of the most common drugs used in the Western Cape. Chronic tik abusers show symptoms that can include violent behaviour, anxiety, confusion and sleep disturbances. They can also display a number of psychotic features, including paranoia, “hearing voices” (auditory hallucinations), mood disturbances and disturbed thinking (i.e. “delusions”, e.g. the sensation of insects creeping under or on the skin, called “formication”). MUD is also accompanied by functional and structural changes in the brain.

Who will be conducting the research?

Researchers from the universities of Stellen­bosch and Cape Town are involved in this multidisciplinary project. We collaborate with researchers worldwide.

Who can take part in this study?

Volunteers should be:

• Between 18 and 65 years old.
• Right-handed.
• Diagnosed with or suspect they have OCD, HPD, GD or MUD.
• Preferably not be on any chronic psychiatric medication at the time of participation.

What would my participation involve?

3 sessions:

1. A screening interview and diagnostic assessment, with questionnaires and taking of a blood sample for genetic analysis.
2. If suitable for the study, participants undergo brain scanning.
3. Completion of a number of computerized and paper-and-pen tasks to assess neurocognitive functioning.

Participation is cost-free and personal information will be strictly confidential.

Will I receive treatment?

No, this is not a treatment study. However, if you are interested in treatment, options will be discussed with you and a referral can be arranged.

Whom can I contact if I am interested in participation?

If you want more information or want to participate, please contact:

• Prof Christine Lochner, tel: 021 – 938 9179, e­mail: CL2@sun.ac.za
• Dr samantha Brooks, tel: 021 – 4045427, e-mail: drsamanthabrooks@gmail.com

2. Cognitive training in patients with hair-pulling disorder (trichotillomania)

Trichotillomania (hair-pulling disorder or HPD) is a condition in which patients engage in recurrent pulling of hair, resulting in hair loss. The negative impact of HPD should not be underestimated. For example, themes that emerged from reports from HPD patients focus on problematic triggering events, negative affect (isolation, embarrassment and shame, anger and frustration fear, guilt, humiliation and pain, body image issues) and control difficulty (self-disclosure, lack of information from the medical community and lack of control). Patients also live with the constant awareness of the impact their difficulty has on self and others in areas of social, occupational, academic and family functioning. Furthermore, patients may avoid accessing health care services due to feelings of shame, which contributes to delays in treatment seeking, incorrect diagnosis and reduced quality of life.

This intervention study will be conducted at the Psychology Department at Stikland Hospital, Bellville. Initially, 40 participants with a diagnosis of HPD will be recruited.
There will be an intervention called cognitive training. Cognitive training is a treatment method that focuses on improving cognitive functions (e.g. memory, attention, concentration, learning, planning). There is evidence to suggest that this method of cognitive training can increase working memory ability. An increase in working memory ability has shown positive effects on other impulse control difficulties (e.g. Attention Deficit Hyperactivity Disorder and Substance Abuse), thus there is reason to think that cognitive training may also be effective for treatment of HPD.

Thus, this study aims to assess whether cognitive training can reduce hair-pulling symptoms. To date, available treatments have not shown long-term reduction of symptoms.
Once referred to the study, the participant will be contacted telephonically and asked a few questions to make sure they are appropriate for inclusion to the study. Then a first contact session will be scheduled where the participant will complete working memory and impulse control tasks and questionnaires to assess their level of functioning before treatment. During the second contact session, the participant will be introduced to the internet-based cognitive training program, which he/she will use, at home, during the next 5 weeks. After completion of the training, a third contact session will be scheduled, during which the participant will complete working memory and impulse control tasks and questionnaires to assess change in hair-pulling symptoms and working memory. A fourth contact session will be scheduled 3 months after completion of the training to assess whether the changes were maintained over a longer period.

All participants will get the same tests. The only difference is that half of HPD patients will receive the real cognitive training program, and the other half will do the placebo training.
If you do qualify for participation, you will be asked to do the following things:

• To attend the 4 contact sessions scheduled with the principle investigator and complete a battery of assessments during the sessions. The sessions will take about 2 hours.
• To complete the internet-based cognitive training program – this entails 25 sessions, at home, over a period of 5 weeks. The sessions are about 30 – 45 minutes each.
• To do the training in a quiet environment where you can concentrate.
• To make use of an electronic device, preferably a computer or laptop, that has access to the internet (the whole 5 week program uses about 50Mb of data).

If you want more information or want to participate, please contact: Ms Derine Sandenbergh: (021) 940 4449 / 4504; e-mail Derine.Sandenbergh@westerncape.gov.za, or Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za

 

3. Cognitive training in patients with obsessive-compulsive disorder (OCD)

OCD is a condition that is known to be associated with problematic functioning of certain regions of the brain. One such problem relates to a concept called “working memory”. Working memory is linked to a person’s control over his/her thoughts and behaviour. Research suggests that greater activation of specific parts of the brain is associated with improved working memory, and thus improved self-control. This study involves a simple “brain game” (i.e “cognitive training” with the so-called n-back working memory task) that trains this specific part of the brain, to test whether this method can improve self-control in people with OCD.

What will your responsibilities be?
In order to participate, you need to have a Smartphone on which the study application will be loaded. If you do not, cognitive training would have to be provided by the UCT Department of Psychiatry and Mental Health on a loan phone which you will be responsible for. You will undergo a comprehensive screening interview with a clinical psychologist to see whether you qualify for participation. The interview also includes the assessment of OCD symptoms and severity.

If you do qualify for participation, you will be asked to do the following things:

1. Attend a screening procedure at Tygerberg Medical School.
2. Attend one session at the Department of Psychiatry and Mental Health at the University of Cape Town where you will:
   1. Have the study procedures explained to you in detail,
   2. Be given a brain scan that will take about 1 ½ hours, and
   3. Be asked to answer questionnaires on impulsivity, anxiety, depression and self-regulation.
3. Engage in cognitive training (i.e. the n-back working memory task) daily for 8 weeks (i.e. 20 sessions, Monday to Friday) on the Smartphone App at home.
4. The task will also be fully explained to you by instructions provided on the App. You are required to concentrate and respond at the appropriate moment as explained by the instructions.
5. You will be required to email your data file to the researcher daily by activating an icon which will be available on the App.
6. Another brain scan that will take about 1 ½ hours post-training, and
7. Attend a post-training interview to assess change in your OCD profile, brain scan and change in neuropsychological functioning.

Will you benefit from taking part in this research?
Based on results from previous research in other psychiatric disorders, we know that it is highly likely that doing brain training in this way will alter the way your brain functions, in a healthy way, so that you can use more self-control to decrease obsessive thoughts and compulsive behaviour. If this can be proven, your participation will help to increase the number of possible effective treatment options for patients with OCD.

Will you be paid to take part in this study and are there any costs involved?
We will provide a Pick n Pay food voucher to the value of R150 at the end of the 8 week cognitive training period.

If you want more information or want to participate, please contact: Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za

 

4. International study on student health and wellness

Adolescents and young adults are at increased risk for mental health problems. This includes, but is not limited to, psychopathologies such as anxiety and mood disorders, substance use and sexual and gender identity disorders. Although in many educational institutions treatment and support services are available, not many students access these. Also, although there is scientific knowledge of current risk factors for mental health problems, there is a lack of evidence-based methods for using this knowledge to identify those at risk and refer them to appropriate services.

This research is part of an international study, headed by Professor Bruffaerts, at Leuven University in Belgium.

This is a four-year longitudinal study at SU and UCT, in which we administer a baseline assessment of lifetime history of risk factors for negative outcomes, such as academic-, mental and health problems to university students during their first year, and then collect follow-up data at the start of each subsequent year (academic years 2-4).

Therefore, this collaborative, international research project proposes to examine health and wellness of students at participating institutions and aims to utilize an e-survey to identify (i) university students at risk for mental health problems, (ii) disorders and dysfunctional behaviours that should be targeted by prevention and treatment programs, and (iii) types of mental health / wellness services utilized by students.

If you want more information, please contact: Mrs Janine Roos 021 938 9229, e-mail: jroos@sun.ac.za, Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za