Imaginal Retraining — A Self-Help Technique to Reduce Cravings
Dear colleagues and others,
Our group has developed a new self-help technique for the reduction of cravings (e.g., for alcohol, nicotine, or high-calorie foods) called imaginal retraining. The intervention has proven effective in various studies. You can obtain our self-help manuals via the donate button at the bottom of this page.
For the new technique, we have adapted a computer-based procedure so it can be carried out without a computer. Thus, it is much more flexible and can be customized to individual problems. The technique has been evaluated as effective in people with strong cravings for alcohol, nicotine and high-calorie foods. Via the link below, you can obtain the manuals "Think Before You Drink" (alcohol) and "Dunk the Junk" (high-calorie foods). The technique can be easily adapted for smoking and other problem behaviors.
Background: Original and new technique
Excessive craving for certain substances is common and plays a major role, for example, in alcohol and nicotine abuse (Carvalho, Heilig, Perez, Probst, & Rehm, 2019) and in excessive, uncontrolled eating behavior (Verzijl, Ahlich, Schlauch, & Rancourt, 2018). Such cravings also contribute to high relapse rates (Boswell & Kober, 2016; Stohs, Schneekloth, Geske, Biernacka, & Karpyak, 2019). Imaginal retraining is designed to reduce cravings for harmful substances or high-calorie foods.
The technique takes advantage of unconscious bodily processes that cause us to automatically move closer to things we like (e.g., hug someone, approach an object out of curiosity) and automatically reject, push away, or distance ourselves from things we dislike. This interplay is strongly anchored both physically and linguistically (we talk, for example, about finding someone attractive or repulsive) and is present in virtually all people. In addicted patients, the tendency to approach craved subsances is elevated.
The predecessor to our technique, classic retraining, is a computerized procedure designed to reduce this elevated tendency. In this version of retraining, patients are instructed to push images of craved substances away from themselves with a joy stick and to pull neutral or positive images toward themselves. Studies have shown that this simple procedure does indeed reduce the risk of relapse. However, many users find the classic task monotonous. Willingness to participate is therefore low and effect sizes tend to be small (Cristea, Kok, & Cuijpers, 2016).
In the new imaginal retraining technique, the various stimuli are pushed away or pulled toward oneself in the imagination, which offers the advantage that the imagined images can be customized (e.g., a particular alcoholic beverage). In addition, the technique is easy to implement in everyday life.
Imaginal retraining has already been tested for effectiveness and acceptance in several randomized controlled studies. In people with problematic alcohol consumption (Moritz, Paulus, et al., 2019), nicotine consumption (Moritz, Göritz, Kraj, et al., 2019), and consumption of high-calorie foods (Moritz, Göritz, Schmotz, et al., 2019), craving for the critical substance was significantly reduced compared to a control group, and behavioral changes (including weight reduction) were also shown in a subgroup. The participants in all the studies described imaginal retraining as easy to use, and they showed high acceptance of the technique. Moreover, a recent study of our working group found that the reduction in craving for tobacco is still detectable after one year (Gehlenborg et al., 2022).
You can obtain our two manuals—on reducing cravings for alcohol ("Think Before you Drink") and high-calorie foods ("Dunk the Junk")—via the link at the bottom of the page. Note that the technique can be easily modified for other problem behaviors such as smoking or gambling. We rely on your experiences and suggestions to improve the technique and the manuals. Please take the time to send feedback to Steffen Moritz (firstname.lastname@example.org).
If you are interested, please click on 'To the manual' button.
We are happy to provide this and our other self-help techniques free of charge to our colleagues in the scientific community and to people with mental health problems with limited means. We kindly ask all other interested persons to make a donation of 20€/$20, which will go directly to our research efforts (donations can be made via betterplace.org with this link). Research is expensive; it requires elaborate basic research and then various steps that lead up to clinical testing on many affected people.
After you make a donation, we will send you a receipt that you can submit for tax purposes. Along with the manuals, you will also receive a link to an app that we have created for people with low self-esteem and depressive symptoms. Two controlled studies have shown the efficacy of this approach.
The materials will be emailed to you within 5 business days.
Boswell, R. G. & Kober, H. (2016). Food cue reactivity and craving predict eating and weight gain: a meta-analytic review. Obesity Reviews, 17, 159–177. Link to article (Abstract)
Carvalho, A. F., Heilig, M., Perez, A., Probst, C., & Rehm, J. (2019). Alcohol use disorders. Lancet (London, England), 394, 781–792. Link to article (Abstract)
Cristea, I. A., Kok, R. N., & Cuijpers, P. (2016). The effectiveness of cognitive bias modification interventions for substance addictions: a meta-analysis. PloS one, 11, e0162226. Link to article (full text)
Fridland, E. & Wiers, C. E. (2018). Addiction and embodiment. Phenomenology and the Cognitive Sciences, 17, 15–42. Link to article (Abstract)
Gehlenborg, J., Göritz, A.S., Moritz, S., Lüdtke, T., & Kühn, S. (2022). Imaginal retraining reduces craving for tobacco in 1-year controlled follow-up study. European Addiction Research, 28, 68-79. Link to article (Abstract)
Moritz, S., Göritz, A. S., Kraj, M., Hottenrott, B., Tonn, P., Ascone, L., Pedersen, A., & Kühn, S. (2020). Imaginal retraining reduces cigarette smoking: a randomized controlled study. European Addiction Research, 26, 355–364. Link to article (Abstract)
Moritz, S., Göritz, A. S., Schmotz, S., Weierstall-Pust, R., Gehlenborg, J., Gallinat, J., & Kühn, S. (2019). Imaginal Retraining decreases craving for high calorie food in overweight and obese women. A randomized controlled trial. Translational Psychiatry, 9, 319. Link to article (full text)
Moritz, S., Paulus, A. M., Hottenrott, B., Weierstall, R., Gallinat, J., & Kühn, S. (2019). Imaginal retraining reduces alcohol craving in problem drinkers: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 64, 158–166. Link to article (Abstract)
Stohs, M. E., Schneekloth, T. D., Geske, J. R., Biernacka, J. M., & Karpyak, V. M. (2019). Alcohol craving predicts pelapse after residential addiction treatment. Alcohol and alcoholism (Oxford, Oxfordshire), 54, 167–172. Link to article (full text)
Verzijl, C. L., Ahlich, E., Schlauch, R. C., & Rancourt, D. (2018). The role of craving in emotional and uncontrolled eating. Appetite, 123, 146–151. Link to article (Abstract)
Wiers, R. W., Boffo, M., & Field, M. (2018). What’s in a trial? On the importance of distinguishing between experimental lab studies and randomized controlled trials: the case of cognitive bias modification and alcohol use disorders. Journal of Studies on Alcohol and Drugs, 79, 333–343. Link to article (Abstract)
Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., & Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychological Science, 22, 490–497. Link to article (full text)