Gabriele Caselli

Rumination as a predictor of drinking behaviour in alcohol abusers: a prospective study

AIMS To investigate the role of depression and rumination in predicting drinking status (absence or presence of alcohol use) and level of alcohol use at 3, 6 and 12 months following a brief course of cognitive-behavioural therapy for alcohol abuse. METHODS A total of 80 out-patients with a diagnosis of alcohol abuse completed measures of depression (Beck Depression Inventory), rumination (Ruminative Responses Scale) and alcohol use (Quantity-Frequency Scale). RESULTS These indicated that rumination predicted drinking status and level of alcohol use at 3-, 6- and 12-month follow-up. The contribution of rumination was independent of depression and initial level of alcohol use. CONCLUSIONS The results confirm that rumination is an important prospective predictor of drinking status and level of alcohol use in alcohol abusers and highlight the potential relevance of targeting rumination in the treatment of alcohol abuse.

Metacognition in addictive behaviors.

BACKGROUND Over the last twenty years metacognitive theory has provided a novel framework, in the form of the Self-Regulatory Executive Function (S-REF) model, for conceptualizing psychological distress (Wells & Matthews, 1994, 1996). The S-REF model proposes that psychological distress persists because of unhelpful coping styles (e.g. extended thinking and thought suppression) which are activated and maintained as a result of metacognitive beliefs. OBJECTIVE This paper describes the S-REF model and its application to addictive behaviors using a triphasic metacognitive formulation. DISCUSSION Evidence on the components of the triphasic metacognitive formulation is reviewed and the clinical implications for applying metacognitive therapy to addictive behaviors outlined.

A triphasic metacognitive formulation of problem drinking.

UNLABELLED In this paper, a triphasic metacognitive formulation of problem drinking and its implications for treatment are presented together with a summary of the evidence consistent with this approach. In the triphasic formulation during the pre-alcohol use phase, alcohol-related triggers, in the form of cravings, images, memories or thoughts, activate positive metacognitive beliefs about extended thinking, which lead to desire thinking, rumination and worry or their combination. The activation of the latter brings to an escalation of cravings and negative affect, strengthening negative metacognitive beliefs about the need to control thoughts and enhancing the likelihood of alcohol use. In the alcohol use phase, positive metacognitive beliefs about alcohol use and a reduction in metacognitive monitoring contribute to dysregulation in alcohol use. Over the course of time and as the drinking problem escalates in severity, negative metacognitive beliefs about the uncontrollability of alcohol use and alcohol-related thoughts emerge, contributing to the perseveration of dysregulated alcohol use. In the post-alcohol use phase following the activation of positive metacognitive beliefs about post-event rumination, the affective, cognitive and physiological consequences of dysregulated alcohol use become the subject of rumination. This, in turn, leads to a paradoxical increase in negative affect and alcohol-related thoughts, together with the strengthening of negative metacognitive beliefs about such thoughts. Intermittent attempts to suppress alcohol-related thoughts increase the likelihood of returning to use alcohol as a means of achieving self-regulation. KEY PRACTITIONER MESSAGE A metacognitive formulation of problem drinking that may aid assessment, conceptualization and treatment across the problem drinking spectrum.

Rumination in problem drinkers

The present study explored the role of the general tendency to ruminate as a predictor of problem drinking (alcohol abuse) in clinical and community samples. A sample of 36 patients with a diagnosis of problem drinking and 37 social drinkers from the general population were compared on the following measures: Beck Depression Inventory (BDI), Ruminative Responses Scale (RRS) and Quantity Frequency Scale (QFS). Mann-Whitney U-tests, and logistic and hierarchical regression analyses were performed on the data. Mann-Whitney U-tests revealed that depression, rumination and alcohol use were significantly higher for problem drinkers than for social drinkers. The logistic regression analysis indicated that rumination was an independent predictor of classification as a problem drinker over and above depression. Finally, the hierarchical regression analysis on the combined samples showed that rumination independently predicted alcohol use. These results highlight the potential relevance of targeting the general tendency to ruminate in the treatment of problem-drinking behaviour.

Metacognitions in Desire Thinking: A Preliminary Investigation

BACKGROUND Desire thinking is defined as a voluntary thinking process orienting to prefigure images, information and memories about positive target-related experience. Recent research has highlighted the role of desire thinking in the maintenance of addictive, eating and impulse control disorders. Currently little is known about metacognitions in desire thinking. AIM To investigate: (1) the presence and content of desire thinking during a desire experience; (2) the presence of metacognitive beliefs in desire thinking; (3) the goal of desire thinking; (4) attentional focus during desire thinking; and (5) the impact of desire thinking on craving. METHOD Twenty-four individuals with a diagnosis of either alcohol abuse, bulimia nervosa, pathological gambling or smoking dependence were assessed using a semi-structured interview. RESULTS Findings indicated that participants engaged in desire thinking and endorsed both positive and negative metacognitive beliefs about this process. The goal of desire thinking was to regulate internal states. Participants also reported that during a desire experience their attentional focus was continuously shifting between internal state and external context and that engaging in desire thinking increased craving. CONCLUSIONS These findings provide preliminary evidence that metacognitions play a role in desire thinking.

Personality and alcohol metacognitions as predictors of weekly levels of alcohol use in binge drinking university students

This study investigated the relative contribution of the Big 5 personality factors and alcohol metacognitions in predicting weekly levels of alcohol use in binge drinking university students. No research to date has investigated whether either of these constructs predicts levels of weekly alcohol use in binge drinkers. A sample of university students (n=142) who were classified as binge drinkers were administered the following self-report instruments: NEO-Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992), Positive Alcohol Metacognitions Scale (PAMS; Spada & Wells, 2008), Negative Alcohol Metacognitions Scale (NAMS; Spada & Wells, 2008), and Khavari Alcohol Test (KAT; Khavari & Farber, 1978). Pearson product-moment correlations showed that weekly levels of alcohol use were negatively correlated with agreeableness and conscientiousness and positively correlated with positive alcohol metacognitions about cognitive self-regulation, negative alcohol metacognitions about uncontrollability and negative alcohol metacognitions about cognitive harm. A hierarchical regression analysis revealed that conscientiousness and positive alcohol metacognitions about cognitive self-regulation were the only two significant predictors of weekly levels of alcohol use when controlling for gender. These findings show that being male, low on conscientiousness and high on positive alcohol metacognitions about cognitive self-regulation raises the risk for increased weekly levels of alcohol use in binge drinking university students. The implications of these findings are discussed.

The Effect of Desire Thinking on Craving: An Experimental Investigation

Desire thinking is a voluntary cognitive process involving verbal and imaginal elaboration of a desired target. Recent research has revealed that desire thinking and craving are distinct constructs and that desire thinking may play a significant role in the escalation of craving. The goal of this study was to explore the effect of desire thinking induction on craving in a nonclinical sample. Forty-five volunteers with no current diagnosis of psychological disorders chose a desired activity and were randomly allocated to three thinking manipulation tasks: distraction, verbal reasoning, and desire thinking. Craving was measured before and after manipulation and during a 3-day period of abstinence from the desired activity. Findings showed that desire thinking had a significant effect on craving after manipulation. This effect appeared to be independent of baseline levels of craving and desire thinking as well as perceived stress changes during the manipulation. Both distraction and verbal reasoning inductions did not lead to a significant change in craving. Desire thinking impacts craving and is a risk factor for craving-related problems.

Desire thinking: what is it and what drives it?

INTRODUCTION The aim of this study was to provide an overview of the construct of desire thinking and test a metacognitive model of desire thinking and craving, based on the work of Spada, Caselli and Wells (2012; 2013), which aims to explain the perseveration of desire thinking. METHOD We conducted two studies involving four clinical samples (total N = 493) and a community sample (N = 494) presenting with different addictive behaviors. The relationships among variables were examined by testing the fit of path models within each sample. RESULTS In the model presented it was proposed that positive metacognitions about desire thinking are associated with, in turn, imaginal prefiguration and verbal perseveration, marking the activation of desire thinking. Verbal perseveration is then associated to negative metacognitions about desire thinking and craving denoting the pathological escalation of desire thinking. Finally, a direct association between positive metacognitions about desire thinking and negative metacognitions about desire thinking would mark those occasions where target-achieving behaviour runs as an automatized schemata without the experience of craving. Results indicated a good model fit in the clinical sample and a variation in the model structure in the community sample. CONCLUSION These findings provide further support for the application of metacognitive theory to desire thinking and craving in addictive behaviors.

Desire Thinking across the Continuum of Drinking Behaviour

Objective: Desire thinking is a voluntary cognitive process involving verbal and imaginary elaboration of a desired target. Recent research has highlighted the role of desire thinking in predicting addictive behaviours independent of other psychological constructs including negative affect and craving. The goal of this research project was to explore the role of desire thinking across the continuum of drinking behaviour. Methods: A sample of alcohol-dependent drinkers (n = 43), problem drinkers (n = 59), and social drinkers (n = 68) completed self-report instruments of desire thinking, negative affect, craving and drinking behaviour. Results: Analyses revealed that alcohol-dependent drinkers and problem drinkers scored higher than social drinkers on imaginal prefiguration, and that alcohol-dependent drinkers scored higher than problem drinkers who in turn scored higher than social drinkers on verbal perseveration. A multi-group discriminant analysis showed that craving, imaginal prefiguration and verbal perseveration loaded on a first function whilst age loaded on a second function. The variables correctly classified 75.9% of cases. Conclusions: The findings suggest that desire thinking may be a risk factor across the continuum of drinking behaviour and that treatment may benefit from specifically targeting this cognitive process.

Profiling metacognition in gambling disorder

BACKGROUND Preliminary research has indicated that general facets of metacognition are associated with problem gambling. In the present study we aimed to investigate whether specific facets of metacognition play a role in explaining gambling initiation and perseveration in individuals presenting with gambling disorder. AIM To investigate: (1) the presence of metacognitive beliefs about gambling; (2) the goal of gambling, and its start and stop signals; and (3) the perceived impact of gambling on self-consciousness. METHOD Ten individuals with a diagnosis of gambling disorder were assessed using metacognitive profiling, a semi-structured interview. RESULTS Findings indicated that all participants endorsed both positive and negative metacognitive beliefs about gambling. The primary goal of gambling was to relieve economic hardship and improve cognitive-emotional state. All participants reported that they did not know when this goal was achieved. Start signals for gambling included the ideas and feelings that gambling could solve problems and sensations that it might be the right time to win. The stop signal for gambling, for all participants, was running out of money. All participants also reported a perceived reduction in self-consciousness during a gambling episode. CONCLUSIONS These findings provide preliminary evidence that specific facets of metacognition play a role in gambling disorder.