Marcantonio M. Spada

An overview of problematic internet use.

Problematic Internet use (PIU), which has become a global social issue, can be broadly conceptualized as an inability to control ones use of the Internet which leads to negative consequences in daily life. The aim of this paper is to give a brief overview of the gradually evolving body of literature on PIU. This shows that the definitions and diagnostic criteria that have been proposed, and the assessment tools that have been developed, stress similarities between PIU, addictive behaviours and impulse-control disorders. Disagreements regarding diagnostic criteria and the lack of large epidemiological studies have resulted in difficulties in establishing the prevalence of PIU in the general population. Studies suggest high comorbidity rates between PIU and numerous psychiatric disorders highlighting the importance of focusing on comorbidity in treatment. There is growing evidence that genetic, personality and individual differences in automatic and controlled aspects of self-regulation may promote the development of PIU. Pharmacological and psychotherapeutic treatments specific to PIU have received limited testing in large, rigorous studies however preliminary evidence suggests that both psychotropic medications (Escitalopram, Naltrexone and Methylphenidate) and cognitive behaviour therapy may have some utility in the treatment of PIU. More research is needed on areas which remain unclear and contribute to the prognosis of PIU, in particular the temporal relationships between psychiatric disorder and PIU, mechanisms of comorbidity and the more subtle psychological changes that occur through Internet use.

The role of metacognitions in problematic Internet use

Research has suggested that negative emotions are associated with problematic Internet use. This study investigated the role of metacognitions as a mediator of the relationship between negative emotions and problematic Internet use. A sample of 97 university students completed the following questionnaires: Hospital Anxiety and Depression Scale, Boredom Proneness Scale, Metacognitions Questionnaire 30, and Internet Addiction Test. All dimensions of metacognition were found to be positively and significantly correlated with problematic Internet use. Positive and significant correlations were also observed between problematic Internet use and negative emotions (anxiety, depression and boredom). Structural equation modeling was used to test a mediation model in which negative emotions predicted metacognitions which in turn predicted problematic Internet use. The results supported the hypothesis that the relationship between negative emotions and problematic Internet use is fully mediated by metacognitions, suggesting that metacognitive theory may be relevant to understanding problematic Internet use. The implications of these findings are discussed.

Metacognition as a mediator of the effect of test anxiety on a surface approach to studying

This study investigated the role of metacognition as a mediator of the effect of test anxiety on a surface approach to studying. The following scales were completed by 109 undergraduate social sciences students: Approaches and Study Skills Inventories for Students (ASSIST), Metacognitions Questionnaire (MCQ), and Test Anxiety Scale (TAS). Positive and significant correlations were observed between test anxiety and a surface approach to studying, and between all five dimensions of metacognition and test anxiety. Positive and significant correlations were also found between four of the five dimensions of metacognition and a surface approach to studying. Structural equation modelling was used to test a mediational model in which test anxiety predicted metacognition which in turn predicted a surface approach to studying. The results supported the hypothesis that the effect of test anxiety on a surface approach to studying is entirely mediated by metacognition. The practical implications of these findings are outlined.

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.

The Relationship among Metacognitions, Attentional Control, and State Anxiety

Abstract The present study explored the relationship among metacognitions, attentional control, and state anxiety. A convenience sample of 142 undergraduate students completed the Meta-Cognitions Questionnaire-30, the Attentional Control Scale, and the State subscale of the State–Trait Anxiety Inventory 3 weeks before end-of-year examinations. A cross-sectional design was adopted, and data analysis consisted of correlation and hierarchical regression analyses. Correlation analyses showed that three dimensions of metacognition (negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, and beliefs about the need to control thoughts) were positively correlated with state anxiety. These same metacognitions were also found to be negatively correlated with attention shifting and, with the exception of cognitive confidence, attention focusing. Both attention focusing and attention shifting were found to be negatively correlated with state anxiety. A hierarchical regression analysis showed that negative beliefs about thoughts concerning uncontrollability and danger and attention focusing independently predicted state anxiety. Overall, these findings support the hypotheses and are consistent with the metacognitive theory of psychological dysfunction in that they show that metacognitions (in the form of negative beliefs about thoughts concerning uncontrollability and danger) and executive control (in the form of attention-focusing) individually contribute to state anxiety. The implications of these findings are discussed.

Metacognitions in Problem Drinkers

The present study examined metacognitions in problem drinkers and a community sample. A sample of 60 problem drinkers and 84 individuals from the general population were compared on the following measures: Hospital Anxiety and Depression Scale, Meta-Cognitions Questionnaire 30, Quantity Frequency Scale and Alcohol Use Disorders Identification Test. Mann–Whitney U-tests, logistic regression analysis and hierarchical regression analyses were performed on the data. Mann–Whitney U-tests revealed that metacognitions, anxiety, depression and drinking scores were significantly higher for problem drinkers than for the general population. The logistic regression analysis indicated that beliefs about cognitive confidence and beliefs about the need to control thoughts were independent predictors of a classification as a problem drinker over and above negative emotions. Finally, hierarchical regression analyses on the combined samples showed that beliefs about cognitive confidence, and beliefs about the need to control thoughts, independently predicted both alcohol use and problem drinking scores. These results add to the argument that metacognitive theory is relevant in understanding excessive and problematic alcohol use.

A metacognitive model of problem drinking

UNLABELLED Previous research has demonstrated significant relationships between metacognition and problem drinking. In this study, we aimed to investigate further these relationships by testing the fit of a metacognitive model of problem drinking in a sample of 174 problem drinkers from a university student population. In the model presented, it is proposed that positive metacognitive beliefs about alcohol use and negative affect lead to alcohol use as a means of affect regulation. Positive metacognitive beliefs about alcohol use are also associated with a reduction in metacognitive monitoring which further contributes to alcohol use. Once alcohol use is initiated it brings a disruption in metacognitive monitoring leading to a continuation in drinking. Following a drinking episode, alcohol use is appraised as both uncontrollable and dangerous, which in turn strengthens negative metacognitive beliefs about alcohol use. These beliefs are associated with an escalation of negative affect, which acts as a trigger for further drinking. The specified relationships among these variables were examined by testing the fit of a path model. Results of this analysis indicated a good model fit consistent with predictions. The conceptual and clinical implications of these data are discussed. KEY PRACTITIONER MESSAGE *A cognitive-attentional model that may aid assessment, conceptualization and treatment for moderate or at risk problem drinkers.

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.