EABCT 2014 An Empirical Test of a Metacognitive Model of Craving

8/11/2019 EABCT 2014 An Empirical Test of a Metacognitive Model of Craving

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Craving

Powerful subjective experience that motivates individualsto seek out and achieve a craved target in order to reach

its desired effects (Marlatt, 1987)

The experience of craving is qualitatively similar across a

range of targets and only quantitavely different fromeveryday desires. (e.g. Castellani & Rugle, 1995; Field et al., 2008; May et al., 2004;Moreno et al., 2009)

This construct has been central to analyses of addictive

behaviour and relapse for decades and is a key focus inCBT treatment for addiction (Skinner & Aubin, 2010; OMalley et al., 2002)

It can be the result of the combination of automatic

(conditioned) and voluntary processes (Kavanagh et al., 2005, Caselli &

Spada 2010).


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Elaborated-Intrusion Theory of Desire

(Kavanagh et al., 2005)

1. Target- or negative affect-related

cues exposure and associations

2. Break over the awareness

treshold (e.g. intrusive thoughts,

memories, sense of deprivation)

3. Cognitive rigid, perseverative

elaboration of intrusions (desirethinking)

4. Escalation and persistence of

subjective craving and deprivation


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Desire Thinking

DTis a voluntary thinking process orienting to prefigure images, information andmemories about positive target-related experience and anticipating how to reach it(Caselli & Spada, 2010; 2011)

I anticipate the sensations I would feel practicing the desired activity

I imagine how I could realize my urges

How could I obtain it?

How could I hide my behaviour?

In the short-term DThelps to manage negative internal states by shifting attention awayfrom them and focusing on positive target related sensations

However in medium-term DT Increases levels of craving and perception of being out of control

Increases accessibility of target-related information

Hinders with down-regulation of desire and craving


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Desire Thinking and

Psychopathology Findings on significant structural differences between the construct of

desire thinking and craving (Caselli & Spada, 2011)

DT is associated to level of alcohol use, nicotine dependence, problematic

gambling and internet addiction independently from craving, negativeaffect and gender (Caselli et al., 2011; 2012, 2013, 2014)

The manipulation of desire thinking has a direct effect on craving accross a

range of addictive behaviors (Caselli, Soliani & Spada, 2013).

What make desire thinking becomes perseverative and

poorly regulated?


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S-REF Theory(Wells & Matthews, 1994)

A set of metacognitive beliefs act as control components of

information processing modes

They are responsible for psychological disturbance by

developing and maintaining a maladaptive mode of

processing

This maladaptive mode of processing (Cognitive-Attentional

Syndromeor CAS) is constituted by perseverative thinking,

threat monitoring, avoidance or safety behaviours)


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The Application of S-REF to Desire Thinking

and Craving

Desire Thinking as a part of the CAS (addiction)

Individuals with addiction disorders would possess both

positive and negative meta-beliefs about desire thinking

(Caselli & Spada, 2010; Spada Caselli & Wells, 2013):

Positive Meta-Beliefs: it helps not to be overhelmed by my

worries, it helps to have a greater control over my

decisions)

Negative Meta-Beliefs:(I cannot stop thinking about my desires,thinking about my desires bring me out of control)


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Metacognitions and Addiction

PMB predict desire thinking over and above craving

and negative affect (Caselli & Spada, 2013)

NMB predict addiction severity over and abovecraving, negative affect and desire thinking (Caselli &

Spada, 2013).

Need to Control Thoughts prospectively predict

relapse in alcohol abusers over and above baseline

alcohol use (Spada, Caselli & Wells, 2011)


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Triphasic

Metacognitive

Formulation of

ProblemDrinking

(Spada, Caselli & Wells,

2013)


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Pre-Engagement Phase


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Aim and Participants

The aim was to test the statistical fit of the metacognitive model of craving

in clinical samples across a range of addictive behaviours: alcohol use

disorder (AUD), Gambling Disorder (GD), Problematic Internet Use (PIU),

Tobacco users (TU)


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Materials

Desire Thinking Questionnaire (DTQ, Caselli & Spada, 2011)

The Metacognitions about Desire Thinking Questionnaire (MDTQ,

Caselli & Spada, 2013)

Specific measures of craving and addictive behaviours

Disorder Craving Addictive Behaviours

Alcohol Use Penn Alcohol Craving Scale Quantity Frequency Scale

Gambling Disorder Gambling Craving Scale South Oaks Gambling Screen

Internet Use The Internet Use Craving Scale The Internet Addiction Test

Tobacco Use Brief Questionnaire of Smoking

Urges

Fagerstrom Test of Nicotine

Dependence


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Path Analysis

A group of multiple regression equations that

estimate simultaneously the coefficient of the whole

system.

Fit indeces

Non-significant chi-square (X2)

Root Mean Square Error of Approximation (RMSEA) .95


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Discussion

Preliminary cross-sectional support for the validity of the

central structure of the model across four different addictive

behaviors: alcohol, gambling, internet and tobacco.

Absence of the link between PMDT and DT-VP in non-

psychoactive substance related addiction (GD and PIU).

Impact of withdrawal symptoms?

Shortened pathway


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Implications

Desire thinking and associated meta-beliefs may be a core

process that discriminate slight experience of

desire/deprivation from excessive craving

Key messages:

1. Desires dontmatter, response to the does

2. We cannot crave less by thinking more about our desires

3. Itsnot good to think too much about a target we do notwant to achieve.


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Implications

Improving on-line meta-awareness about (1) desire thinking,

(2) personal goals and decisions

Improving metacognitive control (e.g. postponing any further

elaboration of target-related information)

Modify Meta-Beliefs about uncontrollability, utility and need

to control target-related intrusions

Attentional Training, Detached Mindfulness, Meta-level

verbal reattribution (Metacognitive Therapy, Wells, 2008).


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Limitations and Future Directions

Limitations

Cross-sectional design

Use of self-report

Samples limited in size

Future Research

Explore neurobiological

basis and behavioral

outcome of desire

thinking

Explore the link between

desire thinking and

intention to use

Explore the prospective

validity of the model


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Thank you for your attention!

Contact details

Dr. Gabriele Caselli

Cognitive Psychotherapy School Studi Cognitivi, Modena, Italy

London South Bank University, London, UK

[email protected]
mailto:[email protected]:[email protected]

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EABCT 2014 An Empirical Test of a Metacognitive Model of Craving

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