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Caselli - Pensiero Desiderante e Alcolismo


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Presentazione Congresso Europeo Terapie Cognitivo-Comportamentali, EABCT 2012, Ginevra.
Oral Presentation at the 42th Congress of European Association of Behavioral and Cognitive Therapies.
Il ruolo del pensiero desiderante lungo il continuum della dipendenza da alcool

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Caselli - Pensiero Desiderante e Alcolismo

  1. 1. Desire Thinking across the Continuum of Drinking Behaviour Gabriele Caselli1,2, Marcantonio M. Spada1,3 1 London South Bank University, London, UK 2 Studi Cognitivi, Cognitive Psychotherapy School, Milano, Italy 3North East London NHS Foundation Trust, London, UK
  2. 2. Antecedents of Drinking Behaviour1. Negative affect (e.g. Anxiety and Depression) • A frequent antecedent of alcohol use (e.g. Ameli et al., 2001) • Alcohol is employed to cope with negative affect (Zack et al., 2002) • Changes in mood strengthen the urge to drink (e.g. Cooney et al., 1997) • Enhance the risk of relapse after treatment (e.g. Caselli et al., 2008)
  3. 3. Antecedents of Drinking Behaviour2. Craving • Powerful subjective experience that motivates individuals to seek out and achieve a craved target in order to reach its desired effects (Marlatt, 1987) • Play a crucial role in the development of alcohol dependence (Ludwig & Wikler, 1974) • Enhance risk drinking during and after treatment (e.g. Flannery et al., 2003; Gordon et al., 2006) • Is a key focus in CBT treatment for alcohol use disorders (O’Malley et al., 2002)
  4. 4. Theories about the link• Conditioning models (Ludwig & Wikler, 1974; Siegel, 1983; Stewart, Dewit, & Eikelboom, 1984)• Cognitive models (Marlatt, 1985; Stacy, 1997; Baker, Morse & Sherman, 1987; Tiffany, 1999)• Elaborated-Intrusion Theory (EI-Theory, Kavanagh et al., 2009)
  5. 5. 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 (desire thinking) 4. Escalation and persistence of subjective craving and deprivation
  6. 6. Desire Thinking• DT is a voluntary thinking process orienting to prefigure images, information and memories about positive target- related experience (Caselli & Spada, 2010; 2011) • Imaginal prefiguration (e.g. I anticipate the sensations I would feel practicing the desired activity • Verbal Perseveration: (e.g. I repeat mentally to myself that I need to practice the desired activity)• In the short-term DT helps to manage negative internal states by shifting attention away from them and focusing on positive target related sensations• However in medium-term DT brings to an escalation of craving as the desired target is perseveratively imagined but not achieved
  7. 7. Desire Thinking and Psychopathology• Findings on significant structural differences between the construct of desire thinking and craving (Caselli & Spada, 2011)• High nicotine dependent patients reports significantly higher levels of desire thinking than moderate and low nicotine dependents (Caselli et al., 2011)• DT induces subjective craving in experimental manipulation (Caselli et al., 2012)
  8. 8. AIMs• Explore the differences in desire thinking in alcohol dependent drinkers, problem drinkers and social drinkers whilst controlling for negative affect (anxiety and depression) and craving• We hypothesized that alcohol dependent drinkers would have higher levels of desire thinking than problem drinkers who in turn would have higher levels than social drinkers
  9. 9. Participants Dependent Problem SocialN 43 59 68Females 14 23 34Age 44 (11.1) 47.2 (11.9) 43.8 (12.5)WAU 90.5 (24.3) 43.1 (11.2) 6.3 (4.9)CriteriaDrug-Free V V vItalian V V V>18 Age V V V> 21 WAU V V XSCID-I V X X
  10. 10. Materials• Negative Affect (HADS - Hospital Anxiety and Depression Scale)• Craving (PACS - Penn Alcohol Craving Scale)• Desire Thinking (DTQ - Desire Thinking Questionnaire) • Imaginal Prefiguration (DTQ-IP) • Verbal Perseveration (DTQ-VP)• Alcohol Use (QFS - Quantity Frequency Scale)
  11. 11. Results - Descriptives Dependent Problem Social Drinkers Drinkers Drinkers (n=68) (n=43) (n=59)Anxiety (HADS-A) 7.2 (2.7) 6.6 (4.0) 5.8 (3.2)Depression (HADS-D) 5.3 (3.7) 4.9 (3.9) 3.9 (3.0)Craving (PACS) 19.4 (4.6) 16.0 (5.2) 4.4 (3.8)Imaginal Prefiguration (DTQ-IP) 13.8 (3.7) 12.1 (3.6) 7.3 (2.2)Verbal Perseveration (DTQ-VP) 14.8 (3.5) 11.8 (3.9) 5.8 (1.5)Alcohol Use (QFS) 90.5 (24.3) 43.0 (11.8) 6.3 (4.9)• Significant covariates for DTQ-IP: age, craving• Significant covariates for DTQ-VP: craving
  12. 12. Results - MANCOVA Drinking Behaviour 1. MANCOVA14 • Dependent: DTQ-VP, DTQ-IP • Covariates:13 gender, age, anxiety, depression and craving • Roy’s Largest Root:12 F=612.56, p<.000111 2. Bonferroni pairwise comparisons10 * • DD/PD > SD in DTQ-IP 9 • DD > PD > SD in DTQ-VP * 8 * • Significant covariates for DTQ-IP: age, craving Alcohol Abusers Problem drinkers Social drinkers (n=68) • Significant covariates for DTQ-VP: craving (n=43) (n=59)
  13. 13. Results – Binary Logistic RegressionDependent Variable: Category Membership pas problem or alcohol dependent drinkers The final step indicates thatAge NS DTQ-VP was theAnxiety (HADS-A) NS only significantDepression (HADS-D) NS predictor of alcohol dependence withCraving (PACS) NS 69.9% of casesImaginal Prefiguration (DTQ-IP) NS correctly classified.Verbal Perseveration (DTQ-VP) .01
  14. 14. Discussion• Desire thinking, especially verbal perseveration component, significantly increases across the continuum of drinking behaviour.• Imaginal prefiguration may play a role as initial factor in the transition from social to problem drinker status• Verbal perseveration may play a role both as an initial factor in the transition from social to problem drinker status, and in the escalation of drinking behaviour to alcohol dependence levels
  15. 15. Discussion• Desire Thinking can be considered as a cognitive control strategy; initial intrusions may result in drinking behavior once desire thinking, as a cognitive process, is activated• Desire thinking may be conceptualized, assessed and treated in order to reduce the risk of transition across the continuum of drinking behaviour.• Patients may attain benefits by learning how to: (1) recognize desire thinking; (2) control it; and (3) reshift and amplify their attention focus
  16. 16. Future Directions• Explore the role of desire thinking in predisposition towards, and maintenance of, drinking behaviour, through longitudinal studies• Examine whether changes in desire thinking occur during the process of problem drinking and alcohol dependence treatment and if they are associated with relapse
  17. 17. Thank you for your attention! Contact details Dr. Gabriele CaselliCognitive Psychotherapy School Studi Cognitivi, Modena, Italy London South Bank University, London, UK