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EABCT 2011 - Metacognitive Processes in Desire Thinking 2


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Presentation at 41° EABCT Congress, Reykjavik 2011
Symposium: Metacognition across psychological disorders new development in theory and treatment

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EABCT 2011 - Metacognitive Processes in Desire Thinking 2

  1. 1. The Roleof Metacognitive Processes in DesireThinking<br />Gabriele Caselli1,2, Marcantonio M. Spada1,3<br />1 London South BankUniversity, London, UK<br />2 Studi Cognitivi, Cognitive PsychotherapySchool, Milano, Italy<br />3North East London NHS Foundation Trust, London, UK<br />
  2. 2. Introduction<br /><ul><li>Craving has been conceptualized as a powerful subjective experience that motivates individuals to seek out and achieve a craved target, or practice a craved activity, in order to reach its desired effects (Marlatt, 1987)
  3. 3. This construct has been central to analyses of addictive behaviour and relapse for decades (Skinner & Aubin, 2010)
  4. 4. The experience of craving is qualitatively similar across a range of targets (e.g. Castellani & Rugle, 1995; Field et al., 2008; May et al., 2004; Moreno et al., 2009)</li></li></ul><li>Theoriesaboutcraving<br /><ul><li>Conditioning models (Ludwig & Wikler, 1974; Siegel, 1983; Stewart, Dewit, & Eikelboom, 1984)
  5. 5. Cognitive models (Marlatt, 1985; Stacy, 1997; Baker, Morse & Sherman, 1987; Tiffany, 1999)
  6. 6. Elaborated-Intrusion Theory (EI-Theory, Kavanagh et al., 2009)</li></ul>DesireThinking<br />
  7. 7. DesireThinking<br /><ul><li>DT is a voluntary thinking process orienting to prefigure images, information and memories about positive target-related experience (Caselli & Spada, 2010; 2011)
  8. 8. I anticipate the sensations I would feel practicing the desired activity
  9. 9. I imagine how I would feel like when engaging in the desired activity
  10. 10. In the short-term DT helps to manage negative internal states by shifting attention away from them and focusing on positive target related sensations
  11. 11. However in medium-term DT brings to an escalation of craving as the desired target is perseveratively imagined but not achieved</li></li></ul><li>DesireThinking and Psychopathology<br />Findings on significant structural differences between the construct of desire thinking and craving (Caselli & Spada, 2011)<br />DT is positively correlated to level of alcohol use independently from craving (Caselli et al., 2011)<br />High nicotine dependent patients reports significantly higher levels of desire thinking than moderate and low nicotine dependents (Caselli et al., 2011)<br />
  12. 12. S-REF Theory(Wells & Matthews, 1994)<br />A set of metacognitive beliefs act as control components of information processing modes<br />They are responsible for psychological disturbance by developing and maintaining a maladaptive mode of processing<br />This maladaptive mode of processing (Cognitive-Attentional Syndrome or CAS) is constituted by perseverative thinking, threat monitoring, avoidance or safety behaviours)<br />
  13. 13. The Applicationof S-REF toDesireThinking and Craving<br />DT maybe a maladaptive and perseverative cognitive controlstrategy (suchasworry or rumination)<br />Accordingto S-REF Theoryitwouldbe part of the CAS mode thatsustains the experienceofcraving<br />Individualswithaddiction and impulsecontroldisorderswouldpossessboth positive and negative metacognitionsaboutdesirethinking<br />AIMS<br />the presence and content of desire thinking during a desire experience<br />the presence of metacognitive beliefs in desire thinking<br />
  14. 14. Participants & Materials<br /><ul><li>The sample comprised of 24 participants (10 men and 14 women) seeking outpatient treatment for desire related problems from the local Mental Health Service of Modena, Italy
  15. 15. Primary diagnosis:
  16. 16. 6 Alcohol Abuse
  17. 17. 6 Bulimia Nervosa
  18. 18. 6 Pathological Gambling
  19. 19. 6 Smoking Dependence
  20. 20. Metacognitive profile (Wells & Matthews, 1994): adapted to focus specifically on cognitive experiences associated with a craving episode</li></li></ul><li>ResultsTriggers and ContentsofDesireThinking<br /><ul><li>Trigger ofDesireThinking
  21. 21. negative emotions and thoughts (14 p)
  22. 22. Internal automatic target-related thought (9 p)
  23. 23. ContentofDesireThinking
  24. 24. ImaginalPrefiguration (Kavanagh et al., 2009)
  25. 25. “Imagining stopping the car to order a drink at the local bar”
  26. 26. “Imagining coming back home and all the chocolate bars that I have on my desk”
  27. 27. Verbal Perseveration (Caselli & Spada, 2010)
  28. 28. “Thinking what I can do to play”
  29. 29. “Repeating to myself I need a cigarette”</li></li></ul><li>ResultsPositive Metacognitive Beliefsabout DT<br />Positive Metacognitive Beliefs concerned the usefulness of desire thinking in: <br />Controlling negative thoughts and emotions (17 p); <br />Increasing positive sensations in the form of excitement and motivation (11 p); <br />Increasing executive control over behaviour (6 p); <br />Helping to plan how to reach goals (4 p)<br />
  30. 30. ResultsNegative Metacognitive Beliefsabout DT<br />Negative Metacognitive Beliefs concerned:<br />The damage to executive control over behaviour (16 p); <br />The uncontrollability of desire thinking (10 p); <br />The negative impact of desire thinking on self-image (4 p) <br />The negative impact of desire thinking on cognitive performance (6 p). <br />
  31. 31. ResultsGoals and Stop Signals<br />The primary goal ofdesirethinking:<br />Reducing negative emotions and thoughts (14p)<br />Feelexcited and motivated (9p)<br />Howtheyrecognizeif their goal had been achieved:<br />I do not know (all)<br />How desire thinking was interrupted:<br />Byachievingdesired target (18p)<br />By some externaldistractingevent (5p)<br />
  32. 32. DiscussionMetacognitions in DesireThinking<br />Negative internalstates<br />PMDT<br />DesireThinking<br />Craving & Deprivation<br />UncontrolledBehaviour<br />AutomaticTarget-relatedtoughts<br />NMDT<br />
  33. 33. Clinical Perspectives<br /><ul><li>Helpingpatientsto discontinue desirethinkingshouldbecome a therapeuticaim
  34. 34. Using metacognitive profilefor case formulation and socializationofuseful information aboutdesirethinking, metacognitive beliefs and metacognitive plans
  35. 35. Verbalreattributionof metacognitive beliefsaboutdesirethinking
  36. 36. Introducing and developingtechniquestodirectlytreatdesirethinking</li></li></ul><li>Thank you for your attention!<br />Contact details<br />Dr. Gabriele Caselli<br />Cognitive Psychotherapy School Studi Cognitivi, Modena, ItalyLondon South Bank University, London, UK<br /><br /><br />