The human brain underpins a stunning range of mental activities but is also limited in a number of important ways, which lead to a range of biases in the way that we think, interact with the world around us, and how we deal with different challenges.

1. Mental Control and Avoidant
Coping in Addictive Behaviour
Professor Tony Moss
Centre for Addictive Behaviours Research
@CABR_LSBU @tonymossuk

2. Doing one thing at once: An easy
practical demonstration
• Please take out your mobile phone/tablet
• Open up any app which allows you to type in
text (email, notes, SMS, etc.)
• I am going to dictate a short message for you to
type
• Here goes…

3. Doing two things at once: Another easy
practical demonstration
• I am now going to dictate another short
message
• But this time, while you are typing, I want you
all to count backwards, out loud, from 100
• Here goes…

4. Doing two things at once: A difficult
practical demonstration
• I am now going to dictate yet another short
message
• But this time, while you are typing, I want you
all to count backwards, out loud, from 100… in
increments of 13!
• Here goes…

5. What was the point of that?
• Doing two things at once is hard!
• In fact, it is not possible to do two complex
things at once
• In the final demonstration, successfully
completing both tasks is dependent upon task
switching

6. What about the second demonstration?
• This highlighted our capacity to engage in
multiple tasks at once, provided at least one of
the tasks are overlearned or habitual
• Why is this the case?

7. Because we are always in two minds
Automatic thinking
• Fast, effortless, context
dependent, (often)
unconscious
• E.g. counting backwards in
increments of 1; using
previously successful
strategies to solve familiar
problems
Controlled thinking
• Slow, effortful, abstract, conscious
• E.g. counting backwards in
increments of 13; solving novel or
complex problems

8. • When asked to count backwards from 100, we
can rely upon our rote knowledge of number
order to complete this task ‘mindlessly’, so to
speak
• This frees up our attentional capacity to take
dictation of a novel text, with minimal need to
switch between tasks

9. • When asked to count backwards in increments
of 13, we lack rote knowledge of this pattern –
so each step back requires attention to be
diverted away from writing, on to the mental
arithmetic, and then back again

10. The truth about multitasking
• We routinely manage complexity in our lives
• This involves planning ahead, dealing with
unexpected events, and switching our focus
rapidly between competing priorities
• This all happens in an emotional context – we
experience affective responses to many things,
to varying degrees of intensity
• So how do we do it?

11. Self Regulation
• People are constantly having to regulate their
behaviour
• This involves:
– Inhibiting inappropriate responses
• E.g. stopping yourself from laughing when you are told about
an embarrassing incident which your friend clearly finds
distressing
– Activating appropriate responses
• E.g. getting out of bed for work when it is still dark outside,
even though you may feel tired and comfy

12. Self Regulation
• Our ability to inhibit or activate responses is not
consistent through time, or across situations
• Baumeister (2003)
– Posited 3 models of self regulation
• Energy model
• Cognitive Model
• Skill Model

13. Self Regulation
• Energy Model
– Self regulation is a mental resource, which can be exhausted
• Cognitive Model
– Self regulation is a cognitive process, which can be more or
less active in time
• Skill Model
– Self regulation is something we learn, and become better at
over time

14. Self Regulation
• Baumeister (2003) suggested that the evidence
supports an Energy Model
– Cognitive model predicts no exhaustion in capacity,
but evidence does not support this
– Skill model predicts no change in capacity between
consecutive tasks, again little evidence in support

15. Self Regulation
• Exercising regulatory control over our mental
activities is not an unlimited ‘skill’ which people
possess
• The exercise of self regulatory control – which
includes rapid task switching (aka multitasking)
– depletes the energy which we have available
other activities
• And the source of this energy?

16. Glucose!
(N.B. also available in
healthy food…!)

17. Ego depletion
• Experimental evidence has shown that
engagement in effortful mental tasks depletes
blood glucose
• This subsequently impairs performance in other
tasks – even those entirely unrelated to the
primary task
• Administration of glucose can reverse some
negative effects in the short term

18. Self Regulatory Control is a Limited
Resource
“The implication is that one important path into
substance abuse and addiction is through ego
depletion. When the self’s resources have been
expended in other tasks, people have less left
over to control their impulsive and appetitive
behaviours. Learning more about how to maintain,
increase, and replenish this resource may
therefore hold one promising key to helping
people avoid addiction”
(Baumeister, 2003)

19. So what does all this mean?
• We cannot truly multitask – but we can rapidly
switch between different demands
• Task switching is a resource intensive activity,
and depletion of our mental energy will impair
performance in the short term
• So does this just means we should be well-
organised and maintain a balanced diet?

20. Yes, but what about emotion?
• We have some degree of affective reaction to
almost everything that we experience
• Some of these responses are positive (joy,
elation, love, happiness, hysterical laughter,
etc.)
• Other events can trigger negative affect – we
can feel fear, frustration, anxiety, worry
• What impact does this have on our ability to
control ourselves?

21. Well it often starts with a thought.

22. Thought Suppression
“Try to pose for yourself this task: not to think of a
polar bear, and you will see that the cursed thing
will come to mind every minute.”
– Dostoevsky, 1863
• A conscious, deliberate attempt to not think
about something
• Is this actually a useful strategy for dealing with
intrusive negative thoughts?

23. Thought Suppression
• No. Not really.
• And the proof?

24. Hello!

25. Thought Suppression
• Shown to produce two main effects:
– Cognitive Rebound – increase in the frequency of the
intrusive thought
– Behavioural Rebound – increase in behaviours related to the
intrusive thought
• Evidence of both in an addiction context, e.g.
for smoking:
– Cognitive: Salkovkis and Reynolds (1994)
– Behavioural: Erskine et al. (2010)

26. Thought Suppression
• Effects explained by Wegner (1994) as the
ironic process of mental control
• This is a dual process theory, suggesting two
processes are involved in controlling thoughts
– Operating process (conscious, aims to create the desired
mental state, consciously searches for presence of unwanted
thought)
– Monitoring process (nonconscious, automatic goal to exercise
mental control)

27. TS & Health
• TS is cognitively demanding
• Some evidence to suggest that this leads to a
temporary suppression of immunological
function (Petrie, Booth & Pennebaker, 1998)
• More robust evidence that TS complicates pre-
existing mental health disorders (e.g. PTSD;
Najmi & Wegner, 2009)

28. TS & Health
• Some evidence goes further, suggesting a
causal link between thought suppression and
the emergence of mental disorders
– E.g. Vazquez, Hervas and Perez-Sales (2008) identified an
association between chronic thought suppression and PTSD
symptoms 2-3 weeks after the 2004 terrorist attacks in Madrid

29. TS & Smoking
• Smokers attempting to quit report actively trying
to suppress smoking-related thoughts
(Salkovkis & Reynolds, 1994)
• Erskine et al. (2010) demonstrated that
suppression of smoking thoughts was
associated with increased smoking a week later

30. TS & Drinking
• Suppression of alcohol-related thoughts
increases the accessibility of these thoughts
(e.g. Klein, 2007)
• This is important as increased accessibility can
lead to increased consumption over time (Moss
& Albery, 2009; 2010, Field & Cox, 2008)

31. Remedies to TS?
• Mindfulness
– Smoking
• TS vs. Mindfulness, evidence that the latter is more
efficacious in reducing negative affect, depression and
nicotine dependence (Rogojanksi, Vettese & Antony,
2011)
– Drinking
• Numerous studies of the efficacy of mindfulness for
alcohol dependence show that it also reduces TS (e.g.
Bowen et al., 2009, Garland et al., 2010; 2012)

32. Anyway, enough of that
• Let’s try to forget about thought suppression,
and consider another avoidant coping style
used to deal with intrusive thoughts

33. Repressive Coping
• A strategic coping mechanism aiming to avoid
or suppress unwanted thoughts, without the
corresponding conscious intention found in
thought suppression (Myers, 2010)
• This is not synonymous with repression, in the
sense of an individual losing access to a
memory (see Erdelyi, 2006), although the terms
are often used interchangeably

34. Repressive Coping
• Repressive copers identified as having:
– Low anxiety (self reported – MAS)
– High defensiveness (MCSDS)
• This classification distinguishes RCs from ‘truly’
low anxious individuals, who score low on the
MCSDS
• Evidence suggests that RCs experience higher
anxiety (based on physiological measurements)
than their low anxiety counterparts

35. Repressive Coping
• Repressive copers appear to be more effective
in exercising mental control than thought
suppressors, to the extent that they do not
seem to experience rebound effects
• However, long term repressive coping is
associated with:
– Increased mortality
– Poor health outcomes for a variety of diseases such as heart
attack, cancer, etc.

36. Repressive Coping
• Frasure-Smith et al. (2002)
– Heart attack patients using a repressive coping
style had poorer 5 year outcomes when involved in
a high-contact support intervention
– Suggests that this disrupted their typical coping
style of avoidance

37. Repressive Coping
• While a highly prevalent coping style (up to
50% in some groups, Myers 2010), the
mechanisms underlying repressive coping are
not very well articulated
• Repressive coping seems to involve two
primary processes (Langens and Morth, 2003)
– Attentional Avoidance (in response to low-levels of threat)
– Thought suppression (in response to high-levels of threat)

38. Repressive Coping
• Barnier, Levin, & Maher (2004) found that
repressive copers seem immune to the
rebound effects typically seen amongst thought
suppressors when using TS as a strategy
• Geraerts et al. (2006, 2007) have argued that
this is evidence of repressive copers being
‘natural suppressors’, having also shown
stronger EF/WM capacity amongst RCs

39. A heuristic model of mental control
• Moss, Erskine, Albery, Allen, & Georgiou (2015)
have argued for a common underlying pathway
linking TS and RC
• Taken together, these strategies are both ways
of exercising control over unwanted thoughts,
but are not necessarily distinct in terms of
underlying mechanisms

40. A heuristic model of mental control

41. Take home messages
• We are limited-capacity processors of
information, living in a vivid emotional world
• Different coping strategies may have short term
beneficial affects, but those that deplete mental
resources may be detrimental in the longer
term

42. Thank you!