This workshop will illustrate and explore the concept of desire thinking and its relevance to addictive behaviours. Examples of key treatment interventions for interrupting desire thinking will be introduced. Pre-workshop Reading Caselli, G. & Spada, M. M. (2016). Desire thinking: A new target for treatment of addictive behaviors? International Journal of Cognitive Therapy, 9(4), 344-355. Workshop Learning Objectives 1. To conceptualise desire thinking. 2. To understand the application of basic treatment interventions aimed at interrupting desire thinking.

1. Desire Thinking:
A New Treatment Target in Addictive Behaviours
iCAAD Conference
London, May 2019
Marcantonio Spada
London South Bank University

2. Repetitive negative thinking
Rumination
Why?
Worry
What if?
Desire thinking
If only…
Self-focussed
attention

3. Repetitive negative thinking: Function
‘How and
now?’ should
be the
question…
Not ‘What
if?’, ‘Why?’,
and ‘If only’
Non action
should be the
alternative to
‘How and
now?’
The Prefrontal Cortex is involved primarily in the dynamic representation of multiple
future and past events in problem-solving situations

4. • Voluntary process involving the elaboration of
a desired target (Caselli & Spada, 2010)
• Imaginal prefiguration
• “I imagine myself involved in the desired activity
as if it were a movie”
• Verbal perseveration
• “If I were not to practice the desired activity for a
long time, I would think about it continuously”
• Target=activity, object or state
Desire thinking

5. • Is present across the continuum of addictive behaviours
(Spada et al., 2015)
• Appears to mediate the relationship between craving and
challenge responses in experimental conditions (Frings et
al., 2018)
• Its activation (Caselli & Spada, 2016) brings to
• Increases in sense of deprivation (fixing attentional focus)
• Increases in accessibility of target-related information
(cognitive content)
• Increases in ‘on-line’ conviction in dysfunctional cognitive
beliefs (e.g. “I deserve it”, “I can stop whenever I want”)
• Biases in decision-making through the neglect inhibitory-
related information
Desire thinking

6. -- Desire thinking hadDesire thinking had
a significant effect ona significant effect on
craving followingcraving following
manipulationmanipulation
- This effect was- This effect was
independent ofindependent of
baseline levels ofbaseline levels of
craving and desirecraving and desire
thinking as well asthinking as well as
perceived stressperceived stress
changes during thechanges during the
manipulationmanipulation
Caselli, G., Soliani, M. & Spada, M. M. (2013). The effect of desire thinking on craving: an experimental
investigation. Psychology of Addictive Behaviors, 27(1), 301-306.
Desire thinking

7. • Desire Thinking Questionnaire (Caselli & Spada,
2011)
• Imaginal prefiguration
• Verbal perseveration
• Metacognitions about Desire Thinking
Questionnaire (Caselli & Spada, 2013)
• Positive metacognitions about desire thinking
• “Imaging something I desire helps me to feel better”
• Negative metacognitions about desire thinking
• “I cannot avoid thinking about a desired activity/object when
it comes to my mind”
• Need to control desire-related thoughts
• “Not being able to control my thoughts about what I desire is
a sign of weakness”
Assessment

8. Craving
Assessment
Meta-system*
Desire Thinking
Low level processing
Metacognitive beliefs
Monitoring Control
Biasing
Positive metacognitions: “If I imagine something I desire I will feel less its absence”
*
Also contains metacognitive plans and models
The Metacognitive Model of Addictive Behaviours
Negative metacognitions: “I cannot avoid thinking about a desired activity/object when
it comes to my mind”

9. • Brief psycho-education on the effect of desire
thinking on craving and use
• Re-appraising beliefs about desire thinking
• Uncontrollability
• Utility
• Postponement of desire thinking
• Attention Training Technique
• Detached mindfulness
Interventions
Warning – These interventions are part of Metacognitive Therapy for Addictive
Behaviours and are presented for illustrative purposes – the effectiveness of these
interventions is still being evaluated in clinical trials (Caselli, Spada & Wells, 2019)

10. Brief psycho-education
• The problem lies in over thinking
• Craving, memories, thoughts, physiological
sensations are normal (why should they not be
there?)
• These experiences are part of re-learning to
live without engagement in an addictive
behaviour

11. Re-appraising beliefs
• Did episodes of desire thinking ever stop in the
past?
• Is desire thinking really uncontrollable all the
time?
• What are the benefits of desire thinking?
• Are these benefits for the long-run?
• What are the costs of desire thinking?
• Have you done enough desire thinking?
• Is more desire thinking needed?
• What is the goal of desire thinking?
• Is this goal ever achieved?

12. Postponement
• Agreeing to return to ‘thinking’ about an
internal state at a specific time of the day
• Two techniques to support this target
• Attention Training Technique (Wells, 1990)
• Detached mindfulness (Wells, 1996)

13. Attention Training Technique
• Desire thinking = loss of cognitive resources for executive
control
• Attention Training Technique (Wells, 1990) –
training/exercise/fitness
• External attentional focusing on multiple auditory stimuli
• Selective attention, attention switching and divided attention
components
• Empirical support clinical utility for depression, panic disorder,
hypochondriasis and recurrent major depression (Wells, 2009)
• Reduction in amygdala activity (Siegle et al., 2007)

14. Attention Training Technique
• Attention Training Technique protocol
• Step 1 – Introduction
• Excessive self-focus leads to an increase of the severity and saliency of symptoms
• Self-focus = Desire thinking
• Step 2 – Self-focus ratings before and after (self-attention test)
-3 -2 -1 0 1 2 3
Entirely externally focused Entirely internally focused on my thoughts,
on the environment feelings or body
• Step 3 – Implementation
• Therapist instructed or audio recording based
• Step 4 – Review and homework setting
• Once per day for 15 minutes

15. Detached mindfulness
• This is the antithesis of the desire thinking - the client is helped to
shift from object mode to metacognitive mode
• Adrian Wells (2005, p. 340) describes detached mindfulness as
“A state of awareness of internal events, without responding to them with
sustained evaluation, attempts to control or suppress them, or respond to
them behaviourally. It is exemplified by strategies such as deciding not to
worry in response to an intrusive thought, but instead allowing the
thought
to occupy its own mental space without further action or interpretation in
the knowledge that it is merely an event in the mind”

16. Detached mindfulness
• Detached mindfulness comprises two features
• Mindfulness – awareness of the thought (developing meta-awareness)
• Detachment – the suspension of any conceptual or coping activity in response
to the thought and the separation of sense of self from the thought
• Detached mindfulness is not a symptom management technique; it is
intended to amplify the array of flexible responses to thoughts and
associated feelings (it serves to illustrate rather than cope)
• A variety of strategies are available (tiger task, cloud metaphor, recalcitrant
child metaphor, passenger train metaphor, verbal loop tape)
• Some differences with mindfulness meditation
• Specific goal of suspending conceptual or coping activity (still going on in
mindfulness?)
• Meditation is practised over many weeks whilst detached mindfulness is used
for specific thought occurrences (e.g. craving)
• No focus on breathing or body scanning
• Specifically developed for Metacognitive Therapy (to target the deactivation
of the repetitive negative thinking) rather than predating psychological theory

17. Concluding thoughts
• The interruption of desire thinking may have
important implications in the treatment of
addictive behaviours
• The gradual decline of desire thinking is
associated with improvements in
• Decision-making
• Cognitive confidence
• Health behaviours

18. • Caselli, G. & Spada, M. M. (2015). Desire thinking: What is it
and what drives it? Addictive Behaviors, 44, 71-79.
• Spada, M. M., Caselli, G., Nikčević, A. V. & Wells, A.
(2015). Metacognition in addictive behaviors. Addictive
Behaviors, 44, 9-15.
• Spada, M. M., Caselli, G. & Wells, A. (2012). The
metacognitive therapy approach to problem drinking. In S.
Hayes & M. Levin (Eds.), Mindfulness and Acceptance for
Addictive Behaviors: Applying Contextual CBT to Substance
Abuse and Behavioral Addictions. New York, USA: New
Harbringer.
Key reading

19. Thank you
Marcantonio Spada
spadam@lsbu.ac.uk
www.marcantoniospada.com