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

1. The Roleof Metacognitive Processes in DesireThinking Gabriele Caselli1,2, Marcantonio M. Spada1,3 1 London South BankUniversity, London, UK 2 Studi Cognitivi, Cognitive PsychotherapySchool, Milano, Italy 3North East London NHS Foundation Trust, London, UK

3. This construct has been central to analyses of addictive behaviour and relapse for decades (Skinner & Aubin, 2010)

5. Cognitive models (Marlatt, 1985; Stacy, 1997; Baker, Morse & Sherman, 1987; Tiffany, 1999)

6. Elaborated-Intrusion Theory (EI-Theory, Kavanagh et al., 2009)DesireThinking

8. I anticipate the sensations I would feel practicing the desired activity

9. I imagine how I would feel like when engaging in the desired activity

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

12. 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 Syndrome or CAS) is constituted by perseverative thinking, threat monitoring, avoidance or safety behaviours)

13. The Applicationof S-REF toDesireThinking and Craving DT maybe a maladaptive and perseverative cognitive controlstrategy (suchasworry or rumination) Accordingto S-REF Theoryitwouldbe part of the CAS mode thatsustains the experienceofcraving Individualswithaddiction and impulsecontroldisorderswouldpossessboth positive and negative metacognitionsaboutdesirethinking AIMS the presence and content of desire thinking during a desire experience the presence of metacognitive beliefs in desire thinking

15. Primary diagnosis:

16. 6 Alcohol Abuse

17. 6 Bulimia Nervosa

18. 6 Pathological Gambling

19. 6 Smoking Dependence

21. negative emotions and thoughts (14 p)

22. Internal automatic target-related thought (9 p)

23. ContentofDesireThinking

24. ImaginalPrefiguration (Kavanagh et al., 2009)

25. “Imagining stopping the car to order a drink at the local bar”

26. “Imagining coming back home and all the chocolate bars that I have on my desk”

27. Verbal Perseveration (Caselli & Spada, 2010)

28. “Thinking what I can do to play”

30. ResultsNegative Metacognitive Beliefsabout DT Negative Metacognitive Beliefs concerned: The damage to executive control over behaviour (16 p); The uncontrollability of desire thinking (10 p); The negative impact of desire thinking on self-image (4 p) The negative impact of desire thinking on cognitive performance (6 p).

31. ResultsGoals and Stop Signals The primary goal ofdesirethinking: Reducing negative emotions and thoughts (14p) Feelexcited and motivated (9p) Howtheyrecognizeif their goal had been achieved: I do not know (all) How desire thinking was interrupted: Byachievingdesired target (18p) By some externaldistractingevent (5p)

32. DiscussionMetacognitions in DesireThinking Negative internalstates PMDT DesireThinking Craving & Deprivation UncontrolledBehaviour AutomaticTarget-relatedtoughts NMDT

34. Using metacognitive profilefor case formulation and socializationofuseful information aboutdesirethinking, metacognitive beliefs and metacognitive plans

35. Verbalreattributionof metacognitive beliefsaboutdesirethinking