Metacognition in alcoholics

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Metacognition in alcoholics

• Jürgen Hoyer Johannes Hacker
• University of Technology, Dresden (Germany)
• Johannes Lindenmeyer
• Salus-Klinik Lindow (Germany)
• EABCT Conference in Istanbul September 2001

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What are metacognitions?

• Defined as cognitions about ones own cognition
• Impact on cognitive processes and behavior
• Metacognition may contribute to a broader
  understanding of clinical problems such as
  anxiety, depression or alcoholism (and,
  specifically, recidivism).
• Meta-cognitive strategies may help people better
  control their thoughts, emotions, and behavior

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Model of object level
META-LEVEL
Flow of information
Control
Monitoring
OBJECT-LEVEL
Behavior (action, cognition, emotion)
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Metacognitions may cause emotional problems

• People may experience stressful discrepancies
  between what they expect (their model of what
  should happen on the object-level) and what they
  subsequently perceive (object-level).
• In the case of alcoholics Patients may
  expect to not think about drinking (or to have no
  intrusions) after deciding to stay abstinent --
  although this expectation is unrealistic.

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Pathways from metacognition to abstinence or
relapse
abstinence
selection of coping strategies
recovery process continued
appraisal normal
thought/ image/ recollection alcohol...
guilt thought-action-fusion negative mood
demoralisation
thought suppression
relapse
denial
meta-cognitive level
Hoyer Hacker, 2001
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Aims/Questions

• Exploration What do patients in alcohol
  inpatient treatment think after they had thoughts
  or intrusions of alcohol?
• Develop measures of metacognition (about thoughts
  of alcohol) and alcohol related thought
  suppression
• Test assumptions about relationships between
  metacognition, thought suppression, and
  demoralisation

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Sample and procedure

• 117 alcoholics in CBT at treatment start
  (inpatient setting)
• Age 42years , Sex 80 male.
• Step 1 to identify those thoughts or intrusions
  about alcohol from a list of 77 items that were
  most important to them
• Step 2 to explore the emotional and cognitive
  appraisal of the most important item using a
  preliminary inventory of meta-cognitions

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• Examples of thoughts or intrusions (object level)
• Have you had the following thoughts,
  recollections or images
• since you have been abstinent?
• Recollection of a nice party where I had some
  drinks (yes/no)
• Image of my favorite drink (yes/no)
• Thought that I could relax when I drank something
  (yes/no)
• Examples of appraisal/metacognitions (meta-level)
• This thought will be harmful for me (0-4)
• I feel bad when I have this thought (0-4)
• This thought is pleasant (0-4)
• I have not been able to concentrate since this
  thought appeared (0-4)

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Most frequent thoughts, images, intrusions

• Recollection of good feelings with alcohol
  (54.4)
• Recollection of a nice party drinking alcohol
  (53.0)
• Recollection of the taste of an alcoholic drink
  (42.7)
• Remembering meeting friends and drinking with
  them (41.4)
• Image of a glass of the favorite drink (39.7)
• Thought Otherwise I would have a drink (37.4)
• Thought Alcohol would work best against my
  feelings of restlessness and tension (36.8)

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Metacognitions Steps toward factor identification

• Formulation of apriori scales
• Identification of the 5 most powerful items per
  apriori scale (except for one scale with only 4
  items)
• Varimax rotation of the remaining 44 items (9
  scales)
• Parallel analysis (comparing empirical and
• random factors)

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Scree-plot
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Five-factor solution

• Thought-action fusion and uncontrollability (a
  .92)
• Negative impact on attention and mood (a .92)
• Shame and guilt (a .82)
• Positive impact (a . 86)
• Intrusiveness (a .78)

Thinking of alcohol almost means having drunk
it.
This thought distracts me a lot.
I feel guilty when having this thought.
My mood improves when I have this thought.
This thought comes unvoluntarily.
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Correlates (1)Metacognition, age, and treatment
history
.01
-0.23
-0.21
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Correlates (2)Metacognition and demoralisation
Positive Impact
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Summary (1)

• Metacognitions about thoughts of alcohol can be
  examined via self-report
• Factors found are reliable
• Some of the apriori expected factors were not
  found, although of theoretical interest (e.g.,
  efforts to abandon a thought or image)
• Preliminary support for construct validity

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Measuring alcohol related thought suppression

• Approach Modification of the White Bear
  Suppression Inventory (WBSI) 15 items contents
  alcohol related
• Examples I always try not to think of
  alcohol.If I think of alcohol I try to get the
  thought out of my mind.
• Internal consistency high (? .93)

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Correlates (3)Thought suppression and age,
treatment history, and metacognition
age no. of
treatments WBSI -.34 .05 alcohol
version
TAF Neg.I. Guilt Pos.I. Intrusive
WBSI .30 .14 .21 .11
.29 alcohol version
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Correlates (4)Thought suppression and
demoralisation
  BDI SCL WBSI .16
.32 alcohol version
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Summary (2)

• Adapted version of WBSI measures alcohol related
  thought suppression reliably
• Convergent validity Expected correlations with
  metacognition and demoralisation were found

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Overview of correlation results
.40
thought- action-fusion negative
mood guilt intrusiveness
demoralisation
.32
.37
thought suppression
Mult. R2 .19 (R .46)
Hoyer Hacker, 2001
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Conclusions

• Metacognitions offer a new perspective on
  cognitive processes related to alcoholism,
  recovery, and treatment and prove relevant for
  demoralisation in inpatient alcohol treatment
• Instrument refinement needed
• Replication/cross-validation needed
• Present data cross-sectional longitudinal
  research needed
• Further steps Investigating relationships with
  self-efficacy regardíng abstinence and cognitive
  correlates of craving