An empirical test of a metacognitive

model of craving
Gabriele Caselli
1,2
, Marcantonio M. Spada
1,3

1
London South Bank University, London, UK
2
Studi Cognitivi, Cognitive Psychotherapy School, Milano, Italy
3
North East London NHS Foundation Trust, London, UK
Craving
Powerful subjective experience that motivates individuals
to seek out and achieve a craved target in order to reach
its desired effects (Marlatt, 1987)
The experience of craving is qualitatively similar across a
range of targets and only quantitavely different from
everyday desires. (e.g. Castellani & Rugle, 1995; Field et al., 2008; May et al., 2004;
Moreno et al., 2009)
This construct has been central to analyses of addictive
behaviour and relapse for decades and is a key focus in
CBT treatment for addiction (Skinner & Aubin, 2010; OMalley et al., 2002)
It can be the result of the combination of automatic
(conditioned) and voluntary processes (Kavanagh et al., 2005, Caselli &
Spada 2010).


Elaborated-Intrusion Theory of Desire
(Kavanagh et al., 2005)
1. Target- or negative affect-related
cues exposure and associations

2. Break over the awareness
treshold (e.g. intrusive thoughts,
memories, sense of deprivation)

3. Cognitive rigid, perseverative
elaboration of intrusions (desire
thinking)

4. Escalation and persistence of
subjective craving and deprivation
Desire Thinking
DT is a voluntary thinking process orienting to prefigure images, information and
memories about positive target-related experience and anticipating how to reach it
(Caselli & Spada, 2010; 2011)
I anticipate the sensations I would feel practicing the desired activity
I imagine how I could realize my urges
How could I obtain it?
How could I hide my behaviour?


In the short-term DT helps to manage negative internal states by shifting attention away
from them and focusing on positive target related sensations


However in medium-term DT
Increases levels of craving and perception of being out of control
Increases accessibility of target-related information
Hinders with down-regulation of desire and craving

Desire Thinking and
Psychopathology
Findings on significant structural differences between the construct of
desire thinking and craving (Caselli & Spada, 2011)

DT is associated to level of alcohol use, nicotine dependence, problematic
gambling and internet addiction independently from craving, negative
affect and gender (Caselli et al., 2011; 2012, 2013, 2014)

The manipulation of desire thinking has a direct effect on craving accross a
range of addictive behaviors (Caselli, Soliani & Spada, 2013).

What make desire thinking becomes perseverative and
poorly regulated?

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)
The Application of S-REF to Desire Thinking
and Craving
Desire Thinking as a part of the CAS (addiction)
Individuals with addiction disorders would possess both
positive and negative meta-beliefs about desire thinking
(Caselli & Spada, 2010; Spada Caselli & Wells, 2013):
Positive Meta-Beliefs: it helps not to be overhelmed by my
worries, it helps to have a greater control over my
decisions)
Negative Meta-Beliefs: (I cannot stop thinking about my desires,
thinking about my desires bring me out of control)
Metacognitions and Addiction
PMB predict desire thinking over and above craving
and negative affect (Caselli & Spada, 2013)

NMB predict addiction severity over and above
craving, negative affect and desire thinking (Caselli &
Spada, 2013).

Need to Control Thoughts prospectively predict
relapse in alcohol abusers over and above baseline
alcohol use (Spada, Caselli & Wells, 2011)
Triphasic
Metacognitive
Formulation of
Problem
Drinking
(Spada, Caselli & Wells,
2013)

Pre-Engagement Phase
Aim and Participants
The aim was to test the statistical fit of the metacognitive model of craving
in clinical samples across a range of addictive behaviours: alcohol use
disorder (AUD), Gambling Disorder (GD), Problematic Internet Use (PIU),
Tobacco users (TU)
Materials
Desire Thinking Questionnaire (DTQ, Caselli & Spada, 2011)
The Metacognitions about Desire Thinking Questionnaire (MDTQ,
Caselli & Spada, 2013)

Specific measures of craving and addictive behaviours


Disorder Craving Addictive Behaviours
Alcohol Use Penn Alcohol Craving Scale Quantity Frequency Scale
Gambling Disorder Gambling Craving Scale South Oaks Gambling Screen
Internet Use The Internet Use Craving Scale The Internet Addiction Test
Tobacco Use Brief Questionnaire of Smoking
Urges
Fagerstrom Test of Nicotine
Dependence
Path Analysis
A group of multiple regression equations that
estimate simultaneously the coefficient of the whole
system.

Fit indeces
Non-significant chi-square (X
2
)
Root Mean Square Error of Approximation (RMSEA) <.08
Standardised root Mean Square Residual (SRMR) < .09
Comparative Fit Index (CFI), Goodness of Fit Index (GFI),
Non-Normed Fit Index (NNFI) > .95
Discussion
Preliminary cross-sectional support for the validity of the
central structure of the model across four different addictive
behaviors: alcohol, gambling, internet and tobacco.

Absence of the link between PMDT and DT-VP in non-
psychoactive substance related addiction (GD and PIU).
Impact of withdrawal symptoms?
Shortened pathway

Implications
Desire thinking and associated meta-beliefs may be a core
process that discriminate slight experience of
desire/deprivation from excessive craving

Key messages:
1. Desires dont matter, response to the does
2. We cannot crave less by thinking more about our desires
3. Its not good to think too much about a target we do not
want to achieve.
Implications
Improving on-line meta-awareness about (1) desire thinking,
(2) personal goals and decisions

Improving metacognitive control (e.g. postponing any further
elaboration of target-related information)

Modify Meta-Beliefs about uncontrollability, utility and need
to control target-related intrusions

Attentional Training, Detached Mindfulness, Meta-level
verbal reattribution (Metacognitive Therapy, Wells, 2008).
Limitations and Future Directions
Limitations
Cross-sectional design
Use of self-report
Samples limited in size
Future Research
Explore neurobiological
basis and behavioral
outcome of desire
thinking
Explore the link between
desire thinking and
intention to use
Explore the prospective
validity of the model
Thank you for your attention!
Contact details
Dr. Gabriele Caselli
Cognitive Psychotherapy School Studi Cognitivi, Modena, Italy
London South Bank University, London, UK
g.caselli@studicognitivi.net