Abstract
In this paper, a triphasic metacognitive formulation of problem drinking and its implications for treatment are presented together with a summary of the evidence consistent with this approach. In the triphasic formulation during the pre-alcohol use phase, alcohol-related triggers, in the form of cravings, images, memories or thoughts, activate positive metacognitive beliefs about extended thinking, which lead to desire thinking, rumination and worry or their combination. The activation of the latter brings to an escalation of cravings and negative affect, strengthening negative metacognitive beliefs about the need to control thoughts and enhancing the likelihood of alcohol use. In the alcohol use phase, positive metacognitive beliefs about alcohol use and a reduction in metacognitive monitoring contribute to dysregulation in alcohol use. Over the course of time and as the drinking problem escalates in severity, negative metacognitive beliefs about the uncontrollability of alcohol use and alcohol-related thoughts emerge, contributing to the perseveration of dysregulated alcohol use. In the post-alcohol use phase following the activation of positive metacognitive beliefs about post-event rumination, the affective, cognitive and physiological consequences of dysregulated alcohol use become the subject of rumination. This, in turn, leads to a paradoxical increase in negative affect and alcohol-related thoughts, together with the strengthening of negative metacognitive beliefs about such thoughts. Intermittent attempts to suppress alcohol-related thoughts increase the likelihood of returning to use alcohol as a means of achieving self-regulation.
| Original language | English |
|---|---|
| Pages (from-to) | 494-500 |
| Number of pages | 7 |
| Journal | Clinical Psychology and Psychotherapy |
| Volume | 20 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Nov 2013 |
Bibliographical note
This is the peer reviewed version of the following article: Spada, M.M., Caselli, G. and Wells, A. (2013), A Triphasic Metacognitive Formulation of Problem Drinking. Clin. Psychol. Psychother., 20: 494-500. https://doi.org/10.1002/cpp.1791, which has been published in final form at https://doi.org/10.1002/cpp.1791. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Keywords
- Alcohol Abuse
- Metacognition
- Problem Drinking
- S-REF Model
- Triphasic Formulation
