The Independent Contribution of Positive and Negative Metacognitions About Smoking to Urge to Smoke, Withdrawal Symptoms and Dependence in Smoking-Dependent Men.

Previous research has indicated that various factors, such as psychological distress, distress intolerance, anhedonia, impulsivity and smoking metacognitions, have been individually linked to the urge to smoke, withdrawal symptoms and dependence. However, these factors have not been collectively examined to determine whether smoking metacognitions independently and significantly contribute to these outcomes. Therefore, the aim of this study was to investigate the impact of distress intolerance, anhedonia, impulsivity and smoking metacognitions on the urge to smoke, withdrawal symptoms and dependency in men who are dependent on smoking. A total of 300 smoking-dependent men completed psychological scales and smoking-related measures. The findings of the study indicated that positive metacognitions about emotion regulation significantly predicted the urge to smoke, even when accounting for other significant predictors such as the number of daily cigarettes smoked, psychological distress, anhedonia and impulsivity. Furthermore, positive metacognitions about cognitive regulation were found to be a significant predictor of withdrawal symptoms, independent of other significant predictors such as psychological distress and the urge to smoke. Smoking dependence was predicted by negative metacognitions about uncontrollability beyond other significant predictors, including the number of daily cigarettes smoked and distress intolerance. These results highlight the role of metacognitions about smoking in both short- and long-term clinical outcomes related to smoking. Consequently, addressing such beliefs during treatment for smoking dependence should be an important therapeutic goal.

The role of interoceptive awareness in shaping the relationship between desire thinking and cigarette consumption.

Interoception, the ability to sense and interpret bodily sensations, has recently emerged as a crucial factor in substance use disorders, including smoking. However, the role of interoceptive awareness in tobacco use remains poorly understood. The relationship between interoceptive ability and addictive behavior is complex, and attempting to conceptualize it as a linear association is unlikely to fully capture the complexity of the mechanisms underlying cravings and urges. We hypothesized that the role played by interoceptive awareness in tobacco use is deeply linked to desire thinking, that is, the conscious and voluntary cognitive process orienting to prefigure images, information, and memories about positive target-related experiences. Desire thinking is typically observed in addiction, where it may contribute to interpreting specific bodily sensations, such as the perceived need for a cigarette. From this perspective, the physiological impact and inclination toward desire thinking contribute to a higher daily cigarette consumption, particularly in situations of low interoceptive awareness. To test this hypothesis, we assessed the physiological activation, the tendency toward desire thinking about smoking, cigarette consumption, and the interoceptive abilities of smoking volunteers. Through a moderation analysis, we showed that desire thinking about smoking predicts a higher number of cigarettes per day in individuals with lower interoceptive awareness (p < .05). These findings suggest that the relationship between desire thinking and interoceptive awareness is a fundamental component of tobacco use, highlighting the importance of taking into account the bodily feedback deriving from the cognitive representation of smoking in addiction research and therapy.

Twisted memories: Addiction-related engrams are strengthened by desire thinking.

Associative learning plays a central role in addiction by reinforcing associations between environmental cues and addiction-related information. Unsupervised learning models posit that memories are adjusted based on how strongly these representations are coactivated during the retrieval process. From a different perspective, clinical models of addiction posit that the escalation and persistence of craving may depend on desire thinking, a thinking style orienting to prefigure information about positive addiction-related experiences. In the present work, we tested the main hypothesis that desire thinking is a key factor in the strengthening of addiction-related associations. A group of adult smoking volunteers (N = 26) engaged in a period of desire thinking before performing an associative learning task in which neutral words (cues) were shown along with images (smoking-related vs. neutral context) at different frequencies. Two retrieval tests were administered, one immediately after encoding and the other after 24 h, to test how the recall of associations changed as a function of retention interval. Two control groups, smokers (N = 21) and non-smokers (N = 22), performed a similar procedure, with a neutral imagination task replacing desire thinking. Participants who engaged in desire thinking increased their performance from the first to the second retrieval test only for the most frequent smoking-related associations. Crucially, this selective effect was not observed in the two control groups. These results provide behavioral evidence in support of the idea that desire thinking plays a role in strengthening addiction-related associations. Thus, this thinking process may be considered a target for reconsolidation-based conceptualizations of, and treatments for, addiction.

Self-perceived substance and behavioral addictions among Jewish Israeli adolescents during the COVID-19 pandemic.

This study examined self-perceived substance and behavioral addictions among Israeli adolescents during the COVID-19 pandemic across different sociodemographic categories. The sample comprised 2,074 adolescents (40% males, 60% females) aged 12-19 years who completed the survey anonymously and with parental consent. We examined what is the prevalence of self-perceived substance and behavioral addictions in this population in the COVID-19 pandemic context. Participants reported self-perceived addictions to social networks (70%), shopping (46%), binge eating (34%), gaming (30%), sex-related behavior (15%), psychoactive substance (31%, including alcohol, tobacco, cannabis, and/or cocaine), and gambling (3%). Moreover, differences were found to be directly related to age, biological sex, religiosity, socioeconomic status, and immigration status. From a lay epidemiological perspective, the current research expands our knowledge about self-perceived addiction among adolescents during the COVID-19 pandemic, offering better understanding of the likelihood probability factors for self-perceived addiction among adolescents and its related negative outcomes, including increased risk factors for later adult life.

Desire thinking as an underlying mechanism in alcohol use disorder and nicotine dependence.

Desire thinking is an emerging construct in the addictive behaviours literature. No research, to date, has investigated its contribution to problematic alcohol use and nicotine dependence in patient samples when accounting for established predictors of addictive behaviours. The present study sought to clarify, in patient samples, the relative contribution of desire thinking in the associations between negative affect, impulsivity and thought suppression on the one hand and craving, problematic alcohol use and nicotine dependence on the other. To achieve this goal, two groups of individuals with alcohol use disorder (AUD) (n = 370; age range = 15-67 years) and nicotine dependence (n = 365; age range = 17-75 years) were selected, and measures of negative affect, impulsivity, thought suppression, craving, desire thinking, problematic alcohol use and nicotine dependence were completed by both groups. Results showed that in both groups, negative affect and thought suppression indirectly affected alcohol and nicotine craving, problematic alcohol use and nicotine dependence through the mediating role of desire thinking. The present study shows the independent role of desire thinking in predicting problematic alcohol use and nicotine dependence in patient samples, indicating its potential relevance for treatment.

Validity of a Norwegian version of the Desire Thinking Questionnaire (DTQ): Associations with problem drinking, nicotine dependence and problematic social media use.

The aim of the current study was to test the validity of the Norwegian version of the Desire Thinking Questionnaire (DTQ). Three cross-sectional surveys were conducted investigating the psychometric properties of the DTQ in alcohol use (N = 588), nicotine use (N = 446) and social media use (N = 359). Principal components and confirmatory factor analyses supported the original two-factor solution consisting of verbal perseveration (VP) and imaginal prefiguration (IP); however, one item was removed to obtain good fit. Internal consistency was acceptable. Both IP and VP showed significant correlations with problem drinking, nicotine dependence and problematic social media use. Regression analyses, controlling for demographics and negative affect, found IP and VP to be significantly associated with all dependent variables. The results confirm that desire thinking is an important construct across different addictive behaviours.

Transcultural, transdiagnostic, and concurrent validity of a revised metacognitions about symptoms control scale.

Anxiety and depression add to the burden of chronic fatigue syndrome (CFS), fibromyalgia (FM), and type 1 diabetes mellitus (T1DM). Metacognitions play a role in this distress. The metacognitions about symptoms control scale (MaSCS) measure metacognitive beliefs regarding symptoms but have weaknesses. The current study created a revised MaSCS (MaSCS-R) in English, German, and Arabic versions using CFS, FM, and T1DM samples and examined the transcultural, transdiagnostic, and concurrent validity of metacognitions about symptom control. This study used data from 563 participants clinically diagnosed with CFS (n = 124; English), FM (n = 348; German), or T1DM (n = 91; Lebanese). CFS and FM data had been used in earlier published studies but were subjected to new analyses. CFS data were used to create the English version of the MaSCS-R and FM and T1DM data for German and Arabic versions. Metacognitions about worry, anxiety, depression, and symptom severity were measured. The three MaSCS-R versions, consisting of two factors (each with four items), had adequate psychometric properties, possessing configural and metric invariance. Metacognitive factors were associated with distress and symptom severity in all three samples. Metacognitions about symptom control have transcultural, transdiagnostic, and concurrent validity.

Metacognitions in smoking: Evidence from a cross-cultural validation of the metacognitions about smoking questionnaire in a Turkish sample.

Metacognitions about the positive and negative effects of smoking have been associated with cigarette use and nicotine dependence. The aim of the present study was to validate the Turkish version of the Metacognitions about Smoking Questionnaire (MSQ; Nikcevic et al., 2015). The sample consisted of 859 self-declared smokers (452 female) aged between 18 and 68 years (mean = 28.3; SD = 7.9). Once the English to Turkish translation of the MDQ was completed, confirmatory factor analyses were conducted based on the four-factor structure of the original measure. Initially results suggested that this model was an inadequate fit of the data obtained. However, by allowing three pairs of items (within factor) to co-vary, a re-specified model was tested that was found to be a satisfactory fit of the data. Internal reliability and predictive validity of the translated scale were observed to be good. The Turkish version of the MSQ exhibited suitable psychometric properties. This study also showed that metacognitions about smoking predict nicotine dependence independently of demographic variables, length of cigarette use, negative affect, and smoking outcome expectancies.

Modelling the contribution of negative affect, outcome expectancies and metacognitions to cigarette use and nicotine dependence.

BACKGROUND: Both positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents. METHODS: The sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004). RESULTS: Anxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use. CONCLUSIONS: Metacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.

The association between metacognitions and the impact of Fibromyalgia in a German sample.

OBJECTIVES: Fibromyalgia is a chronic condition of unknown aetiology, characterised by widespread pain, sleep disturbances, and fatigue. In this paper we examined the relationship metacognitions and the impact of Fibromyalgia in a German sample, detailing the translation and validation of a self-report metacognitive instrument. METHODS: The Metacognitions about Symptoms Control Scale (MaSCS) was translated into German using the back-forward translation process. A total of 348 patients (316 female and 26 male) with Fibromyalgia contributed data to the study to test the structure and psychometric properties of the MaSCS. RESULTS: Confirmatory factor analyses, informed by modification indices, resulted in a 16-item scale consisting of two factors pertaining to positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established convergent validity, indicating that both factors were significantly associated with: (1) established positive and negative metacognitions scales; and (2) with symptoms severity in Fibromyalgia. Regression analyses revealed that positive metacognitions about symptoms control significantly predicted impairment in physical functioning while negative metacognitions about symptoms control significantly predicted the overall Fibromyalgia impact value, when controlling for stress, anxiety, and depression and a general metacognitions. CONCLUSION: The findings support the potential relevance of metacognitions, and utility of the German version of MaSCS, in examining the role of metacognitions in Fibromyalgia and other chronic health conditions.

Treatment Outcome and Metacognitive Change in CBT and GET for Chronic Fatigue Syndrome.

BACKGROUND: Studies have reported that Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are effective treatments for Chronic Fatigue Syndrome (CFS). METHOD: One hundred and seventy-one patients undertook a course of either CBT (n = 116) or GET (n = 55) and were assessed on a variety of self-report measures at pre- and posttreatment and follow-up. AIMS: In this paper we present analyses on treatment outcomes for CBT and GET in routine clinical practice and evaluate whether changes on subscales of the Metacognitions Questionnaire-30 (MCQ-30) predict fatigue severity independently of changes in other covariates, and across the two treatment modalities. RESULTS: Both CBT and GET were equally effective at decreasing fatigue, anxiety, and depression, and at increasing physical functioning. Changes on the subscales of the MCQ-30 were also found to have a significant effect on fatigue severity independently of changes in other covariates and across treatment modalities. CONCLUSION: The findings from the current study suggest that CFS treatment protocols for CBT and GET, based on those from the PACE trial, achieve similar to poorer outcomes in routine clinical practice as in a RCT.

The Metacognitions about Smoking Questionnaire: development and psychometric properties.

OBJECTIVES: Recent research has suggested that metacognitions may play a role in smoking. The goal of the current set of studies was to develop the first self-report instrument of metacognitions about smoking. METHOD: We conducted three studies with samples of smokers (n = 222, n = 143, n = 25) to test the structure and psychometric properties of the Metacognitions about Smoking Questionnaire and examined its capacity to predict smoking behaviour. RESULTS: Exploratory and confirmatory factor analyses supported a four-factor solution: positive metacognitions about cognitive regulation, positive metacognitions about emotional regulation, negative metacognitions about uncontrollability, and negative metacognitions about cognitive interference. Internal consistency, predictive and divergent validity, and temporal stability were acceptable. The metacognition factors correlated positively with daily cigarette use and levels of nicotine dependence, and contributed to the prediction of these outcomes over and above smoking outcome expectancies. CONCLUSIONS: The Metacognitions about Smoking Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested. The metacognition factors explained incremental variance in smoking behaviour above smoking outcome expectancies.

The Metacognitions about Symptoms Control Scale: Development and Concurrent Validity.

OBJECTIVE: This paper presents the development and preliminary validation of a self-report instrument designed to measure metacognitions pertaining to symptoms control in the form of the following: (1) symptoms focusing and (2) symptoms conceptual thinking. METHODS: A total of 124 patients (95 female and 29 male) presenting with chronic fatigue syndrome (CFS) contributed data to the study to test the structure and psychometric properties of the Metacognitions about Symptoms Control Scale (MaSCS). RESULTS: A principal components factor analysis indicated that a two-factor solution best fitted the data. The factors were labelled positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established preliminary concurrent validity, indicating that both positive and negative metacognitions about symptoms control were significantly associated with levels of fatigue in CFS. Regression analysis revealed that positive and negative metacognitions about symptoms control significantly predicted fatigue severity when controlling for anxiety and depression. CONCLUSIONS: The newly developed instrument may help future research that examines the role of metacognitions in CFS, as well as aiding clinical assessment and case formulation. KEY PRACTITIONER MESSAGE: The MaSCS is a useful first instrument to assess metacognitions in CFS. The MaSCS may help to deepen our understanding of symptoms control (symptoms focusing and conceptual thinking about symptoms) in the experience of CFS symptoms. Assessing and conceptualizing symptoms control through the MaSCS may aid treatment of CFS.

Metacognitive factors in chronic fatigue syndrome.

UNLABELLED: Chronic fatigue syndrome (CFS), which is characterized by fatigue and flu-like symptoms that are not alleviated by rest, is a poorly understood condition and an often controversial diagnosis. Earlier research has indicated that general metacognitions are associated with the severity of symptoms in patients with CFS. In the current study, we aimed to determine whether specific metacognitive factors are implicated in CFS. Using the metacognitive profiling interview template we investigated the following: (1) whether patients held positive or negative metacognitions about conceptual processes; (2) what their goals with respect to engaging in these processes were; and (3) what indicated that it was appropriate to stop. We also examined attention focus when experiencing CFS symptoms, and its advantages and disadvantages. Results showed that patients endorsed positive and negative metacognitions pertaining to conceptual processes. The goals of engaging in these processes were to identify the cause of, and devise strategies to cope with, symptoms. Patients were either unable to identify a stop signal for conceptual processing or identified an improvement in fatigue-related symptoms as representing the stop signal. Finally, patients reported that their attention focus when experiencing symptoms included distraction and monitoring of symptoms. Advantages to these strategies included symptom management, whereas disadvantages included an escalation of negative affect. The present findings provide preliminary evidence that specific metacognitive factors may be involved in CFS. KEY PRACTITIONER MESSAGE: Metacognitive profiling that may aid assessment and conceptualisation of psychological distress in CFS.

Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome.

OBJECTIVE: Chronic fatigue syndrome (CFS) describes a condition that is primarily characterized by fatigue and flu-like symptoms that are not alleviated by rest. This study investigated the relationship among metacognitions, negative emotions, and symptom severity in CFS. METHODS: A total of 96 patients who had received a diagnosis of CFS according to the Oxford Criteria completed a battery of self-report measures that consisted of the Depression Anxiety Stress Scales, the 30-Item Metacognitions Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item Short-Form Health Survey-Physical Functioning. RESULTS: Correlation analyses showed that negative emotions and metacognitions were positively correlated with measures of symptom severity and that metacognitions were a better predictor of symptom severity than anxiety and depression. Hierarchical regression analyses indicated that (1) lack of cognitive confidence predicted both mental and physical factors of the CFQ and physical functioning independently of negative emotions and (2) beliefs about the need to control thoughts predicted the mental factor of the CFQ independently of negative emotions and lack of cognitive confidence. CONCLUSION: The data support the potential application of the metacognitive model of psychological disorder to understanding CFS.

Metacognitions in desire thinking: a preliminary investigation.

BACKGROUND: Desire thinking is defined as a voluntary thinking process orienting to prefigure images, information and memories about positive target-related experience. Recent research has highlighted the role of desire thinking in the maintenance of addictive, eating and impulse control disorders. Currently little is known about metacognitions in desire thinking. AIM: To investigate: (1) the presence and content of desire thinking during a desire experience; (2) the presence of metacognitive beliefs in desire thinking; (3) the goal of desire thinking; (4) attentional focus during desire thinking; and (5) the impact of desire thinking on craving. METHOD: Twenty-four individuals with a diagnosis of either alcohol abuse, bulimia nervosa, pathological gambling or smoking dependence were assessed using a semi-structured interview. RESULTS: Findings indicated that participants engaged in desire thinking and endorsed both positive and negative metacognitive beliefs about this process. The goal of desire thinking was to regulate internal states. Participants also reported that during a desire experience their attentional focus was continuously shifting between internal state and external context and that engaging in desire thinking increased craving. CONCLUSIONS: These findings provide preliminary evidence that metacognitions play a role in desire thinking.

Metacognitions about smoking: a preliminary investigation.

Preliminary research has indicated that metacognitions are involved in smoking. In the present study, we aimed to investigate whether specific facets of metacognition play a role in explaining smoking initiation and perseveration. Twelve individuals, self-identified as regular smokers and scoring a positive value on the Fagerström Test of Nicotine Dependence, were assessed using a semi-structured interview to investigate the following: (1) whether they held positive and/or negative metacognitive beliefs about smoking; (2) what their main goal in smoking was, and how they knew if they had achieved their goal; (3) how they directed their focus of attention when smoking; and (4) what they perceived the advantages and disadvantages of these attentional strategies to be. Results indicated that participants endorsed both positive and negative metacognitive beliefs about smoking and that the goal of smoking was to regulate negative emotion and/or to enhance cognitive functioning. Participants reported that they relied either on an internal signal, such as improvement in the emotional/cognitive state, or on a physical sign, in the form of a finished cigarette, to determine if they had achieved their goal. During an episode of smoking, half of the participants reported focusing their attention internally on thoughts and feelings or the sensations of smoking. The remainder of participants reported either an exclusively external focus of attention (e.g., the environment) or a varied focus of attention. Most participants were able to identify advantages to their attentional strategies, whereas two reported perceived disadvantages. The implications of the findings are discussed.

Metacognition as a mediator of the relationship between emotion and smoking dependence.

This study investigated the role of metacognition as a mediator of the relationship between emotion and smoking dependence. A sample of 104 smokers completed the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Metacognitions Questionnaire 30 (MCQ-30), and Fagerström Test of Nicotine Dependence (FTND). Three dimensions of metacognition (positive beliefs about worry, negative beliefs about worry concerning uncontrollability and danger, and beliefs about cognitive confidence) were found to be positively and significantly correlated with smoking dependence. A positive and significant correlation was also observed between anxiety and depression on the one hand, and smoking dependence on the other. Structural equation modeling was used to test a mediational model in which emotion predicted metacognition which in turn predicted smoking dependence. The results supported the hypothesis that the relationship between emotion and smoking dependence is partially mediated by metacognition, suggesting that metacognitive theory may be relevant to understanding smoking dependence. The implications of these findings are discussed.