Metacognitive beliefs about alcohol use: Development and validation of two self-report scales
Introduction
Metacognition refers to the psychological structures, beliefs, events and processes that are involved in the control, modification and interpretation of thinking (Flavell, 1979, Moses and Baird, 1999, Wells, 2000). The great majority of theorists would agree in drawing a distinction between two basic aspects of metacognition (Flavell, 1979, Wells, 2000, Yussen, 1985): metacognitive regulation and metacognitive knowledge (or metacognitive beliefs). Metacognitive regulation refers to a broad spectrum of executive functions, such as monitoring, planning, checking, attention and detection of errors in performance (Wells, 2000). Metacognitive knowledge refers to the information individuals hold about their internal states and about coping strategies that impact on them (Wells, 2000). Examples of metacognitive knowledge may include beliefs concerning the significance of particular types of thoughts (e.g. “Having thought X means I am weak”) and emotions (e.g. “I need to control my anxiety at all times”), and beliefs about cognitive competence (e.g. “I do not trust my problem-solving capabilities”). Examples of information individuals hold about their own coping strategies that impact on internal states may include both positive (“Ruminating will help me find a solution”) and negative (“My checking behaviour is making me lose my mind”) beliefs. In the metacognitive conceptualization of psychological dysfunction (Wells and Matthews, 1994, Wells, 2000) all the above constructs interact in maintaining maladaptive behavior.
The Self-Regulatory Executive function (S-REF: Wells and Matthews, 1994, Wells and Matthews, 1996) theory was the first to conceptualise the role of metacognition in the etiology and maintenance of psychological disturbance. In this theory Wells and Matthews, 1994, Wells and Matthews, 1996 argue that a common style of thinking across psychological disorders leads to dysfunction. They propose that psychological disturbance is maintained by a combination of perseverative thinking styles, maladaptive attentional routines, and dysfunctional behaviors. This array of factors constitutes a cognitive-attentional syndrome (CAS; Wells, 2000). The CAS is derived from the individual's metacognitive knowledge (or metacognitive beliefs), which is activated in problematic situations and drivers coping (such as alcohol use) (Wells and Matthews, 1994, Wells, 2000).
The S-REF theory has led to the development of disorder-specific models of depression (Papageorgiou & Wells, 2003), generalised anxiety disorder (Wells and Matthews, 1994, Wells, 2000), obsessive–compulsive disorder (Wells and Matthews, 1994, Wells, 2000), post-traumatic stress disorder (Wells, 2000) and social phobia (Clark & Wells, 1995). Metacognitive beliefs have been found to be positively associated with depression (Papageorgiou & Wells, 2003), hypochondriasis (Bouman & Meijer, 1999), obsessive–compulsive symptoms (Emmelkamp and Aardema, 1999, Hermans et al., 2003, Myers and Wells, 2005, Wells and Papageorgiou, 1998), pathological procrastination (Spada, Hiou, & Nikčević, 2006), pathological worry (Wells & Papageorgiou, 1998), post-traumatic stress disorder (Roussis & Wells, 2006), predisposition to auditory hallucinations (Baker and Morrison, 1998, Morrison et al., 2000), psychosis (Morrison, French, & Wells, 2007), smoking dependence (Spada, Nikčević, Moneta, & Wells, 2007) and test-anxiety (Matthews et al., 1999, Spada et al., 2006).
Whilst the S-REF theory was initially intended to account for emotional disorders, recent work has examined its application in predicting alcohol use. In a series of preliminary investigations (Spada and Wells, 2005, Spada et al., 2007) evidence was found of: (1) a positive association between a general dimension of metacognition (beliefs about the need to control thoughts) and alcohol use that is independent of negative emotions; and (2) an independent contribution (over negative emotions) of general dimensions of metacognition (beliefs about the need to control thoughts and low cognitive confidence) towards category membership as a problem drinker.
Further research undertaken by Spada and Wells (2006) has identified the existence of specific positive and negative metacognitive beliefs about alcohol use in problem drinkers. Positive metacognitive beliefs about alcohol use can be conceptualised as a specific form of outcome expectancy relating to the use of alcohol as a means of controlling cognition and emotion. From a metacognitive standpoint such beliefs are thought to play a central role in motivating individuals to engage in alcohol use as a means of cognitive-emotional regulation (Spada & Wells, 2006). Examples of positive metacognitive beliefs about alcohol use may include: “Drinking makes me think more clearly” (problem-solving), “Drinking helps me to control my thoughts” (thought control), “Drinking helps me focus my mind” (attention regulation), “Drinking reduces my self-consciousness” (self-image regulation), “Drinking reduces my anxious feelings” (emotion regulation). Negative metacognitive beliefs about alcohol use concern the perception of lack of executive control over alcohol use (e.g. “My drinking persists no matter how I try to control it”), and the evaluation of the negative impact of alcohol use on cognitive functioning (e.g. “Drinking will damage my mind”). From a metacognitive standpoint such beliefs are thought to play a crucial role in the perpetuation of alcohol use by becoming activated during and following a drinking episode, and triggering negative emotional states that compel a person to drink more (Spada & Wells, 2006).
Positive metacognitive beliefs about alcohol use share similarities, but also fundamental differences, with a crucial cognitive variable involved in the initiation and maintenance of alcohol use: positive alcohol outcome expectancies. Positive alcohol outcome expectancies refer to the drinker's perception of the positive outcomes of drinking, and have been shown, by enlarge, to be associated to alcohol use (Brown et al., 1987, Christiansen et al., 1989, Goldman et al., 1999, Leigh, 1989, Maisto et al., 1981). According to Spada and colleagues (Spada, Moneta, & Wells, 2007) the key similarity between positive metacognitive beliefs about alcohol use and positive alcohol outcome expectancies is that both constructs capture motivations for alcohol use. As such there is a degree of overlap between positive metacognitive beliefs about alcohol use pertaining to emotion regulation and positive alcohol outcome expectancies pertaining to tension reduction and the modulation of negative affect. However, these constructs are not identical as correlation coefficients between them of around .50 attest to (Spada, et al., 2007). A key difference between positive metacognitive beliefs about alcohol use and positive alcohol outcome expectancies is that items pertaining to the former construct also tap into the effects of alcohol use on cognition (problem-solving, thought control, attention regulation, and self-image regulation). This particular domain is largely overlooked by current measures of positive alcohol outcome expectancies.
Negative metacognitive beliefs about alcohol use concerning the perception of lack of executive control over alcohol use assess cognitive confidence in regulating alcohol use and can thus be conceptualized as a specific form of cognitive self-efficacy belief. Negative metacognitive beliefs concerning the impact of alcohol use on cognitive functioning are evaluations of the cognitive costs of drinking. These beliefs are related to negative alcohol outcome expectancies (Christiansen et al., 1989, Jones et al., 2001, Stacy et al., 1990) which assesses an individual's estimation that a given behavior will lead to specific negative outcomes (Bandura, 1997). However, they extend current measures of negative outcome expectancies by focussing specifically on alcohol's detrimental effect on cognitive functioning.
The distinctions between alcohol outcome expectancies and metacognitive beliefs about alcohol use are important because according to the metacognitive theory of psychopathology the key markers of dysfunction are beliefs pertaining to the metacognitive rather than cognitive domain (Wells, 2000). In support of the importance of differentiating between alcohol outcome expectancies and metacognitive beliefs about alcohol use a recent study by Spada and colleagues (Spada et al., 2007) employing the Positive Alcohol Metacognitions Scale (PAMS) and the Negative Alcohol Metacognitions Scale (NAMS) in a community sample of 355 individuals revealed that three of the four facets of metacognitive beliefs about alcohol use were an independent contributor to drinking behavior over and above alcohol outcome expectancies. Furthermore, when controlling for metacognitive beliefs, only one sub-facet of negative alcohol outcome expectancies (Negative Social Performance) explained additional variance in drinking behavior.
In view of the recent findings indicating a possible role of metacognitive beliefs in problem drinking and their utility in extending the alcohol outcome expectancy construct, the purpose of this research is to report four studies on the development of PAMS and NAMS.
Section snippets
Participants
A community sample of 261 individuals (121 females and 140 males) agreed to take part in the study which was approved by an ethics committee at a London University. For purposes of inclusion in the study the participants were required to speak English, be at least 18 years of age and have consumed alcohol over the last week. The mean age for the total sample, which consisted primarily of Caucasian university students, was 22.1 years (SD = 3.5 years) and the age range was 18–49 years.
Measures
In order to
Participants
A community sample of 138 individuals (77 females and 61 males) agreed to take part in the study which was approved by an ethics committee at a London University. For purposes of inclusion in the study the participants were required to speak English, be at least 18 years of age and have consumed alcohol over the last month. The mean age for the total sample, which consisted primarily of Caucasian professionals, was 30.0 years (SD = 9.3 years) and the age range was 18 to 60 years.
Measures
To determine the
Participants
A community sample of 53 individuals (33 females and 20 males) agreed to take part in the study which was approved by an ethics committee at a London University. For purposes of inclusion in the study the participants were required to speak English, be at least 18 years of age and have consumed alcohol over the last week. The mean age for the total sample, which consisted primarily of Caucasian professionals, was 34.1 years (SD = 13.5 years) and the age range was 18 to 61 years.
Measures
In order to assess
Participants
The clinical sample consisted of 80 problem drinkers (15 females and 65 males) who were referred or self-referred for treatment to a variety of alcohol services in the south of the United Kingdom. Permission for running the study was granted by an ethics committee at a London University. All patients identified problem drinking as their primary problem for which they were seeking psychological treatment. The mean age for the total sample, which consisted primarily of Caucasian professionals,
Discussion
Extrapolating from Wells and Matthews, 1994, Wells and Matthews, 1996 metacognitive theory of emotional disorders, and recent evidence supporting the existence of specific metacognitive beliefs about alcohol use in problem drinkers (Spada & Wells, 2006), we conducted four studies aimed at developing and validating two self-report scales of positive and negative metacognitive beliefs about alcohol use. Results from the first, second and fourth study suggest that both scales are dimensional. A
References (43)
- et al.
How does the hospital anxiety and depression scale measure anxiety and depression in healthy subjects?
Psychiatry Research
(2003) - et al.
Metacognitive beliefs across the continuum of psychosis: Comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients
Behaviour Research and Therapy
(2007) - et al.
Obsessive–compulsive symptoms: The contribution of metacognitions and responsibility
Journal of Anxiety Disorders
(2005) - et al.
Post-traumatic stress symptoms: Tests of relationships with thought control strategies and beliefs as predicted by the metacognitive model
Personality and Individual Differences
(2006) - et al.
Metacognition as a mediator of the relationship between emotion and smoking dependence
Addictive Behaviors
(2007) - et al.
Modelling cognition in emotional disorder: The S-REF model
Behaviour Research and Therapy
(1996) - et al.
Relationships between worry and obsessive–compulsive symptoms and meta-cognitive beliefs
Behaviour Research and Therapy
(1998) - et al.
Cognitive processes in auditory hallucinations: Attributional biases and metacognition
Psychological Medicine
(1998) - et al.
The alcohol use disorders identification test: Guidelines for use in primary healthcare
(1992) Self-efficacy: The exercise of control
(1997)
A preliminary study of worry and metacognitions in hypochondriasis
Clinical Psychology and Psychotherapy
The alcohol expectancy questionnaire: An instrument for the assessment of adolescent and adult expectancies
Journal of Studies on Alcohol
Using alcohol expectancies to predict adolescent drinking behavior after one year
Journal of Consulting and Clinical Psychology
A cognitive model of social phobia
Motivations for alcohol use among adolescents: Development and validation of a four-factor model
Psychological Assessment
Metacognitions, specific obsessive–compulsive beliefs and obsessive compulsive behaviour
Clinical Psychology and Psychotherapy
Evaluating the use of exploratory factor analysis in psychological research
Psychological Methods
Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry
American Psychologist
Alcohol expectancy theory: The application of cognitive neuroscience
Development of a scale for measuring impaired control over alcohol consumption: a preliminary report
Journal of Studies on Alcohol
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2021, Consciousness and CognitionCitation Excerpt :Definitions of self-regulation varied depending on the context of the study. Despite this, across several studies, self-regulation was described as an ability (Carey, Neal, & Collins, 2004), a motivation (Levesque et al., 2007; Ryan & Connell, 1989), or a set of executive functions (Spada & Wells, 2008) that underlie different aspects of an individual’s life, notably their goal-achievement behaviour and ongoing assessment of keeping track with their plan (Brown, Miller, & Lawendowski, 1999; Gratz & Roemer, 2004). The word “regulation” was often used in explaining the concept; for example, self-regulation as the “ability to regulate” (Carey et al., 2004, p. 253), or “tendency to actively regulate” (Ibáñez, Ruipérez, Moya, Marqués, & Ortet, 2005, p.