OUTCOME EXPECTANCIES, METACOGNITIVE BELIEFS AND

ALCOHOL USEGabriele Caselli1,2, Chiara Bortolai3, Mauro Leoni1,4,

Francesco Rovetto1, Marcantonio Spada5

1 Università degli studi di Parma, Parma, Italy2 Studi Cognitivi, Scuola di Psicoterapia Cognitiva, Modena, Italy

3 Ospedale Privato Accreditato Villa Rosa, Modena, Italy4 Fondazione Sospiro, Cremona, Italy

5 Roehampton University, London, United Kingdom

Giovanni M. Ruggiero, Sandra Sassaroli

Studi Cognitivi, Cognitive Psychotherapy School

Milano, Italy

Special thank goes to…

Introduction• Expectancies refer to a person’s evaluation of an anticipated

outcome (Tolman, 1932)

• Outcome alcohol expectancies (OAE) refer to a explicit or implicit set of beliefs about substance effects (Brown, 1985; Brown, Christiansen & Goldman, 1987)

• The construct of OAE is multidimensional. A typical distinction is the one between positive and negative expectancies about alcohol use (Leigh & Stacy, 1993)– Positive AE: Alcohol reduces my tension, Alcohol helps me to meet

people – Negative AE: Alcohol causes health problems, Alcohol make me

unpleasant

Outcome expectancies and alcohol use

• Ambiguous role of outcome alcohol expectancies in the genesis, maintenance and relapse in pathological drinking behaviour

– Positive correlations (Eastman & Norris, 1982; Jones & McMahon, 1994)

– Negative correlations (Leigh, 1989; Weirs, Hoogeveen, Sergeant & Gunning 1997; Kilbey, Downey & Breslau, 1998; Sharkansky & Finn, 1998)

– No correlations (Southwick, Steele, Marlatt & Lindell, 1981; Fromme, Stroot and Kaplan, 1993)

Metacognitive beliefs and alcohol use

• Metacognitive beliefs (MB) refer to the information individuals hold about their cognitive and emotional internal state and about strategies they could use to regulate it (Wells, 2000)

• Metacognitive beliefs about alcohol use (MBA) refer to the functions and consequences of alcohol use on emotions, thoughts and private experience (Spada & Wells, 2005)– Positive MBA: Alcohol helps me to stop my worries, Alcohol

helps me not to focus my attention on the way other people look at me

– Negative MBA: Alcohol makes me confused; I lose control on my behaviour when I begin to drink.

Outcome expectancies vs metacognitive beliefs

• Expectancies models do not distinguish between social-cognitive and metacognitive domains

• Expectancies measures do not clearly identify beliefs concerning the use of alcohol as a cognitive control and self-regulation tool

• Expectancies models mainly measure general outcomes arising from alcohol use rather than focusing on its specific consequences on internal states

There is a partial overlap but it is limited to beliefs regarding the effects of alcohol

on emotional self-regulation

Aims

• The role of MBA may help understand the contradictory findings regarding the predictive power of general outcome expectancies on alcohol use

• The goals of the present qualitative study was– (1) to expand the MBA construct to include beliefs

that were not considered by previous studies– (2) to compare the presence of social-cognitive OAE

and MBA in a clinical and a community sample

Method (1)• Participants

– 60 patients (18 females) seeking treatment for problem drinking (46.7 years; SD = 9.1)

– 60 social drinkers (19 females; 45.1 years; SD= 9.7)

• Materials– Semi-structured interview was used to explore social-cognitive OAE

and MBA by tracing a recent drinking episode (Matthews & Wells, 1994; Spada & Wells, 2005) • When you were drinking, did you have any thought about the

effect of alcohol use? Can you identify these thoughts?• After a drinking episode, did you have any thought about the

effect of alcohol use? Can you identify these thoughts?• Were there any advantages or disadvantages to drinking?• Did you use alcohol as a coping strategy? If yes, What was your

main goal? How did you know whether you had achieved your goal? What signal informed you that it was all right to stop drinking?

Method (2)• Procedures– Interviews transcripts were assessed by two

postgraduate psychologists that were blinded relatively to both the experimental hypothesis and the group each participant belonged to

– No significant difference between the two assessors was observed

• Statistics– Chi-Square statistics were used to verify difference in

OAE and MBA frequency between clinical and community samples

Results (1)

Results (2)OAE in clinical and community samples

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Results (3)MBA in clinical and community samples

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Preliminary conclusions• Negative OAE about health damage from alcohol use are

less frequent in problem drinkers than in social drinkers

• All positive MBA and negative MBA about executive uncontrollability are more frequent in problem drinkers than in social drinkers

• MBA may have a stronger impact than OAE on alcohol use (Spada, Moneta & Wells, 2007)

• Cognitive regulatory function may be the core motivation for alcohol use in problem drinking