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What is metacognitive therapy and what is the evidence for its usefulness as a treatment for alcohol abuse and dependence?


The psychological treatment principles of metacognitve therapy, is a relatively recent development for the management of mental disorders. As stated by Normann, van Emmerik and Morina (2014), Metacognitive therapy aims to treat the underlying causes of mental disorders, with the belief that a disrupted process of cognition and thinking, known as the ‘Cognitive Attentional Syndrome’ (CAS) leads one to respond the life situations through the exhibition of worrying, rumination and focused attention resulting in adherence to harmful coping strategies. Hence, as researched by Papageorgiou and Wells (2015), metacognitive therapy aims to treat patients suffering from mental disorders by increasing their awareness of their CAS in the development of negative attitudes and harmful behaviors, for the purpose of inculcating habits of self control and regulation on such debilitating processes.

The following paragraphs of the essay, aim to shed light on the basic principles of metacognitve therapy for the treatment of mental disorders associated with debilitating habits such as alcohol abuse and dependence. The essay begins with a brief discussion of the key features associated with alcohol abuse and dependence, as well as the existing treatment principles associated with it. The essay then progresses to extensively discuss on the basic theories and principles behind metacognition and the usage of metacognitive therapy for the purpose of treatment of alcohol abuse and dependence.

Alcohol Abuse and Dependence

While moderate levels of drinking are considered normal, engaging excessively in alcohol consumption amount to more than three to four drinks per day or fourteen drinks per week, often gives rise to detrimental psychological and physiological symptoms and increased susceptibility of alcohol abuse disorder (AUD) (Grant et al., 2015). As researched by Zucker (2015), alcohol use disorder is associated with increase adherence and dependence of alcohol consumption, as indicated through signs and symptoms such as: an controllable desire to drink, loss of control concerning the limitations of alcohol consumption, emergence of negative or harmful thoughts when deprived of drinking, adherence to alcohol consumption during challenging situations, increased engagement to drinking instead of fulfillment of obligations, continuously drinking irrespective of possessing awareness of the harms caused and tendency to engage more in alcohol consumption, rather than performance of daily life activities. As stated by Litten et al., (2015), increased adherence to such symptoms may further worsen the condition of alcohol use disorder in the individual, further aggravating to alcohol dependence and symptoms such as: using alcohol as an escape or coping strategy for management of stressful situations, inability to function or relax adequately without the consumption of alcohol, an obligation to drink more during socialization, an uncontrollable desire to drink more to further perceive the effects associated with alcohol consumption and the emergence of withdrawal symptoms upon avoidance of alcohol such as: sleeping difficulties, seizures, nausea or vomiting and trembling or shakiness. If left untreated, prolonged alcohol abuse and dependence can lead to loss of memory, increased hangovers, gastrointestinal and cardiovascular disorders, hypertension, liver cirrhosis, pancreatitis, damage to the brain and possibly cancer (Gorka et al., 2016).

Alcohol Abuse and Dependence

As observed by Farmer et al., (2015), the principles of psychopathology encompass the study the underlying causative factors  at the social, biological and cognitive platforms behind a mental disorder. Individuals suffering from alcohol abuse disorders, more often than not, also suffer from co-morbid psychopathologies such as antisocial disorders or anxiety disorders. According to Conklin et al., (2015), the psychopathology of alcohol abuse and dependence are associated with the impact of various social, genetic, psychological and genetic factors. The psychopathological risk factors behind alcohol abuse disorders may be present at an early age in the individual and includes factors such as: social or elitist stereotypes associated with alcohol consumption, living in close proximity with a friend or partner who engages in drinking excessively, prevalence of familial or spousal conflicts, presence of a family history of alcoholism, presence of a history of facing traumatic experiences and presence of additional mental health issues such as  depression, anxiety, schizophrenia  or  bipolar disorders (Sampson et al., 2015).

As stated by Kirouac et al., (2017), the major goals underlying the treatment of alcohol include eradication of excessive alcohol consumption and overall improvement of the quality of life of the affected individual. According to Berger et al., (2016), treatments of behaviors associated with alcohol abuse and dependence may involve medication administration as well as intervention strategies involving groups. The selected treatment program may include detoxification procedures and counseling involving setting of goals, group therapy sessions and oral or intravenous administration of medications. Alternatively, additional therapeutic models such as cognitive behavioral therapy, have also been documented to helpful in the treatment of alcohol abuse disorders, in conjunction with the above mentioned treatments and medication administrations (Dalkner et al., 2017).

Prior to discussion of the basic aspects outlining metacognitive therapy, we must enlighten ourselves concerning the aspect of metacognitive theory, which is a specified theory of learning on psychology. As researched by Azevedo (2015), the principles of learning theories, imply administration of conceptual frameworks by individuals for the purpose of information absorption and processing and retention of knowledge during the process of learning or cognition. The theory of metacognition was first formulated by John H. Flavell, an American developmental psychologist in the year 1976 (Ozturk, 2017). As stated by Lysaker et al., (2014), learning theories encompassing metacognition, imply the administration of thinking skills of the highest order, that is, to put into simple words, ‘cognition about cognition’ or ‘thinking about thinking’. An individual engages in metacognition during performance of daily life activities, such as while undertaking a comparative analysis concerning the difficulty level between two tasks, or the act of cross checking information before acceptance of its factual credibility (Ebert, 2015). Hence, as researched by Zalla et al., (2015), metacognition learning theories encompass three parts of metacognitive knowledge (awareness and cognition concerning oneself), metacognitive regulation (controlling learning through cognition and experiences) and metacognitive experiences (usage of cognition for the purpose of perception of experiences). For the adequate administration of metacognitive therapy, metacognitive regulation is of utmost importance which guides individuals in regulating their cognitive skills through administration of three skills of planning, monitoring and evaluating (Cross, 2015). Hence, as stated by Robson (2016), considering these regulating principles of metacognition, an individual suffering from a mental disorder and who is receiving meta cognitive therapy, will be required to engage in planning (selection and usage of resources and coping strategies for performing the challenging task or stimulus concerned), monitoring (which will involve the individual to comprehend and engage in self-awareness concerning his or her performance of the task in response to the stimulus) and evaluation (involving appraisal of the individual’s performance and reappraisal of the situation for improved efficiency of task performance and resource usage during similar situations in the future).

Psychopathology of Alcohol Abuse and Dependence

The treatment principles of metacognitive therapy were formulated by Adrian wells, and highlights the stimulation of the cognitive attentional syndrome, as a the underlying cause behind the occurrence of mental disorders, and the associated harmful coping strategies associated with it (Fleming & Lau, 2014). Hence, as stated by the therapeutic model of metacognition, a person’s engagement in excessive consumption of alcohol is due to the detrimental psychological thought processes of worrying or rumination, monitoring of threats and administration of coping strategies which yield harmful health consequences – key cognitive principles underlying the cognitive attentional syndrome (Hjemdal et al., 2017). Hence, as researched by Morrison et al., (2014), in an individual suffering from alcohol abuse and dependence, the CAS process will involve the presence of challenging situations or stressors perceived as harmful or threatening, hence leading the positive metacogntive beliefs of excessively worrying, followed by cognitive monitoring of the incidence as threatening. This is followed by the administration of coping strategies for the purpose of dealing with the stressor, which may involve harmful behaviors or activities, ultimately leading to excessive alcohol consumption (Capobianco et al., 2018). Hence, as researched by Hagen et al., (2017), these three activities characteristic of the CAS compel the individual the individual to believe that he or she has control over the situation, due to the usage of metacognitive beliefs involving further cognitive understanding of the already stressful situation. However as observed by Dammen, Papageorgiou and Wells (2016), such positive cognitive metacognitve strategies ultimately create a paradoxical situation of harmful coping strategies, such as alcohol abuse and dependence, further leading to aggravation of the magnitude of the existing levels of distress. Hence, the metacognitive model, aims at administration of self-regulation and control in one’s metacognition, through prevention of the activation of the processes associated with CAS (McEvoy et al., 2015).

Despite its relative newness and ongoing research, for the treatment of alcohol abuse and dependence, metacognitive therapy (MCT) can pose to be beneficial therapeutic option.

For the administration of metacognitive therapy, there must be identification of the CAS and distorted metacognitive thought process leading to the problem of excessive alcohol consumption. In accordance to the principles of metacognition, the presence of a stressful stimulus leads to worrying which further aggravates into positive metacognitive beliefs pertaining to alcohol use (Dimaggio et al., 2015). Hence, as researched by Garland et al., (2016), the resultant positive metacognitive belief reduces metacognition recognition pertaining to limitations of alcohol consumption hence leading to the emergence of harmful physiological and psychological symptoms associated with alcohol, further leading to negative metacognitive beliefs of alcohol consumption. Such negative beliefs further act as trigger for increased drinking acting as a continuous cycle of lack of control and dependence on alcohol consumption.

Hence, as stated by Garofalo and Wright (2017), it can be observed that negative or disrupted metacognitive thinking results in excessive and uncontrolled alcohol consumption, which metacognition therapy aims to correct. The therapeutic principles of metacognitive therapy will include around 8 to 12 sessions, which begins with identification of the specific metacognitive beliefs, stress coping strategies and experiences associated with alcohol consumption in the individual by the concerned psychiatrist (Wasmuth et al., 2015). As performed by Outcalt et al., (2016), this is then followed by enlightening the patient concerning his or her identified metacognitive strategies, for the purpose of making him or her aware of the CAS as the underlying cause of drinking. This is then followed by guiding the individual in identifying associated metacognitive beliefs for exercising control over extended, distorted thinking. As researched by Nik?evi? et al., (2017), strategies such as usage of metaphors, detached mindfulness and attentional training technique has been found to be beneficial in aiding the patient to challenge his metacognitive beliefs further leading to increased metacognitive regulation associated with excessive alcohol consumption.

Existing Treatments of Alcohol Abuse and Dependence

The above treatments of MCT have been found to be associated with beneficial effects in patients who are suffering from alcohol abuse and dependence, as documented by a study performed by Caselli et al., (2018), which utilized a systematic case series concerning the administration of MCT treatment in patients suffering from alcohol abuse disorders. As outlined in the research, the treatment involved a preliminary case formulation, followed by administration of dialogue and metaphors to induce self monitoring and regulation of uncontrolled alcohol consumption through negative metacognitive beliefs and self monitoring. A key strategy of MCT is mindfulness which can be achieved through Adaptive Self-Monitoring (ASM) – a goal oriented strategy which aims to administer attentional refocusing towards achievement of key goals acting as feedback or motivational factors for the reformulated cognitive system of the affected individual. The study outcomes were associated with recovery observed in all of the five AUD patients, as evident in their improved scores of the AUDIT C screening (Alcohol Use Disorders Identification Test), reduced metacognitive beliefs and decreased episodes of binge drinking.


Hence, as observed through extensive discussion in the above essay, it can be concluded that metacognitive therapy can be adopted as an effective procedure for the treatment of the alcohol abuse and dependence. The mental disorder of alcohol abuse and dependence has been associate with detrimental physical and mental symptoms due to increased administration of harmful behaviors such as excessive alcohol consumption. Uncontrolled consumption of alcohol has been associated with a disruptive thought process resulting in positive metacognition beliefs and negative metacognitive beliefs further leading to a vicious cycle of excessive alcohol consumption upon perception of the harmful effects of drinking. Through the administration of adequate dialogue, metaphors and adaptive self-monitoring, metacognitive therapy successfully alters the detrimental activation of the cognitive attentional syndrome which leads to excessive worrying, threat perception and harmful behaviors as coping strategies for stressors. Hence, due to the usage of these strategies, metacognitive therapy has been documented to yield beneficial effects in the treatment of alcohol abuse and dependence. However, it is worthwhile to note that metacognitive therapy is a relatively recent approach towards treatment of detrimental mental disorders and hence, there is still ongoing research concerning the scope and credibility of the same for the management of a wide spectrum of psychological disorders.


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Learning Theories: Metacognitive Theory

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