Metacognitive abilities in adults with substance abuse treated in therapeutic community
DOI:
https://doi.org/10.20882/adicciones.719Keywords:
addiction, metacognition, Metacognition Assessment Scale–Abbreviated (MAS–A), rehabilitation, mixed-methodsAbstract
Background: The term metacognition reflects a spectrum of psychological activities that allows people to form and integrate representations about their own mental states and those of others. The main goal of this study was to examine whether people with substance abuse disorders (SUDs), and treated in therapeutic community regime, displayed specific patterns of metacognitive deficits on Self-reflectivity, Understanding others’ mind, Decentration, and Mastery, comparing their scores with two clinical groups of patients with schizophrenia spectrum disorders (SSDs) and anxiety disorders. Method: A mixed-methods (qualitative-quantitative) study was designed. Two hundred and sixteen adults aged 18-65 with principal diagnoses of SUDs (n = 52), SSDs (n = 49), and anxiety disorders (n = 115) were recruited. Qualitative data were obtained with the Metacognition Assessment Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale–Abbreviated (MAS–A). Results: The anxiety disorders group had significantly higher MAS–A total scores than the SUDs group, and the SUDs group obtained significantly higher MAS–A total scores than the SSDs group. Concerning the MAS–A subscale scores, the SUDs group displayed significantly lower scores only on the Mastery subscale compared to the anxiety disorders group, with the SUDs and SSDs groups obtaining equivalent Mastery scores. Conclusions: According to these findings, current interventions for addiction should focus more specifically on improving metacognitive Mastery.References
Alcoholics Anonymous. (2001). Alcoholics Anonymous (4th Ed.). New York, NY: A.A. World Services.
Andreasen, N.C. (1984). The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of lowa.
Bachiller, D., Grau-López, L., Barral, C., Daigre, C., Alberich, C., Rodríguez-Cintas, L.,… Roncero, C. (2015). Grupo motivacional en unidad hospitalaria de desintoxicación, su influencia en mantenimiento de la abstinencia y retención al tratamiento tras alta. Adicciones, 27, 109-118.
Bacon, E. y Izaute, M. (2009). Metacognition in schizophrenia: Processes underlying patients’ reflections on their own episodic memory. Biological Psychiatry, 66, 1031-1037. doi: 10.1016/j.biopsych.2009.07.013.
Bart, G. (2012). Maintenance medication for opiate addiction: The foundation of recovery. Journal of Addictive Diseases, 31, 207–225. doi:10.1080/10550887.2012.694598
Bateman, A.W. y Fonagy, P. (2006). Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide. Oxford, UK: Oxford University Press.
Caletti, E., Paoli, R.A., Florentini, A., Ciqqliobianco, M., Zugno, E., Serati, M. y Altamura, A.C. (2013). Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: Preliminary data. Frontiers of Human Neuroscience, 7, 661. doi:10.3389/fnhum.2013.00661
Chambers, R.A. (2013). Adult hippocampal neurogenesis in the pathogenesis of addiction and dual diagnosis disorders. Drug and Alcohol Dependence, 130, 1–12. doi:10.1016/j.drugalcdep.2012.12.005
Chambers, R.A. y Potenza, M.N. (2003). Neurodevelopment, impulsivity, and adolescent gambling. Journal of Gambling Studies, 19, 53–84. doi:1050-5350/03/0300-0053/0
Chambers, R.A., Bickel, W.K. y Potenza, M.N. (2007). A scale-free systems theory of motivation and addiction. Neuroscience y Biobehavioral Reviews, 31, 1017–1045. doi:10.1016/j.neubiorev.2007.04.005
Chelton, L.G. y Bonney, L.C. (1987). Addiction, affects, and self-object theory. Psychotherapy: Theory, Research, Practice, Training, 24, 40–46. doi:10.1037/h0085689
De Rick, A., Vanheule, S. y Verhaeghe, P. (2009). Alcohol addiction and the attachment system: An empirical study of attachment style, alexithymia, and psychiatric disorders in alcoholic inpatients. Substance Use y Misuse, 44, 99–114. doi:10.1080/10826080802525744
Dinsmore, D.L., Alexander, P.A. y Loughlin, S.M. (2008). Focusing the conceptual lens on metacognition, self-regulation, and self-regulated learning. Educational Psychology Review, 20, 391–409.
Flavell, J.H. (1979). Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American Psychologist, 34, 906–911.
Greene, R.W., Biederman, J., Faraone, S.V., Wilens, T.E., Mick, E. y Blier, H.K. (1999). Further validation of social impairment as a predictor of substance use disorders: Findings from a sample of siblings of boys with and without ADHD. Journal of Clinical Child Psychology, 28, 349–354. doi:10.1207/S15374424jccp280307
IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
Ladegaard, N., Lysaker, P.H., Larsen, E.R. y Videbech, P. (2014). A comparison of capacities for social cognition and metacognition in first episode and prolonged depression. Psychiatry Research, 220, 883–889. doi:10.1207/S15374424jccp280307
López-Duran, A., Becoña Iglesias, E., García Janeiro, J.M., Senra Comesaña, A., Cancelo Martínez, J.,… Díaz Castro, E. (2006) ¿Cómo evolucionan las personas con dependencia de la cocaína que están en tratamiento? Estudio a los tres y seis meses. Adicciones, 18, 327–336.
Luoma, J., Drake, C.E., Kohlenberg, B.S. y Hayes, S.C. (2011). Substance abuse and psychological flexibility: The development of a new measure. Addiction Research and Theory, 19, 3–13. doi:10.3109/16066359.2010.524956
Lysaker, P.H., Ringer, J.M., Buck, K.D., Grant, M.L.A., Olesek, K., Leudtke, B. y Dimaggio, G. (2012). Metacognitive and social cognition deficits in patients with significant psychiatric and medical adversity: A comparison between participants with schizophrenia and a sample of participants who are HIV-positive. Journal of Nervous y Mental Disease, 200, 130–134. doi: 10.1097/NMD.0b013e3182439533
Lysaker, P.H. y Salyers, M.P. (2007). Anxiety symptoms in schizophrenia spectrum disorders: Associations with social function, positive and negative symptoms, hope and trauma history. Acta Psychiatrica Scandinavica, 116, 290–298. doi:10.1111/j.1600-0447.2007.01067.x
Lysaker, P.H., Bob, P., Pec, O., Hamm, J., Kukla, M., Vohs, J. y Dimaggio, G. (2013). Synthetic metacognition as a link between brain and behavior in schizophrenia. Translational Neuroscience, 4, 368–377. doi:10.2478/s13380-013-0131-4
Lysaker, P.H., Carcione, A., Dimaggio, G., Johannesen, J.K., Nicolò, G., Procacci, M. y Semerari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: associations with insight, neurocognition, symptom and function. Acta Psychiatrica Scandinavica, 112, 64–71. doi:10.1111/j.1600-0447.2005.00514.x
Lysaker, P.H., Olesek, K., Buck, K.D., Leonhardt, B.L., Vohs, J., Ringer, J. y Outcalt, J. (2014). Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders. Addictive Behaviors, 39, 558–561. doi:10.1016/j.addbeh.2013.11.007
Lysaker, P.H., Vohs, J., Minor, K.S., Irarrázaval, L., Leonhardt, B., Hamm, J.A.,… Dimaggio, G. (2015). Metacognitive Deficits in Schizophrenia: Presence and Associations with Psychosocial Outcomes. The Journal of Nervous and Mental Disease, 203, 530–536. doi:10.1097/NMD.0000000000000323
Lyvers, M., Onuoha, R., Thorberg, F.A. y Samios, C. (2012). Alexithymia in relation to parental alcoholism, everyday frontal lobe functioning and alcohol consumption in a non-clinical sample. Addictive Behaviors, 37, 205–210. doi:10.1016/j.addbeh.2011.10.012
Marlatt, G.A. y Donovan, D.M. (2005). Relapse Prevention. Maintenance Strategies in the Treatment of Addictive Behaviors (2nd Edition). Nueva York: Guildford Press.
McLeod, H.J., Gumley, A.I., MacBeth, A., Schwannauer, M. y Lysaker, P.H. (2014). Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. Journal of Psychiatry Research, 54, 109–115. doi:10.1016/j.jpsychires.2014.03.018
Muñiz, J., Elosua, P. y Hambleton, R.K. (2013). Directrices para la traducción y adaptación de los tests: segunda edición. Psicothema, 25, 151-157.
O’Brien, C.P. (2008). Evidence-based treatments of addiction. Philosophical Transactions of the Royal Society B: Biological Sciences, 363, 3277–3286. doi:10.1098/rstb.2008.0105
OMS (1992). Décima revisión de la clasificación internacional de las enfermedades (CIE-10). Trastornos mentales y del comportamiento. Descripción clínica y pautas para el diagnóstico. Madrid: Editorial Méditor.
Ottavi, P., D’Alia, D., Lysaker, P.H., Kent, J., Popolo, R., Salvatore, G. y Dimaggio G. (2014). Metacognition-oriented social skills training for individuals with long-term schizophrenia: methodology and clinical illustration. Clinical Psychology y Psychotherapy, 21, 465-473. doi: 10.1002/cpp.1850
Pec, O., Bob, P. y Lysaker, P.H. (2015). Trauma, Dissociation and Synthetic Metacognition in Schizophrenia. Activitas Nervosa Superior, 57, 59–70.
Saladin, M.E., Santa Ana, E. J., LaRowe, S. D., Simpson, A. N., Tolliver, B. K., Price, K. L., ... Brady, K. T. (2012). Does alexithymia explain variation in cue-elicited craving reported by methamphetamine-dependent individuals? American Journal of Addiction, 21, 130–135. doi:10.1111/j.1521-0391.2011.00214.x
Sanz, J. y Navarro, M,E. (2003). Propiedades psicométricas de una versión española del Inventario de ansiedad de Beck (BAl) en estudiantes universitarios. Ansiedad y Estrés, 9, 59-84.
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M. y Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology and Psychotherapy, 10, 238–261. doi:10.1002/cpp.362
Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G.,… Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: correlations with disorder severity and personality styles. Journal of Personality Disorders, 28, 751–766. doi:10.1521/pedi_2014_28_137.
Semerari, A., Cucchi, M., Dimaggio, G., Cavadini, D., Carcione, A., Battelli, V., … Smeraldi, E. (2012). The development of the Metacognition Assessment interview: instrument description, factor structure and reliability in a non-clinical sample. Psychiatry Research, 200, 890–895. doi:10.1016/j.psychres.2012.07.015.
Tarricone, P. (2011). The taxonomy of metacognition. Ney York: Psychology Press.
Thorberg, F.A., Young, R.M., Sullivan, K.A. y Lyvers, M. (2009). Alexithymia and alcohol use disorders: A critical review. Addictive Behaviors, 34, 237–245. doi:10.1016/j.addbeh.2008.10.016
Thorberg, F.A., Young, R.M., Sullivan, K.A., Lyvers, M., Connor, J.P. y Feeney, G.F. (2011). Alexithymia, craving and attachment in a heavy drinking population. Addictive Behaviors, 36, 427–430. doi:10.1016.j.addbeh.2010.12.016
Toneatto, T. (1999). Metacognition and substance use. Addictive Behaviors, 24, 167–174. doi:10.1016/S0306-4603(98)00126-9
van Oosterhout, B., Smit, F., Krabbendam, L., Castelein, S., Staring, A.B. y van der Gaag, M. (2015). Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies. Psychological Medicine, 20, 1–11. doi:10.1017/S0033291715001105
Verrocchio, M.C., Conti, C. y Fulcheri, M. (2010). Deliberate self-harm in substance-dependent patients and relationship with alexithymia and personality disorders: A case-control study. Journal of Biological Regulators and Homeostatic Agents, 24, 461–469.
Volkow, N.D., Fowler, J.S., Wang, G.J., Baler, R. y Telang, F. (2009). Imaging dopamine’s role in drug abuse and addiction. Neuropharmacology, 56(s1), 3–9. doi:10.1016/j.neuropharm.2008.05.022
Wasmuth, S.L., Outcalt, J., Buck, K., Leonhardt, B.L., Vohs, J. y Lysaker, P.H. (2015). Metacognition in persons with substance abuse: Findings and implications for occupational therapists. Canadian Journal of Occupational Therapy, 82, 150–159.
