Metacognitive Therapy in Alcohol Abuse Treatment

This essay discusses the principles and effectiveness of metacognitive therapy in the treatment of alcohol abuse and dependence. It explores the underlying causes of alcohol abuse and the existing treatment options. The essay also explains the concept of metacognition and how it is applied in therapy. It concludes with a discussion on the benefits of metacognitive therapy for individuals struggling with alcohol abuse.

Running head: METACOGNITVE THERAPY IN ALCOHOL ABUSE TREATMENT
METACOGNITIVE THERAPY IN THE TREATMENT OF ALCOHOL ABUSE
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1METACOGNITIVE THERAPY IN ALCOHOL ABUSE TREATMENT
Introduction
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.

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Discussion
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,

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hypertension, liver cirrhosis, pancreatitis, damage to the brain and possibly cancer (Gorka et al.,
2016).
Psychopathology of 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).
Existing Treatments of Alcohol Abuse and Dependence
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

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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).
Learning Theories: Metacognitive Theory
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

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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).
Metacognitive Model of Mental Disorders
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

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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).
Metacognitve Therapy for Alcohol Abuse and Dependence
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.

7METACOGNITIVE THERAPY IN ALCOHOL ABUSE TREATMENT
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 Nikčević 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.
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

8METACOGNITIVE THERAPY IN ALCOHOL ABUSE TREATMENT
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.
Conclusion
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.

9METACOGNITIVE THERAPY IN ALCOHOL ABUSE TREATMENT
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