Presentazione Congresso Europeo Terapie Cognitivo-Comportamentali, EABCT 2012, Ginevra. Oral Presentation at the 42th Congress of European Association of Behavioral and Cognitive Therapies. Il ruolo del pensiero desiderante lungo il continuum della dipendenza da alcool

1. Desire Thinking across the Continuum
of Drinking Behaviour
Gabriele Caselli1,2, Marcantonio M. Spada1,3
1 London South Bank University, London, UK
2 Studi Cognitivi, Cognitive Psychotherapy School, Milano, Italy
3North East London NHS Foundation Trust, London, UK

2. Antecedents of Drinking Behaviour
1. Negative affect (e.g. Anxiety and Depression)
• A frequent antecedent of alcohol use (e.g. Ameli
et al., 2001)
• Alcohol is employed to cope with negative affect
(Zack et al., 2002)
• Changes in mood strengthen the urge to drink
(e.g. Cooney et al., 1997)
• Enhance the risk of relapse after treatment (e.g.
Caselli et al., 2008)

3. Antecedents of Drinking Behaviour
2. Craving
• Powerful subjective experience that motivates
individuals to seek out and achieve a craved target
in order to reach its desired effects (Marlatt, 1987)
• Play a crucial role in the development of alcohol
dependence (Ludwig & Wikler, 1974)
• Enhance risk drinking during and after treatment
(e.g. Flannery et al., 2003; Gordon et al., 2006)
• Is a key focus in CBT treatment for alcohol use
disorders (O’Malley et al., 2002)

4. Theories about the link
• Conditioning models (Ludwig & Wikler, 1974;
Siegel, 1983; Stewart, Dewit, & Eikelboom, 1984)
• Cognitive models (Marlatt, 1985; Stacy, 1997;
Baker, Morse & Sherman, 1987; Tiffany, 1999)
• Elaborated-Intrusion Theory (EI-Theory, Kavanagh et
al., 2009)

5. Elaborated-Intrusion Theory of Desire
(Kavanagh et al., 2005)
1. Target- or negative affect-related
cues exposure and associations
2. Break over the awareness
treshold (e.g. intrusive thoughts,
memories, sense of deprivation)
3. Cognitive rigid, perseverative
elaboration of intrusions (desire
thinking)
4. Escalation and persistence of
subjective craving and deprivation

6. Desire Thinking
• DT is a voluntary thinking process orienting to prefigure
images, information and memories about positive target-
related experience (Caselli & Spada, 2010; 2011)
• Imaginal prefiguration (e.g. I anticipate the sensations I
would feel practicing the desired activity
• Verbal Perseveration: (e.g. I repeat mentally to myself that I
need to practice the desired activity)
• In the short-term DT helps to manage negative internal states
by shifting attention away from them and focusing on positive
target related sensations
• However in medium-term DT brings to an escalation of
craving as the desired target is perseveratively imagined but
not achieved

7. Desire Thinking and
Psychopathology
• Findings on significant structural differences between the
construct of desire thinking and craving (Caselli & Spada,
2011)
• High nicotine dependent patients reports significantly higher
levels of desire thinking than moderate and low nicotine
dependents (Caselli et al., 2011)
• DT induces subjective craving in experimental manipulation
(Caselli et al., 2012)

8. AIMs
• Explore the differences in desire thinking in alcohol
dependent drinkers, problem drinkers and social drinkers
whilst controlling for negative affect (anxiety and depression)
and craving
• We hypothesized that alcohol dependent drinkers would have
higher levels of desire thinking than problem drinkers who in
turn would have higher levels than social drinkers

9. Participants
Dependent Problem Social
N 43 59 68
Females 14 23 34
Age 44 (11.1) 47.2 (11.9) 43.8 (12.5)
WAU 90.5 (24.3) 43.1 (11.2) 6.3 (4.9)
Criteria
Drug-Free V V v
Italian V V V
>18 Age V V V
> 21 WAU V V X
SCID-I V X X

10. Materials
• Negative Affect (HADS - Hospital Anxiety and
Depression Scale)
• Craving (PACS - Penn Alcohol Craving Scale)
• Desire Thinking (DTQ - Desire Thinking
Questionnaire)
• Imaginal Prefiguration (DTQ-IP)
• Verbal Perseveration (DTQ-VP)
• Alcohol Use (QFS - Quantity Frequency Scale)

11. Results - Descriptives
Dependent Problem Social Drinkers
Drinkers Drinkers (n=68)
(n=43) (n=59)
Anxiety (HADS-A) 7.2 (2.7) 6.6 (4.0) 5.8 (3.2)
Depression (HADS-D) 5.3 (3.7) 4.9 (3.9) 3.9 (3.0)
Craving (PACS) 19.4 (4.6) 16.0 (5.2) 4.4 (3.8)
Imaginal Prefiguration (DTQ-IP) 13.8 (3.7) 12.1 (3.6) 7.3 (2.2)
Verbal Perseveration (DTQ-VP) 14.8 (3.5) 11.8 (3.9) 5.8 (1.5)
Alcohol Use (QFS) 90.5 (24.3) 43.0 (11.8) 6.3 (4.9)
• Significant covariates for DTQ-IP: age, craving
• Significant covariates for DTQ-VP: craving

12. Results - MANCOVA
Drinking Behaviour 1. MANCOVA
14
• Dependent: DTQ-VP, DTQ-IP
• Covariates:
13
gender, age, anxiety, depression and
craving
• Roy’s Largest Root:
12
F=612.56, p<.0001
11
2. Bonferroni pairwise comparisons
10
* • DD/PD > SD in DTQ-IP
9 • DD > PD > SD in DTQ-VP
*
8
* • Significant covariates for DTQ-IP: age, craving
Alcohol Abusers Problem drinkers Social drinkers (n=68) • Significant covariates for DTQ-VP: craving
(n=43) (n=59)

13. Results – Binary Logistic Regression
Dependent Variable: Category Membership
p
as problem or alcohol dependent drinkers The final step
indicates that
Age NS
DTQ-VP was the
Anxiety (HADS-A) NS only significant
Depression (HADS-D) NS
predictor of alcohol
dependence with
Craving (PACS) NS 69.9% of cases
Imaginal Prefiguration (DTQ-IP) NS correctly classified.
Verbal Perseveration (DTQ-VP) .01

14. Discussion
• Desire thinking, especially verbal perseveration component,
significantly increases across the continuum of drinking
behaviour.
• Imaginal prefiguration may play a role as initial factor in the
transition from social to problem drinker status
• Verbal perseveration may play a role both as an initial factor
in the transition from social to problem drinker status, and in
the escalation of drinking behaviour to alcohol dependence
levels

15. Discussion
• Desire Thinking can be considered as a cognitive control
strategy; initial intrusions may result in drinking behavior
once desire thinking, as a cognitive process, is activated
• Desire thinking may be conceptualized, assessed and treated
in order to reduce the risk of transition across the continuum
of drinking behaviour.
• Patients may attain benefits by learning how to: (1) recognize
desire thinking; (2) control it; and (3) reshift and amplify their
attention focus

16. Future Directions
• Explore the role of desire thinking in
predisposition towards, and maintenance of,
drinking behaviour, through longitudinal
studies
• Examine whether changes in desire thinking
occur during the process of problem drinking
and alcohol dependence treatment and if they
are associated with relapse

18. Thank you for your attention!
Contact details
Dr. Gabriele Caselli
Cognitive Psychotherapy School Studi Cognitivi, Modena, Italy
London South Bank University, London, UK
g.caselli@studicognitivi.net