Implication des croyances métacognitives dans les conduites addictives : point sur les connaissances

Abstract

Les croyances métacognitives désignent les croyances qu’un individu détient à propos de ses pensées et des stratégies pour les réguler. D’après le modèle métacognitif de Wells (1994), certaines croyances métacognitives dysfonctionnelles contribueraient au développement et au maintien des troubles mentaux. Nous disposons en effet aujourd’hui de nombreuses données attestant d’un lien significatif entre ces croyances métacognitives et la majorité des psychopathologies. Parmi ces études, certaines ont étudié spécifiquement les liens entre métacognitions et conduites addictives. Il semble que des croyances spécifiques à propos des pensées et du comportement addictif jouent un rôle dans le développement et le maintien d’une conduite problématique. Ces études ont abouti récemment à la proposition d’un modèle métacognitif des addictions. Nous proposons à travers cet article une synthèse des études sur le sujet, une présentation dudit modèle et de ses implications cliniques.

Introduction

Metacognitive beliefs refer to beliefs about thinking, as well as a process that controls, monitors and appraises thinking. Wells’ metacognitive model suggests that maladaptive metacognitive beliefs lead to psychological distress (Wells, Matthews, 1994). These beliefs are assessed using the Metacognition questionnaire, considered to be the gold standard for metacognition assessment. Numerous studies have shown that maladaptive metacognition is present across a large range of Axis I disorders (DSM-IV) (Sun et al., 2017). Among these studies, several were specifically interested in the links between metacognitive beliefs and addictive behaviors (Spada et al., 2014). The following article reviews empirical research, which has examined the different relationships between metacognitive beliefs and addictive behaviors, and presents the metacognitive model of addictive behaviors and its clinical implications.

Methods

An electronic database search of MEDLINE, PsycINFO and PsycARTICLES between 1994 and September 2017 was conducted. Only studies examining metacognition based on Wells's metacognitive model in the field of addictive behavior assessing quantitatively dysfunctional metacognition using MCQ-65 and its short form (MCQ-30), or using tools that assessed specific metacognition in addictive behavior, were included. Studies that assessed qualitatively metacognition were also included.

Results

The results showed that general metacognitive beliefs are elevated across addictive behaviors and that beliefs about the need to control thoughts appear to positively predict addictive behaviors (Spada et al., 2014). In addition, a series of interviews identified specific metacognitive beliefs about engaging in addictive behaviors. There are two kinds of specific beliefs. Positive metacognitive beliefs about use refer to beliefs about the effect of addictive behaviors as a means to control and regulate cognition and emotion. Negative metacognitive beliefs about use focus on the perception of lack of executive control over the engagement in the addictive behaviors, uncontrollability of thoughts related to addictive behaviors, and the negative impact of engagement in addictive behaviors on cognitive functioning. These specific beliefs have been identified in nicotine dependence, gambling disorders and problem drinking. Several scales have been developed to assess these specific beliefs in nicotine, alcohol dependence, and in problematic online gaming. Studies showed that these specific beliefs were positively associated with the severity of use and were a predictor of use beyond outcome expectancies. For example, metacognitive beliefs about alcohol use predicted drinking behavior in clinical and non-clinical sample (Spada and Wells, 2009, 2010) or beliefs about cigarette use were positively associated with cigarette use and mediated the relation between anxiety and smoking behavior (Nikčević et al., 2017). With regard to these results, Spada et al. (2014) proposed an application of Wells's metacognitive model to addictive behaviors. In their formulation, addictive behaviors were considered as a “cognitive self-regulatory strategy” that failed due to the activation of cognitive and metacognitive processes (metacognitive beliefs, negative repetitive thinking, attentional bias, poor metacognitive monitoring). The model was composed of three phases : pre-engagement, engagement and post-engagement phase, which describe how cognitive and metacognitive processes operate and lead to addictive behavior. This triphasic formulation suggested that metacognitive therapy (MCT) may be an effective treatment for addictive behavior (Spada et al., 2013). MCT consists of different techniques aiming to reduce dysfunctional cognitive and metacognitive processes through attention modification, challenging metacognitive beliefs and develop new response to mental events (Fisher and Wells, 2009). However, at this time, data about the efficacy of MCT in the field of addictive behavior remains limited and further research is needed (Caselli et al., 2016).