Cognitive and metacognitive factors among alcohol-dependent patients during a residential rehabilitation program: a pilot study

Figures & data

Figure 1 Flowchart showing the patient enrolment process.

Table 1 Sociodemographic and clinical characteristics of the total sample (n=30)

Variable	n (%)
Sex
Male	21 (70)
Female	9 (30)
Education
Low	11 (36.7)
Middle-high	19 (63.3)
Work status
Employed	18 (60)
Not employed	12 (40)
Comorbidity
Yes	17 (56.7)
No	13 (43.3)
Intervention
Pharmaco- and psychotherapy	20 (64.5)
Psychotherapy only	10 (32.3)
Alcohol dependence
≤10 years	9 (30)
>10 years	21 (70)
Polysubstance dependence
Pure alcoholics	24 (80)
Polyabusers	6 (20)
Previous admissions
Yes	17 (56.7)
No	13 (43.3)
Age (years)
Mean ± SD	50.03±10.52

Abbreviation: SD, standard deviation.

Table 2 Changes in mean scores of psychological factors and cognitive–metacognitive scales at admission to discharge from the rehabilitation program (total patients=30)

Variable	Admission, mean (SD)	Discharge, mean (SD)	t	P-value	Cohen’s d
CBA-OE subscales
Anxiety	24.77 (10.78)	12.70 (7.25)	7.002	<0.001	−1.11
Well-being	22.33 (10.84)	34.53 (7.87)	−6.053	<0.001	1.12
Perception of positive change	20.73 (6.66)	27.53 (5.37)	−6.546	<0.001	1.02
Depression	32.70 (13.46)	14.87 (8.10)	8.177	<0.001	−1.32
Psychological distress	30.40 (15.51)	12.03 (11.00)	7.588	<0.001	−1.18
Cognitive and metacognitive scales
PAMS	26.66 (8.18)	23.70 (7.33)	2.022	0.052	−0.36
NAMS	16.23 (4.08)	15.70 (4.22)	0.77	0.448	−0.12
B-RRS	12.61 (3.33)	10.96 (3.28)	3.601	<0.001	−0.50
PACS	17.86 (6.47)	11.06 (7.54)	5.302	<0.001	−1.05

Abbreviations: B-RRS, Brooding subscale of Ruminative Response Scale; CBA-OE, Cognitive Behavioral Assessment – Outcome Evaluation; NAMS, Negative Alcohol Metacognitions Scale; PACS, Penn Alcohol Craving Scale; PAMS, Positive Alcohol Metacognitions Scale; SD, standard deviation.

Figure 2 PAM and NAM at admission (t0) and discharge (t1), with changes between the two evaluations.

Notes: PAM items: 1, Drinking makes me more affectionate; 2, Drinking makes me more confident; 3, Drinking makes me think more clearly; 4, Drinking makes me feel more relaxed; 5, Drinking helps me to control my thoughts; 6, Drinking makes my negative thoughts more bearable; 7, Drinking reduces my anxious feelings; 8, Drinking makes me more sociable; 9, Drinking reduces my self-consciousness; 10, Drinking makes me feel happy; 11, Drinking helps me focus my mind; 12, Drinking helps me fit in socially. NAM items: 1, I have no control over my drinking; 2, If I cannot control my drinking I will cease to function; 3, Drinking will damage my mind; 4, My drinking persists no matter how I try to control it; 5, Drinking will make me lose control; 6, Drinking controls my life.
Abbreviations: NAM, negative alcohol metacognitions; PAM, positive alcohol metacognitions.

Figure 3 B-RRS and PACS at admission (t0) and discharge (t1), with changes between the two evaluations.

Notes: B-RRS items: 1, Think “What am I doing to deserve this?”; 2, Think “Why do I always react this way?”; 3, Think about a recent situation, wishing it had gone better; 4, Think “Why do I have problems other people don’t have?”; 5, Think “Why can’t I handle things better?”. PACS items: 1, During the past week how often have you though about drinking or about how good a drink would make you feel?; 2, At its most severe point, how strong was your craving during the past week?; 3, During the past week how much time have you spent thinking about drinking or about how good a drink would make you feel?; 4, During the past week how difficult would it have been to resist taking a drink if you had known a bottle were in your house?; 5, Keeping in mind your responses to the previous questions, please rate your overall average alcohol craving for the past week.
Abbreviations: B-RRS, Brooding subscale of Ruminative Response Scale; PACS, Penn Alcohol Craving Scale.

Table 3 Results on the four self-report questionnaires (PAMS, NAMS, B-RRS, and PACS) at admission and discharge: a comparison of patients subdivided by sex, work status, treatment intervention, and previous admissions

	Sex				Work status				Intervention type				Previous admissions
	Male, mean (SD)	Female, mean (SD)	F	P-value	Employed, mean (SD)	Not employed, mean (SD)	F	P-value	Pharmaco- and psychotherapy, mean (SD)	Psychotherapy, mean (SD)	F	P-value	Yes, mean (SD)	No, mean (SD)	F	P-value
Admission
PAMS	29.05 (7.97)	21.11 (5.88)	7.178	0.012*	22.75 (7.08)	29.28 (7.99)	5.245	0.03*	27.95 (8.94)	24.1 (6.02)	1.499	0.231	28.05 (6.29)	24.84 (10.13)	1.139	0.295
NAMS	16.66 (3.35)	15.22 (5.54)	0.783	0.384	16 (3.84)	16.39 (4.34)	0.063	0.803	15.2 (3.83)	18.3 (3.94)	4.278	0.048*	16.35 (4.27)	16.07 (3.99)	0.033	0.858
B-RRS	12.23 (3.43)	13.44 (3.12)	0.817	0.374	13.5 (3.85)	12.0 (2.91)	1.478	0.234	12.85 (3.36)	12.1 (3.41)	0.330	0.571	12.76 (3.23)	12.38 (3.59)	0.093	0.763
PACS	19.28 (5.32)	14.55 (7.97)	3.673	0.066	16.25 (6.39)	18.94 (6.47)	1.258	0.272	18.6 (6.36)	16.4 (6.78)	0.764	0.39	20.29 (4.7)	14.7 (7.22)	6.576	0.016*
Discharge
PAMS	24.52 (6.28)	21.77 (9.51)	0.879	0.356	21.5 (5.8)	25.16 (8.01)	1.852	0.184	23.15 (7.04)	24.8 (8.16)	0.330	0.571	24.35 (6.17)	22.8 (8.82)	0.303	0.586
NAMS	16.42 (3.76)	14.00 (4.97)	2.162	0.153	15.0 (3.27)	16.16 (4.79)	0.540	0.469	14.5 (3.77)	18.1 (4.23)	5.601	0.025*	16.64 (4.03)	14.46 (4.31)	2.039	0.164
B-RRS	10.81 (3.32)	11.33 (3.35)	0.156	0.696	11.41 (3.53)	10.66 (3.18)	0.367	0.549	11.25 (3.34)	10.4 (3.27)	0.438	0.514	10.88 (3.2)	11.07 (3.5)	0.025	0.876
PACS	11.43 (7.39)	10.22 (8.27)	0.156	0.695	9.08 (6.0)	11.06 (7.54)	1.402	0.246	10.9 (5.81)	11.4 (10.57)	0.028	0.868	12.8 (6.7)	8.76 (8.1)	2.218	0.148

Note:

* P-value <0.05.

Abbreviations: B-RRS, Brooding subscale of Ruminative Response Scale; NAMS, Negative Alcohol Metacognitions Scale; PACS, Penn Alcohol Craving Scale; PAMS, Positive Alcohol Metacognitions Scale; SD, standard deviation.

Table 4 Correlations among post-treatment CBA-OE subscales and pretreatment cognitive and metacognitive factors

Variable	1	2	3	4	5	6	7	8	9
1. Positive alcohol metacognitions	1
2. Negative alcohol metacognitions	0.41*	1
3. Craving	0.25	0.11	1
4. Brooding	−0.02	0.09	0.07	1
5. Anxiety	0.04	−0.05	0.29	0.58**	1
6. Well-being	−0.09	0.11	−0.22	−0.23	−0.33	1
7. Perception of positive change	−0.07	0.23	−0.42*	−0.24	−0.44*	0.64**	1
8. Depression	−0.07	−0.08	0.24	0.58**	0.78**	−0.32	−0.56**	1
9. Psychological distress	−0.03	0.14	0.11	0.55**	0.75**	−0.04	−0.25	0.72**	1

Notes: Data are presented as Pearson’s correlation coefficient (r).

* P-value <0.05.

** P-value <0.001.

Abbreviation: CBA-OE, Cognitive Behavioral Assessment – Outcome Evaluation.

Table 5 Multivariate regression model for predictors of post-treatment psychological variables

Variable	Anxiety		Depression		Perception of positive change		Psychological distress
	B	P	B	P	B	P	B	P
Positive alcohol metacognitions	0.05	0.70	−0.06	0.69	−0.08	0.51	−0.13	0.60
Negative alcohol metacognitions	−0.30	0.31	−0.28	0.41	0.47	0.06	0.32	0.51
Craving	0.28	0.11	0.29	0.15	−0.34	0.02	0.15	0.60
Brooding	1.27	0.001	1.40	0.001	−0.40	0.14	1.76	0.003

Notes: B, unstandardized coefficient; P, Pearson correlation coefficient.