The Metacognitions about Gambling Questionnaire: Development and psychometric properties

Highlights

• The goal of our studies was to develop a self-report scale of metacognitions about gambling.

• We tested psychometric properties in three studies with both community and clinical samples.

• Findings supported a solution consisting of positive and negative metacognitions about gambling.

• Internal consistency, predictive and divergent validity were acceptable.

• Negative metacognitions were significant prospective predictors of gambling severity.

Abstract

Recent research has suggested that metacognitions may play a role across the spectrum of addictive behaviours. The goal of our studies was to develop the first self-report scale of metacognitions about gambling. We conducted three studies with one community (n = 165) and two clinical (n = 110; n = 87) samples to test the structure and psychometric properties of the Metacognitions about Gambling Questionnaire and examined its capacity to prospectively predict severity of gambling. Findings supported a two factor solution consisting of positive and negative metacognitions about gambling. Internal consistency, predictive and divergent validity were acceptable. All the factors of the Metacognitions about Gambling Questionnaire correlated positively with gambling severity. Regression analyses showed that negative metacognitions about gambling were significantly associated to gambling severity over and above negative affect and gambling-specific cognitive distortions. Finally only gambling severity and negative metacognitions about gambling were significant prospective predictors of gambling severity as measured three months later. The Metacognitions about Gambling Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested.

Introduction

Between the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Pathological Gambling was re-positioned from the Impulse Control Disorders’ (ICD) to the Addictions’ chapter (American Psychiatric Association, 1994, American Psychiatric Association, 2013). Arguably, this shift reflects the changing consensus regarding the significant differences between PG and ICDs in the clinical characteristics and phenomenological experiences associated with these disorders. Of greatest salience is that individuals with ICDs typically report a sense of relief after executing the impulse-driven behaviour whilst those engaging in pathological gambling do not (Shaffer and Korn, 2002). Absence of sense of relief is also accompanied by relevant costs that can give rise to financial, interpersonal, legal and vocational problems for the sufferer, their families and society. Taken together, these considerations give rise to an important question: How is gambling maintained, considering the absence of short-term relief and presence of long-term costs?

A potential answer is provided by behavioural and cognitive approaches to understanding psychopathology. The behavioural approach highlights the role of learning processes like fixed and variable schedules of reinforcement (Dickerson, 1989). The cognitive approach (Sharpe and Tarrier, 1993, Ladouceur and Walker, 1996) highlights the role of irrational and biased cognitive beliefs. These approaches have provided important insights into the understanding of gambling behaviour however they are not without limitations. In particular, the behavioural approach fails to explain why only a small proportion of the total population of gamblers lose control whilst the cognitive approach fails to establish if irrational beliefs play a causal role rather than being a secondary or epiphenomenal effect of cognitive dissonance.

These theoretical limitations may explain why cognitive-behavioural therapy (CBT), which is the most evaluated approach for treating gambling disorder (GD), has been found to be efficacious (e.g. Toneatto, 2005; Toneatto and Millar, 2004) however only in the short term. Indeed there appears to be “insufficient evidence” to support its efficacy in the longer-term (Cowlishaw et al., 2012, p.32). It has been argued that a possible reason for CBT's lack of efficacy in the longer term might be due to residual symptoms that can remain present at a metacognitive level (Lindberg et al., 2011, Spada et al., 2015a, Spada et al., 2015b). In particular, the modification of the content of biased cognitive beliefs, that is the main focus of CBT, do not necessarily imply the modification of implicit or explicit cognitive processes (e.g. worry or rumination) that can facilitate a further emergence of biased cognitions and that can be guided by a specific set of knowledge, labelled metacognitions.

Metacognitions (beliefs about cognition and ways of controlling it) are a central construct in the metacognitive model of psychopathology (Wells and Matthews, 1994, Wells and Matthews, 1996). In this model, metacognitions are purported to play a critical role in the activation and persistence of coping strategies (e.g. perseverative thinking, threat monitoring, thought suppression and maladaptive behaviour), which cause negative thoughts and emotions to persist. In support of this view, metacognitions have been found to be associated with a wide array of psychological and behavioural problems (for a full review, see Wells, 2013) in the anxiety and mood disorders. Furthermore, the therapeutic approach based on the metacognitive model of psychopathology, known as Metacognitive Therapy (MCT), appears to be an effective treatment for depression and a range of anxiety disorders, and possibly superior to traditional CBT (Normann et al., 2014).

Within the field of addictive behaviours numerous studies, using cross-sectional, longitudinal, and experimental designs, have linked metacognitions to alcohol use and problem drinking, whilst other studies demonstrated that metacognitions are also linked to nicotine use and dependence (for review see Spada et al., 2015b). Within the area of addictive behaviours metacognitions can be usefully divided into two broad sets (Spada et al., 2015b, Spada et al., 2013; Spada and Wells, 2009): (1) positive metacognitions about the benefits of engaging in addictive behaviour as a means of cognitive and affective regulation such as “Using alcohol will help me control bad thoughts” or “If I smoke I will achieve greater levels of clarity in my thinking”; and (2) negative metacognitions concerning the uncontrollability and dangers of thoughts about addictive behaviour and engagement in addictive behaviour such as “I cannot stop thinking about my cigarette use” or “using alcohol will damage my mind”. Positive metacognitions have been found to play a central role in motivating individuals to engage in addictive behaviour whilst negative metacognitions are thought be involved in its perpetuation. Negative metacognitions are activated during and following an episode of engagement in an addictive behaviour, triggering difficult cognitive and negative emotional states that compel a person to continue their engagement with it in a maladaptive attempt to regulate these internal states (Spada et al., 2015b).

Recent research has indicated that general metacognitions (specifically, those concerning negative beliefs about the danger and uncontrollability of thoughts and beliefs about the need to control thoughts) predict levels of gambling behaviour when controlling for anxiety and depression (Lindberg et al., 2011). A further study, which focused on eliciting gambling-specific metacognitions in a sample of pathological gamblers (Spada et al., 2015b), identified that gamblers endorsed both positive and negative metacognitions about gambling. Positive metacognitions about gambling referred to the need to gamble as a strategy to control thinking (e.g. to stop worry). Negative metacognitions about gambling referred to the uncontrollability of gambling activity and dangerousness of gambling-related thoughts. However, the study's design (specifically its small sample size) limited the ability to generalise from its findings.

The current study series builds on these two preliminary works by presenting the development and validation of a self-report questionnaire designed to assess metacognitions in gambling, the Metacognitions about Gambling Questionnaire (MGQ). The specific aims are as follows:

• Study 1 aimed at exploring the factor structure of the preliminary version of the MGQ.

• Study 2 aimed at confirming the structure of the MGQ and examining its predictive and divergent validity.

• Study 3 aimed at testing the prospective predictive validity of MGQ in a clinical sample.

We hope that with the development of this self-report questionnaire further quantitative research investigating the role of metacognitions in gambling will be facilitated. We also envisage that the questionnaire may prove useful in identifying individuals with maladaptive metacognitive profiles related to gambling.