Metacognition and Metacognitive Therapy in Gambling Disorder

Abstract

Gambling Disorder (GD) is associated with substantial financial, psychological, and interpersonal harms. Emerging evidence highlights metacognitive mechanisms as central to the onset and maintenance of addictive behaviors. This narrative review synthesizes theoretical and empirical work on metacognitions, the Self-Regulatory Executive Function (S-REF) model, and the Cognitive Attentional Syndrome (CAS) in GD, and evaluates the therapeutic promise of Metacognitive Therapy (MCT). Positive and negative metacognitive beliefs shape how individuals appraise and control internal experiences, fostering maladaptive cycles marked by desire thinking, rumination, attentional bias, and thought suppression. These processes impair monitoring, reduce attentional flexibility, and degrade decision-making, while emotion-regulation deficits across identification, selection, and implementation further perpetuate gambling. Within the S-REF/CAS framework, GD is conceptualized as a cyclical pattern sustained by rigid, repetitive processing of threat- and reward-related cognitions. MCT targets these processes directly via techniques such as detached mindfulness and the attention training technique, aiming to weaken repetitive negative thinking and restore cognitive control. Preliminary evidence including an eight-session pilot focused on gambling-specific distortions suggests acceptability and reductions in cognitive distortions, with broader support from trials in anxiety, depression, and substance use indicating superior or comparable outcomes to cognitive behavioral and acceptance-based approaches. We conclude that metacognitive dysfunctions constitute actionable treatment targets in GD and that MCT is a theoretically coherent, promising intervention.

Keywords

• Gambling disorder
• metacognition
• metacognitive therapy
• cognitive attentional syndrome

Kumar Oynama Bozukluğunda Üstbilişler ve Metakognitif Terapi

Öz

Kumar Oynama Bozukluğu (KOB), bireylerde ciddi finansal, psikolojik ve kişilerarası sorunlara yol açmaktadır. Son yıllarda yapılan araştırmalar, bağımlılık davranışlarının ortaya çıkışı ve sürdürülmesinde üstbilişsel mekanizmaların merkezi bir rol oynadığını göstermektedir. Bu derleme, KOB bağlamında üstbilişler, Kendini Düzenleyici Yürütücü İşlev (KDYİ) modeli ve Bilişsel Dikkat Sendromu’nun (BDS) teorik ve ampirik temellerini incelemekte ve Metakognitif Terapi’nin (MKT) terapötik potansiyelini değerlendirmektedir. Olumlu ve olumsuz üstbilişsel inançlar, bireylerin içsel yaşantılarını değerlendirme ve kontrol etme biçimlerini şekillendirerek arzu düşüncesi, ruminasyon, dikkat yanlılığı ve düşünce baskılama gibi işlevsiz döngüleri beslemektedir. Bu süreçler, dikkat esnekliği ve karar verme becerilerinde bozulmalara, öz farkındalıkta azalmaya ve duygu düzenleme güçlüklerine yol açmaktadır. KDYİ/BDS çerçevesinde KOB, tehdit ve ödül odaklı bilişlerin katı, tekrarlayıcı biçimde işlenmesiyle sürdürülen döngüsel bir süreç olarak kavramsallaştırılmaktadır. MKT, ayrışmış farkındalık ve dikkat eğitimi gibi teknikler aracılığıyla bu süreçleri doğrudan hedefleyerek tekrarlayıcı olumsuz düşünmeyi zayıflatmayı ve bilişsel kontrolü yeniden sağlamayı amaçlar. Kumarla ilişkili bilişsel çarpıtmaları hedefleyen sekiz oturumluk pilot bir çalışma, yöntemin kabul edilebilirliğini ve çarpıtmalarda azalma sağladığını göstermiştir. Anksiyete, depresyon ve madde kullanım bozuklukları alanındaki bulgular da MKT’nin bilişsel davranışçı ve kabul temelli yaklaşımlara benzer ya da üstün sonuçlar verebildiğini ortaya koymaktadır. Metakognitif işlev bozukluklarının KOB’da tedavi edilebilir hedefler oluşturduğu ve MKT'nin teorik olarak tutarlı, umut verici bir müdahale olduğu sonucuna ulaşılmıştır.

Anahtar Kelimeler

• Kumar bağımlılığı
• metakognisyon
• bilişsel dikkat sendromu
• metakognitif terapi

Kaynakça

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