Metacognition and Metacognitive Therapy in Gambling Disorder
Metacognition and Metacognitive Therapy in Gambling Disorder

Summary/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.

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