Cognitive treatment of pathological gamblers

This study evaluates the efficacy of a cognitive treatment for pathological gambling. Five pathological gamblers were treated in a multiple baseline across subjects design. Cognitive correction targeted the erroneous perceptions towards the notion of randomness. Four subjects reported a clinically significant decrease in the urge to gamble, an increase in their perception of control, and no longer met the DSM-IV criteria for pathological gambling. Therapeutic gains were maintained at the 6 month follow-up. Results suggest that cognitive therapy targeting the misconception of the notion of randomness is a promising treatment for pathological gambling, a refractory disorder to most therapeutic interventions.     

Motivational Interviewing Versus Cognitive Behavioral Group Therapy in the Treatment of Problem and Pathological Gambling: A Randomized Controlled Trial

Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance.     

A comparison of individual and group cognitive-behavioural treatment for female pathological gambling

The current study aimed to determine the differential efficacy of a cognitive-behavioural treatment program for female pathological gamblers delivered in individual and group format. Fifty-six female pathological gamblers with electronic gaming machine gambling problems were randomly assigned to the control (waiting list) group or one of the treatment groups (individual or group treatment). Treatment comprised a 12-session program including financial limit setting, alternative activity planning, cognitive correction, problem solving, communication training, relapse prevention, and imaginal desensitisation. Treatment outcome was evaluated with conceptually related measures within the areas of gambling behaviour and psychological functioning. While individual and group treatment formats generally produced comparable outcomes in terms of gambling behaviour and psychological functioning, group treatment failed to produce superior outcomes to the control group in relation to several measures of psychological functioning. Moreover, by the completion of the six-month follow-up, 92% of the gamblers allocated to individual treatment compared with 60% allocated to group treatment no longer satisfied the diagnostic criteria for pathological gambling. These findings suggest that some caution should be employed when delivering cognitive-behavioural treatment in a group format until further research is conducted to establish its efficacy.     

Internet‐based CBT intervention for gamblers in Finland: Experiences from the field

From September 2007 to May 2011 a total of 471 participants (325 males and 146 females) signed up for an 8‐week Internet‐based cognitive behavioral therapy offered for gamblers in Finland. Sixty‐four percent of the participants were pathological gamblers (PGs) (NODS 5> points), 14% were problem gamblers (NODS 3–4 points) and 10% were at risk of gambling problems (NODS 1–2 points). Two hundred and twenty four participants completed the treatment and after the treatment period significant changes were found in the following variables: gambling related problems (NODS), gambling urge, impaired control of gambling, alcohol consumption (AUDIT‐C), social consequences, gambling‐related cognitive erroneous thoughts and depression (MARD‐S). In this sample co‐morbid alcohol consumption was stronger among males. The main finding of this study was that the onset age of gambling was associated with a greater amount of gambling‐related cognitive erroneous thoughts.     

Is control a viable goal in the treatment of pathological gambling?

According to a report of National Gambling Impact Study Commission (National Gambling Impact Study Commission (1999). Final report. Washington, DC: Government Printing Office.), 97% of problem gamblers in the United States do not seek treatment. Within the small proportion of problem gamblers who enter into treatment, a high percentage drops out. Despite the fact that some researchers argue against abstinence as the only acceptable treatment goal and that regaining control over gambling behaviour appears to be possible for some pathological gamblers (PG), abstinence has been the only gambling intervention treatment goal. The primary goal of this study was to verify whether controlled gambling is a viable goal for pathological gamblers. The second goal was to identify the characteristics that predicted a successful outcome for treatment with a controlled gambling goal. Eighty-nine PGs were enrolled in cognitive-behavioural treatment aimed at controlled gambling. Six and twelve month follow-ups were conducted in order to evaluate the maintenance of therapeutic gains and to identify significant predictors of successful controlled gambling. Results showed that using the intent-to-treat procedure, 63% had a score of 4 or less on the DSM-IV at the end of treatment. That proportion was 56% and 51% at the 6- and 12-month follow-ups. If we retain only those who completed the treatment, these proportions increased to 92%, 80% and 71% at post-treatment, 6- and 12-month follow-ups, respectively. On the majority of the measures, significant improvements were found at post-treatment and the therapeutic gains were maintained at the 6- and 12-month follow-ups. However, few variables were identified to predict who would benefit from control rather than abstinence. The clinical and philosophical implications of these results are discussed in this paper.     

Prevalence and correlates of gambling among 16 to 19-year-old adolescents in Norway

There is evidence that young people are at high risk of developing gambling disorders. The prevalence and correlates of gambling among youth therefore merit closer study. During spring 2004, a sample of 1,351 boys and girls (aged 16–19 years) from 151 high-school classes (clusters) participated in an internet survey about gambling. The response rate was 69.8%. The instruments used in the survey were the Hospital Anxiety and Depression Scale, the Alcohol Use Disorders Identification Test and the Massachusetts Adolescent Gambling Screen, in addition to questions about demography. Controlling for the design effect, the estimated prevalence rate was 2.5% for pathological gambling and 1.9% for problem gambling. In all, 7.3% of the boys and 0.6% of the girls fulfilled the criteria for pathological or problem gambling. The results of item analysis of the DSM-IV subscale of MAGS provide support for differential item functioning between boys and girls. A multiple logistic regression analysis revealed that gender (male: OR = 9.09), depression (OR = 9.23), alcohol abuse (OR = 3.62), and dissociation (OR = 1.96) were related to problem and pathological gambling. These results support the view that gambling disorders are best understood as part of an addictive behavior spectrum ( Jacobs, 2000 ).     

Personality disorders and dimensions in pathological gambling

Comorbid DSM-IV Axis II personality disorders appear to be common in pathological gambling (PG) and may contribute to the chronic problems often associated with the disorder. This study sought to examine the relationship between PG, personality disorders, and impulsivity in a sample of pathological gamblers. Personality assessments included the SCID-II, Eysenck Impulsiveness Questionnaire, Tridimensional Personality Questionnaire, and Barratt Impulsiveness Scale. A total of 77 individuals with DSM-IV PG were included in this study, of which 35 (45.5%) met criteria for at least one personality disorder. Specific aspects of impulsivity were associated with certain personality disorders in PG when grouped by cluster, yet the presence of a personality disorder was not positively correlated with gambling severity. It remains unclear how the presence of a personality disorder and aspects of impulsivity may affect treatment outcome. Further exploration of these disorders and dimensions of personality may encourage a more inclusively global treatment approach.     

The effect of knowledge of mathematics on gambling behaviours and erroneous perceptions

This study evaluates the effect of knowledge of mathematics as a protective factor against excessive gambling behaviours and erroneous beliefs. Two groups with different levels of knowledge of mathematics were compared as to their perceptions and behaviours before and during a gambling session. A total of 60 participants (30 men, 30 women) completed a questionnaire evaluating how they perceive the notion of chance and participated in two experimental tasks: the production of a random sequence of heads/tails, and a gambling session on a video lottery terminal. The results show that participants with knowledge of mathematics held more erroneous perceptions of gambling before the experiment whereas both groups showed an equal number of erroneous perceptions and behaviours during gambling. The importance of knowledge of mathematics as a protective factor against excessive gambling is questionable. The theoretical and practical implications of these results are discussed with regard to the prevention of excessive gambling.     

Prevention of pathological gambling: a randomized controlled trial

Although the gambling industry is expanding rapidly throughout North America and around the world, there are only a few empirically evaluated programs aimed at the prevention of pathological gambling (PG). The purpose of this study was to measure the effectiveness of a new prevention program aimed at PG. The Stop & Think! program was designed to teach at-risk video lottery terminal (VLT) gamblers cognitive restructuring and problem-solving skills that may help to prevent the development of PG. These skills were taught through a variety of methods - including an automated educational presentation, video and text vignettes, audio training tapes, and skill rehearsal. The program was evaluated using a randomized, 2-group experimental design with a wait-list control group and pre-, post-, and follow-up measures. Results indicated that, compared with the control group, the experimental group was less at risk for developing a gambling problem after the program. The experimental group endorsed fewer gambling-related cognitive distortions, engaged in less VLT gambling, and had lower scores on a measure of PG. The results of this study provide the basis for the implementation of the Stop & Think! program in the province of Prince Edward Island, Canada, and perhaps other jurisdictions too.     

Symbols presentation modality as a determinant of gambling behavior

In this study, the authors investigated the effects that modality of symbol presentation on video lottery terminals (sequential vs. simultaneous) has on gambling behavior. They predicted that sequential presentation would incite players to prolong their gambling session. Results confirmed this prediction and showed that modality of presentation is a determinant of gambling persistency. The authors discuss the relationship between modality of presentation, hopes of an imminent win, losses, and practical and theoretical issues about other cognitive and emotional elements that may influence gamblers' behaviors.     

Gambling, health and age: data from the National Epidemiologic Survey on Alcohol and Related Conditions.

The health effects of recreational gambling are presently unclear, particularly across age groups. Theories of healthy aging suggest that social activities, including gambling, may be beneficial to the health of older adults. Using cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093), the authors examined associations between gambling (categorized as nongambling, recreational gambling, or problem/pathological gambling) and health and functioning measures stratified by age (40-64 years and >/=65). Problem/pathological gambling was uniformly associated with poorer health measures among both younger and older adults. Among younger respondents, poorer health measures were also found among recreational gamblers. However, among older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Longitudinal studies are needed to clarify the relationship between gambling and health in older adults in the context of healthy aging.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.     

Erroneous verbalizations and risk taking at video lotteries

This study examined the effect of erroneous perceptions verbalized by a game accomplice on participants' gambling. The sample consisted of 22 men and 10 women, aged 18 and older, who did not show excessive gambling problems, but who had played video lotteries at least once during the last 6 months. The participants were randomly assigned into one of three groups, where they gambled in the presence of an accomplicewho verbalized three types of perceptions: (1) the accomplice emitted erroneous thoughts about gambling,(2) the accomplice verbalized adequate thoughts about gambling, or (3) the accomplice did not speak. Results showed that players exposed to an accomplice's erroneous verbalizations took significantly more risksthan players in the other two groups. Erroneous perceptions appear to be easily transmissible and have impacts on gambling behaviour. The practical and theoretical implications of these results are discussed.     

Psychological Factors that Promote and Inhibit Pathological Gambling

This paper describes qualitative data regarding psychological factors that may affect gambling behavior among treatment-seeking pathological gamblers. Participants (n = 84) diagnosed with pathological gambling were treated in a clinical trial examining the efficacy of cognitive behavioral therapy (CBT). Qualitative data were collected from participants during each of 8 structured CBT sessions. Specific gambling-related psychological factors that were assessed include triggers, consequences, high-risk situations, craving experiences, assertiveness skills, cognitive distortions, and coping strategies. The most commonly reported triggers for gambling were lack of structured time and negative emotional state, which were similar to the high-risk times for gambling. The most frequently listed positive consequences of gambling were enjoyment associated with winning and use of gambling as an escape. Negative consequences of gambling included depressed mood, financial problems, and conflict with family. Coping strategies changed during treatment, as participants reported relying less upon avoidance and distraction, and became better able to utilize support networks and cognitive coping skills. These data are important to better understand the factors associated with the development, maintenance, and cessation of pathological gambling.     

Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: a pilot study

The current study aimed to test the clinical effectiveness of a cognitive-behavioural program (CBT) specifically adapted for pathological gamblers with chronic schizophrenia, carried out in a naturalistic setting of community Mental Health Centres. Forty-four pathological gamblers with chronic schizophrenia were assigned either to a standard drug therapy for schizophrenia (control group) or to cognitive-behavioural therapy for pathological gambling plus a standard drug therapy for schizophrenia (experimental group). Psychological treatment comprised a 20-session program including psychoeducation, stimulus control, gradual exposure and relapse prevention. Therapeutic success was defined as abstinence or the occurrence of only 1 or 2 episodes of gambling during the follow-up period. While the patients treated in the experimental group showed a rate of success of 73.9%, only 19% of the participants belonging to the control group gave up gambling at the 3-month follow-up. The CBT group also did better than the control group in the number of gambling episodes and in the amount of money spent on gambling. However, the improvement of the experimental group was weaker at the 6- and 12-month follow-up. These findings support the beneficial effects of CBT as adjunctive therapy for patients with dual diagnoses (schizophrenia and pathological gambling).     

Responsible Gambling Tools: Pop-Up Messages and Pauses on Video Lottery Terminals

The authors examined the effect of messages and pauses, presented on video lottery terminal screens, on erroneous beliefs and persistence to play. At posttest, the strength of erroneous beliefs was lower for participants who received messages conveying information about randomness in gambling as compared to those who received pauses. Pauses also diminished the strength of erroneous beliefs, and there was no difference between the effects of pauses and messages on the number of games played. The authors discuss these results in terms of the use of messages and pauses on video lottery terminals as a strategy for promoting responsible gambling.     

Responsible gambling tools: pop-up messages and pauses on video lottery terminals

The authors examined the effect of messages and pauses, presented on video lottery terminal screens, on erroneous beliefs and persistence to play. At posttest, the strength of erroneous beliefs was lower for participants who received messages conveying information about randomness in gambling as compared to those who received pauses. Pauses also diminished the strength of erroneous beliefs, and there was no difference between the effects of pauses and messages on the number of games played. The authors discuss these results in terms of the use of messages and pauses on video lottery terminals as a strategy for promoting responsible gambling.     

Methods of assessing craving to gamble: A narrative review

Although the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) does not explicitly list craving as a diagnostic criterion for pathological gambling, theories of disordered gambling and research on relapse precipitants suggest that cravings-among other factors-provoke and maintain episodes of gambling. Assessment of craving to gamble is complicated by questions regarding (a) the emotional, cognitive, behavioral, and physiological components of such craving; (b) the degree to which craving is viewed as an acute and fluctuating experience or as a relatively stable preoccupation with or inclination to gamble; (c) the threshold separating mild desire from pathological craving to gamble; and (d) the degree to which disordered gamblers are aware of, and able to report on, their experience of craving. Our literature search revealed various self-report methods that could be used to assess craving to gamble, including single-item rating scales, multi-item questionnaires, and application of the think-aloud procedure. In addition, psychophysiological reactivity (e.g., heart rate, brain activation) to gambling-related stimuli and reaction time (RT) tasks (e.g., gambling Stroop, Lexical Salience Task) may serve as proxy measures of subjective craving to gamble. Although researchers have assessed elements of reliability and validity of many measures, most require additional evaluation to examine their predictive and construct validity and their utility across different modes of gambling. The field would also benefit from further research to develop and evaluate additional self-report and proxy measures. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The Relation Between Sluggish Cognitive Tempo and DSM-IV ADHD

To test the relation between sluggish cognitive tempo (SCT) and DSM-IV ADHD symptoms, parent and teacher ratings of the 18 DSM-IV ADHD items and five potential SCT items were obtained in a community sample of 8-18 year-old twins that was overselected for ADHD and learning disabilities (n = 296). Confirmatory factor analyses revealed that a three-factor model provided the best fit to the data for both parent and teacher ratings. DSM-IV inattention and hyperactivity-impulsivity symptoms loaded on two factors consistent with the DSM-IV model, and five SCT symptoms loaded primarily on a third factor. The SCT and inattention factors were highly correlated, whereas SCT and hyperactivity-impulsivity were weakly related. Both raters indicated that children meeting symptom criteria for the combined and inattentive subtypes exhibited significantly more SCT symptoms than those meeting symptom criteria for hyperactive-impulsive type and the comparison group without ADHD. Children meeting symptom criteria for the inattentive type exhibited significantly more SCT symptoms than those meeting criteria for the combined type, based on teacher ratings. These results suggest that SCT is an internally consistent construct that is significantly associated with DSM-IV inattention.