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.     

Problem Gambling Features and Gendered Gambling Domains Amongst Regular Gamblers in a Swedish Population-Based Study

This study aimed to investigate, from a gender perspective, how different features of problem gambling present in men and women who gamble regularly in Sweden were distributed in four domains based on gambling type (chance or strategy) and setting (public or domestic). Problem gambling features were based on the nine items in the Problem Gambling Severity Index (PGSI). It was hypothesized that men and women gamble in different domains. Further, it was hypothesized that male gamblers overall experienced more problems with gambling than female gamblers, although in the same domains they would report the same level of problems. A further hypothesis predicted that regular female gamblers would experience more health and social problems and men would experience more financial difficulties. Interviews with a subsample of gamblers (n?=?3191) from a Swedish nationally representative sample (n?=?8179) was used to examine how features of problem gambling correspond with gender and the domains. Only the first hypothesis was fully supported. Men were more likely to participate in forms of gambling requiring strategy in a public setting, and women were more likely to participate in chance-based gambling in a domestic setting. Male and female gamblers had similar levels of problem gambling in the bi-variate analysis, but if controlling for age and gambling in multiple domains, women were more at risk than men. Additionally, men and women presented similar health and economic situations. The differences between male and female gamblers in Sweden have implications for research and prevention.     

Impulsivity facets and cognitive distortions associated with problem gambling: Differences between ADHD and non-ADHD gamblers

ObjectiveTo compare the association between (1) impulsivity facets or cognitive distortions, and (2) problem gambling between male gamblers with versus without self-reported Attention-Deficit/Hyperactivity Disorder (ADHD).MethodIn 287 male gamblers recruited online, we assessed problem gambling (South Oaks Gambling Screen; cut-off ≥ 3), Adult ADHD Self-report Scale-V1.1 (ADHD), impulsivity facets (UPPS Impulsive Behavior Scale-short version) and gambling-related cognitions (Gambling-Related Cognitions Scale).ResultsThe prevalence of self-reported ADHD was 21.6%. In both ADHD and non-ADHD groups, problem gambling was associated with negative urgency, positive urgency and the same cognitive distortions. Sensation seeking and lack of premeditation were associated with problem gambling, but only in non-ADHD gamblers (significant interaction effect).ConclusionDifferent impulsivity facets, but not different cognitive distortions, are associated with problem gambling in male gamblers with or without ADHD. Emotion dysregulation (positive and negative urgency) and cognitive distortions are involved in both groups, but sensation seeking and lack of premeditation may be specific to non-ADHD problem gamblers.     

Risky decision making and cognitive flexibility among online sports bettors in Nigeria

Online sports betting is a popular recreational activity in Nigeria. Like other forms of gambling, risk of pathological progression exists for gamblers who continue betting despite severe financial and psychosocial consequences. In the present study, we examined whether this population of gamblers shows deficits in decision making and cognitive flexibility that have been documented in Western gambling populations. Thirty-six online sports bettors and 42 non-gambling participants completed a version of the Iowa gambling task (IGT) and an established set-shifting task for the assessment of cognitive flexibility. The two groups did not differ significantly in the selection of disadvantageous decks on the IGT. In contrast, sports bettors committed significantly more errors on the set-shifting task than non-gambling control participants. As this performance deficit was not specific to trials requiring a set shift, it most likely resulted from gambling-related changes in general cognitive or motivational abilities that are required to successfully complete challenging mental tasks. While our results illustrate that findings from Western populations cannot automatically be generalised to other contexts, it should be noted that we focused on only one particular type of gambling and included mostly participants with mild gambling-related problems.     

Underlying Cognitions in Gambling Behavior Among University Students1

Differences in underlying cognitions across gambling tasks were examined. The South Oaks Gambling Screen, a measure of pathological gambling, was completed by 60 undergraduate students. They also played computer‐simulated games of roulette, slots, and blackjack in a laboratory setting. The “think‐aloud” procedure was used to reveal subjects' cognitions, which were subsequently categorized into cognitive heuristics. Individuals were classified as social gamblers with and without problems and probable pathological gamblers. Results reveal that certain heuristics, including references to an explanation of their losses, hindsight bias, personification of the dealer/machine, chasing behavior, and past experiences were most frequently endorsed by probable pathological gamblers. Empirical evidence supports that probable pathological gamblers are qualitatively different from social gamblers in their emitted verbalized cognitive heuristics.     

Distorsions cognitives et pratique de jeu de hasard et d’argent : état de la question

Cognitive distorsions are inherent to any gambling situation whatever the level of commitment of the gambler. Irrational beliefs lead the subject to overestimate his share of control over the game's outcome to the detriment of chance. Knowing the objective probability to win and having good numeric capacities of reasoning does not prevent the gamblers from developing these false beliefs. According to the concept of double switching proposed by Ladouceur and Sévigny (2005), irrational beliefs would coexist with objective knowledges on the game and would bustle in situation of gambling. The progress and the outcome of the game influence the development and the maintenance of cognitive distorsions, which influences the subject's practice of gambling. Pathological gambling, repeated and persistent gambling behavior, is characterized in particular by the presence of cognitive distortions, leading the subject to maintain, even to increase his gambling practice. Indeed, if cognitive distorsions are present in any situation of gambling, it seems nevertheless that it is more frequent and more intense in problem and pathological gamblers. Cognitive distorsions, in particular illusion of control, thus lead to a more important practice of gambling and a financial risk-taking, favoring the installation and the preservation of problem gambling. Certain factors seem to influence cognitive distorsions. There is a gender effect: women would present fewer irrational beliefs than men. Depression, anxiety and stress would also favor the development of these beliefs in situation of gambling. Several methods exist to estimate cognitive distorsions in gamblers. The first researches are based on assessment made by others (observation and analysis of gambler's verbalizations). Afterward, several self-report scales were created. At the moment, none of these scales has been validated in French language. The identification of gambling related cognitive distortions permit to elaborate adapted modes of treatment. So, the cognitive therapy suggests identifying and restructuring the beliefs to bring the subject to change his gambling behavior. In spite of the current knowledge on cognitive distorsions, certain questions remain open, in particular about the implication of theses beliefs in games implying a part of strategy, in which the subject has effectively a certain control over the game.     

Does the Treatment of Cognitive Distortions Improve Clinical Outcomes for Problem Gambling?

Although dysfunctional beliefs about gambling outcomes among problem gamblers have been well-established, there is less known about whether specifically treating such beliefs is necessarily more effective than other therapeutic approaches. In the present study, brief, homogenous treatments for problem gambling (i.e., cognitive, behavioral, motivational, minimal intervention) were compared to each other. Each intervention was based on approaches empirically demonstrated to be clinically effective. The treatment sample consisted primarily of middle-aged, non-partnered, underemployed men recruited from the community via newspaper advertisements. The results showed that a cognitive approach did not yield superior outcomes than did treatments that did not explicitly address cognitive distortions. It is likely that there are several pathways to therapeutic change that may not necessarily require the modification of gambling-related psychopathology.     

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.     

Subtyping pathological gamblers on the basis of affective motivations for gambling: relations to gambling problems, drinking problems, and affective motivations for drinking

Pathological gamblers who drink when gambling (n=158; 77% men; mean age=36.0 years) completed the Inventory of Gambling Situations (IGS) and gambling and drinking criterion measures. Principal components analysis on the IGS subscales revealed negative (e.g., Unpleasant Emotions) and positive (e.g., Pleasant Emotions) gambling situation factors. Subjecting IGS factor scores to cluster analysis revealed three clusters: (a) enhancement gamblers, with low negative and high positive factor scores; (b) coping gamblers, with very high negative and high positive factor scores; and (c) low emotion regulation gamblers, with low negative and positive factor scores (59%, 23%, and 18% of the sample, respectively). Clusters were validated with a direct measure of gambling motives. Additional validity analyses showed that coping gamblers scored higher than the other groups on a variety of different gambling activities, gambling problems, drinking frequency, drinking problems, and coping drinking motives, whereas low emotion regulation gamblers scored lower than the other groups on gambling frequency, gambling problems, drinking quantity, and enhancement drinking motives. The findings validate this empirical approach to subtyping gamblers and suggest consistency of motives across addictive behaviors.     

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.     

Executive Functioning and Gambling: Performance on the Trail Making Test is Associated with Gambling Problems in Older Adult Gamblers

ABSTRACT

Rates of gambling problems in older adults have risen with increased accessibility of gambling venues. One possible contributor to problem gambling among older adults is decreased self-control brought about by diminished executive functioning. Consistent with this possibility, Study 1 revealed that older adults recruited from gambling venues reported greater gambling problems if they also experienced deficits in executive functioning, measured via the Trail Making Test. Study 2 replicated this finding and demonstrated that problem gambling is associated with increased depression among older adults, mediated by increased financial distress. These studies provide support for the hypothesis that older adult gamblers who have executive functioning problems are also likely to have gambling problems.     

Pathological gambling and suicidality: an analysis of severity and lethality

Pathological gambling represents a major public health issue. Risk factors for suicide such as major depression, substance abuse, marital breakdown, unemployment, financial crises, and legal difficulties are commonly found in populations of pathological gamblers. The objective of this study was to systematically investigate the nature of suicidal behavior among treatment-seeking pathological gamblers and its relationship to gambling characteristics and depression. Indices of suicidality were assessed in a sample of 85 treatment-seeking diagnosed pathological gamblers. High rates of suicidal ideation, suicidal plans, and attempts were found; however, no clear relationship was observed between suicidality and indices of gambling behavior. Depression rather than gambling specific characteristics, marital difficulties, or the presence of illegal behaviors appear to be related to the risk of suicidality.     

Disordered Gambling and Its Treatment

Pathological gambling is an increasing concern with the growth of legalized gambling opportunities, and clinicians who provide general psychotherapy, as well as those specializing in some disorders, are likely to encounter patients with gambling problems. This review article describes the diagnostic criteria for pathological gambling and screening methods for identifying individuals with gambling problems. Problem and pathological gambling are more likely to occur in certain populations, such as among individuals with substance use, mood and anxiety disorders, and medical problems. However, few pathological gamblers seek specialized gambling treatment. This paper reviews different forms of treatments that have been applied to gamblers, along with evidence of their efficacy. Clinical guidelines for identifying and treating gambling problems are outlined as well.     

FI SCHEDULES AND PERSISTENCE AT GAMBLING IN THE U.K. BETTING OFFICE

This study reports on the direct observations of customers in two U.K. betting offices gambling on horse and dog races. These observations revealed that bets were more frequently placed in the last minutes just prior to the start (the OFF), and that this was caused by high-frequency gamblers (customers who had eight or more bets in a session) consistently placing their bets in the last two minutes prior to the OFF. Low-frequency gamblers (three or fewer bets/session) avoided this time period placing their bets earlier, or after the OFF, i.e., on a later race. It was argued that the betting behavior of the “gamblers” could not be explained either in terms of “skillful betting” or solely in terms of variable ratio schedules but was more adequately accounted for in terms of an interval schedule. It was further suggested that time-based schedules might be of heuristic value in generally understanding persistence at gambling while losing.     

Characteristics of problem gamblers 56 years of age or older: a statewide study of casino self-excluders

Gambling among older adults appears to be increasing, though little is known about the characteristics of older adult problem gamblers. The purpose of this study was to compare older adults to younger and middle-aged adults in a cohort of problem gamblers participating in a state-administered casino self-exclusion program. Self-reported problem gamblers (N = 1,601) who voluntary banned themselves from Missouri casinos from 2001 to 2003 were categorized by age as younger adults (ages 21 to 35; n = 490), middle-aged adults (ages 36 to 55; n = 950), and older adults (ages 56 to 79; n = 161), and were compared with respect to demographic variables, gambling participation, and reasons for self-exclusion. Older adult self-excluders typically began gambling in midlife, experienced gambling problems around age 60, reported preferences for nonstrategic forms of gambling, and identified fear of suicide as the primary reason for self-excluding. Implications for intervention, prevention and treatment are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Expertise and gambling: Using Type 2 signal detection theory to investigate differences between regular gamblers and nongamblers

This paper presents an experimental investigation into how individuals make decisions under uncertainty when faced with different payout structures in the context of gambling. Type 2 signal detection theory was utilized to compare sensitivity to bias manipulations between regular nonproblem gamblers and nongamblers in a novel probability-based gambling task. The results indicated that both regular gamblers and nongamblers responded to the changes of rewards for correct responses (Experiment 1) and penalties for errors (Experiment 2) in setting their gambling criteria, but that regular gamblers were more sensitive to these manipulations of bias. Regular gamblers also set gambling criteria that were more optimal. The results are discussed in terms of an expertise-transference hypothesis.     

Internet gambling, substance use, and delinquent behavior: an adolescent deviant behavior involvement pattern

Internet gambling among adolescents is a growing phenomenon that has received little attention to date. This study examines associations between Internet gambling and the severity of gambling, substance use (SU), and delinquent behavior among 1,870 Quebec students aged 14 to 18. The results show a higher proportion of Internet-gambling (IG) students reporting problematic substance use and delinquency, compared with nongamblers (NG) and non-Internet gamblers (NIG). Furthermore, a higher proportion of at-risk and probable pathological gamblers are found among IG compared with NIG. A moderating effect (Baron & Kenny, 1986) of the gambler categories (NIG, IG) was found in the relationship between the associated problems and the severity of gambling. Among IG, the severity of delinquency and of substance use contributes to explaining gambling severity whereas, among NIG, the severity of delinquency is the only factor that significantly contributes to such an explanation. Discussion of the results is based on Jessor, Donovan, and Costa's (1991) general deviance syndrome theory.     

Expertise and gambling: using type 2 signal detection theory to investigate differences between regular gamblers and nongamblers

This paper presents an experimental investigation into how individuals make decisions under uncertainty when faced with different payout structures in the context of gambling. Type 2 signal detection theory was utilized to compare sensitivity to bias manipulations between regular nonproblem gamblers and nongamblers in a novel probability-based gambling task. The results indicated that both regular gamblers and nongamblers responded to the changes of rewards for correct responses (Experiment 1) and penalties for errors (Experiment 2) in setting their gambling criteria, but that regular gamblers were more sensitive to these manipulations of bias. Regular gamblers also set gambling criteria that were more optimal. The results are discussed in terms of an expertise-transference hypothesis.     

Psychobiology of the near-miss in fruit machine gambling

Explanations involving the etiology of pathological gambling have tended to emphasize psychosocial factors. However, the possibility that psychobiological factors may be important in the development of pathological gambling behavior should not be ruled out. Psychobiological approaches are becoming ever more prominent with the three main lines of research being (a) a search for a physiological disposition and/or underlying biological substrate in pathological gamblers, (b) an examination of the role of arousal in gambling, and (c) speculation about endorphin-related explanations. The data from questionnaires and interviews with fruit machine gamblers suggest that both physiological and cognitive factors (e.g., the psychology of the near-miss) may be important in the explanation of excessive fruit machine gambling. Thus, if a gambler becomes physiologically aroused when he or she wins or nearly wins, it will stimulate further play, here termed the psychobiology of the near-miss.     

Pathological Women Gamblers: Gender-Related Aspects of Control

This study examines the control exhibited by pathological women gamblers over their lives and their surroundings, and how this is governed by their perception of their gender role and socio-cultural expectations of them as women. Seventeen pathological women gamblers (13 of whom were mothers) were recruited from three addiction treatment centers in Israel, and participated in semi-structured interviews. Three central themes emerged during analysis: maintaining control over the gender roles—putting child raising and housekeeping duties first despite their gambling habits; control over the choice of gambling venue—gambling far from their home, or where they knew the owners; and moral control—steering clear of immoral behaviors in spite of their addiction to gambling. Further analysis reveals how pathological women gamblers who are also mothers make rational choices that help them juggle between their gender roles and gambling, to minimize the social costs that might be incurred by their gambling habit. Moreover, presenting the gambling behavior as more moral than theft or prostitution enabled them to normalize their behavior. The study’s findings show how the decisions and choices made by the women in this study are shaped by the socio-cultural context in which they are made.