Group therapy for pathological gamblers: a cognitive approach

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.     

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.     

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.     

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.     

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.     

Discounting of probabilistic rewards is associated with gambling abstinence in treatment-seeking pathological gamblers

Individuals with addictive disorders, including substance abusers and pathological gamblers, discount or devalue rewards delayed in time more than controls. Theoretically, preference for probabilistic rewards is directly related to gambling, but limited empirical research has examined probabilistic discounting in individuals with pathological gambling. This study evaluated probability and delay discounting in treatment-seeking pathological gamblers and their association with gambling treatment outcomes during and after treatment. At time of treatment entry, 226 pathological gamblers completed probability and delay discounting tasks. They were then randomized to one of three treatment conditions, and gambling behavior was measured throughout treatment and at a 1-year follow-up assessment. After controlling for possibly confounding variables and treatment condition, more shallow probability discounting was associated with greater reductions in amounts wagered during treatment and likelihood of gambling abstinence at the end of treatment and throughout the follow-up period. No associations were noted between delay discounting and gambling treatment outcomes. These data suggest that probability discounting may be an important construct in understanding pathological gambling and its treatment.     

Do patients with OCD and pathological gambling have similar dysfunctional cognitions?

The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models.     

赌博游戏中的near-miss效应

near-miss效应是指在赌博中, 与一般的输钱和赢钱相比, “几乎赢(near-miss)”的输钱会诱发个体更高的生理唤醒和更强的赌博动机, 从而导致个体持续赌博的一种现象, 是导致赌博成瘾的主要诱因之一。针对这种现象的研究范式大致有三种：老虎机/类老虎机任务、轮盘任务和刮刮乐彩票任务。这种现象的理论解释目前主要有认知曲解假说、控制幻觉理论和受挫假说。near-miss效应的脑机制和病理研究才刚刚起步, 所涉及到的脑功能区域主要包括脑岛、腹侧纹状体等。未来的研究应在near-miss效应发生机制的理论模型建构、研究范式多样化、研究技术多模态化、病理机制和临床干预等方面进一步展开。     

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.     

Internet-Based Treatment of Pathological Gambling with a Three-Year Follow-Up

Effective therapies for pathological gambling exist, but their use is limited to about 10% of the target population. In an attempt to lower the barriers for help, Internet-based cognitive behavioural therapy (ICBT) has been shown to be effective when delivered to a non-depressed sample with pathological gambling. This study sought to extend this finding to a larger, more representative population, and also test a model to predict responder status. Following advertisement, a total of 284 participants started an 8-week ICBT programme with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. The average time spent on each participant, including telephone conversations, e-mail, and administration, was 4 h. In addition to a mixed effects model to evaluate the effectiveness of the treatment, two logistic regression analyses were performed with the following eight pre-defined response predictor variables: work-life satisfaction, primary gambling activity, debts due to gambling, social support, personal yearly salary, alcohol consumption, stage of change, and dissociative gambling. ICBT resulted in statistically significant reductions in the scores of pathological gambling, anxiety, and depression as well as an increase in quality of life compared to pre-treatment levels. Follow-ups carried out in the treatment group at 6, 18, and 36 months indicated that treatment effects were sustained. Using the eight predictor variable model rendered an acceptable predictive ability to identify responders both at post-test (AUC = .72, p < .01) and at 36-month follow-up (AUC = .70, p < .01). We conclude that ICBT for pathological gamblers, even if depressed, can be effective and that outcome can partly be predicted by pre-treatment characteristics.     

CORRECTION DES VERBALISATIONS IRRATIONNELLES CHEZ DES JOUEURS DE POKER-VIDEO*

Earlier studies have shown that irrational thinking dominates rational thinking during gambling. The present study evaluated the effects of cognitive restructuring on gambling behaviors among video poker players. Within a single case experimental design across subjects, the results showed that irrational verbalizations decreased during treatment while rational verbalizations increased. Three out of four players reduced their frequency of gambling following treatment. The theoretical and clinical implications of these results are discussed.     

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.     

BEHAVIORAL TREATMENT FOR PATHOLOGICAL GAMBLING IN PERSONS WITH ACQUIRED BRAIN INJURY

The present investigation examined a behavior‐analytic clinical treatment package designed to reduce the pathological gambling of 3 individuals with acquired brain injury. A prior history of pathological gambling of each patient was assessed via caregiver report, psychological testing, and direct observation of gambling behavior. Using an 8‐week one‐on‐one client—patient format, a treatment program was developed in which the patient learned about the antecedents, consequences, and motivating operations that controlled the emission of gambling behavior. Data were collected on both self‐report of gambling urges and behavior following therapy and during in situ gambling opportunities. The therapy program reduced urges to gamble and actual gambling for all patients. The potential of behavior‐analytic therapy for reducing the pathological gambling of patients with and without brain injury is discussed.     

The reasoning skills and thinking dispositions of problem gamblers: a dual‐process taxonomy

We present a taxonomy that categorizes the types of cognitive failure that might result in persistent gambling. The taxonomy subsumes most previous theories of gambling behavior, and it defines three categories of cognitive difficulties that might lead to gambling problems: The autonomous set of systems (TASS) override failure, missing TASS output, and mindware problems. TASS refers to the autonomous set of systems in the brain (which are executed rapidly and without volition, are not under conscious control, and are not dependent on analytic system output). Mindware consists of rules, procedures, and strategies available for explicit retrieval. Seven of the eight tasks administered to pathological gamblers, gamblers with subclinical symptoms, and control participants were associated with problem gambling, and five of the eight were significant predictors in analyses that statistically controlled for age and cognitive competence. In a commonality analysis, an indicator from each of the three categories of cognitive difficulties explained significant unique variance in problem gambling, indicating that each of the categories had some degree of predictive specificity. Copyright © 2006 John Wiley & Sons, Ltd.     

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.     

Erroneous gambling-related beliefs emerge from broader beliefs during problem-solving: a critical review and classification scheme

Abstract

Erroneous gambling-related beliefs (EGRBs) can be defined as beliefs that imply a failure to recognise how commercial gambling activities are designed to generate a guaranteed loss to players. In theorising about how EGRBs develop, previous reviews have proposed that EGRBs are extensions of decision-making heuristics and associated biases. We propose an alternative generative mechanism: one in which gambling games make substantial wins seem possible through problem-solving and eventual correct strategic action. EGRBs are then beliefs in the possibility of correct strategic action (illusions of control) that develop as players trial candidate strategies—strategies selected based on various broader beliefs. We further propose that EGRBs can be classified based on what is theorised in cognitive science about categories of general human beliefs about the world. For example, it has been theorised that human beliefs about supernatural forces and randomness have certain similarities across cultures, and so we propose that there exists a category of supernatural EGRBs, as well as a category of EGRBs based on broader beliefs about the nature of randomness. We review evidence for this classification scheme and discuss how it can be applied in researching and treating gambling disorder.     

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.     

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.     

Tele-counselling for Problem Gambling: A Case Study

Innovative approaches to the treatment of pathological gambling are required since the number of individuals who seek treatment tend to be fewer than the prevalence studies would indicate. In this study, an innovative approach to the treatment of pathological gambling was used in order to address the common hindrances to treatment-seeking these patients face. One such approach is to offer the option of manual-guided tele-counselling. This case study reports on the progress of one individual who was treated using this modality. For reasons of privacy and anonymity, the individual in this case report preferred to address her problem gambling with the assistance of a therapist whom she never met. The client was provided with 10 weeks of tele-counselling treatment during which six treatment modules were delivered. Problems of access, privacy and anonymity were overcome with this method and the client was able to reduce their gambling behavior significantly with the therapeutic gains being maintained at the 6-month follow-up. The implications for the treatment of problem gambling using a non-traditional approach are discussed.