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.     

澳门人的风险知觉与赌博行为

采用匿名问卷法,调查澳门人的风险知觉与赌博行为。结果显示：（1）赌场的劝世文既无劝勉也无劝阻人们赌博的作用;（2）社会关系网的钱财支援不影响实际赌博次数;（3）多次性博弈与一次性博弈所采用的是不同的机制,一次性博弈不是由期望值所决定的;（4）相互监视和制裁系统会影响赌博：受法律制裁约束的职业者比不受法律制裁约束的职业者更不好赌;自估在赌场遇见认识人的机会与赌博次数呈负相关;（5）性别及母语等“本质趋向”差异表明,所谓澳门人不好赌有其渊源并可能是在长期的文化沉淀中形成的;（6）受教育程度是影响赌博的有效预测变量。这些发现的理论含义一并进行了讨论。     

澳门人少涉赌是规避风险还是规避后悔？

是风险规避还是后悔规避左右人们的冒险行为？基于风险行为跨领域特殊性,本研究假设：决策者是规避风险还是规避后悔具有领域特异性。本研究选取有涉赌经验的澳门居民为样本,以其参与13种博彩的次数为指标考察其真实风险行为。结果验证了上述假设,风险规避说或后悔规避说都不能单独解释个体的风险倾向,个体是风险规避、后悔规避,或二者皆有,取决于其所处的具体风险情境类别。该发现有助于加深对风险行为特征的认识,亦可为预防及应对问题赌博提供启发和指导。     

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.     

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.     

Associations Between Delay Discounting and Risk‐Related Behaviors,Traits, Attitudes,and Outcomes

Delay discounting—preference for immediate, smaller rewards over distal, larger rewards—has been argued to be part of the “generality of deviance”, which describes the co‐occurrence of various forms of impulsive and risky behaviors among individuals. Some studies have linked laboratory‐measured delay discounting to behaviors, traits, attitudes, and outcomes associated with risk, but these associations have been inconsistent. Furthermore, many of these studies have been conducted with exclusively undergraduate samples, or in samples offering low statistical power. In a large community sample (n = 328) diverse in age and socioeconomic status, we examined associations between two measures of behavioral delay discounting (single‐shot and canonical k‐parameter estimation) and behavioral risk‐taking, personality traits associated with risk, domain‐specific risk attitudes, gambling and problem gambling, antisocial behavior, and criminal outcomes. In addition, we explored whether a novel response time latency measure of delay discounting explained variance in these risk‐related outcomes. Results indicated that behavioral delay discounting was consistently associated with all variables related to impulse control: high trait impulsivity, low trait self‐control, risk‐averse attitudes toward financial investment, risk‐prone attitudes toward gambling and health/safety risks, gambling and problem gambling, antisocial conduct, and criminal outcomes. Latency‐measured delay discounting was inconsistently associated with behavioral delay discounting and risk‐related measures. Together, results suggest that delay discounting is associated with poor impulse control consistent with a generality of deviance account. Copyright © 2016 John Wiley & Sons, Ltd.     

Casino Gambling and the Family: Exploring the Connections and Identifying Consequences

Although sanctioned by state governments and widely popular across the United States, gambling remains a controversial activity. For example, casino gambling may be legal and popular, but many believe squandering money is harmful and deviant. People from all backgrounds visit casinos. However, older adults comprise a major portion of the gambling clientele. Along with this have come reports of a wide variety of negative outcomes. Yet, few studies have investigated the relationship between gambling and the family. We use a qualitative in-depth interview grounded theory approach with 34 adults aged 62–88 to investigate the relationship between gambling and family consequences. We explore the impact of gambling on the family with the active aging concept as well as the codependency and sociocultural models of addiction. They offer new ways to understand mild to serious deviance among older adults.     

Glücksspielsucht in der Rechtsprechung des Bundesgerichtshofs

Among the non-substance-related addictions, pathological gambling is the only one that has gained noteworthy forensic relevance. There are numerous parallels to substance-related addictions and not only in the symptomatology. A high proportion of pathological gamblers commit criminal offences to enable them to continue gambling or to pay gambling debts. According to the jurisdiction of the Federal Court of Justice (BGH) pathological gambling in itself cannot be considered as a pathological mental disorder or other serious mental abnormality that substantially diminishes the responsibility of the offender (German Penal Code § 21 StGB); however, the BGH recognizes that in serious cases of pathological gambling mental changes and personality defects can evolve that show similar structure and severity to substance-related addictions and severe withdrawal symptoms might also develop. As with substance-related addictions a substantial diminution of the offender’s responsibility can be assumed, therefore, also with pathological gambling if it has led to most severe personality changes or if the offender suffered from severe withdrawal symptoms while committing an addiction-related crime. According to these criteria a substantial diminution of the offender’s responsibility can be stated only in very rare cases. A custodial addiction treatment order (§ 64 StGB), which is also possible for fully responsible delinquents, is not applicable to cases of mere pathological gambling because the order requires an addiction to alcohol or other drugs. A mental hospital commitment order (§ 63 StGB) can be issued by the court under the same strict conditions that are applied to cases of substance-related addictions. Based on these principles this can only be issued if the defendant is addicted to gambling due to a mental defect that can be distinguished from the addiction itself or if the dependence has already been manifested in very severe personality changes. Pathological gambling can cause a propensity to commit serious offences and therefore, under the further conditions of §§ 66, 66a StGB justify detention for the purpose of incapacitation or a deferred incapacitation order. Even during imprisonment, detainees must be offered a suitable therapy (§ 66c para 2 StGB); however, penitentiaries do not offer the best environment for the treatment of pathological gamblers. The treatment in an addiction therapeutic setting appears to be more promising. Criminal political demands to make custodial addiction treatment orders also applicable to pathological gamblers have, however, very little chance of success.     

Trainee perspectives on their family therapy training

Although research into family therapy training is increasing it has so far mostly focused on the process of the teaching and acquisition of certain concepts and skills. In contrast, the experience of training as family therapists has rarely been investigated. This paper reports on the impact of family therapy training at one training institution in the UK on the personal, relational and professional identities of trainees. Six family therapy trainees were interviewed using semi‐structured interviews at regular intervals over a period of approximately twenty months. Interpretive phenomenological analysis (IPA) was employed to analyse the interviews. The results suggest that participants often found the experience of training as a family therapist overwhelming and de‐skilling, but that it nevertheless provoked a re‐evaluation of some of their established personal, relational and professional identities. In many cases these re‐evaluations seemed to have preceded a process of individuation, of assuming a different or more complex identity.     

Disposable Time and Disposable Income: Problem Casino Gambling Behavior in Older Adults

Increasing numbers of retirees spend their leisure time in the ever-growing number of gambling casinos in this country. For most older adults, casino gambling is a new form of excitement and entertainment. However, for some retirees, especially those vulnerable to depression from the changes and losses that can occur in aging, casino gambling can become disordered, problematic, and/or an addiction. Although prevalence studies have examined the incidence of problem gambling in other age groups, little attention has been directed to the impact of casino gambling on older adults. The authors discuss problem and pathological gambling in retired older adults, and provide clinical case examples of a growing number of older adults with problem gambling behaviors seen in an outpatient geriatric psychiatry clinic. Finally, they urge that an evaluation of gambling behaviors be a routine portion of geriatric clinical evaluations.     

Religion and Gambling Among U.S. Adults: Exploring the Role of Traditions,Beliefs, Practices,and Networks*

Opportunities for legal gambling of various types have expanded rapidly in the United States in recent years. Our study develops a series of theoretical arguments linking multiple dimensions of religious involvement—traditions, beliefs, practices, and networks—with the frequency of gambling activity. Relevant hypotheses are then tested using data from the Panel Study of American Religion and Ethnicity (PS‐ARE), a recent nationwide probability sample of U.S. adults. Findings underscore the importance of co‐religionist networks in deterring gambling. In addition, biblical inerrantists and members of conservative Protestant and sectarian groups are relatively disinclined to gamble. Religious attendance is also inversely associated with gambling frequency. Differences in gambling by religious tradition are amplified among persons with strong co‐religionist networks. Several study limitations are noted, and promising future research directions on the dynamics and functioning of church‐based networks are identified.     

Gambling and Delay Discounting in Japanese Students

The present study examined the relationship between gambling behavior and delay discounting with Japanese residents. Japanese university students were selected into pathological gambler and non‐gambling control groups using a Japanese version of the South Oaks Gambling Screen. In a discounting task, participants chose individually between a large delayed reward and a smaller immediate reward with varied delays. The discounting rate (k‐value) and the area under the curve were significantly higher and smaller, respectively, for the gambler group than for the control group. These findings show that Japanese gamblers discount delayed rewards more steeply than non‐gambling controls, as has been found in U.S. residents.     

The Score Family Assessment Questionnaire: A Decade of Progress

This paper reviews a decade of research (2006–2016) on a family assessment instrument called the Systemic Clinical Outcome and Routine Evaluation (SCORE). The SCORE was developed in Europe to monitor progress and outcome in systemic therapy and has been adopted by the European Family Therapy Association as the main instrument for assessing the outcome in systemic family and couple therapy. There are currently six main versions of this instrument: SCORE‐40, SCORE‐15, SCORE‐28, SCORE‐29, Child SCORE‐15, and Relational SCORE‐15. It has also been translated into a number of European languages. Fifteen empirical studies of the SCORE “family of measures” have been conducted. Most have aimed to establish psychometric properties of these instruments in English and other languages. Others have used the SCORE to document the level of family adjustment in clinical samples or evaluate outcome in treatment trials. There is now sufficient evidence for the reliability and validity of the SCORE to justify the use of brief versions of this instrument to monitor progress and outcome in the routine practice of systemic therapy.     

Probing the link between narcissism and gambling: the mediating role of judgment and decision‐making biases

In this paper, three studies link narcissism to gambling in general, and gambling‐related problems in particular, and the predictive link is shown to be mediated by judgment and decision processes. In Study 1, we demonstrate that narcissism relates to greater self‐reported gambling frequency and gambling‐related monetary expenditures in two samples. We extend these initial findings in Study 2 by showing that narcissism predicts higher reports of gambling‐related pathology, as measured with a DSM‐IV‐based pathological gambling (PG) screen. Finally, we demonstrate in Study 3 that the link between gambling pathology and narcissism is partially mediated by narcissists' overconfidence, heightened risk acceptance, and myopic focus on reward, as measured by participants' behavioral performance on the Georgia Gambling Task (GGT) and Iowa Gambling Task (IGT). Discussion focuses on the empirical validation of the long‐assumed narcissism–gambling link, the decision processes that underlie this link, and relations between narcissists' self‐perceptions and their self‐defeating behavior, especially in risk‐relevant contexts. Copyright © 2007 John Wiley & Sons, Ltd.     

Pathologisches Glücksspiel und Delinquenz

Pathological gambling is characterized by excessive gambling behavior which influences the life and well-being of a person in a dysfunctional way. It often leads to severe consequences in social and family life, career and material matters. This can also include illegal acts. In the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) excessive gambling was classified under impulse-control disorders but was renamed as gambling disorder (GD) and reclassified under the category “substance-related and addictive disorders” in DSM-5, due to parallels to substance use disorders in the clinical characteristics as well as genetic and neurobiological factors. In Germany, approximately 0.5?% of the adult population suffer from GD. Especially gambling machines are associated with an increased risk of gambling-related problems. Common comorbidities are substance-related and affective disorders. The most important risk factors are young age, male gender, a history of migration, gambling-related problems in the family, unemployment, a low educational level and low household income. Delinquent behavior was not considered to be a sufficiently discriminative factor for GD, although there is a correlation between delinquency and gambling behavior. In addition, those GD subjects who show delinquent behavior also show a specific risk profile. Thus, mental health professionals should be aware of possible psychosocial consequences in GD, such as illegal acts, and this should be addressed in the effective treatment strategies, such as cognitive behavioral therapy. Moreover, it is necessary to improve the access routes for affected people into healthcare system in order to ensure early detection and treatment of the disease.     

Aggressive behaviour in adult slot machine gamblers: an interpretative phenomenological analysis

A growing number of studies have reported a link between gambling and aggressive behaviour. The aim of this study was to contextualize objective findings of a previous observational study regarding slot machine gambling and aggressive behaviour (Parke & Griffiths, Psychological Reports, 95, 109–114, 2004). Interpretative Phenomenological Analysis was applied using the Idiographic Case Study method. The data revealed three superordinate themes regarding slot machine gambling‐induced aggression (i.e. Competitive Advantage Reduction, Self‐esteem Reduction, and Cognitive Regret). Within these superordinate themes, subordinate themes emerged identifying how environmental factors and structural characteristics of slot machine gambling, along with the consequences of losing, produced aggressive behaviour. It is concluded that gambling‐induced aggression is a manifestation of the underlying conflict of engaging in dysfunctional behaviour while consciously acknowledging its detrimental effects. Copyright © 2005 John Wiley & Sons, Ltd.     

Mood state and gambling: Using mobile telephones to track emotions

Mobile telephones were used to collect data on the relationship between gambling and mood state from gamblers in the field. Seventeen gamblers called an interactive voice response system running on a computer before, during and after a gambling episode. Measures taken in this way included self‐reports of anxiety/arousal, the amount of money gambled, whether the result was a win or loss, the amount won or lost, and the type of gambling engaged in. Other measures were taken during an initial briefing session using conventional questionnaires that included self‐reports of anxiety/arousal taken in a non‐gambling situation, dissociation during gambling, and a measure of degree of impairment of control. The results showed that subjective anxiety/arousal levels were significantly higher during and after gambling than during the urge to gamble or at baselines. Losing was associated with increased subjective anxiety/arousal after play, and winning was associated with a decrease in subjective anxiety/arousal. This suggests that gambling may be a cause of increased subjective anxiety/arousal, rather than functioning to relieve it. A cluster of variables associated with impaired control and subjective anxiety/arousal levels was also identified. The method of collecting data using mobile telephones appears to be a valuable development.     

Measuring decision‐making competence in Chinese adults

In this study, we translated and localized the Adult Decision‐making Competence scale (A‐DMC) and tested its reliability and validity with large samples. Results show the Chinese A‐DMC has relatively good reliability (Cronbach's alpha above 0.6 and test–retest reliability coefficients ranging from 0.44 to 0.78 on all subscales), comparable with the original version. Regarding validity, results of exploratory factor analysis and confirmatory factor analysis support the one‐factor model, indicating the A‐DMC has good internal consistency and construct validity. A‐DMC scores correlated positively with cognitive ability, constructive decision‐making styles, and good decision outcomes. Additionally, individuals with higher A‐DMC scores were found to perform better on the Cambridge gambling task and Iowa gambling task. These results confirm the validity of the Chinese version of the A‐DMC, which is suitable for measuring decision‐making competence in Chinese adults.     

A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets?

Problem gambling is of serious public, social and clinical concern, especially so because ease of access to different types of gambling is increasing. A systematic review and meta-analysis was carried out to determine whether Cognitive-Behavioural Therapies (CBT) were effective in reducing gambling behaviour. Twenty-five studies which met the inclusion criteria were identified. Overall, there was a highly significant effect of CBT in reducing gambling behaviours within the first three months of therapy cessation regardless of the type of gambling behaviour practiced. Effect sizes were also significant at six, twelve and twenty-four month follow-up periods. Sub-group analysis suggested that both individual and group therapies were equally as effective in the 3 month time window, however this equivalence was not clear at follow-up. All variants of CBT (cognitive therapy, motivational interviewing and imaginal desensitization) were significant, although there was tentative evidence that when different types of therapy were compared cognitive therapy had an added advantage. Meta-regression analyses showed that the quality of the studies influenced the effect sizes, with those of poorer quality having greater effect sizes. These results give an optimistic message that CBT, in various forms, is effective in reducing gambling behaviours. However, caution is warranted because of the heterogeneity of the studies. Evaluation of treatment for problem gambling lags behind other fields and this needs to be redressed in the future.     

The effect of gambling activities on happiness levels of nursing home residents

The current study evaluated the effect of participating in simulated gambling activities on happiness levels of 3 nursing home residents. A 4‐component analysis was used to measure objective responses associated with happiness during baseline, varying durations of engagement in simulated gambling activities, and 2 follow‐up periods. Results indicated that all residents exhibited a higher percentage of happiness levels while engaged in simulated gambling activities compared with baseline. Follow‐up assessment took place 10 min and 30 min following the intervention; no lasting effects were observed.