Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers [open access article]

Abstract
Background and aims: The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

Methods: The sample included n 5 192 patients, aged 19–35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

Results: Three trajectories emerged: T1 (n 5 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n 5 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n 5 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

Discussion and conclusions: Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients’ phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy. Link to the article

Citation: Granero, R., Valero-Solis, S., Fernández-Aranda, F., Gómez-Peña, M., Moragas, L., Mena-Moreno. & Murcia, S.J. (2020). Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers. Journal of Behavioral Addiction, 9(1), 140-152. Retrieved from https://akjournals.com

Similar roles for recovery capital but not stress in women and men recovering from gambling disorder [article]

Background: Understanding gender-related differences is important in recovery processes. Previous studies have investigated gender-related differences in factors associated with gambling disorder (GD), but none to date have considered both positive and negative resources related to recovery. Using a recovery capital (RC) framework that
considers multiple resources available during recovery, this study examined gender-related similarities and differences in associations between positive resources (RC, spirituality) and negative experiences and states (stressful life events, depression, and anxiety) and GD symptom improvement.

Method: One hundred and forty individuals with lifetime GD (101 men) were assessed using DSM-5 diagnostic criteria for GD (past-year and lifetime prior to past-year), the Brief Assessment of RC, the Intrinsic Spirituality Scale, the Stressful Life-events Scale, the Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 for depression. Multiple linear regression and Bayesian statistical analyses were conducted.

Results: RC was positively and significantly associated with GD symptom improvement in women and men. Stressful life events were negatively associated with GD symptom improvement only in men.

Conclusions: RC is an important positive resource for men and women recovering from GD and should be considered in treating both women and men. Understanding specific RC factors across gender groups and stressors, particularly in men, may aid in developing improved interventions for GD. Link to the article

Citation: Gavriel-Fried, B., Moretta, T., & Potenza, M.N. (2019). Similar roles for recovery capital but not stress in women and men recovering from gambling disorder. Journal of Behavioral Addictions 8(4), 770–779.

The effects of a mandatory play break on subsequent gambling among Norwegian video lottery terminal players [open-access article]

Background and aims: Responsible gambling (RG) tools and initiatives have been introduced by social RG operators as a means to help prevent problem gambling. One such initiative is the use of mandatory play breaks (i.e., forced session terminations). Recommendations by RG experts for gambling operators to implement mandatory play breaks appear to be intuitively sensible but are not evidence-based.

Methods: The present authors were given access by the Norwegian gambling operator Norsk Tipping to data from 7,190 video lottery terminal (VLT) players who gambled between January and March 2018. This generated 218,523 playing sessions for further analysis. Once a gambling session reaches a 1-hr play duration, a forced session termination of 90 s comes into effect. This study evaluated the effect of mandatory play breaks on subsequent gambling.

Results: Compared to similar sessions identified using a matched-pairs design, results demonstrated that there was no significant effect of the forced termination regarding the amount of money staked in the subsequent gambling session or on the time duration of the subsequent gambling session.

Conclusions: Although expenditure was higher in the subsequent 24 hr for terminated sessions, this is likely due to higher intensity gamblers being more likely to trigger mandatory breaks. Implications of these findings are discussed.
Link to the article

Citation: Auer, M., Hopfgartner, N. & Griffiths, M.D. (2019). The effects of a mandatory play break on subsequent gambling among Norwegian video lottery terminal players. Journal of Behavioral Addictions 8(3), 522–529. DOI: 10.1556/2006.8.2019.51

How learning misconceptions can improve outcomes and youth engagement with gambling education programs [open-access article].

Background and aims: Gambling education programs typically focus on promoting gambling as a high-risk activity with harmful effects; however, these programs demonstrate limited effects on the prevention of gambling problems. This paper proposes a clear theoretical framework to inform the content and delivery of gambling education initiatives and draws on psychological and pedagogical research to address some of the practical issues associated with its implementation.
Methods: Literature was reviewed across fields of psychology, public health, and pedagogy to provide key recommendations to improve the outcomes of gambling education.
Results: Four key recommendations were made for the development of future gambling education programs centering on theoretical approach, specialized content, and delivery.
Discussion and conclusions: Recommended advancements are as follows: (a) evidence suggests shifting away from messages about gambling harms and instead applying a cognitive-developmental framework of problem gambling that may improve youth engagement by increasing personal relevance. (b) The cognitive model of problem gambling suggests that misconceptions about the profitability of gambling games (e.g., the gambler’s fallacy) play an important role in the development of problems and should be a key target for education. However, exposing such misconceptions requires the challenge of teaching the mathematical principles that underpin them. (c) The pedagogical field provides valuable insights into teaching complex concepts. Research that applies the conceptual change model to science education suggests misconceptions also facilitate learning new complex information, such as gambling-related mathematical concepts (i.e., randomness and statistics). (d) In addition, improvements in computer-assisted teaching methods provide opportunities to use simulations and visualizations to help teach abstract concepts and correct such misconceptions. Article available online

Citation: Brittany Keen, Fadi Anjoul & Alex Dblaszczynski. (2019). How learning misconceptions can improve outcomes and youth engagement with gambling education programs. Journal of Behavioral Addictions 8(3), 372–383. DOI: 10.1556/2006.8.2019.56

Reward reactivity and dark flow in slot-machine gambling: “Light” and “dark” routes to enjoyment [open-access article].

Background and aims: Slot machines are a very popular form of gambling. In this study, we look at two different routes to enjoying slots play. One route involves the degree to which players react to rewards. The other route involves what we call dark flow – a pleasurable, but maladaptive state where players become completely engrossed in slots play, providing an escape from the depressing thoughts that characterize their everyday lives.

Methods: One hundred and twenty-nine high-frequency slots players were tested on slot-machine simulators set up in the lobby of a casino. We measured reward reactivity using post-reinforcement pauses (PRPs) and the force with which players pressed the spin button following different slot-machine outcomes. For each player, we calculated the slopes of PRPs and force as a function of credit gains. We also assessed players’ slots game enjoyment and their experience of dark flow, depression, and problem gambling.

Results: Both the PRP and the force measures of reward reactivity were significantly correlated with players’ enjoyment of the slots session, but neither measure was correlated with either problem gambling or depression. Ratings of dark flow were strongly correlated with slots enjoyment (which accounted for far more positive affect variance than the reward reactivity measures) and were correlated with both problem gambling scores and depression.

Discussion and conclusions: Our results suggest that of these two routes to enjoying slot-machine play, the dark flow route is especially problematic. We contend that the dark flow state may be enjoyable because it provides escape from the negative thoughts linked to depressionArticle available online

Citation: Dixon, M.J., Gutierrez, J., Larche, C.J., Stange, M., Graydon, C., Kruger, T.B., & Smith, S.D. (2019). Reward reactivity and dark flow in slot-machine gambling: “Light” and “dark” routes to enjoyment. Journal of Behavioral Addictions. doi: 10.1556/2006.8.2019.38

The interplay between chasing behavior, time perspective, and gambling severity: An experimental study [open-access article].

Background and aims: Chasing refers to continued gambling in an attempt to recoup previous losses and is one of the diagnostic criteria for gambling disorder. However, research on the topic is still in its infancy. This study investigated whether chasing behavior mediates the relationship between time perspective and gambling severity.
Methods: Nonproblem gamblers (N = 26) and problem gamblers (N = 66) with the same demographic features (age and gender) were compared on the Consideration of Future Consequences and a computerized task assessing chasing. The Italian South Oaks Gambling Screen was used to discriminate participants in terms of gambling severity.
Results: Significant correlations were found relating to gambling severity, chasing, and time perspective. More specifically, the results showed that problem gamblers reported more chasing and a foreshortened time horizon. Chasers, compared to nonchasers, were found to be more oriented to the present. Regression analysis showed that male gender, present-oriented time perspective, and chasing were good predictors of gambling severity. Finally, to clarify if present orientation was on the path from chasing to gambling severity or if chasing was the mediator of the impact of present orientation on gambling severity, a path analysis was performed. The results indicated that present orientation had a direct effect on gambling severity and mediated the relationship between chasing and gambling involvement.
Conclusion: The findings support the exacerbating role of chasing in gambling disorder and for the first time show the relationship of time perspective, chasing, and gambling severity among adults. Article available online

Reference: Ciccarelli, M., Cosenza, M., Griffiths, M.D., D’Olimpio. F., & Nigro, G. (2019). The interplay between chasing behavior, time perspective, and gambling severity: An experimental study. Journal of Behavioral Addictions. DOI: 10.1556/2006.8.2019.29

Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life [open access article]

Background and aims: Problem gambling is characterized by high stigma and self-stigma, making relevant measurement of the burden of the disorder complex. The aim of our qualitative study was to describe health related quality of life (HRQOL) impacted by problem gambling from the patients’ perspective.

Methods: We conducted 6 focus groups with 25 current or lifetime at-risk problem gamblers to identify key domains of quality of life impacted by problem gambling. A content analysis from the focus groups data was conducted using Alceste© software, using descendant hierarchical classification analysis, to obtain stable classes and the significant presences of reduced forms. The class of interest, detailing the core of impacted quality of life, was described using a cluster analysis.

Results: Thematic content analysis identified three stable classes. Class 1 contained the interviewers’ speech. Class 3 was composed of the vocabulary related to gambling practice, games and gambling venues (casino, horse betting, etc.). Class 2 described the core of impact of gambling on quality of life and corresponded to 43% of the analyzed elementary context units. This analysis revealed seven key domains of impact of problem gambling: loneliness, financial pressure, relationships deterioration, feeling of incomprehension, preoccupation with gambling, negative emotions, and avoidance of helping relationships.

Conclusions: We identified, beyond objective damage, the subjective distress felt by problem gamblers over the course of the disorder and in the helping process, marked in particular by stigma and self-stigma. Four impacted HRQOL areas were new and gambling-specific: loneliness, feeling of incomprehension, avoidance of helping relationships, and preoccupation with gambling. These results support the relevance of developing, in a next step, a specific HRQOL scale in the context of gambling. Access full article

Reference: VBonfils, N.A., Grall-Bronnec, M., Caillon, J., Limosin, F., Benyamina, A., Aubin, H., & Luquiens, A. (2018). Giving room to subjectivity in understanding and assessing problem gambling: A patient-centered approach focused on quality of life. Journal of Behavioral Addictions. DOI:10.1556/2006.7.2018.137