Anxiety, Depression and Emotion Regulation Among Regular Online Poker Players

The impact of COVID-19 pandemic on gambling: A systematic review

BACKGROUND AND AIMS

Since the COVID-19 outbreak, people's habits changed radically. In fact, to limit the spread of SARS-CoV-2, governments implemented restrictive measures that influenced the lives of individuals. The aim of this systematic review is to analyze the impact of COVID-19 on gambling by examining three different outcomes: frequency, expenditure, and transition among possible types of gambling.

METHODS

All studies assessing the impact of restrictive measures implemented to limit the spread of SARS-CoV-2 on gambling were included. For the search, two different databases were used: Pubmed and CINAHL. Moreover, two different populations were analyzed: the general population, and subjects who used to gamble before SARS-CoV-2 pandemic. All qualitative studies, reports not based on peer-review, and papers in which the statistical unit was not the subject but the gambling or wagering operators were excluded.

RESULTS

From the search, 408 reports were identified. Of these, 28 were included in the systematic review. From the studies, a strong reduction in the frequency and expenditure of land-based gambling emerged, while the results about online gambling were different among the studies. However, a reduction was observed assessing sports betting, and an increase emerged considering online casino and skill games. Finally, a significant migration from land-based gambling to online platforms was identified. The main reasons for these findings were the physical closures of land-based gambling venues and the more time spent at home, the suspension or cancelation of sporting events on which subjects used to bet, and more mental health issues during this challenging period.

CONCLUSIONS

The COVID-19 pandemic greatly affected subjects' habits, including gambling, by reducing land-based gambling and sports betting, and increasing gambling on online platforms. This shift poses significant challenges, requiring a comprehensive approach to monitor and mitigate the negative consequences of this increase in online gambling caused by the pandemic.

Excite, or Take Flight? Exploring the Relationship between Difficulties with Emotion Regulation, Outcome Expectancies, and Problem Gambling

Emotional dysregulation is a transdiagnostic process associated with a range of addictive behaviours including problem gambling, with emerging research indicating that emotionally oriented reasons for gambling (i.e., excitement, escape) are associated with problem gambling. However, the relationships between difficulties with emotion regulation, reasons for gambling, and problem gambling, are unclear. The current study tested whether the association between difficulties with emotion regulation and problem gambling could be explained by escape and excitement gambling outcome expectancies. A total of 187 regular gamblers recruited via social media (50.3% male, 48.7% female) completed measures of difficulties with emotion regulation, gambling outcome expectancies, and problem gambling severity (Mage = 41.07, SD = 15.8). Analyses revealed that escape outcome expectancies partially mediated the relationship between difficulties with emotion regulation and problem gambling severity. However, the mediating effect of excitement on this relationship was not significant. The findings suggest that individuals with greater emotional regulation difficulties may engage in problem gambling to help manage aversive emotional states. The study's findings illustrate the importance of considering emotional dysregulation and outcome expectancies in problem gambling treatment planning and public health strategies.

Emotional dysregulation in relation to substance use and behavioral addictions: Findings from five separate meta-analyses

Background/objective

Emotional dysregulation (ED) is a transdiagnostic variable underlying various psychiatric disorders, including addictive behaviors (ABs). This meta-analysis examines the relationship between ED and ABs (alcohol, tobacco, cannabis, gambling, and gaming), and indicators of AB engagement (frequency, quantity/time of use, severity, and problems).

Method

Searches were conducted in PubMed, Scopus, WoS, and PsycINFO. Five separate meta-analysis were run using random-effects models. Moderators (age, sex, continental region, and sample type; community vs. clinical), and publication bias were evaluated.

Results

A total of 189 studies (N = 78,733; 51.29 % women) were identified. ED was significantly related to all ABs. Problems and severity indicators exhibited the largest effects (r's .118-.372, all p <.023). There were larger effect sizes for cannabis problems (r = .372), cannabis severity (r = .280), gaming severity (r = .280), gambling severity (r = .245), gambling problems (r = .131), alcohol problems (r = .237), alcohol severity (r = .204), and severity of nicotine dependence (r = .118). Lack of impulse control exhibited some of the largest effects in relation to ABs. Clinical samples of cannabis users vs. community-based exhibited larger magnitude of associations.

Conclusions

Interventions targeting ABs should address lack of strategies and impulsive behaviors as an emotion regulation strategy specifically, as it is a common risk factor for ABs.

Online Gambling: A Systematic Review of Risk and Protective Factors in the Adult Population

In recent decades, internet gambling has seen strong growth and diffusion due to intrinsic characteristics that make it particularly attractive to players (accessibility, anonymity, variety of games). This paper aims to present the current state of knowledge of the risk and protective factors of online gambling. A literature search conducted in the PubMed, PsychInfo, and Scopus databases found 42 articles, which were included in the review. Methodological aspects and risk and protective factors were analysed cross-sectionally. The results concerning risk and protective factors were distinguished by the level of analysis: individual, relational, and contextual. Two types of comparisons were considered: online vs. offline gamblers and online nonproblematic vs. problematic gamblers. The results of the two comparisons were juxtaposed to analyse their consistency and the different associations with factors. In general, the review showed that risk factors and variables at the individual level are investigated to a greater extent, while protective factors at the relational and contextual level need more in-depth study in future research. More specifically, this review found that even if online and offline gamblers shared most risk and protective factors, there are variables that they would not have in common. These factors could be important to consider in preventive interventions aimed at online gamblers and online problematic gamblers.

Emotional Dysregulation, Shame and Guilt Predict Severity of Gambling Among a Population of Gamblers

Over the last few years, gambling has diversified, particularly with the arrival of legislation authorizing online gambling in 2010 in France. Psychology has been very interested in emotional regulation strategies, and more recently and more sparsely in the presence of shame and guilt. Through an observational study (N = 1955) shame, guilt, and emotional regulation were assessed among gamblers. We found that (i) Less guilt is associated with problem gambling, (ii) Shame-proneness is similar regardless of the type of gamblers, (iii) Every facet of emotion regulation indicates less effective strategies for problem gamblers excepted for a behavior oriented to a goal. These results suggest the importance of shame or guilt as predictors of problem gambling, as well as processes underlying emotion regulation.

The Role of Anxiety and Depression in the Emotion Regulation Strategies of People Suffering from Post-Traumatic Stress Disorder

Researchers have explored the links between cognitive emotion regulation, impaired cognitive functioning, and anxiety-depression, including the link to anxiety and depression levels. However, very few studies have examined these dimensions in clinical populations with post-traumatic stress disorder (PTSD). A sample of 183 participants was divided into three groups: 59 trauma-exposed with PTSD, 61 trauma-exposed without PTSD, and 63 non-trauma-exposed non-PTSD (controls). All participants were assessed on the following dimensions: PTSD (PCL-5), cognitive emotion regulation (CERQ), anxiety and depression (HADS). Results indicate a specific profile of emotion regulation associated with PTSD. Compared to other groups, participants with PTSD showed more difficulty managing their emotions, with more rumination, self-blame, and catastrophizing. Moreover, these difficulties were also correlated with levels of anxiety and depression, that is, participants with PTSD who had higher anxiety and depression scores used more maladaptive strategies. The PTSD group used significantly more maladaptive cognitive emotion regulation strategies than the other groups, with distinct profiles related to anxiety and depressive symptomatology.

Shame and Blame in Gambling: Relationship with Emotion Regulation and Gambling Motives

Gambling disorder is a problem that is affecting increasingly more people. It is associated with difficulties in emotion regulation, gambling motives, blame, and shame. This study aims to study the relationship between gambling severity, blame, and shame, independently and together with emotion regulation and gambling motives; to analyse the mediating role of emotion regulation in the relationship between gambling severity and shame; and to compare mean differences in the study variables according to the sample group. For this purpose, a clinical and non-clinical sample of 158 individuals (119 males and 39 females) ranging in age from 12 to 30 years (M = 19.70, SD = 5.35) was divided into three groups. The questionnaires were administered online and on paper. The results showed that blame and shame are related to the severity of gambling. In the case of shame, this relationship was found to be partially mediated by the emotion regulation strategy of self-blame. Gambling severity, blame and shame were also found to be related to various gambling motives and different emotion regulation strategies. All this information can be of great use in the prevention and treatment of gambling problems.

A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder

Gambling Disorder is a complex and multifaceted phenomenon which requires a careful understanding by analysing both the life experiences and the psychopathological components linked to this type of behaviour. This study aimed to apply a Comprehensive Model of Addiction and to delve deeper the dimensions involved in the vulnerability and maintenance of the disease. Therefore, the effect of alexithymia and traumatic experiences in mediating the relationship between insecure attachment and dissociation, as well as the roles of impulsiveness and compulsiveness in influencing obsessiveness were explored in pathological gamblers. A sample composed of 253 individuals with a mean age of 47.8 years (SD = 12.4) with a diagnosis of Gambling Disorder (82.6% males, 17.4% females) completed the battery of measures. Results showed that alexithymia significantly mediates the relationship between insecure attachment and dissociation, while no significance was found in the effect of complex trauma. Furthermore, a significant impact role of impulsiveness and compulsiveness in determining obsessiveness was found. Therefore, the data suggested that alexithymia may increase the risk of developing a gambling disorder, mediating the association between insecure attachment and dissociation. The model of craving which could have a core role in disease maintenance processes was also confirmed, highlighting a significant influence of impulsiveness and compulsiveness on obsessiveness. Such findings might have relevant implications to increase the effectiveness of both preventive interventions and therapeutic works, favouring positive results for a better mental health of the subjects.

Emotion regulation-enhanced group treatment for gambling disorder: a non-randomized pilot trial

BACKGROUND

Despite the association of Gambling Disorder (GD) with poor mental health, treatment options generally lack components targeting emotional difficulties. This study investigated the feasibility and acceptability of adding strategies of emotion regulation to an eight-session weekly group treatment.

METHOD

This non-randomized pilot study recruited 21 treatment-seeking adults with GD, (mean age = 36.3, 19% females) from addiction care. In a mixed methods design, measures of within-group changes in self-reported symptoms of GD were complemented with thematic analysis of post-treatment interviews regarding the feasibility of the treatment.

RESULTS

Within-group scores on the Gambling Symptoms Assessment Scale (G-SAS) showed a 47% decrease (β: -0.1599, 95% CI: - 0.2526 to - 0.0500) from pre-treatment to 12-month follow-up, with Hedges' g = 1.07 (CI: 0.57-1.60). The number of GD-symptoms according to the Structured Clinical Interview for Gambling Disorder (SCI-GD) decreased from 7.0 (SD = 1.60) at pre-treatment to 2.1 (SD = 2.36) at 12-month follow-up. Participants completed an average of 6.3 sessions and rated the intervention high in satisfaction and acceptability. Feasibility interviews showed no noticeable negative effects or ethical issues. Furthermore, helpful components in the treatment were: increased awareness of emotional processes and strategies to deal with difficult emotions.

CONCLUSIONS

Adding emotion regulation strategies in the treatment of GD is feasible and acceptable and warrants further investigation in a controlled trial.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov (Identifier NCT03725735 ).

Self-control and problematic use of social networking sites: Examining distress tolerance as a mediator among Argentinian college students

Introduction

Use of Social networking sites (SNSs) is a highly prevalent behavior worldwide and, for some individuals, its use can turn maladaptive. There has been growing interest to identify which variables are associated with problematic use of SNSs.

Aim

The present study cross-sectionally examined whether the associations between different features of self-control (i.e., impulsivity-like traits, self-regulation and emotion regulation) indirectly relate to two outcomes of SNSs (hours of use and problematic use) via distress tolerance.

Methods

A sample of 509 Argentinean college students (70.3% female; Mean age = 21.15 ± 5.15) completed an online survey.

Results

Two significant indirect effects were found: a) higher negative urgency was associated with higher problematic use of SNSs via lower distress tolerance and b) higher self-regulation was associated with lower problematic use of SNSs via higher distress tolerance. Positive urgency, negative urgency and self-regulation had significant direct associations with problematic use of SNSs while neither component of emotion regulation was significantly associated with SNSs outcomes. No significant direct or indirect effects were found between any of the self-control features and time spent using SNSs.

Conclusions

The results highlight dysfunctional self-control, particularly emotion-driven impulsivity and low self-regulation, as relevant components of maladaptive SNSs that seem to operate by decreasing the perceived capacity to tolerate negative affect. In this context, interventions targeting the development and improvement of distress tolerance abilities might have a positive impact on problematic use of SNS.

The Role of ADHD Symptomatology and Emotion Dysregulation in Gambling Disorder

Objectives: Although emotion regulation deficits have been implicated in gambling disorder and ADHD, the interplay between these factors has yet to be systematically studied. We examined relationships between ADHD symptoms, emotion regulation, and gambling disorder severity in a sample of treatment-seeking gambling disorder patients (n = 98). We also examined clinical differences between patients with and without ADHD symptomatology. Method: Structural equation modeling (SEM) evaluated direct and indirect effects of ADHD and emotion regulation on gambling disorder severity. Results: Significant correlations between ADHD symptomatology and emotion regulation and between emotion regulation and gambling disorder severity were identified. Differences in emotion regulation were found between gambling disorder patients with and without ADHD symptomatology. Path analysis revealed emotion regulation to be a mediator between ADHD and gambling disorder. Conclusion: Our findings indicate the presence of ADHD symptomatology to be associated with greater severity of gambling disorder and greater emotional dysregulation.

Prevalence of Internet-based addictive behaviors during COVID-19 pandemic: a systematic review

With the outbreak of the COVID-19 worldwide pandemic, many countries have imposed lockdowns which have caused an increase in Internet use. As large-scale disasters may have an impact on addictions, a review on Internet-based addictive behaviors seems necessary. The goals of this review are to find whether Internet-based addictive behaviors have increased during the pandemic and to define the main reasons for this increase. The systematic search was conducted in Google Scholar, Science Direct, PsycINFO, and PubMed in October of 2020, to determine the current evidence and observations concerning the Internet-based addictive behaviors amid COVID-19. Studies were included if they considered the Internet-based addictive behaviors during the current pandemic. We used all the names of the coronavirus 2 (SARS-CoV2 previously 2019 nCoV), the name of the coronavirus disease 2019 (COVID-19), and common Internet-based addictive behaviors, namely Internet addiction, online gaming disorder, online gambling disorder, pornography use, and smartphone use disorder. The study design is PEOs, finding if individuals' exposure to the COVID-19 pandemic has caused an increase in Internet-based addictive behaviors. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The articles found in this review proved an increase in Internet-based addictive behaviors during the COVID-19 pandemic mostly due to financial hardships, isolation, problematic substance use, and mental health issues such as depression, anxiety, and stress. Effective interventions should be scaled up to prevent and reduce online addictive behaviors, as well as accessible guidelines, particularly for adolescents.

Online Gambling in the Midst of COVID-19: A Nexus of Mental Health Concerns, Substance Use and Financial Stress

This study examined the emerging impact of COVID-19 on gambling during the first 6 weeks of emergency measures in Ontario, Canada. A cross-sectional online survey of 2005 gamblers, including a sub-sample of 1081 online gamblers (age 18 years and older), was administered to assess risky gambling behaviours and motivations, financial impacts from COVID-19, the influence of COVID-19 on online gambling, mental health concerns and substance use. A series of odds ratio comparisons and measures of association were carried out. Results show significant likelihood of online gambling among those classified as high-risk gamblers (according to the Problem Gambling Severity Index) and those with past experience of online gambling, though migration from land-based gambling was apparent. Among high-risk online gamblers, the most predictive risk factors included moderate and severe anxiety and depression, reduced work hours, being influenced to gamble due to COVID-19, gambling under the influence of cannabis or alcohol and risky gambling motives tied to mental health concerns, including gambling because it helps with nervousness and depression, chasing gambling losses and seeking to earn income. This study has confirmed many of the risk associations presented in emerging COVID-19-related studies and past research on global economic crisis relating to gambling risk, mental health concerns and substance use. However, unlike many past studies, the present paper takes note of all of these elements holistically and provides incremental clarity on online gambling risk factors during the pandemic, specifically.

Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents

BACKGROUND

Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.

METHODS

Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.

RESULTS

The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16-3.25 among parents and 1.12-8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.

CONCLUSIONS

Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

Altered neural processing of negative stimuli in people with internet gaming disorder: fMRI evidence from the comparison with recreational game users

BACKGROUND

Abundant clinical studies have suggested that emotion dysregulation seems to be the essential pathogenesis for Internet gaming disorder (IGD). However, the neural mechanism of emotion regulation for IGD is still unclear.

METHODS

Subjective evaluation and fMRI data were collected from 50 subjects (IGD: 24; recreational game user (RGU): 26) while they were performing an emotion reappraisal task. We collected and compared their brain features during emotion processing of different visual stimuli.

RESULTS

Higher activation in the left dorsal anterior cingulate cortex (dACC), right ventral ACC, left claustrum and bilateral insula was observed in participants with IGD during emotion reappraisal relative to that of the RGU participants. In addition, generalized psychophysiological interaction analysis also showed that IGD participants had stronger functional connectivity between the right insula and bilateral dorsolateral prefrontal cortex (DLPFC) than the RGU participants.

CONCLUSIONS

The results suggest that IGD participants could not down-regulate their negative emotional experiences as efficiently as the RGU participants, although they engaged more cognitive resources. These results reveal the special neural circuits of emotion dysregulation in IGD individuals and provide new neural perspective for the intervention of IGD.

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

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.

Pathological personality facets and emotion (dys)regulation in gambling disorder

A number of researches showed high prevalence of personality disorders among addicted gamblers. However, there are still few studies investigating the role of pathological personality facets in Gambling Disorder (GD). Moreover, the nature of the relationship between GD and pathological personality is not clear. We administered to a group of addicted gamblers (N = 79) and a group of healthy participants (N = 101) a battery of self-report questionnaires encompassing the South Oaks Gambling Screen (SOGS), The Personality Inventory for DSM-V (PID-5), the Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ). Analyses of variance showed that addicted gamblers, compared to healthy participants, scored higher on most of the subscales of the DERS, on the Suppression Dimension of the ERQ and on the five main domains of the PID-5 whereas they obtained lower scores on the Reappraisal subscale of the ERQ. Moreover, multiple regression analyses indicated that some specific facets of pathological personality, emotion dysregulation and lack of cognitive reappraisal, significantly predict GD's severity. Finally, emotion dysregulation levels and lack of cognitive reappraisal partially mediated the relationship between these and GD's severity. Our results confirmed the central roles played by both pathological personality and deficit in emotion regulation capacities in GD. Specifically, Impulsivity, Lack of Perseverance and Suspiciousness may be important predictors of GD severity. Moreover, emotion dysregulation and lack of adaptive emotion regulation strategies partially explained such relationship. As such, training for emotion regulation abilities appears strategically useful in the treatment of addicted gamblers with pathological personality traits.

The predictive capacity of DSM-5 symptom severity and impulsivity on response to cognitive-behavioral therapy for gambling disorder: A 2-year longitudinal study

BACKGROUND

DSM-5 proposed a new operational system by using the number of fulfilled criteria as an indicator of gambling disorder severity. This method has proven to be controversial among researchers and clinicians alike, due to the lack of studies indicating whether severity, as measured by these criteria, is clinically relevant in terms of treatment outcome. Additionally, numerous studies have highlighted the associations between gambling disorder and impulsivity, though few have examined the impact of impulsivity on long-term treatment outcomes.

METHODS

In this study, we aimed to assess the predictive value of DSM-5 severity levels on response to cognitive-behavioral therapy (CBT) in a sample of male adults seeking treatment for gambling disorder (n = 398). Furthermore, we explored longitudinal predictors of CBT treatment response at a follow-up, considering UPPS-P impulsivity traits.

RESULTS

Our study failed to identify differences in treatment outcomes between patients categorized by DSM-5 severity levels. Higher baseline scores in negative urgency predicted relapse during CBT treatment, and higher levels of sensation seeking were predictive of drop-out from short-term treatment, as well as of drop-out at 24-months.

CONCLUSIONS

These noteworthy findings raise questions regarding the clinical utility of DSM-5 severity categories and lend support to the implementation of dimensional approaches for gambling disorder.

The crucial role of recovery capital in individuals with a gambling disorder

BACKGROUND AND AIMS

The concept of recovery capital (RC) describes the internal and external resources that individuals draw upon to initiate and sustain the processes of addiction recovery. This concept has been primarily applied to individuals recovering from substance addictions. In this study, the RC concept was applied to individuals with a gambling disorder (GD) to test its associations with the diagnosis and severity of GD and with levels of psychopathology as manifested in depression and anxiety.

METHODS

A sample of 140 individuals who recovered or did not recover from a GD was drawn from lists of former and currently treated individuals in five gambling treatment centers in Israel. The DSM-5 diagnostic criteria for GD, Assessment of Recovery Capital and Brief Assessment of Recovery Capital Scales adapted to Gambling, Generalized Anxiety Disorder Scale, and the Patient Health Questionnaire 9 which measures depression were used.

RESULTS

RC clearly distinguishes between individuals who have recovered from GD and those who have not. A structural equation model showed significant negative associations between RC and GD severity, depression, and generalized anxiety. The associations between GD severity and depression and anxiety were not significant. However, when omitting the path between RC and depression/anxiety, the associations between GD and depression/anxiety became significant.

CONCLUSIONS

RC plays an important role in GD severity and diagnosis, as well as in psychopathology. This study extends the concept of RC to the area of gambling and contributes to the growing body of studies that have found parallels and common denominators between substance addiction and behavioral addictions.

Conceptualizing gambling disorder with the process model of emotion regulation

Introduction Nowadays, gambling disorder (GD) is a worldwide health issue and there is a growing need to both improve our understanding of this disorder and to tailor specific interventions for its treatment. Moreover, theoretical models and preliminary empirical results suggest that difficulty in regulating emotional states might be involved in GD. However, literature describing clinical and theoretical aspects of emotional dysregulation among pathological gamblers (PGs) shows a lack of systematic description. Objectives We aimed to provide, within an exhaustive theoretical framework of emotion regulation (ER) processing, empirical evidence supporting a conceptual model of GD as an ER affliction. Methods We commented on empirical evidence on the relationship between ER and GD in the light of two main conceptual models of emotion (dys)regulation. Results The results suggest there are actual deficits of ER processing among PGs, manifesting themselves through different ways and in different steps of the ER timeline. In addition, dysregulation of positive emotions may play a central role in GD. From a clinical point of view, we pointed out that deficits in ER might be multiple in nature and an assessment for GD should be accurate to identify the specific components accounting for the development and maintenance of the disorder. It should also orientate the clinician in selecting therapeutic objectives. Conclusions The nature of emotional states that are difficult to regulate might account for the GD severity and indicate the subtype of PGs the patient belongs to. Treatment programs should be tailored on the specificity of PGs.

Work Stress and Depressive Symptoms in Fishermen With a Smoking Habit: A Mediator Role of Nicotine Dependence and Possible Moderator Role of Expressive Suppression and Cognitive Reappraisal

This study examined pathways of influence between work stress, depressive symptoms, nicotine dependence, expressive suppression, and cognitive reappraisal in fishermen with smoking habits in Qionghai, Hainan province, China (N = 1068). These fishermen responded to multiple assessments a week before leaving on a deep-sea fishing trip, including a Mental Stressor Investigation Questionnaire (MSIQ), the Center for Epidemiological Studies Depression Scale (CES-D), the Russell Reason for Smoking Questionnaire (RRSQ), and an Emotion Regulation Questionnaire (ERQ). Structural equation modeling (SEM) analyses of the collected data in Mplus 7 showed that work stress and nicotine dependence were independent predictors of depressive symptoms. The relationship between work stress and depressive symptoms was found to be partially mediated by nicotine dependence and be moderated by cognitive reappraisal. The evidence suggests it advantageous to examine the need of work stress, nicotine dependence, and cognitive reappraisal when attempting to understand depressive symptoms in fishermen with a smoking habit. These findings suggest that improving nicotine dependence through work stress management and training in cognitive reappraisal could be utilized as effective modalities for improving depressive symptoms.