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Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review. Eur J Psychotraumatol 2023; 14:2178203. [PMID: 37052089 PMCID: PMC9970237 DOI: 10.1080/20008066.2023.2178203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce.Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD.Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted.Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD.Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation.HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.
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Dighton G, Wood K, Armour C, Fossey M, Hogan L, Kitchiner N, Larcombe J, Rogers RD, Dymond S. Gambling problems among United Kingdom armed forces veterans: Associations with gambling motivation and posttraumatic stress disorder. INTERNATIONAL GAMBLING STUDIES 2022. [DOI: 10.1080/14459795.2022.2063923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Glen Dighton
- School of Psychology, Swansea University, Swansea, UK
| | - Katie Wood
- School of Psychology, Swansea University, Swansea, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, Queen’s University Belfast, Northern Ireland, UK
| | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, UK
| | - Lee Hogan
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Neil Kitchiner
- Veterans NHS Wales, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | | | - Robert D. Rogers
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
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Gambling and military Service: Characteristics, comorbidity, and problem severity in an epidemiological sample. Addict Behav 2021; 114:106725. [PMID: 33199103 DOI: 10.1016/j.addbeh.2020.106725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
Active military members and veterans both show elevated risk of Gambling Disorder. However, research comparing these groups to civilians in epidemiological samples is sparse. There is also some research suggesting that there is a stronger association between military service and poor mental outcomes for women. The current study applies bivariate analyses and generalized linear modelling predicting Problem Gambling Severity Index scores to a representative, complex survey sample of 2176 New Jersey adult residents. The results show that problem gambling scores for past and current military service members were more than double that of the civilian participants after controlling for relevant demographic and behavioral characteristics. Additionally, the relationship between problem gambling scores and military service was significantly stronger for women than men. Bivariate analyses indicated that active military service members scored higher on the Problem Gambling Severity Index, indicated greater weekly participation in online gambling, lottery, electronic gambling machine, and sports betting, and nearly 20 times the rate of suicidal ideation compared with civilians. Additional regression analysis show that among military service members problem gambling scores were associated with suicidal ideation, tobacco use, and substance use problems. The results are discussed in the context of a period of expansion of online gambling opportunities. Constrained options for leisure coupled with the high propensity for risk taking among military service members and the relative ease of concealing online gambling on base may expose military service members to disproportionately higher risk of Gambling Disorder.
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Sharman S, Butler K, Roberts A. Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations. Addict Behav 2019; 99:106071. [PMID: 31473572 DOI: 10.1016/j.addbeh.2019.106071] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored. METHODS To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups. RESULTS Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group. CONCLUSION Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.
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Affiliation(s)
- Steve Sharman
- University of East London School of Psychology, University of East London, Water Lane, Stratford, London E15 4LZ, United Kingdom.
| | - Kevin Butler
- School of Psychology, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
| | - Amanda Roberts
- School of Psychology, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
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Milton AC, La Monica H, Dowling M, Yee H, Davenport T, Braunstein K, Flego A, Burns JM, Hickie IB. Gambling and the Role of Resilience in an International Online Sample of Current and Ex-serving Military Personnel as Compared to the General Population. J Gambl Stud 2019; 36:477-498. [PMID: 31620927 DOI: 10.1007/s10899-019-09900-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Compared to the general population, military personnel are particularly vulnerable to developing gambling problems. The present study examined the presentation of gambling-including gambling frequency, personal thoughts on reducing gambling and recommendations from others to reduce gambling-across these populations. Additionally, the study measured the association between gambling and various psychosocial risk and protective factors-including psychological distress, suicidal ideation, external encouragement to reduce substance use, days out of role, personal wellbeing, resilience, social support and intimate bonds. Data was extracted from the Global Health & Wellbeing Survey, an online self-report survey conducted in Australia, Canada, New Zealand, the United Kingdom and the United States. Of the 10,765 eligible respondents, 394 were military veterans and 337 were active military personnel. Consistent with previous research, a higher proportion of gambling behaviours were observed in both current and ex-serving military samples, compared to the general population. To varying degrees, significant associations were found between the different gambling items and all psychosocial risk and protective factors in the general population sample. However, the military sample yielded only one significant association between gambling frequency and the protective factor 'resilience'. A post hoc stepwise linear regression analysis demonstrated the possible mediating role resilience plays between gambling frequency and other psychosocial risk (psychological distress, and suicidal thoughts and behaviour) and protective factors (personal wellbeing) for the military sample. Given the findings, it is recommended that routine screening tools identifying problem gambling are used within the military, and subsequent resilience focused interventions are offered to at risk personnel.
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Affiliation(s)
- A C Milton
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia. .,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia.
| | - H La Monica
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - M Dowling
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - H Yee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - T Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - K Braunstein
- Project Synergy, InnoWell Pty Ltd, Sydney, NSW, Australia
| | - A Flego
- The Movember Foundation, Melbourne, VIC, Australia
| | - J M Burns
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| | - I B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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