In Search of Executive Impairment in Pathological Gambling: A Neuropsychological Study on Non-treatment Seeking Gamblers

Neurophysiological Correlates of Near-Wins in Gambling: A Systematic Literature Review

Identification of specific patterns of brain activity related to problem gambling may provide a deeper understanding of its underlying mechanisms, highlighting the importance of neurophysiological studies to better understand development and persistence of gambling behavior. The patterns of cognitive functioning have been investigated through electroencephalography (EEG) studies based on the near-win/near-miss (NW) effect. The main goal of the present study was to evaluate the neurophysiological basis of NWs and their modulation by gambling problems through a systematic review of event-related potentials (ERP) studies elicited by feedback events. The review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). A total of 15 studies were included, 12 comprising non-problem gamblers (NPGs) and three comparing problem gamblers (PGs) with matched controls. For the P300 component, the win outcome elicited a larger amplitude than the other outcomes (NW and loss), followed by the NW outcome, which elicited a larger amplitude than loss in some studies. For feedback-related negativity (FRN), the loss outcome evoked a more negative amplitude in several studies, despite eliciting a similar amplitude to NW outcomes in others. For PGs, the NW outcome evoked a higher amplitude of P300 than loss, while NPGs showed a similar amplitude to both outcomes. The present review gathered information from different sources and provides a consistent view of the different studies. However, studies lack systematic and robust methodologies, leading to inconsistent results and making it difficult to reach any definitive conclusions.

Learning and memory processes in behavioural addiction: A systematic review

Similar to addictive substances, addictive behaviours such as gambling and gaming are associated with maladaptive modulation of key brain areas and functional networks implicated in learning and memory. Therefore, this review sought to understand how different learning and memory processes relate to behavioural addictions and to unravel their underlying neural mechanisms. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched four databases - PsycINFO, PubMed, Scopus, and Web of Science using the agreed-upon search string. Findings suggest altered executive function-dependent learning processes and enhanced habit learning in behavioural addiction. Whereas the relationship between working memory and behavioural addiction is influenced by addiction type, working memory aspect, and task nature. Additionally, long-term memory is incoherent in individuals with addictive behaviours. Consistently, neurophysiological evidence indicates alterations in brain areas and networks implicated in learning and memory processes in behavioural addictions. Overall, the present review argues that, like substance use disorders, alteration in learning and memory processes may underlie the development and maintenance of behavioural addictions.

Decomposition of Reinforcement Learning Deficits in Disordered Gambling via Drift Diffusion Modeling and Functional Magnetic Resonance Imaging

Gambling disorder is associated with deficits in reward-based learning, but the underlying computational mechanisms are still poorly understood. Here, we examined this issue using a stationary reinforcement learning task in combination with computational modeling and functional resonance imaging (fMRI) in individuals that regular participate in gambling (n = 23, seven fulfilled one to three DSM 5 criteria for gambling disorder, sixteen fulfilled four or more) and matched controls (n = 23). As predicted, the gambling group exhibited substantially reduced accuracy, whereas overall response times (RTs) were not reliably different between groups. We then used comprehensive modeling using reinforcement learning drift diffusion models (RLDDMs) in combination with hierarchical Bayesian parameter estimation to shed light on the computational underpinnings of this performance deficit. In both groups, an RLDDM in which both non-decision time and decision threshold (boundary separation) changed over the course of the experiment accounted for the data best. The model showed good parameter and model recovery, and posterior predictive checks revealed that, in both groups, the model accurately reproduced the evolution of accuracies and RTs over time. Modeling revealed that, compared to controls, the learning impairment in the gambling group was linked to a more rapid reduction in decision thresholds over time, and a reduced impact of value-differences on the drift rate. The gambling group also showed shorter non-decision times. FMRI analyses replicated effects of prediction error coding in the ventral striatum and value coding in the ventro-medial prefrontal cortex, but there was no credible evidence for group differences in these effects. Taken together, our findings show that reinforcement learning impairments in disordered gambling are linked to both maladaptive decision threshold adjustments and a reduced consideration of option values in the choice process.

Working memory performance in disordered gambling and gaming: A systematic review

BACKGROUND

Converging evidence supports that gaming and gambling disorders are associated with executive dysfunction. The involvement of different components of executive functions (EF) in these forms of behavioural addiction is unclear.

AIM

In a systematic review, we aim to uncover the association between working memory (WM), a crucial component of EF, and disordered gaming and gambling. Note that, in the context of this review, gaming has been used synonymously with video gaming.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we systematically searched for studies published from 2012 onwards.

RESULTS

The search yielded 6081 records after removing duplicates, from which 17 peer-reviewed journal articles were eligible for inclusion. The association between WM and problem or disordered gaming and gambling have been categorized separately to observe possible differences. Essentially, problem gaming or gambling, compared to disorder, presents lesser severity and clinical significance. The results demonstrate reduced auditory-verbal WM in individuals with gambling disorder. Decreased WM capacity was also associated with problem gambling, with a correlation between problem gambling severity and decreased WM capacity. Similarly, gaming disorder was associated with decreased WM. Specifically, gaming disorder patients had lower WM capacity than the healthy controls.

CONCLUSION

Working memory seems to be a significant predictor of gambling and gaming disorders. Therefore, holistic treatment approaches that incorporate cognitive techniques that could enhance working memory may significantly boost gambling and gaming disorders treatment success.

Stressful life events and gambling: The roles of coping and impulsivity among college students

Substantial research has found a robust relationship between stressful life events and increased negative health outcomes and a greater predisposition to various forms of substance use and gambling behavior; however, less is known about the individual factors that explain this relationship. The present study examines the moderating factors of gambling to cope and individual impulsivity factors (e.g., perseverance, premeditation, and negative urgency) on the relationship between stressful life events over the past year and gambling problems among a sample of college students. Participants included 653 total students (48.57% female; M = 26.31 years old; SD = 8.35 years) enrolled in universities across the United States who scored three or higher on the South Oaks Gambling Screen, an indicator of risk for problematic gambling. We found a positive relationship between stressful life events and gambling problems. Gambling to cope moderated the link between stressful life events and gambling problems such that for those higher in gambling to cope, stressful life events had little impact on gambling problems while those at lower to moderate levels of gambling to cope saw a positive relationship between stressful life events and gambling problems. Moreover, we found two significant three-way interactions between stressful life events, gambling to cope, and impulsivity factors of perseverance and premeditation in predicting problems. These findings suggest that prevention and/or treatment strategies should consider how gambling to cope and impulsivity factors in conjunction with an individual's report of stressful life events relate to problematic gambling and associated consequences.

Some Neuropsychological Profiles and Personality Traits of Undergraduate Regular Online Football Gamblers (a New Online Gambling Game) in Nigeria

Online football (soccer) gambling is among the relatively new sports betting games in Nigeria that use internet connections. Like other gambling games, some psychological profiles either propel or sustain the behavior. We tested some neuropsychological profiles and personality traits that distinguish the regular online football gamblers from non-gamblers. Using a between group design, we tested 140 (60: online football gamblers; 80: non-gamblers) university undergraduate students between the ages of 18-26 years on specific neuropsychological domains (i.e., attention, inhibition and executive function) and personality traits. The neuropsychological tasks used were the Series Addition Task (a modified version of Paced Auditory Serial Addition Task), Stroop-Word Color Test and Trail Making Test (TMT), Parts A and B. The personality traits were assessed using the Big Five Personality Inventory. The findings showed significant differences between the online football gamblers and non-gamblers, reflecting greater agreeableness, conscientiousness, neuroticism and openness to experience for the football gamblers. However, on the attention tasks, the non-gamblers made significantly fewer errors on forward addition and backward subtraction tasks, but did take more time to complete the backward counting task as compared to gamblers. On the other hand, online football gamblers took significantly less time to complete the Stroop congruence task and made significantly fewer errors on Stroop incongruence task. Similarly, the online football gamblers took less time to complete the TMT B and made fewer errors on TMT A. University undergraduate regular online football gamblers, as compared to non-gamblers, demonstrate stronger personality traits of ambition and gregariousness, and perform better on tasks of executive function, though they had more difficulty on tasks of divided and sustained attention.

Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder

Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F_1,16 = 8.128, p = 0.01, ɳp² =0.33) and better cognitive flexibility (F_1,16 =8.782, p = 0.009, ɳp² = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.Trial registration: Clinicaltrials.gov NCT03477799.

Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students

BACKGROUND AND AIMS

Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample.

METHODS

A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses.

RESULTS

The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99].

DISCUSSION AND CONCLUSIONS

For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.

Cognitive training: A new avenue in gambling disorder management?

INTRODUCTION

Cognitive deficits are being robustly documented in gambling disorder. Cognitive training has been increasingly investigated as a treatment of substance use disorders. Four training components have been listed to date: cognitive bias, response inhibition, working memory, and goal-directed. This review aimed at the identification of use and efficacy findings in cognitive training in gambling disorder.

METHODS

We conducted a systematic search to identify use and efficacy data of cognitive training in gambling disorder. No use or efficacy data was available.

DISCUSSION AND PERSPECTIVES

Studies assessing cognitive training in gambling disorder are being conducted and first results should be upcoming. Methodological challenges have been identified. Several candidate target cognitive functions of training programs are being investigated, relying on the most documented impairments in gambling disorder, inhibition, reward sensitivity and decision making. Gambling-specific or neutral environments are to be distinguished clearly and do not rely on similar assumptions, i.e. general vulnerability or vulnerability expressed only in the specific context of gambling. Proper control groups with placebo conditions should be implemented. Assessment of efficacy should include clinical and neuropsychological assessments to give information of underlying mechanisms of action.