The “Zone”: a Qualitative Exploratory Study of an Altered State of Awareness in Electronic Gaming Machine Problem Gambling

Post-reinforcement pauses during slot machine gambling are moderated by immersion

The post-reinforcement pause (PRP) is an operant effect in which response latencies increase on trials following the receipt and consumption of reward. Human studies demonstrate analogous effects in electronic gambling machines that utilise random ratio reinforcement schedules. We sought to identify moderators of the human PRP effect, hypothesising that the magnitude of gamblers' PRPs is moderated by the type of reinforcing outcome (genuine wins vs. losses-disguised-as-wins [LDWs] vs. free-spin bonus features) and individuals' level of gambling immersion, a cognitive state linked to problem gambling. Experienced slot machine users (N = 53) played a real slot machine for 20 min. The dependent variable was defined as the time delay in the initiation of each bet ("Spin Initiation Latency"; SIL). Using 80% of trials, a linear model was fit regressing SIL on the independent variables (outcome type, immersion, and outcome-by-immersion interaction), and a larger group of covariates (participant ID, trial number, winnings, etc.) selected using double-robust LASSO-regularised regression. The previously unseen 20% of cases were used to validate the model. Positively reinforcing outcome types (wins, LDWs, bonus spins) showed significantly larger SILs than losses, indicating a PRP effect. Immersion did not predict response latencies, but win-by-immersion and LDW-by-immersion interactions indicated that pauses were greater among more immersed participants. The small number of free-spin bonus features showed similar trends that were not statistically significant. These results indicate that gamblers immersed in play remained sensitive to in-game reinforcement (contrary to a prevailing account), and provide guidance for researchers bridging laboratory research and real-world behaviour.

The role of contextual factors in avenues to recover from gambling disorder: a scoping review

Introduction

Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions.

Methods

A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps-titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34).

Results and discussion

Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Case Study Demonstration of the Potential Acceptability and Effectiveness of a Novel Telehealth Treatment for People Experiencing Gambling Harm

The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.

Making EGMs Accountable: Can an Informative and Dynamic Interface Help Players Self-regulate?

Electronic gaming machines (EGMs) are recognised as one of the most harmful gambling forms, because they promote high-speed repetitive gambling and automatically reinvest winnings. These features, amongst others, make it difficult for EGM gamblers to keep track of their play. Tools to assist gamblers exist, but have limited effectiveness because they require user registration and manual activation, leading to low uptake. The present study aimed to evaluate the effect of a more informative interface (including removal of automatic reinvestment of winnings) and pop-up messages on gambling behaviour, and on player experience. A total of 213 Australian participants, recruited through social media, played a simulated online EGM. The experiment was a two (standard vs. informative interface) × two (pop-ups absent vs. present) between-subjects design. The informative interface: promoted keeping track of spins played; increased accurate estimation of amount spent (as did pop-up messages) and time played; and provided game usage figures which acted as cues to quit play. Once the initial deposit (but not winnings) was expended, informative interface users could opt to reinvest their winnings, although many opted to exit at that point. No difference in total spending or dissociation was observed between experimental groups. Informative interface users reported no reduction in enjoyment. Pop-up messages reduced enjoyment with the standard interface, but increased enjoyment when paired with an informative interface. These findings indicate that a more informative interface and pop-up messages may be useful in reducing the harmful nature of EGMs.

Responsible product design to mitigate excessive gambling: A scoping review and z-curve analysis of replicability

Objectives

Systematic mapping of evaluations of tools and interventions that are intended to mitigate risks for gambling harm.

Design

Scoping Review and z-curve analysis (which estimates the average replicability of a body of literature).

Search strategy

We searched 7 databases. We also examined reference lists of included studies, as well as papers that cited included studies. Included studies described a quantitative empirical assessment of a game-based (i.e., intrinsic to a specific gambling product) structural feature, user-directed tool, or regulatory initiative to promote responsible gambling. At least two research assistants independently performed screening and extracted study characteristics (e.g., study design and sample size). One author extracted statistics for the z-curve analysis.

Results

86 studies met inclusion criteria. No tools or interventions had unambiguous evidence of efficacy, but some show promise, such as within-session breaks in play. Pre-registration of research hypotheses, methods, and analytic plans was absent until 2019, reflecting a recent embracement of open science practices. Published studies also inconsistently reported effect sizes and power analyses. The results of z-curve provide some evidence of publication bias, and suggest that the replicability of the responsible product design literature is uncertain but could be low.

Conclusion

Greater transparency and precision are paramount to improving the evidence base for responsible product design to mitigate gambling-related harm.

The Frantic Seeking of Credit during Poker Machine Problem Gambling: A Public Health Perspective

(1) Background: Financial harms associated with problem gambling are substantial and result in suicidal ideation, depression, anxiety and relationship damage, causing distress for problem gamblers and their families. This paper examines Electronic Gaming Machine gamblers’ frantic use of credit during episodes of gambling as a substantial public health burden. (2) Methods: This qualitative study comprised 29 participants purposefully selected who participated in either focus groups or in-depth interviews, which were analysed using thematic, textual analysis. (3) Results: Ready access to credit in the gambling venues enabled problem gamblers to engage in desperate credit transactions to continue to gamble. Many showed frantic, repeated patterns of e-credit withdrawal, which may be typical of gambling while “in the zone”, when it is highly likely that the gamblers are not able to make informed decisions about the use of credit. This pattern of the electronic withdrawal of cash may well be recognisable electronically by financial institutions in real-time, as part of a duty of care potentially owed by banks to their customers. It would provide an opportunity for the identification of people at financial risk due to gambling and systemic intervention to limit the financial harm at a time when financial decision-making is impaired. (4) Conclusions: Although this finding needs further confirmation, there are significant implications for harm minimisation and early intervention for affected PGs. It also raises the issue of the ‘duty of care’ owed to PG customers by financial institutions.

Zoned in or zoned out? Investigating immersion in slot machine gambling using mobile eye-tracking

BACKGROUND AND AIMS

Immersion during slot machine gambling has been linked to disordered gambling. Current conceptualizations of immersion (namely dissociation, flow and the machine zone) make contrasting predictions as to whether gamblers are captivated by the game per se ('zoned in') or motivated by the escape that immersion provides ('zoned out'). We examined whether selected eye-movement metrics can distinguish between these predictions.

DESIGN AND SETTING

Pre-registered, correlational analysis in a laboratory setting. Participants gambled on a genuine slot machine for 20 minutes while wearing eye-tracking glasses.

PARTICIPANTS

Fifty-three adult slot machine gamblers who were not high-risk problem gamblers.

MEASUREMENTS

We examined self-reported immersion during the gambling session and eye movements at different areas of the slot machine screen (the reels, the credit window, etc.). We further explored these variables' relationships with saccade count and amplitude.

FINDINGS

The ratio of dwell time on the game's credit window relative to the game's reels was positively associated with immersion (t₍₅₁₎  = 1.68, P = 0.049 one-tailed, R²  = 0.05). Follow-up analyses described event-related changes in these patterns following different spin outcomes.

CONCLUSIONS

Immersion while gambling on a slot machine appears to be associated with active scanning of the game and a focus on the game's credit window. These results are more consistent with a 'zoned in' account of immersion aligned with flow theory than a 'zoned out' account based on escape.