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Salerno L, Grassi E, Makris N, Pallanti S. "A Theta Burst Stimulation on Pre-SMA: Proof-of-Concept of Transcranial Magnetic Stimulation in Gambling Disorder". J Gambl Stud 2022; 38:1529-1537. [PMID: 35596900 PMCID: PMC9123619 DOI: 10.1007/s10899-022-10129-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
Gambling Disorder (GD) is a condition constituting a public health concern, with a burden of harm which is much greater than that of drug addiction. Patients with GD are generally reluctant to pharmacologic treatment and seem to prefer nonpharmacological interventions. Therefore, this proof-of-concept study aimed to investigate the feasibility of continuous Theta Burst Stimulation (cTBS) on the pre-SMA in six patients (5 males, 1 female), aged 30–64 years, with a DSM-5 diagnosis of Gambling Disorder and no comorbid mood disorders. Participants received over 10 sessions of Continuous TBS (cTBS) over pre-SMA bilaterally and have been evaluated using rating scales, including the PG-YBOCS and the CGI, before treatment (T0), at day 10 of treatment (T1) and at day 30 after treatment (T2); cTBS intervention was safe and without side effects. Since the design of our study does not allow us to draw conclusions on the effectiveness of the intervention with respect to the improvement of the functioning of the subject with GD, a more in-depth study, including a sham condition, neurocognitive measures of disinhibition and decision making, and collecting follow-up data on the sustained effect of TBS over a longer period is ongoing.
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Affiliation(s)
| | | | - Nikos Makris
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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2
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Perandrés-Gómez A, Navas JF, van Timmeren T, Perales JC. Decision-making (in)flexibility in gambling disorder. Addict Behav 2021; 112:106534. [PMID: 32890912 DOI: 10.1016/j.addbeh.2020.106534] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Behavioral flexibility -the ability to dynamically readjust our behavior in response to reward contingency changes- is often investigated using probabilistic reversal learning tasks (PRLT). Poor PRLT performance has been proposed as a proxy for compulsivity, and theorized to be related to perseverative gambling. Previous attempts to measure inflexibility with the PRLT in patients with gambling disorder have, however, used a variety of indices that may conflate inflexibility with more general aspects of performance in the task. METHODS Trial-by-trial PRLT acquisition and reacquisition curves in 84 treatment-seeking patients with gambling disorder and 64 controls (non-gamblers and non-problem recreational gamblers) were analyzed to distinguish between (a) variability in acquisition learning, and (b) reacquisition learning in reversed contingency phases. Complementarily, stay/switch responses throughout the task were analyzed to identify (c) premature switching, and (d) sensitivity to accumulated negative feedback. RESULTS AND INTERPRETATION Even after controlling for differences in acquisition learning, patients were slower to readjust their behavior in reversed contingency phases, and were more prone to maintain their decisions despite accumulated negative feedback. Inflexibility in patients with gambling disorder is thus a robust phenomenon that could predate gambling escalation, or result from massive exposure to gambling activities.
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Affiliation(s)
- Ana Perandrés-Gómez
- Department of Experimental Psychology, Mind, Brain and Research Center (CIMCYC), Universidad de Granada, Spain
| | - Juan F Navas
- Department of Clinical Psychology, Universidad Complutense de Madrid, Spain; Universitat Oberta de Catalunya, Spain
| | - Tim van Timmeren
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - José C Perales
- Department of Experimental Psychology, Mind, Brain and Research Center (CIMCYC), Universidad de Granada, Spain.
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Raimo S, Cropano M, Trojano L, Santangelo G. The neural basis of gambling disorder: An activation likelihood estimation meta-analysis. Neurosci Biobehav Rev 2020; 120:279-302. [PMID: 33275954 DOI: 10.1016/j.neubiorev.2020.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
Previous imaging studies suggested that impairments of prefrontal-striatal and limbic circuits are correlated to excessive gambling. However, the neural underpinnings of gambling disorder (GD) continue to be the topic of debate. The present study aimed to identify structural changes in GD and differentiate the specific brain activity patterns associated with decision-making and reward-processing. We performed a systematic review complemented by Activation likelihood estimation (ALE) meta-analyses on morphometric and functional studies on neural correlates of GD. The ALE meta-analysis on structural studies revealed that patients with GD showed significant cortical grey-matter thinning in the right ventrolateral and ventromedial prefrontal cortex compared to healthy subjects. The ALE meta-analyses on functional studies revealed that patients with GD showed a significant hyperactivation in the medial prefrontal cortex and in the right ventral striatum during decision-making and gain processing compared to healthy subjects. These findings suggest that GD is related to an alteration of brain mechanisms underlying top-down control and appraisal of gambling-related stimuli and provided indications to develop new interventions in clinical practice.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Maria Cropano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
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The fuzzy future: Time horizon, memory failures, and emotional distress in gambling disorder. Addict Behav 2019; 97:7-13. [PMID: 31112912 DOI: 10.1016/j.addbeh.2019.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/12/2019] [Accepted: 05/12/2019] [Indexed: 02/07/2023]
Abstract
This study aimed to first investigate the interplay among self-rated ability in both retrospective and prospective memory, time perspective, and negative affectivity to gambling severity. Two hundred and three habitual players took part in the study. Participants were administered the South Oaks Gambling Screen (SOGS), the Consideration of Future Consequences scale (CFC-14), the Prospective and Retrospective Memory Questionnaire (PRMQ), as well as the Depression, Anxiety and Stress Scales-21 (DASS-21). Overall, data indicated that the higher the involvement in gambling, the higher the depression levels and the shorter the time horizon. The results of linear regression analysis showed that, along with gender, years of education, depression, and inattention to the future consequences of actual behavior, the negative self-perception of prospective memory functioning represents a significant predictor of gambling severity. Finally, to clarify if depression was on the path from prospective memory to gambling severity or if prospective memory was the mediator of the impact of depression on gambling severity, data were submitted to path analysis. Results indicated that depression has a direct effect on gambling severity and mediates the association between prospective memory and gambling involvement. The relation between gambling severity and prospective memory scores suggests that impairment in prospective memory plays a key role in adult problematic gambling.
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Gaming Disorder Is a Disorder due to Addictive Behaviors: Evidence from Behavioral and Neuroscientific Studies Addressing Cue Reactivity and Craving, Executive Functions, and Decision-Making. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00258-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Sharman S, Clark L, Roberts A, Michalczuk R, Cocks R, Bowden-Jones H. Heterogeneity in Disordered Gambling: Decision-Making and Impulsivity in Gamblers Grouped by Preferred Form. Front Psychiatry 2019; 10:588. [PMID: 31481905 PMCID: PMC6709538 DOI: 10.3389/fpsyt.2019.00588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Previous research has indicated that disordered gamblers display deficits in impulsivity and risky decision-making, compared to healthy control groups. However, disordered gamblers are not a homogenous group, and differences in performance on neurocognitive tasks may be related to the form of gambling in which an individual chooses to engage. The present study used neurocognitive tasks and questionnaire measures to ascertain group differences in gamblers grouped by preferred form of gambling. Method: Treatment-seeking pathological gamblers from the National Problem Gambling Clinic, London (n = 101), completed a neurocognitive assessment comprising the Cambridge gamble task (CGT), the stop-signal task (SST), a probabilistic reversal learning task (PRL), and the Kirby Monetary Choice Questionnaire, as well as questionnaire measures of gambling severity, impulsivity, depression, and anxiety. Analyses compared gamblers who favored fixed-odds betting terminals (FOBTs) (the modal form) to gamblers who preferred other forms of gambling (non-FOBT). Results: The FOBT group showed impaired decision-making under risk on the CGT compared to the non-FOBT group, choosing the likely option less on more uncertain decisions. The FOBT group made fewer perseverative errors on the PRL task, had lower depression and anxiety scores, and were less likely to have a family history of problem gambling than the non-FOBT group. Discussion: Decision-making and cognitive flexibility differences between gamblers grouped by gambling type supports preferred form as an important source of heterogeneity in gambling disorder. Decision-making strategies and risk attitudes should be considered when approaching cognition-focused treatment strategies, allowing interventions to be targeted at specific cognitive deficits.
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Affiliation(s)
- Steve Sharman
- School of Psychology, College of Applied Health and Communities, University of East London, London, United Kingdom.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Luke Clark
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Lincoln, United Kingdom
| | - Rosanna Michalczuk
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,South London and Maudsley Trust, Bethlem Royal Hospital, London, United Kingdom
| | - Rachel Cocks
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Royal Holloway, University of London, London, United Kingdom
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, London, United Kingdom.,Faculty of Medicine, Faculty of Medicine Centre, Imperial College London, London, United Kingdom
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Trait impulsivity and cognitive domains involving impulsivity and compulsivity as predictors of gambling disorder treatment response. Addict Behav 2018; 87:169-176. [PMID: 30048796 DOI: 10.1016/j.addbeh.2018.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Gambling disorder (GD) is a highly heterogeneous condition with high rates of chronicity, relapses and treatment dropout. The aim of this study was to longitudinally explore the associations between trait impulsivity, impulsivity-compulsivity related cognitive domains, and treatment outcome in an outpatient sample of adult patients with GD. METHODS 144 adult male participants diagnosed with GD undergoing cognitive-behavioural treatment (CBT) at a specialized outpatient service completed a series of neuropsychological tests to assess executive functioning (including cognitive flexibility, inhibition control and decision making) and psychometric questionnaires. RESULTS Trait impulsivity predicted low compliance [UPPS-P negative urgency (B = 0.113; p = 0.019)] and relapse [UPPS-P negative urgency (B = 0.140; p = 0.015)] at 5 weeks of treatment and dropout at the end of treatment [(UPPS-P sensation seeking B = 0.056; p = 0.045)]. Cognitive flexibility performance predicted: dropout rates at the end of treatment [WCST perseverative errors (B = 0.043; p = 0.042)]; dropout [WCST categories completed (B = -1.827; p = 0.020)] and low compliance or relapses at follow-up [WCST perseverative errors (B = 0.128; p = 0.020)]; and time to first relapse [WCST failure to maintain set (B = -0.374; p = 0.048)] and time to dropout [WCST perseverative errors (B = 0.0198; p = 0.019)]. CONCLUSIONS Our findings indicate impulsivity-compulsivity levels may influence response to GD treatment (i.e.: low compliance and dropout or relapse rates) thus representing a potential target for improving treatment outcomes.
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Dawson A, Dissanayaka NN, Evans A, Verdejo-Garcia A, Chong TTJ, Frazzitta G, Ferrazzoli D, Ortelli P, Yücel M, Carter A. Neurocognitive correlates of medication-induced addictive behaviours in Parkinson's disease: A systematic review. Eur Neuropsychopharmacol 2018; 28:561-578. [PMID: 29653742 DOI: 10.1016/j.euroneuro.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/06/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022]
Abstract
Dopaminergic medication can induce severe addictive behaviours (e.g., pathological gambling) in susceptible Parkinson's disease (PD) patients. It is still unknown which particular neurocognitive processes become exacerbated or dysfunctional in PD patients with addictive behaviours. We sought to systematically review the relevant literature to identity potential neurocognitive correlates of medication-induced addictive behaviours in PD. We framed our review around neurocognitive processes central to four dominant accounts of substance addiction: 'aberrant learning', 'incentive sensitization', 'impulsivity to compulsivity' and 'impaired response inhibition and salience attribution'. Searches of the PubMed and Scopus databases were completed on June 23, 2017. To be included, studies were required to involve: (a) medicated PD patients, without a history of deep brain stimulation, with and without addictive behaviours; (b) a reward-related or decision-making task; and (c) statistical comparison of addictive and non-addictive groups' 'on' medication performance on the task(s). Studies were summarised qualitatively with statistically significant (p<.05) group differences and effect sizes (Cohen's d) highlighted. 35 studies were included. Findings showed that the extant literature is highly heterogeneous. The domains of reward and punishment learning, reflection impulsivity and disadvantageous decision-making exemplify this. More homogeneity exists in domains in which (a) neurocognitive dysfunction is not apparent (motor control, cognitive/attentional flexibility and cognitive control) or (b) typical neurocognitive processes appear exacerbated by medication (reward motivation and choice impulsivity). Future large-scale neurocognitive studies are still required to develop our scientific understanding of addictive behaviours in PD and aid their clinical treatment and prediction.
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Affiliation(s)
- Andrew Dawson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Nadeeka N Dissanayaka
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia; School of Psychology, The University of Queensland, St. Lucia, Queensland 4029, Australia
| | - Andrew Evans
- The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Antonio Verdejo-Garcia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Trevor T J Chong
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Giuseppe Frazzitta
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Davide Ferrazzoli
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Paola Ortelli
- Movement Disorders and Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital, Gravedona ed Uniti, Como 22015, Italy
| | - Murat Yücel
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia
| | - Adrian Carter
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria 3800, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland 4029, Australia
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Boffo M, Willemen R, Pronk T, Wiers RW, Dom G. Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial. Trials 2017; 18:452. [PMID: 28974265 PMCID: PMC5627491 DOI: 10.1186/s13063-017-2190-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers. METHODS/DESIGN Participants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes. DISCUSSION This study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour. TRIAL REGISTRATION Netherlands Trial Register, NTR5096 . Registered on 11 March 2015.
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Affiliation(s)
- Marilisa Boffo
- Addiction Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands. .,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Wilrijk, Belgium. .,Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
| | - Ronny Willemen
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Wilrijk, Belgium.,Centre for Alcohol and other Substance Problems (CAD Limburg), Hasselt, Belgium
| | - Thomas Pronk
- Addiction Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Wilrijk, Belgium
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