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Snippe L, Boffo M, Galvin H, Willemen R, Pronk T, Dom G, Wiers RW. How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers. J Gambl Stud 2024; 40:521-554. [PMID: 38006537 DOI: 10.1007/s10899-023-10263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/27/2023]
Abstract
Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.
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Affiliation(s)
- Leroy Snippe
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands.
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium.
| | - Marilisa Boffo
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Harriet Galvin
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Department of Psychology, Education and Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Thomas Pronk
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Wilrijk, Belgium
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129, 1018 WS, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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2
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Gancarz AM, Hagarty DP, Cobb MM, Kausch MA, Krieg B, Alammari N, Gilbert K, Russo J, Dietz DM. Operant novelty seeking predicts cue-induced reinstatement following cocaine but not water reinforcement in male rats. Psychopharmacology (Berl) 2023; 240:2201-2215. [PMID: 37552291 PMCID: PMC10506955 DOI: 10.1007/s00213-023-06441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
RATIONALE An important facet of cocaine addiction is a high propensity to relapse, with increasing research investigating factors that predispose individuals toward uncontrolled drug use and relapse. A personality trait linked to drug addiction is high sensation seeking, i.e., a preference for novel sensations/experiences. In an animal model of sensation seeking, operant novelty seeking predicts the acquisition of drug self-administration. OBJECTIVE The primary goal of this research was to evaluate the hypothesis that sensitivity to the reinforcing effects of novel sensory stimuli predicts more intensive aspects of drug-taking behaviors, such as relapse. METHODS Rats were first tested for Operant Novelty Seeking, during which responses resulted in complex visual/auditory stimuli. Next, rats were trained to respond to water/cocaine reinforcers signaled by a cue light. Finally, rats were exposed to extinction in the absence of discrete cues and subsequently tested in a single session of cue-induced reinstatement, during which active responses resulted in cues previously paired with water/cocaine delivery. RESULTS The present study showed operant responses to produce novel sensory stimuli positively correlate with responding for cocaine during self-administration and during discrete cue-induced reinstatement, but no association with performance during extinction. A different pattern of associations was observed for a natural reward, in this case, water reinforcement. Here, the degree of novelty seeking also correlated with responding to water reinforcement and extinction responding; however, operant novelty seeking did not correlate with responding to water cues during testing of cue-induced reinstatement. Taken together, the incongruence of relationships indicates an underlying difference between natural and drug reinforcers. CONCLUSION In summary, we found a reinforcer-dependent relationship between operant novelty seeking (i.e., sensation seeking) and responsivity to extinction and discrete cues signaling availability for cocaine (i.e., craving), demonstrating the validity of the operant novelty seeking model to investigate drug seeking and relapse.
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Affiliation(s)
- Amy M Gancarz
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA.
| | - Devin P Hagarty
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Moriah M Cobb
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Michael A Kausch
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Brandon Krieg
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Nora Alammari
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Kameron Gilbert
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - Jacqueline Russo
- Department of Psychology, California State University, Bakersfield, Dorothy Donahoe Hall (DDH) H106, 9001 Stockdale Highway, Bakersfield, CA, 93311, USA
| | - David M Dietz
- Clinical and Research Institute On Addictions, University at Buffalo, Buffalo, NY, USA
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Mestre-Bach G, Potenza MN. Features Linked to Treatment Outcomes in Behavioral Addictions and Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2873. [PMID: 36833569 PMCID: PMC9957199 DOI: 10.3390/ijerph20042873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Behavioral addictions are incompletely understood with respect to their underlying etiologies. This incomplete understanding may contribute to the frequent relapse and dropout rate often observed with behavioral addictions. The present state-of-the-art review aimed to review the literature that explored sociodemographic and clinical factors that link to poor treatment responses. Despite multiple studies, the definitions and evaluations of relapse and dropout are heterogeneous, complicating comparisons across studies. A scientific consensus on the conceptualization of both terms would help to better understand psychological features linked to treatment outcomes in behavioral addictions.
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Affiliation(s)
- Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, 26006 La Rioja, Spain
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
- Connecticut Mental Health Center, New Haven, CT 06519, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
- Wu Tsai Institute, Yale University, New Haven, CT 06510, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, USA
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4
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Lucas I, Granero R, Fernández-Aranda F, Solé-Morata N, Demetrovics Z, Baenas I, Gómez-Peña M, Moragas L, Mora-Maltas B, Lara-Huallipe ML, Jiménez-Murcia S. Gambling disorder duration and cognitive behavioural therapy outcome considering gambling preference and sex. J Psychiatr Res 2023; 158:341-349. [PMID: 36638624 DOI: 10.1016/j.jpsychires.2022.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Gambling Disorder (GD) is a behavioural addiction that leads to high level of clinical distress and, in general, it is characterized by enduring symptomatology that presents high rates of chronicity. However, there is high variability of illness duration among patients who seek treatment for GD. Previous studies reported mixed results about the relevance of illness duration in GD treatment outcome. However, there are different profiles of patients who are diagnosed with GD. For this reason, this study aimed to evaluate the effect of illness duration in the treatment outcome of different profiles of GD patients according to their gambling preference and sex. The sample were 1699 patients diagnosed with GD. All patients received cognitive-behavioural therapy in a group format. Treatment outcome was evaluated in terms of relapsing to gambling behaviours and dropout from treatment. Results showed higher probability of poor outcome in the first years of the disorder for strategic gambling compared to non-strategic or mixed forms of gambling. Moreover, women also showed higher probability of poor outcomes than men since the first stages of the disorder. This study draws attention to the relevance of illness duration in the treatment outcome of specific profiles of GD patients. In particular, patients who presented a preference for strategic forms of gambling and women who are diagnosed with GD would have a higher risk of poor treatment outcomes since the first stages of the disorder. These results highlight the importance of an early intervention in these patients in order to prevent the chronicity of the disorder.
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Affiliation(s)
- Ignacio Lucas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Neus Solé-Morata
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Isabel Baenas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Laura Moragas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Bernat Mora-Maltas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Milagros Lizbeth Lara-Huallipe
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Hashworth T, Reis S, Townsend M, O.’Garr J, Grenyer BF. Personal agency and borderline personality disorder: a longitudinal study of outcomes. BMC Psychiatry 2022; 22:566. [PMID: 35996102 PMCID: PMC9396765 DOI: 10.1186/s12888-022-04214-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low personal agency is the concept of attributing successes and failures to external factors rather than personal characteristics. Previous research supported links between low personal agency and symptoms of borderline personality disorder (BPD). The present research followed patients in an outpatient dialectical behavioural therapy (DBT) group from intake to 12 months follow up to examine the impact of personal agency on outcome. METHODS Patients (N = 57, age 18-72, 91.5% female) were assessed at intake, after three months of DBT treatment, and 12 months follow up on measures of symptoms and personal agency. Three separate measures were used to assess treatment outcomes: the BPD Checklist, the Personality Inventory for DSM-5 (PID-5), and the Mental Health Inventory (MHI-5). RESULTS Mixed model analyses found BPD symptoms significantly reduced as a result of DBT treatment and were maintained at follow-up. However, 47% of participants continued to meet BPD criteria 12 months later, despite treatment. Regression analyses indicated that low personal agency at intake was associated with higher BPD symptom severity at post-treatment and 12 month follow up. In addition, low personal agency at intake was associated with greater levels of negative affectivity at post-treatment. Personal agency did not relate to levels of depression and anxiety. CONCLUSIONS Despite the reductions in BPD symptomology, personal agency did not significantly change over time. Those with lower agency at intake continued to do more poorly at follow up. We speculate that poor outcomes may be contributed to by patients' lack of engagement in recovery due to poor agency and an external locus of control. As such, therapeutic approaches, like DBT, may require additional strategies to appropriately target low personal agency. Further research is needed to understand if other treatment protocols may facilitate positive change in personal agency.
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Affiliation(s)
- Talia Hashworth
- grid.1007.60000 0004 0486 528XSchool of Psychology, University of Wollongong, Wollongong, Australia
| | - Samantha Reis
- grid.1007.60000 0004 0486 528XSchool of Psychology, University of Wollongong, Wollongong, Australia
| | - Michelle Townsend
- grid.1007.60000 0004 0486 528XSchool of Psychology, University of Wollongong, Wollongong, Australia ,grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute, University of Wollongong, Wollongong , Australia
| | - Jessica O.’Garr
- South Coast Private Mental Health Hospital, Wollongong, Australia
| | - Brin F.S. Grenyer
- grid.1007.60000 0004 0486 528XSchool of Psychology, University of Wollongong, Wollongong, Australia ,grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute, University of Wollongong, Wollongong , Australia
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Ramos-Grille I, Aragay N, Valero S, Garrido G, Santacana M, Guillamat R, Vallès V, Gomà-i-Freixanet M. Relationship between depressive disorders and personality traits: the value of the alternative five factor model. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Dudfield FWH, Malouff JM, Meynadier J. The Association between the Five-factor Model of Personality and Problem Gambling: a Meta-analysis. J Gambl Stud 2022; 39:669-687. [PMID: 35604521 PMCID: PMC10175427 DOI: 10.1007/s10899-022-10119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 01/08/2023]
Abstract
AbstractThis meta-analysis examined the associations between five-factor personality model traits and problem gambling. To be eligible for inclusion in the meta-analysis, studies had to provide effect size data that quantified the magnitude of the association between all five personality traits and problem gambling. Studies also had to use psychometrically sound measures. The meta-analysis included 20 separate samples from 19 studies and 32,222 total participants. The results showed that problem gambling was significantly correlated with the five-factor model of personality. The strongest personality correlate of problem gambling was neuroticism r = .31, p = < 0.001, 95% CI [0.17, 0.44], followed by conscientiousness r = − .28, p = < 0.001, 95% CI [-0.38,-0.17] ), agreeableness r = − .22, p = < 0.001, 95% CI [-0.34, − 0.10], openness r = − .17, p = < 0.001, 95% CI [-0.22,-0.12], and extraversion r = − .11, p = .024, 95% CI [-0.20,-0.01]. These results suggest problem gamblers tend to share a common personality profile – one that could provide clues as to the most effective ways to prevent and to treat problem gambling.
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Affiliation(s)
| | - John M Malouff
- University of New England Psychology, Armidale, NSW 2351, Australia.
| | - Jai Meynadier
- University of New England Psychology, Armidale, NSW 2351, Australia
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8
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Vintró-Alcaraz C, Munguía L, Granero R, Gaspar-Pérez A, Solé-Morata N, Sánchez I, Sánchez-González J, Menchón JM, Jiménez-Murcia S, Fernández-Aranda F. Emotion regulation as a transdiagnostic factor in eating disorders and gambling disorder: Treatment outcome implications. J Behav Addict 2022; 11:140-146. [PMID: 35254287 PMCID: PMC9109626 DOI: 10.1556/2006.2022.00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/19/2021] [Accepted: 02/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A first approach addressed to ascertain whether emotion regulation (ER) could be a transdiagnostic construct between eating disorders (EDs) and gambling disorder (GD) (through a joint clinical clustering analysis of both disorders) was performed by Munguía et al. (2021). Both conditions were represented by a severe, moderate, and low ER profile subgroups, according to the degree of ER difficulties. Results showed a linear relationship between the severity of ER difficulties and the severity of the disorder and the psychopathological state. AIMS Based on the aforementioned cross-sectional study, the objective of this longitudinal research was to explore the treatment response of the different ER subgroups. METHODS 459 adult patients (n = 277 ED; n = 182 GD) were included. Several clinical variables, as well as outcome indicators (after completing 16 weeks of cognitive-behavioral therapy), were evaluated. RESULTS The three subgroups found in the previous cross-sectional study were taken for the performance of the present research. ED and GD distribution in each subgroup replicates the one exposed by Munguía et al. (2021), as well as their characterization, considering psychopathology, disorder severity and personality traits. The low ER subgroup reported a better response to treatment, whereas the severe group had the highest rates of non-remission and dropouts. CONCLUSIONS Our results suggest that greater difficulties in ER lead to poorer treatment outcomes. Therefore, tailored treatments for patients with poor ER abilities would be recommended to improve adherence and treatment outcomes.
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Affiliation(s)
- Cristina Vintró-Alcaraz
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 08907 Barcelona, Spain
| | - Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain
| | - Roser Granero
- Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 08907 Barcelona, Spain,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Anahi Gaspar-Pérez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain
| | - Neus Solé-Morata
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 08907 Barcelona, Spain
| | | | - José M. Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, 08907 Barcelona, Spain,CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 08907 Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, 08907 Barcelona, Spain,Corresponding author. Tel.: +34 932607227; fax +34-93-2607193. E-mail:
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, 08907 Barcelona, Spain,Department of Clinical Sciences, School of Medicine, University of Barcelona, 08907 Barcelona, Spain,Corresponding author. Tel.: +34 932607227; fax +34-93-2607193. E-mail:
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9
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Lara-Huallipe ML, Granero R, Fernández-Aranda F, Gómez-Peña M, Moragas L, Del Pino-Gutierrez A, Valenciano-Mendoza E, Mora-Maltas B, Baenas I, Etxandi M, Menchón JM, Jiménez-Murcia S. Clustering Treatment Outcomes in Women with Gambling Disorder. J Gambl Stud 2021; 38:1469-1491. [PMID: 34932187 DOI: 10.1007/s10899-021-10092-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/16/2022]
Abstract
The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.
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Affiliation(s)
- Milagros Lizbeth Lara-Huallipe
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Roser Granero
- Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona-UB, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Amparo Del Pino-Gutierrez
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, Universitat de Barcelona-UB, Barcelona, Spain
| | - Eduardo Valenciano-Mendoza
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mikel Etxandi
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona-UB, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, IDIBELL and CIBERObn. C/ Feixa Llarga S/N, Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona-UB, L'Hospitalet de Llobregat, Barcelona, Spain.
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Reasons for dropping out of internet-based problem gambling treatment, and the process of recovery – a qualitative assessment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractProblem gambling (PG) is a condition affecting the economy, mental health, and relationships of both the individuals with gambling problems, and concerned significant others (CSOs). While PG is treatable, few individuals with gambling problems seek treatment, and many drop out of treatment. This qualitative study aims to investigate a) the reasons for individuals with gambling problems to drop-out from Internet-based PG treatment, and b) what individuals with gambling problems and CSOs find helpful and unhelpful processes in PG recovery. A total of 16 participants (8 individuals with gambling problems and 8 CSOs) who had participated in an Internet-based PG treatment were interviewed over the telephone in a semi-structured interview. The interviews were analyzed using thematic analysis. Drop-out from treatment was one aspect of an overarching theme identified as unstable path to recovery, where alternating periods of progress and setbacks delineate several aspects of PG. Relapses, negative emotions, and changing life circumstances were identified to separately, and in combination, contribute to drop-out. Drop-outs were also explained by participants’ experiences of a reduced need for treatment. Openness and a support from CSOs and peers were identified as themes important for recovery. The results suggest that PG treatments should consider the emotional state, and comorbidities of the patients, in order to reduce drop-out and improve chances of recovery.
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Ciccarelli M, Cosenza M, Nigro G, Griffiths M, D’Olimpio F. Gaming and gambling in adolescence: the role of personality, reflective functioning, time perspective and dissociation. INTERNATIONAL GAMBLING STUDIES 2021. [DOI: 10.1080/14459795.2021.1985583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Marina Cosenza
- Università Degli Studi Della Campania “Luigi Vanvitelli”
| | - Giovanna Nigro
- Università Degli Studi Della Campania “Luigi Vanvitelli”
| | - Mark Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, UK
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12
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Quilty LC, Otis E, Haefner SA, Michael Bagby R. A Multi-Method Investigation of Normative and Pathological Personality Across the Spectrum of Gambling Involvement. J Gambl Stud 2021; 38:205-223. [PMID: 33655450 DOI: 10.1007/s10899-021-10011-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
Pathological Gambling (PG) has been linked to both specific personality traits and personality disorders (PDs). However, previous studies have used a wide variety of research designs that preclude clear conclusions about the personality features that distinguish adults with PG from other groups. The current investigation seeks to advance this research by using a sample including adults who do not gamble, who gamble socially, and who exhibit PG, using self-report, informant-report, and interview-rated measures of personality traits and disorders. A total of 245 adults completed measures of gambling behaviour and problems, as well as normative and pathological personality over two assessment visits. A multivariate ANCOVA was conducted to investigate differences between groups. Analyses supported numerous group differences including differences between all groups on the Neuroticism facet of Impulsivity, and between non-gambling/socially gambling and PG groups on the Conscientiousness facet of Self-Discipline. Adults with PG exhibited more symptoms of Borderline, Paranoid, Schizotypal, Avoidant, and Dependent PDs than adults who gamble socially or not at all. The current investigation provides a comprehensive survey of personality across a wide range of gambling involvement, using a multi-method approach. Our findings help to clarify the most pertinent personality risk factors for PG.
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Affiliation(s)
- Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Elijah Otis
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
| | - Sasha A Haefner
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Ontario Institute for Studies in Education, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - R Michael Bagby
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada
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Strømme R, Børstad KH, Rø AE, Erevik EK, Sagoe D, Chegeni R, Aune Mentzoni R, Kaur P, Pallesen S. The Relationship Between Gambling Problems and the Five-Factor Model of Personality: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:740235. [PMID: 34712156 PMCID: PMC8545825 DOI: 10.3389/fpsyt.2021.740235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: The aim of the present meta-analysis was to synthesize results from the association between problem gambling (PG) and dimensions of the five factor model of personality and to identify potential moderators (gambling diagnosis: yes/no, comorbidity: yes/no and trait assessment: four or fewer items vs. five items or more) of these associations in meta-regressions. Methods: Searches were conducted in six databases; Medline, Web of Science, PsychInfo, Google Scholar, OpenGrey, and Cochrane Library (conducted on February, 22, 2021). Included studies: (1) reported a relationship between PG and at least one of the personality traits in the five-factor model, (2) contained information of zero-order correlations or sufficient data for such calculations, and (3) were original articles published in any European language. Case-studies, qualitative studies, and reviews were excluded. All articles were independently screened by two authors. Final agreement was reached through discussion or by consulting a third author. Risk of bias of the included studies was assessed by the Newcastle-Ottawa Scale. Data were synthesized using a random effects model. Results: In total 28 studies, comprising 20,587 participants, were included. The correlations between PG and the traits were as follows: Neuroticism: 0.273 (95% CI = 0.182, 0.358), conscientiousness -0.296 (95% CI = -0.400, -0.185), agreeableness -0.163 (95% CI = -0.223, -0.101), openness -0.219 (95% CI = -0.308, -0.127), and extroversion -0.083 (95% CI = -0.120, -0.046). For all meta-analyses the between study heterogeneity was significant. Presence of gambling diagnosis was the only moderator that significantly explained between-study variance showing a more negative correlation to extroversion when participants had a gambling diagnosis compared to when this was not the case. Discussion: The results indicated some publication bias. Correcting for this by a trim-and-fill procedure showed however that the findings were consistent. Clinicians and researchers should be aware of the associations between personality traits and PG. Previous studies have for example showed neuroticism to be related to treatment relapse, low scores on conscientiousness to predict treatment drop-out and agreeableness to reduce risk of treatment drop-out. Systematic Review Registration: PROSPERO (CRD42021237225).
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Affiliation(s)
- Rune Strømme
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Andrea Eftang Rø
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Eilin Kristine Erevik
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Centre for Gambling and Gaming Research, University of Bergen, Bergen, Norway
| | - Dominic Sagoe
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Centre for Gambling and Gaming Research, University of Bergen, Bergen, Norway
| | - Razieh Chegeni
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Rune Aune Mentzoni
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Centre for Gambling and Gaming Research, University of Bergen, Bergen, Norway
| | - Puneet Kaur
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Centre for Gambling and Gaming Research, University of Bergen, Bergen, Norway.,Optentia, The Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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Amendola S, Spensieri V, Biuso GS, Cerutti R. The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach. Scand J Psychol 2020; 61:809-818. [PMID: 32754935 DOI: 10.1111/sjop.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18 years (M age = 13.80; SD = 2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Stefano Biuso
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Mann K, Lemenager T, Zois E, Hoffmann S, Nakovics H, Beutel M, Vogelgesang M, Wölfling K, Kiefer F, Fauth-Bühler M. Comorbidity, family history and personality traits in pathological gamblers compared with healthy controls. Eur Psychiatry 2020; 42:120-128. [DOI: 10.1016/j.eurpsy.2016.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 12/02/2016] [Accepted: 12/03/2016] [Indexed: 12/24/2022] Open
Abstract
AbstractBackgroundWhile DSM-5 classified pathological gambling as an addictive disorder, there is debate as to whether ICD-11 should follow suit. The debate hinges on scientific evidence such as neurobiological findings, family history of psychiatric disorders, psychiatric comorbidity, and personality variables.MethodsIn the “Baden-Württemberg Study of Pathological Gambling”, we compared a group of 515 male pathological gamblers receiving treatment with 269 matched healthy controls. We studied differences in sociodemographic characteristics, gambling-related variables, psychiatric comorbidity (lifetime), family history of psychiatric conditions, as well as personality traits such as impulsivity (Barratt Impulsiveness Scale), sensation seeking (Zuckerman's Sensation Seeking Scale) and the NEO-FFI big five. Personality traits were validated in an age- and ethnicity-matched subsample of “pure” gamblers without any psychiatric comorbidity (including nicotine dependence). Data were analyzed using two-sample t-tests, Chi2 analyses, Fisher's exact test and Pearson correlation analysis, as appropriate. Bonferroni correction was applied to correct for multiple comparisons.ResultsOnly 1% of the gamblers had been diagnosed with an impulse control disorder other than gambling (ICD-10). Notably, 88% of the gamblers in our sample had a comorbid diagnosis of substance dependence. The highest axis I comorbidity rate was for nicotine dependence (80%), followed by alcohol dependence (28%). Early age of first gambling experience was correlated with gambling severity. Compared to first-degree relatives of controls, first-degree relatives of pathological gamblers were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), pathological gambling (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Significant group differences were observed for the NEO-FFI factors neuroticism, agreeableness and conscientiousness. Gamblers were also more impulsive than controls, but did not differ from controls in terms of sensation seeking.ConclusionsOur findings support classifying pathological gambling as a behavioural addiction in the ICD-11. This decision will have a significant impact on the approaches available for prevention (e.g. age limits) and treatment.
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The Associations Between Maladaptive Personality Traits, Craving, Alcohol Use, and Adolescent Problem Gambling: An Italian Survey Study. J Gambl Stud 2019; 36:243-258. [DOI: 10.1007/s10899-019-09872-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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17
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Jara-Rizzo MF, Navas JF, Catena A, Perales JC. Types of Emotion Regulation and Their Associations with Gambling: A Cross-Sectional Study with Disordered and Non-problem Ecuadorian Gamblers. J Gambl Stud 2019; 35:997-1013. [DOI: 10.1007/s10899-019-09868-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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18
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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: 30] [Impact Index Per Article: 5.0] [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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Mestre-Bach G, Steward T, Granero R, Fernández-Aranda F, Del Pino-Gutiérrez A, Mallorquí-Bagué N, Mena-Moreno T, Vintró-Alcaraz C, Moragas L, Aymamí N, Gómez-Peña M, Sánchez-González J, Agüera Z, Lozano-Madrid M, Menchón JM, Jiménez-Murcia S. The predictive capacity of DSM-5 symptom severity and impulsivity on response to cognitive-behavioral therapy for gambling disorder: A 2-year longitudinal study. Eur Psychiatry 2018; 55:67-73. [PMID: 30390474 DOI: 10.1016/j.eurpsy.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edificio B, Bellaterra, Cerdanyola del Vallès, 08193 Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona, Barcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Teresa Mena-Moreno
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona, Passeig de la Vall d'Hebron, 171, 08035 Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Jéssica Sánchez-González
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain.
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GAMBLING DISORDER: PERSONALITY CHARACTERISTICS IN A CLINICAL SAMPLE. PATHOPHYSIOLOGY 2018. [DOI: 10.1016/j.pathophys.2018.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Mallorquí-Bagué N, Tolosa-Sola I, Fernández-Aranda F, Granero R, Fagundo AB, Lozano-Madrid M, Mestre-Bach G, Gómez-Peña M, Aymamí N, Borrás-González I, Sánchez-González J, Baño M, Del Pino-Gutiérrez A, Menchón JM, Jiménez-Murcia S. Cognitive Deficits in Executive Functions and Decision-Making Impairments Cluster Gambling Disorder Sub-types. J Gambl Stud 2018; 34:209-223. [PMID: 29058168 DOI: 10.1007/s10899-017-9724-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To identify Gambling Disorder (GD) subtypes, in a population of men seeking treatment for GD, according to specific executive function domains (i.e., cognitive flexibility, inhibition and working memory as well as decision making) which are usually impaired in addictive behaviors. A total of 145 males ranging from 18 to 65 years diagnosed with GD were included in this study. All participants completed: (a) a set of questionnaires to assess psychopathological symptoms, personality and impulsivity traits, and (b) a battery of neuropsychological measures to test different executive functioning domains. Two clusters were identified based on the individual performance on the neuropsychological assessment. Cluster 1 [n = 106; labeled as Low Impaired Executive Function (LIEF)] was composed by patients with poor results in the neuropsychological assessment; cluster 2 patients [n = 46; labeled as High Impaired Executive Function (HIEF)] presented significantly higher deficits on the assessed domains and performed worse than the ones of LIEF cluster. Regarding the characterization of these two clusters, patients in cluster 2 were significantly older, unemployed and registered higher mean age of GD onset than patients in cluster 1. Additionally, patients in cluster 2 also obtained higher psychopathological symptoms, impulsivity (in both positive and negative urgency as well as sensation seeking) and some specific personality traits (higher harm avoidance as well as lower self-directedness and cooperativeness) than patients in cluster 1. The results of this study describe two different GD subtypes based on different cognitive domains (i.e., executive function performance). These two GD subtypes display different impulsivity and personality traits as well as clinical symptoms. The results provide new insight into the etiology and characterization of GD and have the potential to help improving current treatments.
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Affiliation(s)
- Núria Mallorquí-Bagué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Iris Tolosa-Sola
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Fernándo Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Beatriz Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | | | - Marta Baño
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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22
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Kim HS, Cassetta BD, Hodgins DC, Tomfohr-Madsen LM, McGrath DS, Tavares H. Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:370-377. [PMID: 28884607 PMCID: PMC5971405 DOI: 10.1177/0706743717730825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. METHOD The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. RESULTS Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. CONCLUSION Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.
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Affiliation(s)
- Hyoun S. Kim
- Department of Psychology, University of Calgary, Calgary, Alberta
| | | | - David C. Hodgins
- Department of Psychology, University of Calgary, Calgary, Alberta
| | | | | | - Hermano Tavares
- Impulse Control Disorders Outpatient Unit, Institute and Department of Psychiatry, University of São Paulo, Butantã, São Paulo, Brazil
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23
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Aragay N, Barrios M, Ramirez-Gendrau I, Garcia-Caballero A, Garrido G, Ramos-Grille I, Galindo Y, Martin-Dombrowski J, Vallès V. Impulsivity profiles in pathological slot machine gamblers. Compr Psychiatry 2018; 83:79-83. [PMID: 29625378 DOI: 10.1016/j.comppsych.2018.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/16/2018] [Accepted: 03/17/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables. METHODS 126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles. RESULTS According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2. CONCLUSIONS We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches.
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Affiliation(s)
- Núria Aragay
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain).
| | - Maite Barrios
- Quantitative Psychology Unit, Faculty of Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (Neuro UB), University of Barcelona, Barcelona, Spain
| | - Isabel Ramirez-Gendrau
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Anna Garcia-Caballero
- Pathological Gambling Unit, Consorci Sanitari de Terrassa, Barcelona, (Spain); Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Gemma Garrido
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Irene Ramos-Grille
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | - Yésika Galindo
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
| | | | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, (Spain)
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24
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Pickering D, Keen B, Entwistle G, Blaszczynski A. Measuring treatment outcomes in gambling disorders: a systematic review. Addiction 2018; 113:411-426. [PMID: 28891116 PMCID: PMC5836978 DOI: 10.1111/add.13968] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross-study evaluations and hindered the development of best-practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery. METHODS A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6-month follow-up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adhered to. RESULTS Thirty-four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty-three different outcome measures were identified: 25 (39.7%) assessed gambling-specific constructs, 36 (57.1%) assessed non-gambling specific constructs, and two instruments were used across both categories (3.2%). Self-report instruments ranged from psychometrically validated to ad-hoc author-designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing. CONCLUSIONS In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder-specific symptoms and behaviours suggests a multi-dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.
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Affiliation(s)
| | - Brittany Keen
- School of PsychologyUniversity of SydneySydneyAustralia
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25
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Maniaci G, La Cascia C, Picone F, Lipari A, Cannizzaro C, La Barbera D. Predictors of early dropout in treatment for gambling disorder: The role of personality disorders and clinical syndromes. Psychiatry Res 2017; 257:540-545. [PMID: 28886591 DOI: 10.1016/j.psychres.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/22/2017] [Accepted: 08/05/2017] [Indexed: 12/12/2022]
Abstract
Several treatment options for gambling disorder (GD) have been tested in recent years; however dropout levels still remain high. This study aims to evaluate whether the presence of psychiatric comorbidities predicts treatment outcome according to Millon's evolutionary theory, following a six-month therapy for GD. The role of severity, duration of the disorder, typology of gambling (mainly online or offline) and pharmacological treatment were also analysed. The recruitment included 194 pathological gamblers (PGs) to be compared with 78 healthy controls (HCs). Psychological assessment included the South Oaks Gambling Screen and the Millon Clinical Multiaxial Inventory-III. The "treatment failure" group (n = 70) comprised PGs who prematurely dropped out of the treatment whereas the "abstinent group" (n = 124) included PGs who completed the treatment regardless of whether the outcome was successful or not. As expected, the presence of psychiatric comorbidities was highlighted as a significant predictor in dropping out of the therapy. Specifically negativistic personality disorder, antisocial personality disorder, drug dependence and PTSD were associated with early dropout. These variables were predictive of treatment outcome independently from the typology of gambling, severity, duration of the disorder and pharmacological treatment. Implications for psychological and psychiatric care are discussed.
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Affiliation(s)
- G Maniaci
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy.
| | - C La Cascia
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | - F Picone
- Dept. Pathological Addiction, ASP Palermo, Italy
| | - A Lipari
- Dept. Pathological Addiction, ASP Palermo, Italy
| | - C Cannizzaro
- Department of Sciences for Health Promotion and Mother and Child Care"Giuseppe D'Alessandro"University of Palermo, Italy
| | - D La Barbera
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
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26
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Lee JY, Park SM, Kim YJ, Kim DJ, Choi SW, Kwon JS, Choi JS. Resting-state EEG activity related to impulsivity in gambling disorder. J Behav Addict 2017; 6:387-395. [PMID: 28856896 PMCID: PMC5700729 DOI: 10.1556/2006.6.2017.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and aims Impulsivity is a core feature of gambling disorder (GD) and is related to the treatment response. Thus, it is of interest to determine objective neurobiological markers associated with impulsivity in GD. We explored resting-state electroencephalographic (EEG) activity in patients with GD according to the degree of impulsivity. Methods In total, 109 GD subjects were divided into three groups according to Barratt impulsiveness scale-11 (BIS-11) scores: high (HI; 25th percentile of BIS-11 scores, n = 29), middle (MI; 26th-74th percentile, n = 57), and low-impulsivity (LI) groups (75th percentile, n = 23). We used generalized estimating equations to analyze differences in EEG absolute power considering group (HI, MI, and LI), brain region (frontal, central, and posterior), and hemisphere (left, midline, and right) for each frequency band (delta, theta, alpha, beta, and gamma). Results The results indicated that GD patients in the HI group showed decreased theta absolute power, and decreased alpha and beta absolute power in the left, right, particularly midline frontocentral regions. Discussion and conclusions This study is a novel attempt to reveal impulsive features in GD by neurophysiological methods. The results suggest different EEG patterns among GD patients according to the degree of impulsivity, raising the possibility of neurophysiological objective features in GD and helping clinicians in treating GD patients with impulsive features.
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Affiliation(s)
- Ji Yoon Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea,Interdisciplinary Program in Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Su Mi Park
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea,Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Jin Kim
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Dai Jin Kim
- Department of Psychiatry, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Sam-Wook Choi
- Department of Psychiatry, True Mind Mental Health Clinic, and Korea Institute on Behavioral Addictions, Seoul, Republic of Korea,Health Care & Information Research Institute, Namseoul University, Cheonan, Republic of Korea,Corresponding authors: Jung-Seok Choi, MD, PhD; Department of Psychiatry, SMG-SNU Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul 07061, Republic of Korea; Phone: +82 2 870 3461; Fax: +82 2 831 2826; E-mail: ; Sam-Wook Choi, MD, PhD; Department of Psychiatry, True Mind Mental Health Clinic, and Korea Institute on Behavioral Addictions, F7, KR Tower, 1 141, Teheran-ro, Gangnam-gu, Seoul 06132, Republic of Korea; Phone: +82 2 568 0005; Fax: +82 2 568 1580; E-mail:
| | - Jun Soo Kwon
- Interdisciplinary Program in Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Seok Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea,Corresponding authors: Jung-Seok Choi, MD, PhD; Department of Psychiatry, SMG-SNU Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul 07061, Republic of Korea; Phone: +82 2 870 3461; Fax: +82 2 831 2826; E-mail: ; Sam-Wook Choi, MD, PhD; Department of Psychiatry, True Mind Mental Health Clinic, and Korea Institute on Behavioral Addictions, F7, KR Tower, 1 141, Teheran-ro, Gangnam-gu, Seoul 06132, Republic of Korea; Phone: +82 2 568 0005; Fax: +82 2 568 1580; E-mail:
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27
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Echeburúa E, Gómez M, Freixa M. Prediction of Relapse After Cognitive-Behavioral Treatment of Gambling Disorder in Individuals With Chronic Schizophrenia: A Survival Analysis. Behav Ther 2017; 48:69-75. [PMID: 28077222 DOI: 10.1016/j.beth.2016.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/20/2016] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Abstract
Gambling disorder (GD) in individuals with chronic schizophrenia is relevant because there are higher rates of GD in schizophrenic populations (10%) than in the nonschizophrenic population (1%-5%). In addition, these patients have more severe alcohol use disorder (i.e., meeting at least 6 of the DSM-5 11 criteria for diagnosis of this disorder), higher depression scores, a poor adherence to treatment, and more frequent use of outpatient mental health care. One of the main problems in GD is therapeutic failure (defined as three or more lapse episodes during treatment) or relapse (three or more lapse episodes in the follow-up period). Predicting a relapse of GD in individuals with chronic schizophrenia can be useful in targeting the patients for aftercare services. The main aim of this study was to estimate the time to a GD relapse (survival rate) and to evaluate some of the qualitative and quantitative variables related to a GD relapse by a survival analysis. The sample consisted of 35 patients with chronic schizophrenia and GD who were treated with pharmacological and cognitive-behavioral therapy. The therapeutic failure rate in the treatment period was 43%, and it was associated with the number of episodes of schizophrenia, the age of gambling onset, and the age of the patients. The relapse rate in the follow-up period was 32%, and it was associated with the patients' age, educational level, and weekly allowance. The implications of this study for future research are discussed.
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28
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Gori A, Craparo G, Caretti V, Giannini M, Iraci-Sareri G, Bruschi A, Janiri L, Ponti L, Tani F. Impulsivity, alexithymia and dissociation among pathological gamblers in different therapeutic settings: A multisample comparison study. Psychiatry Res 2016; 246:789-795. [PMID: 28029440 DOI: 10.1016/j.psychres.2016.10.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 10/19/2016] [Accepted: 10/22/2016] [Indexed: 11/15/2022]
Abstract
Since many psychopathological traits seem to be related to Gambling Disorder (GD), impulsivity, alexithymia and dissociation could play a central role in gambling behaviors, particularly in pathological gambling. We test this hypothesis in four distinct samples of gamblers, three undergoing different types of treatments and a control group. The study sample consists of 204 subjects (males 87.3%, mean age=47.75 years, SD=12.08) divided into four groups: (1) 59 subjects belonging to an Outpatients Treatment Program in the National Health System (NHS); (2) 60 subjects of an Outpatients Self-Help Group Program; (3) 35 subjects belonging to a Residential Treatment Program (Inpatients Program); and (4) 50 subjects without gambling problems (Control Group). Results show a positive relationship between gambling behaviors, impulsivity and alexithymia, and a negligible link between gambling behaviors and dissociation. Findings also display the presence of higher levels of all these features in pathological gamblers with higher scores on the SOGS, and particularly, in participants attending a Residential Treatment Program (Inpatients Program). This study confirms the hypothesis of the presence of higher levels of impulsivity, alexithymia and dissociation in pathological gamblers with a greater severity and seems to indicate a significant importance of impulsivity and alexithymia in predicting gambling behaviors.
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Affiliation(s)
- Alessio Gori
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy; Department of Education and Psychology, University of Florence, Florence, Italy; New Social Pathologies Research Unit, University of Florence, Florence, Italy; Italian Society of Psychological Assessment (SIPDC), Italy.
| | - Giuseppe Craparo
- Italian Society of Psychological Assessment (SIPDC), Italy; University of Enna "Kore", Enna, Italy
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy; Italian Society of Psychological Assessment (SIPDC), Italy
| | - Marco Giannini
- Italian Society of Psychological Assessment (SIPDC), Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Angelo Bruschi
- Institute of Psychiatry and Clinical Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Clinical Psychology, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Ponti
- New Social Pathologies Research Unit, University of Florence, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Franca Tani
- New Social Pathologies Research Unit, University of Florence, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
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29
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Martínez Ortega Y, Gomà-i-Freixanet M, Valero S. Psychometric Properties and Normative Data of the Zuckerman–Kuhlman Personality Questionnaire in a Psychiatric Outpatient Sample. J Pers Assess 2016; 99:219-224. [DOI: 10.1080/00223891.2016.1217419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yolanda Martínez Ortega
- Mental Health Center, Althaia University Hospital of Manresa, Catalonia, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalonia, Spain
| | | | - Sergi Valero
- Psychiatry Department, Vall d'Hebron University Hospital, CIBERSAM, Universitat Autònoma de Barcelona, Catalonia, Spain
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30
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Personality profile of binge drinking in university students is modulated by sex. A study using the Alternative Five Factor Model. Drug Alcohol Depend 2016; 165:120-5. [PMID: 27262897 DOI: 10.1016/j.drugalcdep.2016.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The prevalence of binge drinking (BD), found especially among young people, is increasing worldwide and has become an important social and health concern. We studied, for the first time, the personality profile, using the Alternative Five Factor Model, among university students with BD and healthy controls, taking into account the possible influence of sex. METHODS 70 participants with BD (30 men) and 70 healthy controls (30 men) were included, selected to control for characteristics that are known to be related to BD (physical and mental disorders, consumption of other drugs, circadian rhythms), completed the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). RESULTS The scores on Neuroticism-Anxiety and Impulsive Sensation-Seeking were higher in the BD group compared to the controls (p<0.001 in both cases). The higher scores in the BD group in Neuroticism-Anxiety are due to higher scores in the women's group (p=0.014), while those in Impulsive Sensation-Seeking are due to higher scores in the men's group (p=0.009), both in the Impulsivity and in the Sensation-Seeking subscales (p<0.045). CONCLUSIONS Sex could be a factor that modulates the endophenotype of drug dependence (impulsive and anxious personality) and the prevention and/or treatment programs for BD should include not only the management of the personality risk factors but also different tailored approaches according to sex.
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Merkouris SS, Thomas SA, Browning CJ, Dowling NA. Predictors of outcomes of psychological treatments for disordered gambling: A systematic review. Clin Psychol Rev 2016; 48:7-31. [PMID: 27372437 DOI: 10.1016/j.cpr.2016.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 04/22/2016] [Accepted: 06/21/2016] [Indexed: 12/20/2022]
Abstract
This systematic review aimed to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling across multiple time-points (i.e., post-treatment, short-term, medium-term, and long-term). A systematic search from 1990 to 2016 identified 50 articles, from which 11 socio-demographic, 16 gambling-related, 21 psychological/psychosocial, 12 treatment, and no therapist-related variables, were identified. Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points. Likely predictors of successful treatment outcomes also included older age, lower gambling symptom severity, lower levels of gambling behaviours and alcohol use, and higher treatment session attendance. Significant associations, at a minimum of one time-point, were identified between successful treatment outcomes and being employed, ethnicity, no gambling debt, personality traits and being in the action stage of change. Mixed results were identified for treatment goal, while education, income, preferred gambling activity, problem gambling duration, anxiety, any psychiatric comorbidity, psychological distress, substance use, prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point. Further research involving consistent treatment outcome frameworks, examination of treatment and therapist predictor variables, and evaluation of predictors across long-term follow-ups is warranted to advance this developing field of research.
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Affiliation(s)
- S S Merkouris
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully road, Notting Hill, Victoria 3165, Australia; School of Psychology, Faculty of Health, Deakin University, Geelong, Locked Bag 20000, Geelong, 3220, Australia.
| | - S A Thomas
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully road, Notting Hill, Victoria 3165, Australia; International Institute for Primary Health Care Research, Shenzhen City, Guangdong Province, People's Republic of China
| | - C J Browning
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully road, Notting Hill, Victoria 3165, Australia; RDNS Institute, RDNS, 31 Alma road, St Kilda, Victoria 3182, Australia; International Institute for Primary Health Care Research, Shenzhen City, Guangdong Province, People's Republic of China
| | - N A Dowling
- School of Psychology, Faculty of Health, Deakin University, Geelong, Locked Bag 20000, Geelong, 3220, Australia; Melbourne Graduate School of Education, University of Melbourne, Australia; Centre for Gambling Research, School of Sociology, Australian National University, ACT, Australia
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[To take into account addicted patients' motivation to seek treatment. About a case report of a disordered gambler]. Presse Med 2016; 45:1147-1153. [PMID: 27067629 DOI: 10.1016/j.lpm.2016.02.018] [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] [Received: 12/29/2015] [Revised: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Only few subjects with addictive disorders seek treatment. Early identification and intervention are capital. Compliance for addictions' treatment remains low. Motivation enhancement promotes alliance and therapeutic compliance. Therapeutic goals should be discussed with the patient. It is important to diagnose the psychiatric and addictive comorbid disorders, which are frequent.
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Jiménez-Murcia S, Del Pino-Gutiérrez A, Fernández-Aranda F, Granero R, Hakänsson A, Tárrega S, Valdepérez A, Aymamí N, Gómez-Peña M, Moragas L, Baño M, Sauvaget A, Romeu M, Steward T, Menchón JM. Treatment Outcome in Male Gambling Disorder Patients Associated with Alcohol Use. Front Psychol 2016; 7:465. [PMID: 27065113 PMCID: PMC4815556 DOI: 10.3389/fpsyg.2016.00465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/15/2016] [Indexed: 11/15/2022] Open
Abstract
Aims: The primary objective of this study was to analyze the association between alcohol consumption and short-term response to treatment (post intervention) in male patients with gambling disorder enrolled in a group cognitive behavioral therapy (CBT) program. Methods: The sample consisted of 111 male individuals with a diagnosis of Gambling Disorder, with a mean age of 45 years (SD = 12.2). All participants were evaluated by a comprehensive assessment battery and assigned to CBT groups of 10–14 patients attending 16 weekly outpatient sessions lasting 90 min each. Results: The highest mean pre- and post-therapy differences were recorded for the alcohol risk/dependence group on the obsessive/compulsive and anxiety dimensions of the SCL-90-R. As regards the presence of relapses and dropouts over the course of the CBT sessions, the results show a significant association with moderate effect size: patients with risk consumption or alcohol dependence were more likely to present poor treatment outcomes. Conclusions: Alcohol abuse was frequent in GD, especially in patients with low family income and high accumulated debts. High levels of somatization and high overall psychopathology (measured by the SCL-90-R) were associated with increased risk of alcohol abuse. Alcohol abuse was also associated with poor response to treatment.
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Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of BarcelonaBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Anders Hakänsson
- Division of Psychiatry, Department of Clinical Sciences, Lund University Lund, Sweden
| | - Salomé Tárrega
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Ana Valdepérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Anne Sauvaget
- Addictology and Psychiatry Department, Nantes University Hospital Nantes, France
| | - Maria Romeu
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Departament of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain; CIBER Salud Mental, Instituto Carlos IIIBarcelona, Spain
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Lim MSM, Jocham G, Hunt LT, Behrens TEJ, Rogers RD. Impulsivity and predictive control are associated with suboptimal action-selection and action-value learning in regular gamblers. INTERNATIONAL GAMBLING STUDIES 2015; 15:489-505. [PMID: 27274706 DOI: 10.1080/14459795.2015.1078835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heightened impulsivity and cognitive biases are risk factors for gambling problems. However, little is known about precisely how these factors increase the risks of gambling-related harm in vulnerable individuals. Here, we modelled the behaviour of eighty-seven community-recruited regular, but not clinically problematic, gamblers during a binary-choice reinforcement-learning game, to characterise the relationships between impulsivity, cognitive biases, and the capacity to make optimal action selections and learn about action-values. Impulsive gamblers showed diminished use of an optimal (Bayesian-derived) probability estimate when selecting between candidate actions, and showed slower learning rates and enhanced non-linear probability weighting while learning action values. Critically, gamblers who believed that it is possible to predict winning outcomes (as 'predictive control') failed to use the game's reinforcement history to guide their action selections. Extensive evidence attests to the ease with which gamblers can erroneously perceive structure in the reinforcement history of games when there is none. Our findings demonstrate that the generic and specific risk factors of impulsivity and cognitive biases can interfere with the capacity of some gamblers to utilise structure when it is available in the reinforcement history of games, potentially increasing their risks of sustaining gambling-related harms.
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Affiliation(s)
- Matthew S M Lim
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Gerhard Jocham
- Centre for Functional Magnetic Resonance Imaging of the Brain (fMRIB), University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Laurence T Hunt
- Centre for Functional Magnetic Resonance Imaging of the Brain (fMRIB), University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Timothy E J Behrens
- Centre for Functional Magnetic Resonance Imaging of the Brain (fMRIB), University of Oxford, John Radcliffe Hospital, Oxford, UK
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Smith D, Battersby M, Harvey P. Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults? Addict Behav 2015; 48:12-8. [PMID: 25935717 DOI: 10.1016/j.addbeh.2015.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies. METHODS We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N=454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity. RESULTS Men (n=280, mean age=37.4years, SD=11.4) were significantly younger than women (n=174, mean age=48.7years, SD=12.9) (p<0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p<0.001 and p=0.004, respectively) whilst insignificant for women (p=0.164 and p=0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women. CONCLUSION This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention.
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Affiliation(s)
- David Smith
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide, SA 2001, Australia.
| | - Malcolm Battersby
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide, SA 2001, Australia.
| | - Peter Harvey
- Flinders University, Department of Psychiatry, Flinders Human Behaviour and Health Research Unit, GPO Box 2100, Adelaide, SA 2001, Australia.
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