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Shchaslyvyi AY, Antonenko SV, Telegeev GD. Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1077. [PMID: 39200687 PMCID: PMC11353953 DOI: 10.3390/ijerph21081077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024]
Abstract
The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.
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Affiliation(s)
- Aladdin Y. Shchaslyvyi
- Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, 150, Zabolotnogo Str., 03143 Kyiv, Ukraine; (S.V.A.); (G.D.T.)
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Najavits LM, Ledgerwood DM, Afifi TO. A Randomized Controlled Trial for Gambling Disorder and PTSD: Seeking Safety and CBT. J Gambl Stud 2023; 39:1865-1884. [PMID: 37306874 PMCID: PMC10258785 DOI: 10.1007/s10899-023-10224-z] [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: 05/21/2023] [Indexed: 06/13/2023]
Abstract
Studies show a compelling association between gambling disorder and posttraumatic stress disorder. However, there have been no randomized controlled trials for this co-morbidity. The aim of the current study was to compare two evidence-based models, one that addresses both disorders and another that addresses gambling alone. Sixty-five men and women with gambling disorder and posttraumatic stress disorder were randomized to one of two treatment conditions delivered via telehealth, Seeking Safety (integrated treatment for gambling and posttraumatic stress disorder) or Cognitive-Behavioral Therapy for Pathological Gambling (for gambling alone), in a randomized controlled non-inferiority trial. Primary outcomes were net gambling losses and number of sessions gambling. Secondary outcomes were posttraumatic stress disorder symptoms, coping skills, general psychiatric symptoms, global functioning, and gambling cognitions. Assessment occurred at baseline, 6-weeks, 3 months (end of treatment) and 1-year. On most measures, including primary outcomes, participants improved significantly over time with no difference between treatment conditions. Seeking Safety patients had significantly higher session attendance. Effect sizes were large for gambling, posttraumatic stress disorder and coping. All other measures except one showed medium effect sizes. Therapeutic alliance, treatment satisfaction, and the telehealth format were all rated positively. This was the first randomized trial of Seeking Safety in a gambling disorder population. Seeking Safety showed comparable efficacy to an established gambling disorder intervention; and significantly higher Seeking Safety attendance indicates especially strong engagement. Our finding of overall comparable results between the two treatments is consistent with the comorbidity treatment literature.Trial registration: ClinicalTrials.gov NCT02800096; Registration date: June 14, 2016.
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Affiliation(s)
- Lisa M. Najavits
- Treatment Innovations, Newton Centre, MA USA
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA USA
| | - David M. Ledgerwood
- Department of Psychology, University of Windsor, Windsor, ON Canada
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI USA
| | - Tracie O. Afifi
- Department of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Canada
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Stefanovics EA, Potenza MN, Tsai J, Pietrzak RH. Prevalence and Clinical Characteristics of Recreational and At-Risk/Problematic Gambling in a National Sample of U.S. Military Veterans. J Gambl Stud 2023; 39:1077-1097. [PMID: 36378356 DOI: 10.1007/s10899-022-10165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
Gambling among U.S. military veterans is common, with more extensive involvement linked to gambling disorder and associated problems. This study examined associations between recreational gambling (RG) and at-risk/problem gambling (ARPG), and clinical measures (psychiatric disorders, substance use), behaviors (suicidality, homelessness, arrests) and functioning in a nationally representative sample of U.S. military veterans. Data were analyzed from 4069 veterans who participated in the National Health and Resilience in Veterans Study. Chi-square tests, analyses of variance (ANOVAs) and logistic regressions were conducted to examine unadjusted and adjusted associations between gambling group status and lifetime and current psychiatric diagnoses and behavioral and functioning measures. A significant minority of U.S. veterans reported gambling, with 27.3% (95% confidence interval [CI] 25.5-29.1%) exhibiting RG and 4.9% (95% CI 4.0-5.9%) screening positive for ARPG. The prevalence of ARPG was higher among younger, non-White, male veterans, while RG was more prevalent among retired veterans and those with higher household incomes relative to non-gambling (NG) individuals. ARPG was associated with greater trauma burden, lifetime and current psychiatric diagnoses, mental health treatment, alcohol and drug use disorders, suicidal ideation, homelessness, arrests, and poorer functioning relative to NG and RG, with stronger magnitude differences relative to NG. RG was associated with substance use disorders and arrest histories relative to NG. Results of the current study provide an up-to-date estimate of the current prevalence of RG and ARPG among U.S. veterans and underscore the importance of routine screening and monitoring of gambling problems, as well as interventions for ARPG in this population.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), VA Connecticut Healthcare System (116A-4), 950 Campbell Avenue, Building 36, West Haven, CT, 06516, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center, Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
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Rosansky JA, Borgogna NC, Kraus SW, Grubbs JB. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022; 19:1813-1823. [PMID: 36216746 DOI: 10.1016/j.jsxm.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exposure to traumatic experiences represent one factor that may contribute to the development of hypersexual behaviors. AIM We investigated the associations between posttraumatic stress symptoms and hypersexual behaviors by analyzing survey data from 2 samples. METHOD The first sample consisted of n = 585 college students, and the second consisted of n = 786 adults recruited via Amazon's Mechanical Turk (MTurk), n = 337 of whom completed a 6-month follow-up survey. We conducted 3 hierarchical regression analyses adjusting for age, gender, sexual orientation, impulsivity, drug use, alcohol use, and gambling. OUTCOMES The primary outcomes for this investigation were associations between posttraumatic stress symptoms, measured using the PTSD Checklist for DSM-IV and DSM-5 (PCL-C and PCL-5), and hypersexual behaviors, measured using the Hypersexual Behavior Inventory (HBI). RESULTS A significant regression, R2 = 0.230, R2adjusted = 0.211, F (14,570) = 12.17, P < .001, revealed posttraumatic stress symptoms were associated with hypersexual behaviors in the university student sample (β = 0.154). A significant regression using the MTurk sample, R2 = 0.403, R2adjusted = 0.392, F (14,771) = 37.13, P < .001, confirmed this finding (β = 0.259). In addition, a significant regression, R2 = 0.562, R2adjusted = 0.541, F (15,321) = 27.42, P < .001, indicated that posttraumatic stress symptoms were longitudinally associated with increased hypersexual behaviors (β = .190) after adjusting for all variables, including baseline hypersexuality. CLINICAL TRANSLATION Results suggest that individuals experiencing posttraumatic stress symptoms are at increased risk for current and future hypersexual behaviors. STRENGTHS & LIMITATIONS This investigation involved secondary analyses of adults who had gambled at least once in their lives and findings may not generalize to those who have never gambled. Furthermore, longitudinal findings may be impacted by selection bias (42% completion rate) and may not generalize to follow up periods longer than 6-months. CONCLUSION This study provides support for the hypothesis that posttraumatic stress symptoms are associated with increased hypersexual behavior, and further research is indicated to explore the etiology and directionality of this relationship. Rosansky JA, Borgogna NC, Kraus SW, et al. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022;19:1813-1823.
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Affiliation(s)
- Joseph A Rosansky
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychology, Bowling Green State University, Bowling Green, OH, USA.
| | - Nicholas C Borgogna
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Joshua B Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
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Dighton G, Wood K, Armour C, Fossey M, Hogan L, Kitchiner N, Larcombe J, Rogers RD, Dymond S. Gambling problems among United Kingdom armed forces veterans: Associations with gambling motivation and posttraumatic stress disorder. INTERNATIONAL GAMBLING STUDIES 2022. [DOI: 10.1080/14459795.2022.2063923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Glen Dighton
- School of Psychology, Swansea University, Swansea, UK
| | - Katie Wood
- School of Psychology, Swansea University, Swansea, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, Queen’s University Belfast, Northern Ireland, UK
| | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, UK
| | - Lee Hogan
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Neil Kitchiner
- Veterans NHS Wales, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | | | - Robert D. Rogers
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, UK
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
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Derman RC, Lattal KM. Persistent effects of acute trauma on Pavlovian-to-instrumental transfer. Front Behav Neurosci 2022; 16:1028262. [PMID: 36386783 PMCID: PMC9659590 DOI: 10.3389/fnbeh.2022.1028262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
In humans, an acutely traumatic experience can lead to post-traumatic stress disorder (PTSD), which is often characterized by changes in anxiety and motivation months after trauma. There are few demonstrations of the persistent motivational effects of an acute stressor in rodent approaches to PTSD. In two experiments, we evaluated the persistent effects of a battery of footshocks in one context on appetitive Pavlovian conditioning, instrumental learning, and Pavlovian-to-instrumental transfer (PIT) in a different context. In Experiment 1, a battery of footshocks before appetitive training caused deficits in single-outcome PIT (SO-PIT) in male Long Evans rats. The same battery of footshocks after appetitive training, but before testing had little effect on SO-PIT overall, but there were some deficits in within-stimulus expression of SO-PIT. In Experiment 2, the battery of footshocks had no effect on sensory-specific PIT in male or female rats, but two sex differences emerged: males showed more generalized fear from the aversive to the appetitive context compared to females, and females showed less evidence for sensory-specific PIT compared to males. Males showed robust sensory-specific PIT, with clear extinction and spontaneous recovery of the sensory-specific PIT effect across test sessions. These findings show that (a) an acute trauma can have persistent effects on general motivational processes and (b) in sensory-specific PIT, females may show transfer through generalized motivational processes, whereas males may rely on specific features of the cues and outcomes to augment instrumental responding selectively. We discuss implications for current approaches to stress and motivation in preclinical approaches to PTSD.
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Geng F, Tu L, Zhan N, Zhang Y, Wang J. Associations of substance abuse histories and gambling addiction history with post-traumatic stress symptoms and depressive symptoms among Chinese prisoners. Eur J Psychotraumatol 2021; 12:1906022. [PMID: 33968330 PMCID: PMC8075087 DOI: 10.1080/20008198.2021.1906022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Although there are over two million prisoners in China, few studies have reported the prevalence and correlates of mental health problems in this population. Objective: This study investigated the prevalence rates of trauma exposure, post-traumatic stress disorder (PTSD) and depression among Chinese male prisoners and further examined the associations of substance abuse histories and gambling addiction history with PTSD and depressive symptoms. Method: Participants were 1,484 male prisoners (mean age 35.44 years, sd = 9.66) recruited from a large prison in Guangdong, China. Self-administered standardized questionnaires were used to assess trauma exposure, histories of substance abuse and perceived gambling addiction, social supports, childhood trauma, PTSD and depression. Criminal background information was extracted from jail record. Linear regressions were performed to examine the correlates of PTSD and depressive symptoms. Results: Of these participants, 78.8% had experienced at least one trauma exposure, 26.7% had drug addiction, 85.5% had smoked cigarettes, 70.8% had used alcohol and 21.4% had gambling addiction before incarceration. The prevalence rates of PTSD and depression were 7.1% and 28.8%, respectively. Trauma exposure was significantly associated with PTSD and depressive symptoms, but not substance abuse histories and gambling history except for drinking. Histories of drinking and perceived gambling addiction were significantly related to PTSD and depressive symptoms after adjustment of demographics, criminal background, health status, social supports, childhood trauma and lifetime traumatic exposure. Conclusions: Trauma exposure, PTSD and depression are common among prisoners. Furthermore, this study for the first time demonstrates a significant relationship between gambling addiction history and PTSD.
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Affiliation(s)
- Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Liangqi Tu
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Yeqing Zhang
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, P.R. China
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Chee TT, Lui YS. Pathological Gambling, Gambling Disorder, and Problem Gambling Among the Chinese Ethnic Population Living in Western Countries: Is Culture a Sufficient Explanation for the Reported Excess Rates? J Gambl Stud 2021; 37:927-945. [PMID: 33521910 DOI: 10.1007/s10899-021-10012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
A significant gap remains in the understanding of the psychosocial and cultural factors and processes in the development and maintenance of pathological gambling, gambling disorder, and problem gambling among the Chinese ethnic population living in the Western countries. This narrative reviews papers on gambling and pathological gambling among the Chinese ethnic group in Western countries to provide a deeper understanding of the cultural and psychosocial factors and processes that lead to the development and maintenance of pathological gambling, gambling disorder, and problem gambling. The factors leading to development of problem gambling, which also carry distinctive cultural differences, include acculturation process among Chinese migrants to western countries, their social learning patterns in gambling, the patterns and motivation seen in Chinese gamblers, their gambling-related cognitive bias and distortions as well as barriers to their help-seeking behaviours. The collectivistic oriental culture may explain for intrafamilial development of gambling behaviour and this strong male authority in the traditional Chinese family set-up also reinforces this influence. The Chinese culture is associated with increased risk-taking behaviour. Superstitious thinking is more prevalent in the Chinese culture and this can be manifested in individuals' perceptions of fate and luck. Future research projects studying pathological gambling and ethnic minorities in the UK should seek greater understanding and improved management of this condition in a small but highly relevant population.
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Affiliation(s)
- Tji Tjian Chee
- Department of Psychological Medicine, National University Hospital, Singapore, 119228, Singapore
| | - Yit Shiang Lui
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University Health System, 1E Kent Ridge Road, Level 9 NUHS Tower Block, Singapore, 119228, Singapore.
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Kraus SW, Potenza MN, Ngo T, Pugh K, Bernice K, Shirk SD. Screening for Gambling Disorder in VA Primary Care Behavioral Health: A Pilot Study. Issues Ment Health Nurs 2020; 41:1076-1082. [PMID: 32783750 DOI: 10.1080/01612840.2020.1793249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current pilot study assessed the prevalence of at-risk/problem gambling using the Brief Biosocial Gambling Screen (BBGS) among a sample of U.S. military veterans seeking mental health treatment services in a primary care medical setting at a Veterans Affairs (VA) hospital in the Northeast. Out of the 260 veterans screened, 85 veterans (32.7%) reported gambling behaviors within the past 12 months. No significant differences were found between gambling and non-gambling veterans on demographics, medical, or mental health conditions collected in the study. Among veteran past-year gamblers, five veterans (5.9%) screened positive for at-risk/problem gambling. The estimated prevalence of problem gambling was 1.9% among veterans screened in a primary care behavioral health clinic. Results suggest that self-disclosure of problem gambling among veterans, as well as outreach efforts by VA health care providers, could serve to increase veterans' participation in treatment services for problem gambling. Larger, well-powered studies that examine the utility of the BBGS for detecting problem gambling among military populations are needed.
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Affiliation(s)
- Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Marc N Potenza
- Connecticut Council on Problem Gambling, Wethersfield, Connecticut, USA.,Connecticut Mental Health Center, New Haven, Connecticut, USA.,Department of Neuroscience and Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tu Ngo
- Edith Nourse Rogers Memorial Hospital, Bedford, Massachusetts, USA
| | - Kendra Pugh
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Hospital, Bedford, Massachusetts, USA
| | - Katarina Bernice
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Hospital, Bedford, Massachusetts, USA
| | - Steven D Shirk
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Hospital, Bedford, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Grubbs JB, Chapman H. Predicting Gambling Situations: The Roles of Impulsivity, Substance Use, and Post-Traumatic Stress. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819852641. [PMID: 31258327 PMCID: PMC6591666 DOI: 10.1177/1178221819852641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/02/2019] [Indexed: 12/04/2022]
Abstract
Gambling disorder and symptoms of post-traumatic stress are highly comorbid.
Numerous studies suggest that the presence of one (either disordered gambling or
post-traumatic stress) substantially increases the odds of later developing the
other. However, little is known about the etiological links between these two
domains or the nuances of the comorbidity. Past research has suggested that
symptoms of post-traumatic stress might be related to unique motivations for and
beliefs about gambling. The present work sought to examine whether or not
symptoms of post-traumatic stress might also be related to specific situational
vulnerabilities to gambling behaviors. Using a large cross-sectional sample of
Internet-using adults in the United States who were primarily recreational
gamblers (N = 743; 46% men, Mage = 36.0, SD = 11.1),
as well as an inpatient sample of US Armed Forces veterans seeking treatment for
gambling disorder (N = 332, 80% men, Mage = 53.5,
SD = 11.5), the present work tested whether or not symptoms of post-traumatic
stress were uniquely related to a variety of gambling situations. Results in
both samples revealed that even when controlling for potentially confounding
variables (eg, substance use and trait impulsivity), symptoms of post-traumatic
stress were uniquely related to gambling in response to negative affect,
gambling in response to social pressure, and gambling due to a need for
excitement. These findings are consistent with recent work suggesting that
individuals with post-traumatic stress symptoms are more likely to engage in
gambling behaviors for unique reasons that differ from gamblers without such
symptoms.
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Affiliation(s)
- Joshua B Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Heather Chapman
- Gambling Treatment Program, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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