Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: Profiles and longitudinal prediction of treatment outcomes

Video slot machine use in adolescence: the role of self-efficacy beliefs, current and expected personal fulfillment at the social and educational level

Introduction

Video slot machines (VSMs), which are available on electronic gaming machines and online platforms, are widely recognized for their high potential to trigger harmful gambling behaviors. Yet, the psychological factors associated with VSM use among adolescents remain poorly investigated.

Methods

We estimated adjusted odds ratios (OR) and corresponding 95% confidence intervals (CI) of current regular (at least monthly) VSM use according to self-efficacy beliefs regarding everyday problem-solving ability, along with current and expected personal fulfillment at the social, and educational level among 7,959 Italian high school students aged 15-17.

Results

Current regular VSM use was reported by 108 students (1.4%). Notably, this behavior was more frequently reported by those with either particularly high or low self-ratings in problem-solving ability, current and expected social fulfillment, as well as by those with lower self-ratings in both current and expected educational/work fulfillment.

Conclusions

These findings underscore that during adolescence, gambling behaviors are associated with diverse psychological profiles, each entailing distinct vulnerabilities. Effectively addressing adolescent gambling necessitates a comprehensive approach, with a strong emphasis on educational support. Given the increasing challenges in curbing underage exposure and access to the most harmful gambling formats, this study offers valuable insights for the design of health promotion and prevention strategies.

Mediating Effect of Perceived Personal Luck in the Relationship Between Narcissism and Problem Gambling in Strategic Gamblers: An Exploratory Study

Gambling is becoming increasingly frequent among the French population, which has led to an increased number of individuals exhibiting problematic gambling patterns. Studies have found links between narcissism and cognitive distortions in relation to problem gambling, specifically among strategic gamblers, but none has tested perceived personal luck as one type of cognitive distortion in this regard. This study's purpose was to explore the relationship between narcissism, perceived personal luck and problem gambling among strategic gamblers, and to test for the mediating role of perceived personal luck in the relationship between narcissism and problem gambling. A total of 88 regular strategic gamblers were included (mean age = 37.8), with 49 non-problematic gamblers and 39 problematic gamblers. Participants completed the Problematic Gambling Severity Index, the Narcissistic Personality Inventory, and the Personal Luck Usage Scale. Results showed a significant relationship between narcissism and problem gambling, but no significant link between perceived personal luck and problem gambling and no significant mediation effect of perceived personal luck. These results may indicate a strong perception of personal skills compared to a weak perception of personal luck among problem gamblers of strategic games. This study emphasizes the importance of addressing types of gambling and types of cognitive distortions when investigating problem gambling.

Online Games and Cognitive Distortions: A Comparative Analysis in Students with and without Disabilities

Online games have experienced significant growth in recent years, with gaming becoming a popular form of entertainment for people of all ages. However, their impact on cognition, especially among vulnerable groups such as students with disabilities, is a topic that requires deeper exploration. The objectives of this study are twofold: firstly, to understand the typology of risk players (non-risk players, players with problems, and pathological players); and secondly, to compare cognitive distortions among students with problematic profiles. Both objectives will be analyzed based on the presence or absence of disability. A total of 704 students from various Spanish universities (135 with disabilities and 569 without disabilities), aged between 18 and 38, participated in the study by completing the Gamblers Belief Questionnaire (GBQ), aimed at measuring cognitive distortions related to gambling problems, as well as the Massachusetts Gambling Screen questionnaire, aimed at measuring gambling addiction. The results indicate a higher percentage of students with disabilities showing a greater risk profile for addiction. Additionally, this group of students exhibits more cognitive distortions. These findings underscore the need for a comprehensive approach to addressing online gaming addiction and cognitive distortions among university students, with and without disabilities. Preventive measures are necessary, such as education on responsible technology use and the promotion of alternative activities. Moreover, specific intervention strategies need to be developed, including access to psychological health services for this student population.

Association between endocrine and neuropsychological endophenotypes and gambling disorder severity

BACKGROUND

Neurobiological characteristics have been identified regarding the severity of gambling disorder (GD). The aims of this study were: (1) to examine, through a path analysis, whether there was a relationship between neuroendocrine features, potentially mediational GD variables, and GD severity, and (2) to associate neuroendocrine variables, with GD severity-related variables according to gambling preferences.

METHODS

The sample included 297 outpatients with GD. We analyzed endocrine concentrations of different appetite-related hormones (ghrelin, liver antimicrobial peptide 2 [LEAP-2], leptin, adiponectin), and neuropsychological performance (working memory, cognitive flexibility, inhibition, decision making, premorbid intelligence). Path analysis assessed mechanisms between neuroendocrine features and GD severity, including mediational GD variables (impulsivity traits and gambling-related cognitive distortions). Partial correlations evaluated the associations between neuroendocrine variables, including impulsivity traits, and variables related to GD severity (DSM-5, South Oaks Gambling Screen, illness duration, and gambling-related cognitive distortions).

RESULTS

Lower adiponectin concentrations predicted greater GD severity, while higher LEAP-2 concentrations predicted more gambling-related cognitive distortions. Likewise, better neuropsychological performance directly predicted GD severity, but worse neuropsychological performance was associated with GD severity through the mediational variables of impulsivity traits and gambling-related cognitive distortions. Also, in non-strategic individuals with GD, poor working memory was associated with gambling expectancies and predictive control. In strategic individuals with GD, poor cognitive flexibility was associated with illusion of control, predictive control, and inability to stop gambling.

CONCLUSIONS

These results provide updated information about the comprehension of the interaction between neuroendocrine features, clinical variables, and severity of GD. Thus, neurobiological functions seem to be strongly related to GD severity.

How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers

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.

Betting on Your Feelings: The Interplay between Emotion and Cognition in Gambling Affective Task

Background: Gambling Disorder (GD) is a bio-psycho-social disorder resulting from the interaction of clinical, cognitive, and affective factors. Impulsivity is a crucial factor in addiction studies, as it is closely linked to cognitive distortions in GD by encompassing impulsive choices, motor responses, decision-making, and cognitive biases. Also, emotions, mood, temperament, and affective state are crucial in developing and maintaining GD. Gambling can be used as a maladaptive coping strategy to avoid or escape problems and distress. Methods: The aim of the present study is to explore differences in personality traits and emotion regulation of people suffering from GD, substance-dependent gamblers (SDGs), and healthy controls (HCs). Additionally, the study proposes a new experimental task: the "Gambling Affective Task" (GAT) to investigate the influence of affective priming on risk-taking behaviors. Results: Our findings indicate that participants placed lower bets following positive priming. Additionally, SDGs wagered significantly higher amounts than HCs, regardless of priming type. In general, participants exhibited longer response times after positive priming trials, compared to negative and neutral priming trials. These findings suggest that experiencing positive emotions can act as a protective factor by delaying and lengthening gambling behaviors. By comparing gamblers with and without substance comorbidity, we can gain insight into the exclusive factors of GD and improve our understanding of this disorder. Conclusions: By elucidating the impact of emotional states on risk-taking, the research also provides new insights into the prevention and treatment of GD.

Treatment discontinuation in pharmacological clinical trials for gambling disorder

BACKGROUND

Gambling disorder affects 0.5-2% of the population, and of those who receive treatment, dropout tends to be relatively high. Very little is known about participant-specific variables linked to treatment discontinuation/dropout in gambling disorder, especially in pharmacological clinical trial settings.

METHODS

Data were pooled from eight previous randomized, controlled pharmacological clinical trials conducted in people with gambling disorder. Demographic and clinical variables were compared between those who did versus did not subsequently dropout from those treatment trials.

RESULTS

The sample comprised data from 635 individuals, and the overall rate of treatment dropout was 40%. Subsequent treatment dropout was significantly associated with the following: positive family history of gambling disorder in one or more first degree relatives (relative risk [RR] of dropout in those with positive history vs not = 1.30), preference for mainly strategic vs non-strategic gambling activities (RR = 1.43), lower levels of education (Cohen's D = 0.22), and higher levels of functional disability (Cohen's D = 0.18). These variables did not differ significantly as a function of treatment condition (medication versus placebo). Dropouts and completers did not differ significantly in terms of the other demographic or clinical variables that were considered.

CONCLUSIONS

This study identified several candidate participant-specific predictors of pharmacological treatment dropout in gambling disorder. The findings highlight the need for future studies to address a wider range of contextual variables at large scale (including also study-specific variables e.g. trial/intervention duration), including in naturalistic treatment and clinical trial settings, with a view to developing algorithms that might usefully predict dropout risk.

A Systematic Review on Intervention Treatment in Pathological Gambling

Over the last century, there has been a growing interest in researching pathological gambling, particularly in industrialized nations. Historically, gambling was widely perceived as morally questionable, condemned by religious groups. However, contemporary concerns have shifted towards the health repercussions of gambling disorders and broader societal impacts like increased crime and money laundering. Governments, aiming to mitigate social harm, often regulate or directly oversee gambling activities. The global surge in legal gambling has resulted in a substantial rise in its prevalence, popularity, and accessibility in the last two decades. This paper provides a comprehensive overview of global research on interventions for pathological gambling. Through a systematic search on platforms such as EBSCO, PubMed, and Web of Science, 13 relevant records were identified. The revised findings indicate a heightened occurrence of behavioral addictions, linking them to the early onset of gambling issues and their severe consequences. The research emphasizes the active role that clients play in the process of self-directed change and therapy. Therapists recognizing clients as both catalysts for change and potential obstacles can enhance their effectiveness. A common source of resistance arises when clients and therapists are in different stages of the change process, underlining the importance of therapists aligning with clients' readiness for change. Recognizing the urgent need for a better understanding of this problem in adolescents, this study emphasizes the necessity to tailor prevention and treatment plans based on gender and age-specific requirements.

Do attention-deficit/hyperactivity symptoms influence treatment outcome in gambling disorder?

BACKGROUND AND AIMS

Numerous studies point to the comorbidity between gambling disorder (GD) and attention deficit hyperactivity disorder (ADHD). However, there is a lack of research exploring how ADHD symptoms might influence psychological treatment outcomes for GD. Therefore, we aimed to explore differences between patients with GD with and without self-reported ADHD symptoms regarding psychopathology, personality, sociodemographic and treatment outcome measures.

METHOD

This longitudinal study included 170 patients with GD receiving cognitive behavioral therapy. Multiple self-reported instruments were used to assess clinical variables and sociodemographic measures prior to treatment.

RESULTS

A clinical profile characterized by greater GD severity, higher psychopathology and impulsivity, and less adaptive personality features was observed in patients with self-reported ADHD symptoms compared to those without. No significant differences in treatment response (measured by dropout and relapse rates) were observed between the two groups. However, patients with self-reported ADHD symptoms experienced more severe relapses (i.e., gambled more money) and GD patients who relapsed scored higher on measures of ADHD, particularly inattention.

CONCLUSION

Individuals with GD and self-reported symptoms of ADHD may experience more severe relapses following treatment, suggesting a need for more vigilant follow-up and interventions for patients with this comorbidity.

Cognitive Distortions Associated with Alcohol and Marijuana Use in Uruguayan Citizens

Background: Psychological distress (i.e., incipient symptoms of anxiety, stress, and depression) may promote substance use through increased emission of cognitive distortions. These are automatic irrational thoughts that can promote distress, which in turn increases substance use. Aim: This study analyzed, in a sample of Uruguayan citizens, the unique contribution of cognitive distortions on the frequency and quantity of alcohol or marijuana use, over and above the contribution of psychological distress or the use of emotion regulation strategies. We also assessed whether these variables were associated with having initiated or resumed the use of a substance. Methods: A survey asked about alcohol and marijuana use, psychological distress, emotion regulation strategies, and cognitive distortions. The study comprised a convenience sample of 1132 participants (Mean age = 29.07 ± 8.19 years, 72.26% women). Separate hierarchical linear regression analyses were conducted on the frequency and quantity of alcohol or marijuana use, whereas a logistic regression was applied on having initiated or resumed the use of a substance. Results: Several cognitive distortions were significant predictors of frequency and quantity of alcohol consumption or frequency of marijuana use, over and above psychological distress. Differential emission of automatic thoughts was also associated, along with higher scores of psychological distress, with a significantly higher probability of having initiated the use of a new substance or having resumed the use of a substance. Conclusions: Cognitive distortions may promote alcohol and marijuana use. Interventions aimed at modifying these distortions should be considered to reduce the emission of these behaviors.

Comorbid psychiatric diagnoses and gaming preferences in US armed forces veterans receiving inpatient treatment for gambling disorder

Armed Forces Veterans are uniquely vulnerable to problem gambling and gambling disorder. Even so, research regarding the full clinical profile of veterans with gambling problems lags. Gambling activities vary widely from each other, but most gambling activities can be understood as either strategic (i.e., involving some measure of skill and decision-making as a part of the gambling practice) or non-strategic (i.e., gambling activities that are entirely based on chance). Prior works have found that gamblers that prefer strategic gambling activities and those that prefer nonstrategic gambling activities often differ from each other in key ways, with the two preferences being linked to varying motivations for gambling, varying cognitions about gambling, and the course of gambling disorder. The present work sought to examine how preferences for strategic vs. nonstrategic gambling might be related to psychiatric comorbidities among U.S. Armed Forces Veterans receiving inpatient treatment for Gambling Disorder. Data from U.S. Armed Forces Veterans (N = 401) receiving residential treatment for GD between the years of 2010-2016 were analyzed. Results demonstrated that gamblers that preferred strategic gambling, as opposed to non-strategic gambling, were more likely to be younger, more likely to be men, less likely to have a nicotine use disorder, and less likely to have PTSD. Such findings suggest that gamblers with PTSD are likely to prefer nonstrategic games and may imply a unique vulnerability to gambling problems related to non-strategic gambling among armed forces veterans.

Anandamide and 2-arachidonoylglycerol baseline plasma concentrations and their clinical correlate in gambling disorder

INTRODUCTION

Different components of the endocannabinoid (eCB) system such as their most well-known endogenous ligands, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), have been implicated in brain reward pathways. While shared neurobiological substrates have been described among addiction-related disorders, information regarding the role of this system in behavioral addictions such as gambling disorder (GD) is scarce.

AIMS

Fasting plasma concentrations of AEA and 2-AG were analyzed in individuals with GD at baseline, compared with healthy control subjects (HC). Through structural equation modeling, we evaluated associations between endocannabinoids and GD severity, exploring the potentially mediating role of clinical and neuropsychological variables.

METHODS

The sample included 166 adult outpatients with GD (95.8% male, mean age 39 years old) and 41 HC. Peripheral blood samples were collected after overnight fasting to assess AEA and 2-AG concentrations (ng/ml). Clinical (i.e., general psychopathology, emotion regulation, impulsivity, personality) and neuropsychological variables were evaluated through a semi-structured clinical interview and psychometric assessments.

RESULTS

Plasma AEA concentrations were higher in patients with GD compared with HC (p = .002), without differences in 2-AG. AEA and 2-AG concentrations were related to GD severity, with novelty-seeking mediating relationships.

CONCLUSIONS

This study points to differences in fasting plasma concentrations of endocannabinoids between individuals with GD and HC. In the clinical group, the pathway defined by the association between the concentrations of endocannabinoids and novelty-seeking predicted GD severity. Although exploratory, these results could contribute to the identification of potential endophenotypic features that help optimize personalized approaches to prevent and treat GD.

Validity and Reliability of a Revised S-UPPS-P Impulsive Behavior Scale: The Interplay between Impulsivity and Working Memory

Impulsivity is a multidimensional construct. The UPPS-P model of impulsivity differentiates five distinct dimensions: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The present study, reports the first translation and validation of the recently revised short form of the UPPS-P scale (S-UPPS-P) on a Persian-speaking sample, examining the relationship between impulsivity and working memory. who also completed the Positive and Negative Affect Scale (PANAS), the Buss and Perry Aggression Questionnaire, the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Wechsler Digit Span Task (WDST). A series of confirmatory factor analyses, and Cronbach's alpha results supported the factor structure of the scale. The findings supported the S-UPPS-P model's hypothesized correlations with PANAS, aggressiveness, and the construct validity of the model. The results of hierarchical regression analysis showed that backward and forward digit span scores of the WDST predicted the S-UPPS-P impulsivity scores over the portion explained by BIS/BAS, PANAS, and aggression scores. To conclude, the revised S-UPPS-P Impulsive Behavior Scale was well supported even in a very different population than usually sampled, adding to growing evidence that it assesses distinct but interrelated aspects of the impulsivity construct. Our findings also suggest that attentional capacities and working memory play important roles in the prediction of impulsivity.

Features Linked to Treatment Outcomes in Behavioral Addictions and Related Disorders

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.

Gambling disorder duration and cognitive behavioural therapy outcome considering gambling preference and sex

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.

The Dimensional Structure of the Gambling Attitudes and Beliefs Survey: Challenging the Assumption of the Unidimensionality of Gambling-Specific Cognitive Distortions

The aim of the present study was to examine the dimensional structure of the Gambling Attitudes and Beliefs Survey (GABS). The GABS was administered to a sample of 415 individuals with self-reported problem or pathological gambling who were taking part in two different treatment studies preregistered with the German Clinical Trials Register (DRKS00013888) and ClinicalTrials.gov (NCT03372226). Exploratory factor analyses revealed a three-factor structure. We labeled the factors sensation seeking/illusion of control, luck/gambler's fallacy, and attitude/emotions. Subsequent confirmatory factor analyses proved the three-factor model superior to the one-factor model proposed by the developers of the GABS. All dimensions were significantly correlated with symptom severity scores. Group comparisons showed significantly higher factor scores on the first factor (sensation seeking/illusion of control) for individuals reporting both skill-based and chance-based gambling compared to those reporting only chance-based gambling. The present study questions the unidimensionality of the GABS. A multidimensional assessment of gambling-related cognitive biases, beliefs, and positively valued attitudes may be useful in determining treatment outcomes and goals and in the development of novel interventions.

Cognitive Factors that Predict Gambling Fallacy Endorsement

Gambling fallacies are a collection of error-stricken beliefs about gambling and how gambling works. Gambling fallacies, while common in the general public, appear to increase as a function of gambling severity. This being the case, many interventions have focused on reducing gambling fallacies as a means of treating problem-gambling. Less research, however, has investigated what factors contributes to gambling fallacy susceptibility in the first place. Available studies have identified associations between gambling fallacy susceptibility and isolated individual differences in, for example, statistical reasoning/understanding, intelligence, or cognitive ability. The current study aimed to assess these cognitive factors in conjunction, and their relative predictive potential for gambling fallacy susceptibility. In an Australian university student sample (n = 90) it was found that there were moderate to strong association between gambling fallacy endorsement and general intelligence, probabilistic reasoning ability, rational cognitive style and the ability to suppress intuitive thought, however, only probabilistic reasoning, rational cognitive style and the ability to suppress intuitive thinking contributed to the prediction of fallacy endorsement. Importantly, each of these factors are malleable. Interventions for the correction of gambling-specific fallacious beliefs should focus on these factors.

e-Estesia: A Serious Game for Reducing Arousal, Improving Emotional Regulation and Increasing Wellbeing in Individuals with Gambling Disorder

Gambling disorder (GD) is associated with deficits in emotion regulation and impulsivity-related personality traits. In recent years there has been an increase in the use of serious games (SG) to address these factors with positive results. The aim of this study was to analyze the efficacy of the intervention with a new SG (e-Estesia), as an adjunct to a CBT intervention for GD. The sample comprised two groups (experimental group (n = 40) and control group (n = 64)) of patients with GD diagnosis. Both groups received 16 weekly CBT sessions and, concurrently, only the experimental group received 15 additional sessions with e-Estesia. Pre-post treatment with e-Estesia administered in both groups were: DSM-5 Criteria, South Oaks Gambling Screen, Symptom Checklist-Revised and measure of relapses, dropout and compliance of treatment. As regards the experimental group were also administered: Difficulties in Emotion Regulation Scale, Emotion Regulation Questionnaire, and Impulsive Behavior Scale. No statistically significant differences in the general psychopathological state, emotion regulation or impulsivity were found when comparing the groups. However, patients enrolled in the e-Estesia intervention had significantly less relapses and better indicators of treatment compliance than the control group. Considering these results, the use of complementary tools such as SG are useful for addressing GD.

Metacognition and the effect of incentive motivation in two compulsive disorders: Gambling disorder and obsessive-compulsive disorder

AIMS

Compulsivity is a common phenotype among psychiatric disorders, such as obsessive-compulsive disorder (OCD) and gambling disorder (GD). Deficiencies in metacognition, such as the inability to estimate one's performance via confidence judgments could contribute to pathological decision-making. Earlier research has shown that patients with OCD exhibit underconfidence, while patients with GD exhibit overconfidence. Moreover, it is known that motivational states (e.g. monetary incentives) influence metacognition, with gain (respectively loss) prospects increasing (respectively decreasing) confidence. Here, we reasoned that OCD and GD symptoms might correspond to an exacerbation of this interaction between metacognition and motivation.

METHODS

We hypothesized GD's overconfidence to be exaggerated during gain prospects, while OCD's underconfidence to be worsened in loss context, which we expected to see represented in ventromedial prefrontal cortex (VMPFC) blood-oxygen-level-dependent activity. We tested those hypotheses in a task-based functional magnetic resonance imaging (fMRI) design (27 patients with GD, 28 patients with OCD, 55 controls). The trial is registered in the Dutch Trial Register (NL6171).

RESULTS

We showed increased confidence for patients with GD versus patients with OCD, which could partly be explained by sex and IQ. Although our primary analyses did not support the hypothesized interaction between incentives and groups, exploratory analyses did show increased confidence in patients with GD specifically in gain context. fMRI analyses confirmed a central role for VMPFC in the processing of confidence and incentives, but no differences between the groups.

CONCLUSION

Patients with OCD and those with GD reside at opposite ends of the confidence spectrum, while no interaction with incentives was found, nor group differences in neuronal processing of confidence.

An empirical investigation of the Pathways Model of problem gambling through the conjoint use of self-reports and behavioural tasks

BACKGROUND AND AIMS

Blaszczynski and Nower (2002) conceptualized their Pathways Model by postulating the existence of three subtypes of problem gamblers who share common characteristics, but also present specific ones.

METHODS

This study investigated how the psychological mechanisms postulated in the Pathways Model predict clinical status in a sample that combined treatment-seeking gamblers (n = 59) and non-problematic community gamblers (n = 107). To test the Pathways Model, we computed a hierarchic logistic regression in which variables associated with each postulated pathway were entered sequentially to predict the status of the treatment-seeking gambler. Self-report questionnaires measured gambling-related cognitions, alexithymia, emotional reactivity, emotion regulation strategies and impulsivity. Behavioural tasks measured gambling persistence (slot machine task), decision-making under uncertainty (Iowa Gambling Task) and decision-making under risk (Game of Dice Task).

RESULTS

We showed that specific factors theorized as underlying mechanisms for each pathway predicted the status of clinical gambler. For each pathway, significant predictors included gambling-related cognitive distortions and behaviourally measured gambling persistence (behaviourally conditioned pathway), emotional reactivity and emotion regulation strategies (emotionally vulnerable pathway), and lack of premeditation impulsivity facet (impulsivist-antisocial pathway).

DISCUSSION AND CONCLUSIONS

Our study adds to the body of literature confirming the validity of the Pathways Model and hold important implications in terms of assessment and treatment of problem gambling. In particular, a standardized assessment based on the Pathways Model should promote individualized treatment strategies to allow clinicians to take into account the high heterogeneity that characterizes gambling disorder.

Anxiety predicts impulsive-compulsive behaviours in Parkinson's disease: Clinical relevance and theoretical implications

Patients with Parkinson's disease (PD) often present symptoms of anxiety, depression and apathy. These negative affect manifestations have been recently associated with the presence of impulsive compulsive behaviours (ICBs). However, their relation with the use of dopamine replacement therapy (DRT), a renewed risk factor for ICBs, is still not fully understood. Elucidating the role of these different ICBs predictors in PD could inform both prevention/intervention recommendations as well as theoretical models. In the present study, we have analysed data collected in 417 PD patients, 50 patients with Parkinsonian symptoms but with scan without evidence of dopaminergic deficit (SWEDD), and 185 healthy controls (HC). We examined each patient's clinical profile over a two-year time window, investigating the role of both negative affect and DRT on ICBs. Results confirmed the presence of higher levels of anxiety in both the clinical groups, and of higher level of ICBs in SWEDD patients, respect to both PD and HC. Mixed model analyses revealed a statistically significant association between anxiety and ICBs in the SWEDD patients who did not take any DRT. Findings suggest the independence between anxiety and DRT in ICBs development, and provide new evidence for the motivational opponency theoretical framework.

Binge eating disorder

Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.

Delay Discounting in Gambling Disorder: Implications in Treatment Outcome

Impulsive choice, measured by delay discounting (DD) tasks, has been shown in patients with gambling disorders (GD). However, the impact of DD and treatment outcome has been scarcely explored in GD patients. The aims of this study were: (1) to examine the baseline association between DD and clinical variables in GD patients depending on their age and gambling preferences (strategic vs. non-strategic); and (2) to estimate the predictive role of DD on poorer outcomes of cognitive-behavioral therapy (CBT) when considering also the effect of other clinical variables. 133 treatment-seeking male GD patients were evaluated at baseline with a DD task and measures of GD severity, personality traits and psychopathology. Treatment outcome was measured in terms of dropout from CBT and relapses. Results showed baseline associations between DD and GD severity (correlation coefficient R = 0.408 among strategic gamblers and R = 0.279 among mixed gamblers) and between DD and positive/negative urgency (R = 0.330 for the youngest patients, R = 0.244 for middle age, and around R = 0.35 for gamblers who reported preferences for strategic games). Other personality traits such as high harm avoidance and low cooperativeness were also related to DD at baseline (R = 0.606 among strategic gamblers). Regarding treatment outcome, a steeper discount rate predicted a higher risk of relapses in strategic gamblers (odds ratio OR = 3.01) and middle-age ones (OR = 1.59), and a higher risk of dropout in younger gamblers (OR = 1.89), non-strategic gamblers (OR = 1.70) and mixed gamblers (R = 4.74). GD severity mediated the associations between age, DD, personality traits and poor CBT outcome. In conclusion, impulsive choice affects treatment response in individuals with GD and may interfere with it to a significant extent. Considering DD in GD, patients seeking treatment could help control its impact on treatment adherence and relapses.

Do emotion regulation and impulsivity differ according to gambling preferences in clinical samples of gamblers?

BACKGROUND AND AIMS

Emotion regulation (ER) and impulsivity impairments have been reported in patients with gambling disorder (GD). However, both constructs have not been studied in depth jointly in clinical samples. Therefore, the aim of this study was to analyze ER and impulsive tendencies/traits in a sample of n = 321 treatment-seeking individuals with GD by differentiating them according to their gambling preference (n = 100 strategic; n = 221 non-strategic).

METHODS

Our sample was assessed through the DERS (ER), the UPPS-P (impulsivity), and the DSM-5 (GD severity).

RESULTS

The non-strategic group included a higher proportion of women and reported greater ER impairments, and more impulsive traits/tendencies compared to strategic gamblers. GD severity was associated with all DERS subscale (except for awareness) and with urgency dimensions of the UPPS-P.

DISCUSSION AND CONCLUSIONS

Our findings confirm that strategic and non-strategic gamblers differ in their ER processes and impulsive tendencies, showing the first clinical group a more adaptive profile. These results suggest the relevance of assessing these ER and impulsivity in order to tailor better treatment approaches.

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

Background and Aims: COVID-19 pandemic and confinement have represented a challenge for patients with gambling disorder (GD). Regarding treatment outcome, dropout may have been influenced by these adverse circumstances. The aims of this study were: (a) to analyze treatment dropout rates in patients with GD throughout two periods: during and after the lockdown and (b) to assess clinical features that could represent vulnerability factors for treatment dropout.

Methods: The sample consisted of n=86 adults, mostly men (n=79, 91.9%) and with a mean age of 45years old (SD=16.85). Patients were diagnosed with GD according to DSM-5 criteria and were undergoing therapy at a Behavioral Addiction Unit when confinement started. Clinical data were collected through a semi-structured interview and protocolized psychometric assessment. A brief telephone survey related to COVID-19 concerns was also administered at the beginning of the lockdown. Dropout data were evaluated at two moments throughout a nine-month observational period (T1: during the lockdown, and T2: after the lockdown).

Results: The risk of dropout during the complete observational period was R=32/86=0.372 (37.2%), the Incidence Density Rate (IDR) ratio T2/T1 being equal to 0.052/0.033=1.60 (p=0.252). Shorter treatment duration (p=0.007), lower anxiety (p=0.025), depressive symptoms (p=0.045) and lower use of adaptive coping strategies (p=0.046) characterized patients who abandoned treatment during the lockdown. Briefer duration of treatment (p=0.001) and higher employment concerns (p=0.044) were highlighted in the individuals who dropped out after the lockdown. Treatment duration was a predictor of dropout in both periods (p=0.005 and p<0.001, respectively).

Conclusion: The present results suggest an impact of the COVID-19 pandemic on treatment dropout among patients with GD during and after the lockdown, being treatment duration a predictor of dropout. Assessing vulnerability features in GD may help clinicians identify high-risk individuals and enhance prevention and treatment approaches in future similar situations.

Clustering Treatment Outcomes in Women with Gambling Disorder

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.

Impulsive Personality Traits Mediate the Relationship Between Attention-Deficit/Hyperactivity Disorder Symptoms and Psychiatric Comorbidity among Patients with Severe Alcohol Use Disorder

Attention-deficit/hyperactivity disorder (ADHD) is an established risk factor for developing alcohol use disorder (AUD), and AUD-ADHD comorbidity is associated with additional psychiatric diagnoses. Several lines of evidence support the role of impulsivity as a pathway of these relationships; however, impulsivity is not a unitary construct. Thus, we sought to explore whether separate aspects of impulsivity may explain the relationship between ADHD symptoms and psychiatric comorbidity among inpatients (N = 136) with AUD. Methods: We assessed ADHD symptoms (childhood ADHD [Wender Utah Rating Scale], adult ADHD [Adult ADHD self-report scale]), health-related quality of life (HRQL; EQ-5D-5L), psychiatric comorbidity (Mini International Neuropsychiatric Interview), and impulsive personality traits (Urgency, Premeditation, Perseverance, Sensation seeking [UPPS] scale). Results: 19% of patients screened positive in the retrospective assessment of childhood ADHD, and 17% for adult ADHD. Participants reported moderate levels of problem severity in the HRQL dimensions, and 65% had ≥1 current psychiatric disorders other than AUD and ADHD. Multiple mediation indicated that there was a significant direct effect of childhood ADHD symptoms on psychiatric comorbidity (β = 0.224, 95% CI [0.080, 1.114]), and indirect effects of both reacting impetuously when experiencing negative emotions (negative urgency; β = 0.999, 95% CI [0.043, 0.461]) and the tendency to not finish tasks (lack of perseverance; β = 0.075, 95% CI [0.002, 0.297]). Conclusions: The subcomponents of impulsivity to react rashly when experiencing negative emotions and the tendency to not persist in activities seem to contribute to the relationship between ADHD symptoms (particularly those in childhood) and psychiatric comorbidity among patients with severe AUD.

Exploring the Predictive Value of Gambling Motives, Cognitive Distortions, and Materialism on Problem Gambling Severity in Adolescents and Young Adults

Gambling motives and cognitive distortions are thought to be associated because both coping and financial motives to gamble appear to be predictors of gambling related cognitive distortions. Therefore, there is an argument to be made that gambling motives, cognitive distortions, and materialism share common attributes and might be related to problem gambling severity. The present paper aims to examine the relationship between these three variables, both in a clinical and community setting, to see if they can predict gambling severity. A sample of 250 participants from the general population and 31 participants from the clinical population was recruited. The results showed that the clinical sample scored higher on gambling severity, cognitive distortions, materialism, and gambling motives. It also showed that low scores in enhancement motives and higher scores in social motives and gambling related cognitions predicted gambling severity in older gamblers, whereas for younger patients, gambling severity was best predicted by higher scores in materialism and coping motives, and lower scores for enhancement and social motives. In the community sample, gambling severity correlated with gambling related cognitive distortions and with gambling motives (except for social and coping motives within the women subsample). These results testify to the importance of materialism, cognitive distortions, and gambling motives as risk factors for problem gambling both in community and clinical samples.

Mentalizing Failures, Emotional Dysregulation, and Cognitive Distortions Among Adolescent Problem Gamblers

Over the past decade, several studies have investigated the relationship between cognitive distortions and emotion regulation among adolescent gamblers, demonstrating the exacerbating role of alcohol consumption when co-occurring with gambling problems. An important construct, that to date has been largely neglected, is mentalizing (i.e. the ability to reflect on one's own and others' mental states). The aim of the present study was (for the first time) to investigate the relative contribution of mentalization, emotional dysregulation, cognitive distortions, and alcohol consumption among adolescent gamblers. A total of 396 students (69.2% females) aged 14–19 years were recruited from secondary schools in Southern Italy. Assessment measures included the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Difficulties in Emotion Regulation Scale (DERS), the Gambling Related Cognitions Scale (GRCS), and the Alcohol Use Disorders Identification Test (AUDIT). Regression analysis showed that, along with male gender, the best predictors of adolescent gambling were scores on two GRCS subscales (i.e., ‘inability to stop gambling’ and ‘interpretative bias’), the RFQ-8’s ‘uncertainty about mental states’ dimension, and the DERS ‘impulse control difficulties’ factor, with the overall model explaining more than one-third of the total variance. The results clearly indicated that, along with gambling-related cognitive distortions, uncertainty about mental states, and difficulties remaining in control of one’s behavior when experiencing negative emotions contributed significantly to problematic gambling among adolescents.

Impulsivity, Emotion Regulation, Cognitive Distortions and Attentional Bias in a Spanish Sample of Gambling Disorder Patients: Comparison between Online and Land-Based Gambling

Several risk factors have been related to the onset and maintenance of gambling disorder (GD). The aim of this study was to explore the differences in emotion dysregulation, impulsivity, cognitive distortions, and attentional bias between online and land-based gamblers. The sample consisted of 88 treatment-seeking patients from the Behavioral Addictions Unit at the Hospital de la Santa Creu i Sant Pau, Barcelona (Spain). Patients were divided into two groups by considering their main type of gambling, i.e., online (n = 26) and land-based gambling (n = 62). Online gamblers were younger, more often employed, with a higher educational level than land-based gamblers. Regarding the rest of the variables, statistically significant differences were only found in Positive Urgency, one of the UPPS-P subscales, in which the land-based gambling group scored higher than the online gambling group. In this exploratory study, individuals with online and land-based GD phenotypes did not differ either in difficulties in emotion regulation or in attentional and cognitive biases. However, land-based GD patients showed a higher tendency to succumb to strong impulses under the influence of positive emotions. These preliminary findings warrant the need to continue investigating GD phenotypes in larger patient samples.

Effects of a psychosocial intervention at one-year follow-up in a PREDIMED-plus sample with obesity and metabolic syndrome

This study examines if overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms, and if these variables could be modified after 1 year of a multimodal intervention (diet, physical activity, psychosocial support). 342 adults (55-75 years) with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus Cognition study were randomized to the intervention or to the control group (lifestyle recommendations). Cognitive and psychopathological assessments were performed at baseline and after 1-year follow-up. At baseline, higher impulsivity was linked to higher food addiction and depressive symptoms, but not to body mass index (BMI). Food addiction not only predicted higher BMI and depressive symptoms, but also achieved a mediational role between impulsivity and BMI/depressive symptoms. After 1 year, patients in both groups reported significant decreases in BMI, food addiction and impulsivity. BMI reduction and impulsivity improvements were higher in the intervention group. Higher BMI decrease was achieved in individuals with lower impulsivity. Higher scores in food addiction were also related to greater post-treatment impulsivity. To conclude, overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms in mid/old age individuals with MetS. Our results also highlight the modifiable nature of the studied variables and the interest of promoting multimodal interventions within this population.

Five-year follow-up on a sample of gamblers: predictive factors of relapse

BACKGROUND AND AIMS

Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse.

METHODS

Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. "Relapse" was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit.

RESULTS

The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse.

CONCLUSIONS

Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

Longitudinal Changes in Gambling, Buying and Materialism in Adolescents: A Population-Based Study

Gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values lead to impaired functioning in important areas of life. The aims of the present longitudinal study are (1) to evaluate the change produced after one year in those mentioned variables and (2) to examine the gender role in these changes and to analyze the mediational mechanisms among the variables of the study. The sample was composed of 182 adolescents (103 females and 79 males) from secondary education Spanish institutions who completed self-administered questionnaires. Structural equation modeling has been used to explore associations between the different variables. Our results show significant decreases in compulsive buying, materialism, and cognitive biases related to gambling after one year. Gambling disorder severity was directly related to cognitive distortions of gambling and being a man. Compulsive buying was associated with older age and the female gender. Materialism was associated with compulsive buying and the male gender. In conclusion, gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values change over time in different ways, according to gender. The understanding of gambling disorder and compulsive buying in adolescents could potentially lead to early prevention and treatment programs for the specific needs of gender and age.

Gambling-Specific Cognitions Are Not Associated With Either Abstract or Probabilistic Reasoning: A Dual Frequentist-Bayesian Analysis of Individuals With and Without Gambling Disorder

BACKGROUND

Distorted gambling-related cognitions are tightly related to gambling problems, and are one of the main targets of treatment for disordered gambling, but their etiology remains uncertain. Although folk wisdom and some theoretical approaches have linked them to lower domain-general reasoning abilities, evidence regarding that relationship remains unconvincing.

METHOD

In the present cross-sectional study, the relationship between probabilistic/abstract reasoning, as measured by the Berlin Numeracy Test (BNT), and the Matrices Test, respectively, and the five dimensions of the Gambling-Related Cognitions Scale (GRCS), was tested in a sample of 77 patients with gambling disorder and 58 individuals without gambling problems.

RESULTS AND INTERPRETATION

Neither BNT nor matrices scores were significantly related to gambling-related cognitions, according to frequentist (MANCOVA/ANCOVA) analyses, performed both considering and disregarding group (patients, non-patients) in the models. Correlation Bayesian analyses (bidirectional BF10) largely supported the null hypothesis, i.e., the absence of relationships between the measures of interest. This pattern or results reinforces the idea that distorted cognitions do not originate in a general lack of understanding of probability or low fluid intelligence, but probably result from motivated reasoning.

Contribution of sex on the underlying mechanism of the gambling disorder severity

Significant increasing prevalences have been observed in gambling disorder (GD) in the last decades. This study analyzed the underlying mechanisms of the gambling severity with path analysis (implemented through Structural Equation Modeling, SEM), and assessed the potential moderator effect of the patients’ sex. A sample of n = 512 treatment-seeking patients was assessed for sociodemographics and clinical state previously to the treatment. Results obtained in two separate SEM (for men and women) revealed differences in the direct effects and the mediational links. Among the male subsample, higher GD severity was directly related to the higher cognitive bias and the younger age of onset of the problematic gambling, while impulsivity levels and age of onset achieved an indirect effect on the disordered gambling mediated by the cognitive bias. Among females, GD severity was directly increased by younger age of onset, higher cognitive bias and lower self-directedness, while lower socioeconomic positions, and higher levels in harm avoidance achieved an indirect effect on the gambling severity mediated also by the distortions related to the gambling activity. These results provide new empirical evidence for a better understanding of the GD etiology, suggesting that the underlying complex links mediating the GD severity are strongly related to the patients’ sex. The results can also contribute to design more effectiveness and precise therapy programs of patient-centered care.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder

BACKGROUND AND AIMS

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

METHODS

Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

RESULTS

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

CONCLUSION

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Dimensions of Impulsivity in Gambling Disorder

Impulsivity is a multidimensional construct. Although gambling disorder (GD) has been associated with high impulsivity, impulsivity across multiple domains has not been thoroughly investigated in this population. We first aimed to examine whether associations between three facets of impulsivity (response impulsivity, choice impulsivity and impulsive tendency) varied between GD patients and healthy controls (HC). We next aimed to evaluate relationships between these three types of impulsivity, as proposed by theoretical models of impulsivity, and their associations with GD severity. The sample included 97 treatment-seeking adult men with GD, diagnosed according to DSM-5 criteria, and 32 male HCs recruited from the general population. Greater impulsivity in all three domains was found in men with GD in comparison to men without GD. Associations between impulsivity facets were found in both groups, with response impulsivity being the only domain associated with GD severity. Our findings confirm that multiple domains of impulsivity are relevant in GD. Future studies should examine the extent to which treatments aimed at targeting specific aspects of impulsivity improve outcomes.

Impulsivity, Lack of Premeditation, and Debts in Online Gambling Disorder

Background and Objectives: Gambling disorder (GD) is a recurrent and persistent problematic gambling behavior that impairs multiple areas of an individual's life. GD can persist through two modes: online or offline. This study aims to compare sociodemographic, clinical, and psychological characteristics between treatment-seeking online and offline gamblers and analyze the effect of the gambling mode (online or offline) on anxiety, depression, impulsivity, and debts. Methods: Seventy-nine treatment-seeking gamblers (96.2% males), who were simultaneously receiving treatment at a specialized Pathological Gambling and Behavioral Addictions Unit, participated in this study. The sample was divided into two subsamples: online (n = 29, 100% males) and offline (n = 50, 94% males); the characteristics of these two groups were compared and analyzed using Chi-Square test (χ²), t-Test or Mann-Whitney U-test (p < 0.05). Multiple linear regression analyses were performed to determine the effects of gambling mode on significant variables (lack of premeditation and debts). Results: The online sample with a mean age of 29.4 years mainly chose to engage in sports betting (45%, p < 0.05) and showed a higher lack of premeditation levels (25.8 points, p < 0.05) than the offline sample. In addition, the online sample was younger with respect to their onset to gambling (20.2 years, p < 0.05) and the beginning of their gambling problems (25 years, p < 0.05) compared to the offline sample. Online gambling increased the levels of lack of premeditation by an average of 5.43 points compared to offline gambling (p < 0.05). Accumulated debts of the online sample were lower (€11,000) than those of the offline sample (€12,000). However, the interaction between age and gambling mode revealed that online gamblers increased their debt amounts with age at an average increase of €2,726.33 per year compared to offline gamblers (p < 0.05). No significant influence of gambling mode was found on GD severity, anxiety, and depression levels. Conclusions: Gambling mode has a significant relationship with lack of premeditation-a component of impulsivity-and accumulation of debts in treatment-seeking people with GD; however, no relationship was found with the rest of the variables analyzed. Future research with larger samples is needed to confirm these findings.