Proposal for a cognitive model to the treatment of pathological gambling

Alter Game: A Study Protocol on a Virtual "Serious Game" for Relapse Prevention in Patients With Gambling Disorder

Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.

Treatment of gambling disorder: review of evidence-based aspects for best practice

PURPOSE OF REVIEW

Despite a significant body of literature related to the treatment of gambling disorder, there are still an insufficient number of evaluation studies regarding their effectiveness or firm conclusions on specific treatment elements that contribute to it. The aim of this article was to provide a review of scientific results regarding the treatment of gambling disorder, to present the most commonly applied modalities of treatment and to explore the elements of the most successful therapeutic interventions.

RECENT FINDINGS

A substantial body of literature has shown that the most successful therapeutic protocols are psychological interventions, especially based on cognitive-behavioral therapy/methods and/or motivational interviewing. Other interventions with promising results include different self-help interventions and mindfulness. Interventions such as couples therapy and support groups, may have positive effects in terms of increasing therapeutic adherence and retention, while pharmacotherapy is especially useful in patients with comorbidities.

SUMMARY

Gambling disorder is a complex mental health problem caused by a wide spectrum of different biological, psychological, and social risk factors. Treatment options for gambling disorder need to be wide, flexible, accessible, and economically justified, providing early inclusion, retention, and sustainability of long-term effects of the treatment, that is, abstinence and higher quality of psychosocial functioning.

The association of cognitive distortions and the type of gambling in problematic and disordered gambling

BACKGROUND

Previous studies have shown that particular types of gambling are related to the development of gambling-related problems. Further, gambling-related cognitive distortions contribute to the development of disordered gambling. The aim of the present study is to compare different gambling types with respect to cognitive distortions and the development of disordered gambling.

METHODS

Based on a proactively screened sample of vocational school students (N = 6718), 309 students were selected to undergo an in-depth interview. We assessed the Gamblers-Belief-Questionnaire (GBQ) to measure gambling-related cognitive distortions and the Stinchfield questionnaire for assessing gambling-related problems. Associations between cognitive distortions, gambling-related symptoms, and types of gambling were analysed using logistic regression analyses.

RESULTS

Higher scores on the GBQ subscale "belief in luck/perseverance" led to a significantly higher chance to be classified as a person with Gambling Disorder (Conditional Odds Ratio (COR) = 1.05, Confidence Interval (CI) = 1.02-1.08) as well as problematic gambling (COR = 1.04, CI = 1.01-1.06). Higher scores on the subscale "illusion of control" were also associated with problematic gambling (COR = 1.04, CI = 1.00-1.08). The multivariate analyses of the gambling types identified only sports betting as a predictor for problematic gambling (COR = 1.91, CI = 1.05-3.49). When controlling for cognitive distortions, sports betting was not significant anymore. With respect to disordered gambling, gambling on electronic gambling machines (EGMs) turned out to be a risk factor besides cognitive distortions (COR = 2.59, CI = 1.04-6.49).

DISCUSSION

The present study confirmed the high relevance of cognitive distortions for problematic and disordered gambling especially for sports betting and gambling on EGMs. Preventive measures and psychotherapy should take these relationships into account.

Treatment of problem gambling: development, status, and future

Purpose

– The purpose of this paper is to seek to present an overview of past, present, and future approaches to the treatment of problem gambling.

Design/methodology/approach

– This paper reviews the literature concerning conceptual, historical, and clinical research perspectives on the treatment of problem gambling.

Findings

– Perspectives on the etiology, maintenance, conceptualization, and treatment of problem gambling have evolved over time. Once seen as a failure of moral character, problem gambling is now considered to be an addictive disorder with similarities to substance abuse disorders. Empirical research into the treatment of problem gambling is progressing, but is relatively sparse compared to the body of research in other addictive disorders. Methodological issues have been identified that will need to be addressed in future research. Currently, cognitive-behavioral approaches have received the most attention and have the greatest amount of research support. Brief interventions, pharmacological interventions, family therapy, and Gamblers Anonymous are also in use. Future directions for problem gambling treatment that are being researched and implemented are mindfulness-based interventions and internet-based treatment approaches.

Originality/value

– This review should be useful to those seeking general information about problem gambling treatment, its development, status, and future directions.