A Proof of Concept for Using Brief Dialectical Behavior Therapy as a Treatment for Problem Gambling

Excite, or Take Flight? Exploring the Relationship between Difficulties with Emotion Regulation, Outcome Expectancies, and Problem Gambling

Emotional dysregulation is a transdiagnostic process associated with a range of addictive behaviours including problem gambling, with emerging research indicating that emotionally oriented reasons for gambling (i.e., excitement, escape) are associated with problem gambling. However, the relationships between difficulties with emotion regulation, reasons for gambling, and problem gambling, are unclear. The current study tested whether the association between difficulties with emotion regulation and problem gambling could be explained by escape and excitement gambling outcome expectancies. A total of 187 regular gamblers recruited via social media (50.3% male, 48.7% female) completed measures of difficulties with emotion regulation, gambling outcome expectancies, and problem gambling severity (Mage = 41.07, SD = 15.8). Analyses revealed that escape outcome expectancies partially mediated the relationship between difficulties with emotion regulation and problem gambling severity. However, the mediating effect of excitement on this relationship was not significant. The findings suggest that individuals with greater emotional regulation difficulties may engage in problem gambling to help manage aversive emotional states. The study's findings illustrate the importance of considering emotional dysregulation and outcome expectancies in problem gambling treatment planning and public health strategies.

The role of contextual factors in avenues to recover from gambling disorder: a scoping review

Introduction

Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions.

Methods

A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps-titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34).

Results and discussion

Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Effects of DBT-based interventions on alexithymia: a systematic review

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Online dialectical behavioral therapy for adults with internet addiction: A quasi-experimental trial during the COVID-19 pandemic

The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.

Predicting Problem Gambling Severity: Interplay between Emotion Dysregulation and Gambling-related Cognitions

Understanding how emotion regulation and gambling-related cognitive distortions relate to gambling problems has direct relevance for problem gambling prevention and treatment. Although these factors have been identified as robust psychological correlates for problem gambling, the interplay between emotional regulation and cognitive biases in influencing problem gambling behaviours is yet to be fully understood. Accordingly, this study examined the explanatory role of cognitive distortions in the association between emotion regulation difficulties and problem gambling behaviours and also explored the interaction between emotion regulation and cognitive distortions in predicting gambling severity. A total of 301 adults (182 males and 119 females; age range: 18-71 years, M = 32.62, SD = 10.03) completed an online questionnaire comprising measures of emotional regulation difficulties, gambling-related beliefs and problem gambling severity. Analyses revealed that emotion regulation difficulties and erroneous gambling beliefs were positively related to problem gambling severity. Further, cognitive distortions partially accounted for the relationship between emotional regulation difficulties and problem gambling, although emotion regulation retained a direct relationship with problem gambling. There was no interaction between emotional regulation and cognitive distortions. The findings indicate that emotion regulation may serve as a precursor to the development of cognitive distortions, while also directly influencing problem gambling. Implications for assessment and treatment of problem gambling are discussed.

The Effect of Dialectical Behavioral Therapy on Emotion Dysregulation in Couples

Background

Divorce rates have increased during the last decade, leading to a greater focus of marital scholars on the importance of understanding couple-maintaining strategies within marital life. Distresses in couples are attributable to difficulties controlling felt, experienced, and expressed emotions; thus, emotion dysregulation is a core stressor in couples with maladaptive responses.

Objective

The aim of the study was to evaluate the effect of Dialectical Behaviour Therapy (DBT) on outpatient couples to treat emotion dysregulation.

Methods

We recruited 20 couples with marital distress in which partners presented emotion dysregulation. We offered the couples the opportunity to join a couple DBT group at their convenience and based on the immediate availability of treatment slots. We measured the treatment efficacy using psychometric tools (the Difficulties in Emotion Regulation Scale (DERS) and the Dyadic Adjustment Ccale (DAS) at baseline and after DBT therapy.

Results

Both male and female partners presented significant improvements in marital adjustment DAS and emotion regulation scores. Female partners showed significantly greater amplitude changes in both scales. Female partners showed significant improvement in most DERS subscales (except the GOALS subscale); on the other hand, male partners showed significant improvements in impulse, awareness, strategies, and clarity subscales. We found significant improvements in most DAS subscales in both sexes; only affectional expression remained unchanged before and after therapy.

Conclusion

DBT for couples is an effective approach to treat emotion dysregulation.

Investigating predictive factors of dialectical behavior therapy skills training efficacy for alcohol and concurrent substance use disorders: A machine learning study

BACKGROUND

Dialectical Behavior Therapy Skills Training (DBT-ST) as stand-alone treatment has demonstrated promising outcomes for the treatment of alcohol use disorder (AUD) and concurrent substance use disorders (SUDs). However, no studies have so far empirically investigated factors that might predict efficacy of this therapeutic model.

METHODS

275 treatment-seeking individuals with AUD and other SUDs were consecutively admitted to a 3-month DBT-ST program (in- + outpatient; outpatient settings). The machine learning routine applied (i.e. penalized regression combined with a nested cross-validation procedure) was conducted in order to estimate predictive values of a wide panel of clinical variables in a single statistical framework on drop-out and substance-use behaviors, dealing with related multicollinearity, and eliminating redundant variables.

RESULTS

The cross-validated elastic net model significantly predicted the drop-out. The bootstrap analysis revealed that subjects who showed substance-use behaviors during the intervention and who were treated with the mixed setting (i.e., in- and outpatient) program, together with higher ASI alcohol scores were associated with an higher probability of drop-out. On the contrary, older subjects, higher levels of education, together with higher scores of DERS awareness subscale were negatively associated to drop-out. Similarly, lifetime co-diagnoses of anxiety, bipolar, and gambling disorders, together with bulimia nervosa negatively predicted the drop-out. The machine learning model did not identify predictive variables of substance-use behaviors during the treatment.

CONCLUSIONS

The DBT-ST program could be considered a valid therapeutic approach especially when AUD and other SUDs co-occur with other psychiatric conditions and, it is carried out as a full outpatient intervention.

Efficacy of Dialectical Behavioral Therapy for Emotion Dysregulation in Patients with Dual Diagnosis of Borderline Personality Disorder and Substance Use Disorder

Background:

The published evidence supports the efficacy of dialectical behavioral therapy (DBT) to treat patients with borderline personality disorder and particular emphasis on emotion dysregulation as a psychopathological construct.

Aim:

To assess the efficacy of DBT for improving emotion dysregulation among patients with dual diagnosis of borderline personality disorder and substance use disorder.

Methods:

We recruited 40 patients meeting DSM-5 criteria for borderline personality disorder and substance use disorder and assigned them to one of two groups of 20 participants each. One group underwent DBT therapy and the other group followed a treatment-as-usual (TAU) protocol over one year. We used the scores of the difficulties in emotion regulation scale (DERS) at baseline, immediately after therapy, and 4 months after therapy to assess emotion dysregulation.

Results:

We found significant improvements (p<0.05) in the DBT group after therapy that were maintained at least for 4 months afterwards based on the DERS scores (including subscale scores). More patients dropped out of the treatment in the TAU group than in the DBT group.

Conclusion:

DBT is a potentially efficacious psychological intervention to treat emotion dysregulation in patients with borderline personality disorder and substance use disorder.

Neural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy-A Review

The biological component of the biosocial theory of emotion regulation stipulates that borderline personality disorder (BPD) arises from biological vulnerabilities to heightened emotional reactivity. Comprehensive reviews have consistently implicated abnormalities in the amygdala, anterior cingulate cortex, and hippocampus in the neurobiology of BPD. While Dialectical Behavior Therapy (DBT) is the leading evidence-based psychotherapy for the treatment of BPD, there remains a paucity of literature examining changes in the neurobiology of BPD following DBT treatment. Nine studies were identified that examined neurobiological changes in BPD after the completion of DBT. Results indicated that there was significant deactivation of amygdala activity as well as the anterior cingulate cortex in patients with BPD after DBT treatment. As well, several studies found after DBT treatment, BPD patients had a decreased activity in the inferior frontal gyrus in response to arousing stimuli and increased activity in response to inhibitory control. Future research on the neurobiological change after DBT treatment can help clarify biological mechanisms of change in BPD.

Gambling motives: Association with addictive disorders and negative and positive mood in youth

Gambling disorder and other comorbid addictive disorders may have similar underlying affective and motivational patterns. This study aims at examining the association between gambling disorder, comorbid addictive disorders (i.e., alcohol, drugs, spending, and videogames), positive and affective mood, and gambling motives in a community sample. A sample of 1099 adolescents and young adults was recruited from educational centres, from which 569 (51.7%) scored as non-problem gamblers, 42 (3.8%) as at-risk gamblers, and 53 (4.8%) as problem gamblers. Results suggest that enhancement, social, and coping motives are greater among problem gamblers and at-risk gamblers as compared to non-problem gamblers. Problem gamblers scored higher in gambling and comorbid disorders than at-risk gamblers, and also higher in gambling motives and negative mood when compared to non-problem gamblers. Likewise, gambling severity was significantly associated to gambling motives, negative mood, and other addictive disorders. Finally, enhancement motives were predictive of gambling, alcohol, drugs, and spending while controlling for the effect of age, sex, and positive and negative mood. These results shed light into the nature of the relationship between gambling and other comorbid addictions and can be used to tailor prevention and treatment strategies.

Feasibility, Acceptance, and Safety of Metacognitive Training for Problem and Pathological Gamblers (Gambling-MCT): A Pilot Study

Approximately 90% of problem and pathological gamblers remain untreated. This treatment gap may be diminished by the implementation of low-threshold treatment programs. As cognitive distortions play a crucial role in the development and maintenance of gambling problems, interventions targeting gambling-related biases may be particularly effective. The aim of the present study was to examine the feasibility, acceptance, and safety of a novel metacognitive training for individuals with gambling problems (Gambling-MCT). Twenty-five participants were included in an uncontrolled pilot trial with two assessment points (intervention). The intervention comprised eight training modules targeting gambling-specific cognitive distortions. At baseline and post assessment, symptom severity, as measured with the PG-YBOCS, and gambling-related cognitive distortions, as measured with the GABS, were assessed. In addition, interim assessments measuring session-specific changes were conducted. Subjective appraisal was examined after each module and also post treatment. On average, participants took part in 4.16 (SD = 2.84) training sessions. Both intent-to-treat and per protocol analyses showed significant improvements on the PG-YBOCS and the GABS (d_z = 0.37–1.37). After Bonferroni correction for multiple testing, linear mixed models for the analysis of session-specific changes showed no deterioration in participants’ mental state after any of the modules. Subjective appraisal of Gambling-MCT was good. The present pilot study provides first evidence for the feasibility, acceptance, and safety of Gambling-MCT. Recruitment of participants remains challenging, emphasizing the importance of overcoming patient-related treatment barriers. Future studies need to investigate the efficacy of Gambling-MCT in randomized controlled trials.

Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance

BACKGROUNDS

Dialectical behavior therapy skills training (DBT-ST) is an effective treatment for alcohol use disorder (AUD). AUD frequently co-occurs with other addictive behaviors.

OBJECTIVE

s: These secondary analyses of prior studies on the effectiveness of a 3-month DBT-ST program for AUD investigated pre- post-treatment changes in the severity of concurrent addictive behaviors. The study hypothesized that emotion regulation and experiential avoidance should be the key therapeutic mechanisms involved in the treatment of addictive behaviors.

METHODS

The research included 186 individuals (110 males; 76 females) with a primary diagnosis of AUD. Mediational models were performed considering shorter PROMIS questionnaire subscales (i.e., gambling, sex, shopping, food binging, and starvation) as dependent variables. The difficulties in emotion regulation scale and acceptance and action questionnaire-II total scores were independent and mediator variables, respectively.

RESULTS

Clinical variables significantly improved during the treatment, independent of baseline levels. Changes in emotion regulation showed significant total effects on improvements in addictive behaviors. Significant indirect effects of changes in experiential avoidance were detected considering compulsive buying and dysfunctional eating behaviors.

CONCLUSION

The DBT-ST was a feasible treatment for several addictive behaviors frequently reported by individuals with AUD. The improvements in emotion regulation and experiential avoidance were relevant therapeutic mechanisms involved in the treatment of these conditions. Future controlled trials and follow-up studies are recommended to support the efficacy of DBT-ST as a stand-alone intervention for the treatment of different classes of addictive behaviors.

Dialectical Behaviour Therapy for Emotion Regulation Difficulties: A Systematic Review

While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.

Gambling Motives: Application of the Reasons for Gambling Questionnaire in an Australian Population Survey

The Reasons for Gambling Questionnaire (RGQ) consist of 15 items forming five factors: enhancement, social, money, recreation and coping. The RGQ was developed for use in the 2010 British Gambling Prevalence Survey (BGPS) and has now been employed in the second Social and Economic Impact Study (SEIS) of Gambling in Tasmania study conducted in 2011 in Australia. Given differences between Britain and Australia in terms of socio-demographic profiles, gambling cultures and attitudes, gambling access and availability, gambling regulation, and rates and patterns of gambling participation, the aims of this study were to analyse the RGQ data from the SEIS to: (1) determine the most commonly endorsed gambling motives in an Australian jurisdiction, (2) explore the factor structure of the RGQ in an Australian sample, and (3) explore how motives for gambling vary among different Australian population sub-groups. A representative sample of the Tasmanian population who had gambled in the previous 12 months (n = 2,796) were administered the RGQ via computer-assisted telephone interviewing. The five most commonly endorsed reasons for gambling were for fun (62%), followed by the chance of winning big money (52%), it being something to do with friends and family (48%), to be sociable (40%), and excitement (38%). A principal component analysis revealed a five-factor structure that is slightly different from that derived in the BGPS: money, regulate internal state, positive feelings, social, and challenge reasons. Finally, gambling motives varied according to socio-demographic factors, number of gambling activities, problem gambling severity, and participation on different gambling activities. Although some of these findings are consistent with those from the BGPS, there are also some slight differences, suggesting that there may be regional-specific variations in gambling motives.

The Prevalence of Comorbid Personality Disorders in Treatment-Seeking Problem Gamblers: A Systematic Review and Meta-Analysis

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.

Delay discounting rates: a strong prognostic indicator of smoking relapse

BACKGROUND

Recent evidence suggests that several dimensions of impulsivity and locus of control are likely to be significant prognostic indicators of relapse.

METHOD

One-hundred and thirty-one treatment seeking smokers were enrolled in six weeks of multi-component cognitive-behavioral therapy with eight weeks of nicotine replacement therapy.

ANALYSIS

Cox proportional hazard regressions were used to model days to relapse with each of the following: delay discounting of $100, delay discounting of $1000, six subscales of the Barratt Impulsiveness Scale (BIS), Rotter's Locus of Control (RLOC), Fagerstrom's Test for Nicotine Dependence (FTND), and the Perceived Stress Scale (PSS). Hazard ratios for a one standard deviation increase were estimated with 95% confidence intervals for each explanatory variable. Likelihood ratios were used to examine the level of association with days to relapse for different combinations of the explanatory variables while accounting for nicotine dependence and stress level.

RESULTS

These analyses found that the $100 delay discounting rate had the strongest association with days to relapse. Further, when discounting rates were combined with the FTND and PSS, the associations remained significant. When the other measures were combined with the FTND and PSS, their associations with relapse non-significant.

CONCLUSIONS

These findings indicate that delay discounting is independently associated with relapse and adds to what is already accounted for by nicotine dependence and stress level. They also signify that delay discounting is a productive new target for enhancing treatment for tobacco dependence. Consequently, adding an intervention designed to decrease discounting rates to a comprehensive treatment for tobacco dependence has the potential to decrease relapse rates.

[Dialectical behavior therapy : a review of studies on skills training groups and applications in psychiatric settings]

Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings.

Mindfulness and problem gambling treatment

Mindfulness originated from Buddhist contemplative practice 2500 years ago. Mindfulness has increasingly been integrated into a variety of health care programs to address issues such as chronic pain, mental health problems, and addictions. The purpose of this study was to evaluate the feasibility of teaching problem gamblers about mindfulness meditation as part of regular treatment for problem gambling. The study evaluated an 8-week mindfulness group program that included 17 clients from the Problem Gambling Institute of Ontario at the Centre for Addiction and Mental Health (88% male) using questionnaires that were distributed before the first group session and after the final group session. The evaluation was a mixed method design that included both qualitative and quantitative feedback about the group. All of the participants showed an improvement in their levels of mindfulness after the 8-week treatment program. The Mindfulness Attention Awareness Scale (MAAS) scores increased from a pre-test score of 3.65 (SD = 1.01) to a post-test score of 4.40 (SD = 0.78). Qualitative feedback about the group also highlighted a number of improvements in the clients’ lives that included being more in control, relaxed and able to stay in the now. The results indicated that mindfulness was successfully taught during the 8-week group program. This study evaluated the suitability of mindfulness as an intervention as part of a problem gambling treatment service. However, the study did not evaluate whether mindfulness improved the clients’ ability to resist relapse. Future studies are needed to examine the long-term impact of mindfulness sessions.