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Francis LM, Youssef GJ, Greenwood CJ, Enticott PG, Curtis A, Graeme LG, Mansour KA, Olsson CA, Skouteris H, Milgrom J, Williams J, Knight T, Macdonald JA. Father trait anger: Associations with father–infant bonding and subsequent parenting stress. Front Psychol 2023; 14:1114084. [PMID: 36968729 PMCID: PMC10036745 DOI: 10.3389/fpsyg.2023.1114084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionParent anger presents a risk to family safety and child development. Father trait anger may also compromise the early relational context of fathers and offspring, yet evidence is lacking. The aim of this study is to examine effects of father trait anger on parenting stress in the toddler years, and the mediational role of father–infant bonding.MethodData were from 177 Australian fathers of 205 children. Trait anger (total, angry temperament, and angry reaction), father–infant bonding subscales (patience and tolerance, affection and pride, and pleasure in interaction), and subsequent parenting stress (parental distress, difficult child, and parent–child dysfunctional interaction) were assessed. At each of the subscale levels, mediational path models examined whether father–infant bonding explained the relationship between trait anger and parenting stress. Models were presented where there was at least a small association between the mediator and both the predictor and outcome.ResultsPatience and tolerance was the only domain of father–infant bonding correlated with both trait anger and all parenting stress outcomes. Patience and tolerance partially mediated the effect of total trait anger on parental distress and fully mediated effects on difficult child and parent–child dysfunctional interaction. Patience and tolerance fully mediated relationships between angry temperament and all domains of parenting stress. Angry reactions only had a direct effect on parental distress.DiscussionFather trait anger both directly and indirectly (through patience and tolerance in the father–infant bond) impacts their experiences of parenting stress in the toddler years. Early interventions to manage father trait anger and improve father–infant bonding may benefit fathers and children.
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Affiliation(s)
- Lauren M. Francis
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Lauren M. Francis,
| | - George J. Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Christopher J. Greenwood
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Peter G. Enticott
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Ashlee Curtis
- Centre for Drug Use, Addictive and Anti-social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Liam G. Graeme
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Kayla A. Mansour
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Craig A. Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Heidelberg, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanne Williams
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, VIC, Australia
- School of Health and Social Development, Deakin University Faculty of Health, Burwood, VIC, Australia
| | - Tess Knight
- Cairnmillar Institute, Hawthorn East, VIC, Australia
| | - Jacqui A. Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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Cavicchioli M, Calesella F, Cazzetta S, Mariagrazia M, Ogliari A, Maffei C, Vai B. Investigating predictive factors of dialectical behavior therapy skills training efficacy for alcohol and concurrent substance use disorders: A machine learning study. Drug Alcohol Depend 2021; 224:108723. [PMID: 33965687 DOI: 10.1016/j.drugalcdep.2021.108723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Via Stamira d'Ancona, 20127, Milan, Italy.
| | - Federico Calesella
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Silvia Cazzetta
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Movalli Mariagrazia
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Via Stamira d'Ancona, 20127, Milan, Italy
| | - Anna Ogliari
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Child in Mind Lab, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Via Stamira d'Ancona, 20127, Milan, Italy
| | - Benedetta Vai
- Department of Psychology, University "Vita-Salute San Raffaele", Via Stamira d'Ancona, 20127, Milan, Italy; Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy; Fondazione Centro San Raffaele, Via Olgettina, 60, 20132 Milan, Italy
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Kurilla A. Is Subtyping of Gamblers Based on the Pathways Model of Problem and Disordered Gambling Valid? A Systematic Review. J Gambl Stud 2021; 37:983-1006. [PMID: 33386516 DOI: 10.1007/s10899-020-09995-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
Gamblers are a heterogenous group in terms of the presence of comorbid psychopathology, maladaptive personality traits, and motivation to gamble. The Pathways Model, the most promising comprehensive framework to explain this heterogeneity, classifies gamblers into three subtypes. The aim of this review was to determine whether or not subtyping of gamblers based on the Pathways Model of problem and disordered gambling is valid. A literature review was conducted using the following online databases: Academic Search Complete, PubMed, Web of Science, and PsychINFO. Studies were selected or excluded based on meeting predetermined criteria. Fourteen studies examining subtyping of gamblers based on the Pathways Model were reviewed and evaluated. Results suggest that in the adult population there are three subtypes of gamblers that largely coincide with the subtypes defined in the Pathways Model. Of these, the emotionally vulnerable subtype is the most problematic and inconsistent. In contrast, for adolescents, at least four gambler subtypes have been identified. The extant literature on subtyping of gamblers suffers from some severe limitations. Further research is required to fully validate the Pathways Model.
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Affiliation(s)
- Adam Kurilla
- Psychology Department, College of Humanities and Sciences, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284-2018, USA.
- Center for Treatment of Drug Dependencies, Hranicna 2, 821 05, Bratislava, Slovak Republic.
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Kovács I, Demeter I, Janka Z, Demetrovics Z, Maraz A, Andó B. Different aspects of impulsivity in chronic alcohol use disorder with and without comorbid problem gambling. PLoS One 2020; 15:e0227645. [PMID: 31999707 PMCID: PMC6992191 DOI: 10.1371/journal.pone.0227645] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) and problem gambling are highly comorbid disorders. This study aims to explore the role of four aspects of impulsivity (trait concept of impulsivity, choice impulsivity, impulsive aggression and response inhibition/decision-making) in long-term chronic AUD patients with and without problem or pathological gambling symptoms. METHODS Cognitively intact chronic AUD patients were enrolled with (n = 32) and without (n = 71) problem gambling symptoms in an inpatient clinic for chronic alcohol users. Multiple facets of impulsivity, cognitive ability, psychopathological symptoms, alcohol and gambling severity were measured. RESULTS Chronic AUD patients with gambling disorder symptoms showed longer lifetime alcohol consumption, more severe alcohol use and higher psychopathological symptom severity than AUD patients without gambling symptoms. Gambling severity correlated with overall trait impulsivity, but not with choice impulsivity, impulsive aggression or cognitive impulsivity with controlling for lifetime alcohol consumption, lifetime alcohol use and psychopathological symptom severity. High trait impulsivity and non-planning was associated with comorbid gambling symptoms in AUD patients, which was independent of the level of intelligence, age and psychopathological symptoms. CONCLUSION Comorbid gambling disorder symptoms in chronic AUD was connected to more severe alcohol-related variables. Higher trait impulsivity was also linked with gambling disorder symptoms in patients with chronic AUD. This accents the need of special focus on comorbid GD symptoms in AUD, since prognosis and treatment for them may vary.
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Affiliation(s)
- Ildikó Kovács
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ildikó Demeter
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Janka
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Aniko Maraz
- Institute für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bálint Andó
- Department of Psychiatry, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Cavicchioli M, Ramella P, Vassena G, Simone G, Prudenziati F, Sirtori F, Movalli M, Maffei C. 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. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:368-384. [PMID: 31990583 DOI: 10.1080/00952990.2020.1712411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Federica Sirtori
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele" , Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital , Milan, Italy
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Rodda S, Merkouris SS, Abraham C, Hodgins DC, Cowlishaw S, Dowling NA. Therapist-delivered and self-help interventions for gambling problems: A review of contents. J Behav Addict 2018; 7:211-226. [PMID: 29895185 PMCID: PMC6174602 DOI: 10.1556/2006.7.2018.44] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 01/12/2023] Open
Abstract
Background and aims To date, no systematic approach to identifying the content and characteristics of psychological interventions used to reduce gambling or problem gambling has been developed. This study aimed to develop a reliable classification system capable of identifying intervention characteristics that could, potentially, account for greater or lesser effectiveness. Methods Intervention descriptions were content analyzed to identify common and differentiating characteristics. A coder manual was developed and applied by three independent coders to identify the presence or absence of defined characteristics in 46 psychological and self-help gambling interventions. Results The final classification taxonomy, entitled Gambling Intervention System of CharacTerization (GIST), included 35 categories of intervention characteristics. These were assigned to four groups: (a) types of change techniques (18 categories; e.g., cognitive restructuring and relapse prevention), (b) participant and study characteristics (6 categories; e.g., recruitment strategy and remuneration policy), and (c) characteristics of the delivery and conduct of interventions (11 categories; e.g., modality of delivery and therapist involvement), and (d) evaluation characteristics (e.g., type of control group). Interrater reliability of identification of defined characteristics was high (κ = 0.80-1.00). Discussion This research provides a tool that allows systematic identification of intervention characteristics, thereby enabling consideration, not only of whether interventions are effective or not, but also of which domain-relevant characteristics account for greater or lesser effectiveness. The taxonomy also facilitates standardized description of intervention content in a field in which many diverse interventions have been evaluated. Conclusion Application of this coding tool has the potential to accelerate the development of more efficient and effective therapist-delivered and self-directed interventions to reduce gambling problems.
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Affiliation(s)
- Simone Rodda
- School of Population Health, University of Auckland, Auckland, New Zealand
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | | | - Charles Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David C. Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
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Pickering D, Keen B, Entwistle G, Blaszczynski A. Measuring treatment outcomes in gambling disorders: a systematic review. Addiction 2018; 113:411-426. [PMID: 28891116 PMCID: PMC5836978 DOI: 10.1111/add.13968] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/29/2017] [Accepted: 08/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross-study evaluations and hindered the development of best-practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery. METHODS A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6-month follow-up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adhered to. RESULTS Thirty-four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty-three different outcome measures were identified: 25 (39.7%) assessed gambling-specific constructs, 36 (57.1%) assessed non-gambling specific constructs, and two instruments were used across both categories (3.2%). Self-report instruments ranged from psychometrically validated to ad-hoc author-designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing. CONCLUSIONS In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder-specific symptoms and behaviours suggests a multi-dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.
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Affiliation(s)
| | - Brittany Keen
- School of PsychologyUniversity of SydneySydneyAustralia
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21st Century Cognitive Behavioural Therapy for Anger: A Systematic Review of Research Design, Methodology and Outcome. Behav Cogn Psychother 2018; 46:385-404. [DOI: 10.1017/s1352465818000048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Past reviews of cognitive behavioural therapy (CBT) for anger have focused on outcome in specific subpopulations, with few questions posed about research design and methodology. Since the turn of the century, there has been a surge of methodologically varied studies awaiting systematic review.Aims:The basic aim was to review this recent literature in terms of trends and patterns in research design, operationalization of anger, and covariates such as social desirability bias (SDB). Also of interest was clinical outcome.Method:After successive culling, 42 relevant studies were retained. These were subjected to a rapid evidence assessment (REA) with special attention to design (ranked on the Scientific Methods Scale) measurement methodology (self-monitored behaviour, anger questionnaires, and others’ ratings), SDB assessment, and statistical versus clinical significance.Results:The randomized controlled trial characterized 60% of the studies, and the State Trait Anger Expression Inventory was the dominant measure of anger. All but one of the studies reported statistically significant outcome, and all but one of the 21 studies evaluating clinical significance laid claim to it. The one study with neither statistical nor clinical significance was the only one that had assessed and corrected for SDB.Conclusions:Measures remain relatively narrow in scope, but study designs have improved, and the outcomes suggest efficacy and clinical effectiveness. In conjunction with previous findings of an inverse relationship between anger and SDB, the results raise the possibility that the favourable picture of CBT for anger may need closer scrutiny with SDB and other methodological details in mind.
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Yakovenko I, Hodgins DC. A scoping review of co-morbidity in individuals with disordered gambling. INTERNATIONAL GAMBLING STUDIES 2017. [DOI: 10.1080/14459795.2017.1364400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Igor Yakovenko
- School of Public Health, University of Alberta, Edmonton, Canada
| | - David C. Hodgins
- School of Public Health, University of Alberta, Edmonton, Canada
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10
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Abstract
General Strain Theory (GST: Agnew Criminology 30:47-87, 1992) posits that deviant behaviour results from adaptation to strain and the consequent negative emotions. Empirical research on GST has mainly focused on aggressive behaviours, while only few research studies have considered alternative manifestations of deviance, like substance use and gambling. The aim of the present study is to test the ability of GST to explain gambling behaviours and substance use. Also, the role of family in promoting the adoption of gambling and substance use as coping strategies was verified. Data from 266 families with in mean 8 observations for each group were collected. The multilevel nature of the data was verified before appropriate model construction. The clustered nature of gambling data was analysed by a two-level Hierarchical Linear Model while substance use was analysed by Multivariate Linear Model. Results confirmed the effect of strain on gambling and substance use while the positive effect of depressive emotions on these behaviours was not supported. Also, the impact of family on the individual tendency to engage in addictive behaviours was confirmed only for gambling.
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Affiliation(s)
- Romy Greco
- Department of Law, Libera Università SS Maria Assunta (LUMSA), Taranto, Italy.
| | - Antonietta Curci
- Department of Education, Psychology, Communication, University of Bari, Bari, Italy
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Dowling N, Merkouris S, Lorains F. Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research. Addict Behav 2016; 58:21-30. [PMID: 26900888 DOI: 10.1016/j.addbeh.2016.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 12/15/2022]
Abstract
Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study.
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12
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An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers. J Gambl Stud 2016; 32:1079-1100. [DOI: 10.1007/s10899-016-9600-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Aust N Z J Psychiatry 2015; 49:519-39. [PMID: 25735959 PMCID: PMC4438101 DOI: 10.1177/0004867415575774] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. METHODS A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. RESULTS Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. CONCLUSIONS The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Burwood, VIC, Australia,Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia,Centre for Gambling Research, Australian National University, Canberra, ACT, Australia
| | - Sean Cowlishaw
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Alun C Jackson
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie S Merkouris
- School of Psychology, Deakin University, Burwood, VIC, Australia,Problem Gambling Research and Treatment Centre, Monash University, Melbourne, VIC, Australia
| | - Kate L Francis
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Darren R Christensen
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Anger in pathological gambling: clinical, psychopathological, and personality correlates. SPANISH JOURNAL OF PSYCHOLOGY 2015; 17:E39. [PMID: 25011386 DOI: 10.1017/sjp.2014.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs.
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15
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Problem gambling subtypes based on psychological distress, alcohol abuse and impulsivity. Addict Behav 2014; 39:1741-5. [PMID: 25119420 DOI: 10.1016/j.addbeh.2014.07.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
The notion of comorbidities within problem gambling populations has important clinical implications, particularly for appropriate treatment matching. The comorbidities most commonly cited in problem gambling literature include depression, anxiety, alcohol abuse and impulsivity. Previous research shows evidence of patterns in multiple co-occurring comorbidities and that there may be different subtypes of gamblers based on these patterns. To further the current understanding of gambling subtypes, the aim of our study was to identify subtypes of gamblers currently in treatment. Hierarchical Cluster Analysis yielded four mutually exclusive groups of 202 gamblers: (1) gamblers with comorbid psychological problems (35%); (2) 'pure' gamblers without other comorbidities (27%); (3) gamblers with comorbid alcohol abuse (25%); and (4) 'multimorbid' gamblers (13%). The four groups differed on demographic information, drug use and gambling behaviours including gambling activity and problem gambling severity. Gamblers with comorbid psychological problems were more likely to be older women on low income, more likely to report a family history of psychological problems and were more often electronic gaming machine players. As expected, 'pure' gamblers had lower problem gambling severity and were more likely to report current abstinence. Gamblers with comorbid alcohol abuse were more likely to be young men who used stimulant drugs, endorsed a higher quality of life and worked full-time. 'Multimorbid' gamblers were elevated on all comorbidities, had general problems related to their health and wellbeing and reported high rates of hostility and aggression. These groups combine elements of existing conceptual models of gambling subtypes and may require different treatments.
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16
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Weinstock J, Rash CJ. Clinical and Research Implications of Gambling Disorder in DSM-5. CURRENT ADDICTION REPORTS 2014; 1:159-165. [PMID: 26885470 DOI: 10.1007/s40429-014-0026-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders contains significant changes related to the diagnosis of gambling problems. These changes include the renaming of the disorder from pathological gambling to gambling disorder, reclassification of gambling disorder from an impulse control disorder to an addictive disorder, removal of the illegal acts criterion, lowering diagnostic threshold to endorsement of four criteria, and recognizing that the course of the disorder is no longer chronic for all diagnosed. This paper reviews the rationale and research support for these changes. Implications of the new revisions for both research and clinical practice are reviewed, including a discussion about future directions for research efforts.
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Affiliation(s)
| | - Carla J Rash
- Calhoun Cardiovascular Center - Division of Behavioral Health, University of Connecticut Health Center, Farmington, CT 06030-3944
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Abstract
Abstract
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.
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18
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Mechanisms of Action in the Relationship between Mindfulness and Problem Gambling Behaviour. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9475-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Bresin K, Robinson MD. Losing control, literally: Relations between anger control, trait anger, and motor control. Cogn Emot 2013; 27:995-1012. [DOI: 10.1080/02699931.2012.755119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Cowlishaw S, Merkouris S, Dowling N, Anderson C, Jackson A, Thomas S. Psychological therapies for pathological and problem gambling. Cochrane Database Syst Rev 2012; 11:CD008937. [PMID: 23152266 DOI: 10.1002/14651858.cd008937.pub2] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Various psychological therapies for pathological and problem gambling have been evaluated in randomised trials. A synthesis of best-quality evidence is required. OBJECTIVES The objective was to synthesise evidence from randomised trials of psychological therapies for pathological and problem gambling (cognitive-behaviour therapy (CBT), motivational interviewing therapy, integrative therapy, other psychological therapy), in order to indicate the efficacy of therapies and durability of therapy effects, relative to control conditions. SEARCH METHODS We conducted a search of the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR), which includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (The Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also carried out complementary searches of MEDLINE, EMBASE, PsycINFO, LILACS and CENTRAL for studies published between January 1980 and October 2011. We examined the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov and also conducted manual searches of selected journals and reference lists of included studies. SELECTION CRITERIA Included studies were clinical trials using random allocation to groups, considering pathological or problem gamblers, and evaluating a psychological therapy for pathological or problem gambling. Control conditions included 'no treatment' controls, referral to Gamblers Anonymous and non-specific treatment component controls. DATA COLLECTION AND ANALYSIS We systematically extracted data on the characteristics and results of studies. Primary outcomes were measures of gambling symptom severity, financial loss from gambling and frequency of gambling. Secondary outcomes were occurrence of pathological gambling diagnoses and depression and anxiety symptoms. Treatment effects were defined by comparisons between therapy and control conditions at post-treatment assessments (conducted from 0 to 3 months following completion of treatment) and follow-up assessments (conducted from 9 to 12 months following completion of treatment), respectively, using the standardised mean difference (SMD) or risk ratio (RR). We synthesised results through random-effects meta-analysis. MAIN RESULTS Fourteen studies (n = 1245) met the inclusion criteria. Eleven studies compared CBT with control and comparisons at 0 to 3 months post-treatment showed beneficial effects of therapy that ranged from medium (when defined by financial loss from gambling: SMD -0.52; 95% confidence interval (CI) -0.71 to -0.33, n = 505) to very large (for gambling symptom severity: SMD -1.82; 95% CI -2.61 to -1.02, n = 402). Only one study (n = 147) compared groups at 9 to 12 months follow-up and produced smaller effects that were not significant. Four studies of motivational interviewing therapy were identified and mainly considered samples demonstrating less severe gambling (relative to studies of pathological gamblers). Data suggested reduced financial loss from gambling following motivational interviewing therapy at 0 to 3 months post-treatment (SMD -0.41; 95% CI -0.75 to -0.07, n = 244), although comparisons on other outcomes were not significant. The effect approached zero when defined by gambling symptom severity (SMD -0.03; 95% CI -0.55 to 0.50, n = 163). Studies compared groups at 9 to 12 months follow-up and found a significant effect of motivational interviewing therapy in terms of frequency of gambling (SMD -0.53; 95% CI -1.04 to -0.02, n = 62), with comparisons on other outcomes that were not significant. Two studies of integrative therapies also considered samples demonstrating overall low gambling severity, and found no significant effects of therapy at 0 to 3 months post-treatment. Comparisons at 9 to 12 months follow-up suggested a medium effect from therapy in terms of gambling symptom severity, with no significant differences for other outcomes. One study (n = 18) considered another psychological therapy (i.e.Twelve-Step Facilitated Group Therapy) and suggested beneficial effects in terms of most outcomes at 0 to 3 months post-treatment. The evidence supporting these various classes of therapy ranged from very low to low quality. AUTHORS' CONCLUSIONS This review supports the efficacy of CBT in reducing gambling behaviour and other symptoms of pathological and problem gambling immediately following therapy. However, the durability of therapeutic gain is unknown. There is preliminary evidence for some benefits from motivational interviewing therapy in terms of reduced gambling behaviour, although not necessarily other symptoms of pathological and problem gambling. However, the findings are based on few studies and additional research is needed to inform conclusions. There is also evidence suggestive of some possible benefit from integrative therapies, and other psychological therapies for pathological and problem gambling. However, there are too few studies and evidence is insufficient to evaluate these therapies. The majority of studies in this review varied in risk of bias, and much of the evidence comes from studies with multiple limitations. The current data may thus reflect overestimates of treatment efficacy.
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Affiliation(s)
- Sean Cowlishaw
- School of Psychology and Psychiatry,Monash University, Melbourne, Australia.
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Fink A, Parhami I, Rosenthal RJ, Campos MD, Siani A, Fong TW. How transparent is behavioral intervention research on pathological gambling and other gambling-related disorders? A systematic literature review. Addiction 2012; 107:1915-28. [PMID: 22487136 PMCID: PMC3401241 DOI: 10.1111/j.1360-0443.2012.03911.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To review the transparency of reports of behavioral interventions for pathological gambling and other gambling-related disorders. METHODS We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) Statement to develop the 59-question adapted TREND questionnaire (ATQ). Each ATQ question corresponds to a transparency guideline and asks how clearly a study reports its objectives, research design, analytical methods and conclusions. A subset of 23 ATQ questions is considered particularly important. We searched PubMed, PsychINFO and Web of Science to identify experimental evaluations published between 2000 and 2011 aiming to reduce problem gambling behaviors or decrease problems caused by gambling. Twenty-six English-language reports met the inclusion criteria and were reviewed by three abstractors using the ATQ. RESULTS The average report adhered to 38.4 (65.1%) of the 59 ATQ transparency guidelines. Each of the 59 ATQ questions received positive responses from an average of 16.9 (63.8%) of the reports. The subset of 23 particularly relevant questions received an average of 15.3 (66.5%) positive responses. Thirty-two of 59 (54%) ATQ questions were answered positively by 75% or more of the study reports, while 12 (20.3%) received positive responses by 25% or fewer. Publication year did not affect these findings. CONCLUSIONS Gambling intervention reports need to improve their transparency by adhering to currently neglected and particularly relevant guidelines. Among them are recommendations for comparing study participants who are lost to follow-up and those who are retained, comparing study participants with the target population, describing methods used to minimize potential bias due to group assignment, and reporting adverse events or unintended effects.
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Affiliation(s)
- Arlene Fink
- University of California, Los Angeles (UCLA) Gambling Studies Program, Los Angeles, CA 90095, USA.
| | - Iman Parhami
- UCLA Gambling Studies Program, Los Angeles, CA, USA
,Department of Psychiatry and Biobehavioral Sciences at University of California, Los Angeles, USA
| | - Richard J. Rosenthal
- UCLA Gambling Studies Program, Los Angeles, CA, USA
,David Geffen School of Medicine, University of California, Los Angeles, USA
,Department of Psychiatry and Biobehavioral Sciences at University of California, Los Angeles, USA
| | - Michael D. Campos
- UCLA Gambling Studies Program, Los Angeles, CA, USA
,Department of Psychiatry and Biobehavioral Sciences at University of California, Los Angeles, USA
| | - Aaron Siani
- UCLA Gambling Studies Program, Los Angeles, CA, USA
,David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Timothy W. Fong
- UCLA Gambling Studies Program, Los Angeles, CA, USA
,David Geffen School of Medicine, University of California, Los Angeles, USA
,Department of Psychiatry and Biobehavioral Sciences at University of California, Los Angeles, USA
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Problem Anger in Psychotherapy: An Emotion-Focused Perspective on Hate, Rage, and Rejecting Anger. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2012. [DOI: 10.1007/s10879-012-9214-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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