Conceptualizing gambling disorder with the process model of emotion regulation

Problematic Gambling Behavior in a Sample of Gamblers: The Role of Alexithymia, Dissociation Features, and External Locus of Control

Gambling disorder is a severe condition that significantly compromises the lives of those affected. In light of this clinical relevance, the literature on the antecedents of this form of addiction is constant and continually evolving. Consistently with this framework, the present research aimed at investigating the role of some risk factors in gambling disorder, with a specific focus on alexithymia, dissociation, and locus of control. The research involved a sample of 290 participants (183 males and 107 females; Mage = 34.43, SD = 14.65) who practice gambling at least occasionally. They completed an online survey including the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Locus of Control of Behavior. ANOVA and a moderated-mediation model were implemented to analyse the collected data. Results showed that 19.0% of the participants were At Risk and Problem Gamblers, while 27.6% fell into the category of Problematic Gamblers. Problematic Gamblers showed significantly higher levels of alexithymia, dissociation, and external locus of control. Moreover, a significant association between alexithymia and the severity of problematic gambling behaviour was found and was significantly mediated by absorption (a dissociation feature). Furthermore, the external locus of control significantly moderated this indirect effect. The role of gender as a covariate was also investigated. Such findings may offer further insights into the field of clinical research on gambling disorder and may provide useful information for effective clinical practice.

Chasing among older-aged gamblers: the role of mentalizing and psychological distress

Background

Despite the increasing proportion of older-aged individuals suffering from problematic gambling, research on gambling among this specific age cohort is still in its infancy. Chasing is a pathognomonic feature of disordered gambling and is considered one of the key risk factors in the transition from recreational to disordered gambling. Despite the increased research on chasing over the past decade, no previous study has ever examined the psychological determinants of chasing behavior among old-aged gamblers. Given the importance of chasing in facilitating and maintaining problem gambling, and the paucity of research examining gambling among older individuals, the present study is the first to empirically investigate the joint role of chasing behavior, negative affectivity, and mentalizing among older-aged gamblers.

Methods

The sample comprised 116 older-aged gamblers who were administered the South Oaks Gambling Screen (SOGS), the Depression Anxiety Stress Scale (DASS-21) and the Reflective Functioning Questionnaire (RFQ-8) to assess gambling severity, psychological distress, and mentalizing, respectively. Participants also performed the ChasIT, a computerized task that assesses chasing behavior, in which participants were randomly assigned to three different experimental conditions: loss, control, and win.

Results

No effect of the experimental conditions of ChasIT on chasing behavior was observed. Regression analyses indicated that heightened levels of gambling severity and lower levels of certainty about mental states (i.e., hypermentalizing) predicted both the decision to chase and chasing frequency. Along with problem gambling and hypermentalizing, chasing frequency was also predicted by high levels of depression.

Conclusions

The present study demonstrated the association between disordered gambling, depression, and hypermentalizing in chasing behavior among older-aged gamblers. The findings make an important contribution to providing insight regarding variables that are associated with chasing among older-aged gamblers, one of the least represented populations of gamblers in the literature. The results suggest that specific training on mentalizing abilities could help gamblers to reflect on their own behaviors in terms of mental states, rather than following the impulse to gamble in order to ameliorate poor mood.

Gender and trait rumination moderates the link between trait impulsivity and gambling problems severity in young adults

AIMS

Trait impulsivity and trait rumination appear to uniquely contribute to problem gambling. However, only a limited number of studies have investigated their relationship with each other, and no study has tested whether their interplay could explain problem gambling. In this study, we aimed to examine these associations, especially focusing on the putative moderator role of gender.

METHODS

The present study utilized data from the first wave of the Budapest Longitudinal Study, representatively surveying young adults. The final, weighted sample consisted of N = 1202 (649 men; mean age = 28.04 years; SD = 4.31) participants who reported gambling in the past year. Gambling severity was assessed by the Problem Gambling Severity Index (PGSI), trait impulsivity was measured by Barratt Impulsiveness Scale short form (BIS-R-10), while rumination was assessed by the short version of Ruminative Response Scale (RRS).

RESULTS

Multiple linear regression analysis showed significant positive association between impulsivity and problematic gambling, and we found that both trait rumination and gender moderated this association, even after controlling for depressed mood, age, level of education, and subjective relative wealth. For men, when the level of trait rumination was high, higher levels of trait impulsivity were associated with an increase in gambling problems. However, these associations were not found among women.

CONCLUSIONS

Our results suggested that the interplay of trait rumination and trait impulsivity might contribute to problem gambling, potentially by the impulsive desire to alleviate negative mood states. Our results also revealed that these associations could be stronger among men than in women.

Alternation of psychological resilience may moderate mentalization toward mental health conditions from macro- and microstructure aspects

OBJECTIVE

We aim to investigate the interplay between mentalization, brain microstructure, and psychological resilience as potential protective factors against mental illness.

METHOD

Four hundred and twenty-six participants (mean age 40.12±16.95; 202 males, 224 females), without psychiatric or neurological history, completed assessments: Dissociative Process Scale (DPS), Peace of Mind (PoM), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Resilience Scale for Adults (RSA), and Magnetic Resonance Imaging (MRI) structures with selected regions of interest, and Diffusion Tensor Imaging (DTI) maps from various tracts in the right hemisphere and connection to the frontal areas, including anterior thalamic radiation (ATR), Cingulum (hippocampus) (CH), Corticospinal tract (CST), Superior longitudinal fasciculus (SLF), Inferior fronto-occipital fasciculus (IFOF), and Uncinate fasciculus (UF) were analyzed.

RESULTS

Two clusters, representing hypomentalization (HypoM) and hypermentalization (HyperM), were identified based on DPS, CPSS, and RFQ responses. One-way ANOVA showed no significant age or gender differences between clusters. The HypoM group exhibited lower PoM scores, higher BDI and BAI scores, and lower RSA scores (ps< 0.05). Structural brain metric comparison showed significant differences in GMV in the right caudal middle frontal gyrus (rcMFG), right superior frontal gyrus (rsFG), and right frontal pole (rFP) between groups. In addition, the HyperM individuals with a higher risk of depression and a higher ratio of intrapersonal to interpersonal factors of resilience were found with reduced GMV on the rcMFG. Additionally, analyses of DTI metrics revealed significant differences between two groups in rATR and rSLF in terms of fractional anisotropy (FA) values; rATR, rCST, rUF, rSLF, rCH and rIFOF in terms of mean diffusivity (MD) values, and radial diffusivity (RD) (corrected p = 0.05). Moreover, the positive correlation between different domains of resilience and white matter (WM) integrity implied further enhancement of intrapersonal or interpersonal resilience factors that are different for people with different mentalization.

CONCLUSIONS

The findings underscore the importance of considering both intrapersonal and interpersonal factors in understanding the interactions between psychological resilience and mental health conditions relevant to brain mechanisms.

Understanding the Co-occurrence of Gambling Disorder and Problematic Pornography Use: Exploring Sociodemographic and Clinical Factors

The co-occurrence between gambling disorder (GD) and problematic pornography use (PPU) has not yet been explored. Therefore, the present study compared (a) sociodemographic variables, (b) GD-related factors, (c) substance use, (d) psychopathology, (e) personality features, (f) impulsivity, and (g) emotion regulation between individuals with GD (GD group) and those with co-occurring GD and PPU (GD+PPU group). The sample consisted of 359 treatment-seeking individuals with GD: n = 332 individuals had GD only (GD group) and n = 37 individuals had GD and co-occurring PPU (GD+PPU group). GD severity, impulsivity, psychopathology, personality, emotion regulation, and other sociodemographic and clinical variables were assessed. No between-group differences in sociodemographic measures were observed. The GD+PPU group demonstrated greater GD severity and a higher likelihood of substance use compared to those without PPU. Furthermore, the presence of PPU was associated with worse psychopathology, higher impulsivity (except for lack of premeditation and positive urgency), more difficulties in emotion regulation (except for non-acceptance of emotions and limited access to emotions), and a personality profile characterized by lower levels of self-directedness and cooperativeness. The co-occurrence of GD and PPU seems associated with a more dysfunctional clinical profile.

Emotional Dysregulation, Shame and Guilt Predict Severity of Gambling Among a Population of Gamblers

Over the last few years, gambling has diversified, particularly with the arrival of legislation authorizing online gambling in 2010 in France. Psychology has been very interested in emotional regulation strategies, and more recently and more sparsely in the presence of shame and guilt. Through an observational study (N = 1955) shame, guilt, and emotional regulation were assessed among gamblers. We found that (i) Less guilt is associated with problem gambling, (ii) Shame-proneness is similar regardless of the type of gamblers, (iii) Every facet of emotion regulation indicates less effective strategies for problem gamblers excepted for a behavior oriented to a goal. These results suggest the importance of shame or guilt as predictors of problem gambling, as well as processes underlying emotion regulation.

Impulsivity, Gambling-Related Cognitions, Cognitive Reappraisal and Gambling Behaviour in a Malaysian Sample

The relationships between cognitive reappraisal and problem gambling have been widely studied in different contexts. However, previous research findings remain inconsistent. This discrepancy might be attributed to the effects of interactions between cognitive reappraisal and other risk factors for problem gambling. Using moderation models, this study examined the association between impulsivity, gambling-related cognitive distortions, cognitive reappraisal and problem gambling in a sample of Malaysian gamblers. A total of 149 community gamblers (103 males, 46 females; mean age = 32.18) completed an online questionnaire. Problem gambling was measured with the South Oaks Gambling Screen (SOGS); cognitive reappraisal was measured using the Emotion Regulation Questionnaire-Cognitive Reappraisal Subscale (ERQ-CR); impulsivity was measured with the Short-UPPS-P Impulsive Behaviour Scale (SUPPS-P); and gambling-related cognitive distortions were measured using the Gambling Related Cognitions Scale (GRCS). The results revealed impulsivity and gambling-related cognitive distortions as significant predictors of problem gambling. At high levels, impulsivity and cognitive distortions are significant moderator variables that strengthen the association between cognitive reappraisal and problem gambling. These findings demonstrate that reappraisal skills could exacerbate problem gambling severity amongst impulsive or self-deceptive gamblers. Future research with larger and more representative samples is needed to validate and generalise these findings.

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.

Problematic Internet Use Among Adolescent Male and Female Psychiatric Inpatients: A Gender Perspective

Problematic internet use (PIU) is of treatment interest in adolescent clinical samples. Gender specific differences in terms of personality traits and psychopathological symptoms remain unclear. In an adolescent clinical sample (n = 104; 69 girls) PIU, psychopathology, temperament and character traits as well as emotional and behavioral problems were assessed. 62% of the sample showed subthreshold PIU and 34% full PIU (fPIU). Boys reported more gaming whereas girls social networking. Sex specific analyses revealed gender differences: Girls with fPIU scored significantly higher on internalizing/externalizing problems/behavior, novelty seeking and transcendence, and lower on persistence, self-directedness, and cooperativeness than girls without fPIU. Boys with fPIU scored significantly higher on internalizing problems and self-transcendence and lower on harm avoidance than boys without fPIU. Gender plays an important role in PIU. Gender specific differences in both application use as well as symptomatic, temperament and character traits call for a gender specific approach in prevention and treatment integration.

Individual risk factors and prediction of gambling disorder in online sports bettors - the longitudinal RIGAB study

Introduction

While research in online sports betting is dominated by studies using objective player tracking data from providers to identify risky gambling behavior, basicresearch has identified various putative individual risk factors assumed to underlie the development of gambling disorder across all types of gambling. This study aims to examine individual risk factors and their longitudinal clinical relevance in online sports bettors.

Methods

German online sports bettors (N = 607, Mage = 34, 92% male) from a provider based sample took part in an online survey. The study team randomly preselected customers to be invited. N = 325 (53,45%) of the participants also took part in an online follow-up survey one year later. Crosssectional and longitudinal associations of putative risk factors and DSM-5 gambling disorder in online sports bettors were analyzed. These risk factors include alcohol and tobacco use, impulsivity, difficulties in emotion identification, emotion regulation strategies, comorbid mental disorders and stress.

Results

We found more pronounced impulsivity, difficulties in emotion identification, emotion suppression, comorbid mental disorders and stress were cross-sectionally associated with gambling disorder, and longitudinally predicted gambling disorder in online sports bettors (with the exception of emotion suppression). In an overall model only lack of premeditation and perceived helplessness remained significant as predictors for gambling disorder. Online sports bettors with gambling disorder predominantly showed more pronounced risk factors, which were also confirmed longitudinally as relevant for the maintenance of gambling disorder.

Discussion

Risk factors such as impulsivity and stress and appropriate coping mechanisms should consequently be integrated not only into prevention efforts to identify individuals at risk early, but also into intervention efforts to tailor treatment.

Relationship between Internet addiction and body mass index and the predictive role of emotion dysregulation

In recent years, the widespread use of the Internet has led to increasing concerns about problematic behaviors related to excessive Internet use and their potential consequences. This study aimed to investigate the relationship between Internet addiction (IA), body mass index (BMI), and emotion dysregulation (ED). Specifically, the study aimed to determine if IA significantly predicts obesity and if both Internet addiction and obesity can be significantly predicted by ED. 367 school-attending adolescents (Mage = 13.35; SD = 0.82; 49% girls) in Tekab participated in the study. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Internet Addiction Test (IAT), while BMI was calculated using self-reported data to assess their obesity levels. The results indicated that ED significantly predicted both IA and increased BMI levels (p < 0.001). Furthermore, IA also significantly predicted elevated BMI levels (p < 0.001). Our findings showed that ED significantly predicted both higher IA and BMI values, while IA also significantly predicted elevated BMI levels These results have important implications for treatment. To address excessive Internet use or overeating behavior in individuals with either condition, it may be necessary to target the underlying emotional dysregulation that contributes to the problem.

Looking at Sex Differences in Gambling Disorder: The Predictive Role of the Early Abandonment Schema, Gambling Motives and Alexithymia in Depression

A growing body of research indicates differences between men and women with gambling disorder. However, although alexithymia, gambling motives or abandonment have been associated with GD, women's clinical profile remains unexplored. This study aims, firstly, to explore mean differences in gambling motives (i.e. enhancement, coping and social [SOC]), the early maladaptive abandonment schema, alexithymia and depression in women and men with GD. Secondly, to analyse the correlation between the aforementioned variables as a function of sex. Thirdly, to examine the predictive role of gambling motives, early abandonment schema and alexithymia in depression as a function of sex. Lastly, to analyse the mediating role of COP between the early maladaptive abandonment schema and depression in women with GD, and the mediating role of ENH and the early maladaptive abandonment schema between alexithymia and depression in men with GD. The sample comprised 108 adults with GD diagnosis, of whom 60 were women and 48 were men. Regression and mediation analyses were carried out to explore possible sex differences in GD, through the SPSS programme. Results showed that depressive symptoms are predicted by alexithymia in men with GD and by the early maladaptive abandonment schema in women with GD. Regarding mediation analyses, the results suggest that COP mediated the relationship between early abandonment schema and depressive symptoms in females; and ENH and abandonment schema mediated the relationship between alexithymia and depressive symptoms in males. These results provide evidence of the relevance of considering sex differences when establishing therapeutic strategies in GD rehabilitation.

Longitudinal joint trajectories of gambling disorder and hypomentalization: A latent class growth analysis among young adults

INTRODUCTION

Only a few studies have investigated the relationship between risk for gambling disorder (GD) and mentalization difficulties. However, these results on positive correlations were all from cross-sectional studies; therefore, it would be important to investigate the longitudinal relationship between the constructs.

AIMS

It was aimed to identify subgroups of gamblers with different joint growth trajectories of risk for GD and hypomentalization (i.e., uncertainty of understanding own and others' mental states) and to compare the identified latent classes along impulsivity, sensation seeking and depression.

METHODS

Data from waves 1-3 of the Budapest Longitudinal Study were used. The final sample included 219 young adult gamblers who completed the study questionnaire and reported past-year gambling in all three waves (Females: N = 93 [42.29%]; Mean age: 28.36 years [SD = 4.29]). Standardized questionnaires were administered to measure the main constructs.

RESULTS

A four-class model was retained based on latent class growth analysis. Class 1 had consistently moderately high risk for GD and hypomentalization, and Class 4 presented consistently low risk for GD and hypomentalization. Classes 2-3 were characterized by low risk for GD and increasing hypomentalization. Class 1 had significantly higher sensation seeking and depression compared with the other subgroups in multiple cases. Class 4 showed significantly lower impulsivity and sensation seeking than the other classes.

CONCLUSIONS

Elevated hypomentalization was presented among individuals with risk for GD. However, there is little empirical evidence to support that the two constructs have convergently changing trajectories. A cautious interpretation of the results is recommended due to low symptom presence.

Roles for Alexithymia, Emotion Dysregulation and Personality Features in Gambling Disorder: A Network Analysis

Although there is a growing interest in exploring the specific role of both emotional regulation processes and alexithymia in gambling disorder (GD), evidence remains scarce. In order to delve deeper into the complex interactions between these factors, the present study aimed at exploring a network of the core GD-related features, including GD symptomatology and severity, emotion dysregulation, alexithymia, and personality features. The sample included N = 739 treatment-seeking patients with GD (691 men and 48 women), aged 18-78 years (mean age = 39.2, SD = 13.2). The DSM-5 diagnostic criteria were assessed in, and the South Oaks Gambling Screen, Difficulties in Emotion Regulation Scale (DERS), and Temperament and Character Inventory-Revised were administered to, participants. A network analysis was conducted to reveal inter-relationships between these elements. Three nodes related to emotion dysregulation showed the most critical position in the whole network of the present study: "lack of emotional awareness", "non-acceptance of emotional responses", and "difficulties engaging in goal-directed behaviors". When analyzing emotional dysregulation using the different DERS subscales, two independent clusters were identified. One cluster encompassed alexithymia dimensions ("lack of awareness" and "lack of clarity"), while the other cluster included all other emotion-dysregulation dimensions. Identification of the emotion-dysregulation- and GD-related features with the highest centrality/linkage may be particularly useful for developing valid measurement tools and precise management plans for individuals with GD.

Clinical Differences of mild, Moderate, and Severe Gambling Disorder in a Sample of Treatment Seeking Pathological Gamblers in Sweden

INTRODUCTION

Gambling disorder (GD) is classified among the addictive disorders in the DSM-5 and the severity of the diagnosis can be specified as mild, moderate and severe. It has been seen that individuals with more severe gambling problems have a higher rate of comorbid disorders and other health problems compared to individuals with a milder clinical picture.

AIMS

The aim of this study was to explore clinical psychiatric differences related to the severity of disorder in treatment-seeking patients with GD.

METHOD

A sample of 163 patients with GD seeking treatment at an outpatient clinic was diagnosed using the SCI-GD, screened for comorbid diagnoses using the MINI, and further completed a range of self-report questionnaires measuring alcohol-, and drug-problems, symptoms of depression and anxiety, emotion regulation, cognitive distortions, and quality of life.

RESULTS

Greater severity was associated to more problems with alcohol and illicit drugs. Severe gamblers were more likely to gamble to "escape", and had more symptoms of depression and anxiety. Participants with moderate and severe gambling disorder had more difficulties with emotion regulation. Cognitive distortions were the same between severities. All groups had Quality-of-Life problems at a clinical level.

DISCUSSION

There are some distinctive differences between GD of different severities. The features shown by patients with severe GD indicates a more emotionally vulnerable group with increased symptom severity. Further knowledge about the features of GD severity levels is important for treatment planning in the clinic.

Difficulties in Emotion Regulation and Problematic Pornography Use: The Mediating Role of Loneliness

Objectives

To analyze the association between difficulties in emotion regulation and problematic pornography use (PPU) and test the mediating effect of loneliness.

Methods

All 339 participants (M = 28.53 years, SD = 10.32) completed online self-report scales assessing difficulties in emotion regulation, PPU, and loneliness.

Results

Difficulties in emotion regulation are positively correlated with PPU. Loneliness partially mediates the relationship between difficulties in emotion regulation and PPU. Gender and intimate relationship status had moderating effects on the tested mediation model.

Conclusions

Greater difficulties in emotion regulation have a significant indirect effect on PPU through loneliness.

Ready, set, …and difficultly slowing down: What role does alexithymia, emotional regulation and interoceptive awareness play in exercise dependence?

Alexithymia is associated with a diverse range of addictive behaviours including exercise addiction symptoms. In addition, emerging research indicates that emotional regulation and interoceptive processes may help explain this relationship. Thus, the current study tested the ability of emotion regulation to mediate the relationship between alexithymia and exercise addiction symptoms and whether interoceptive awareness moderates these relationships. A total of 404 physically active adults (86.8 % female) completed measures of alexithymia, exercise dependence symptoms, difficulties with emotion regulation and interoceptive awareness (Mage = 43.72, SD = 14.09). Alexithymia, emotion regulation, interoceptive awareness and exercise dependence symptoms were all significantly correlated. Further analysis revealed that emotional regulation mediated the relationship between alexithymia and exercise dependence, although the mediation model did not vary as a function of interoceptive awareness. These findings underscore the importance of considering emotion-focused processes in treatment planning and other initiatives designed to help individuals who display exercise dependence symptoms.

Relationship Between Non-Suicidal Self-Injury and Emotion Dysregulation Among Male and Female Young Adults

Over recent years, non-suicidal self-injury (NSSI) has been associated with emotion dysregulation. However, only a few quantitative studies have empirically investigated differences in emotion dysregulation among people who self-harm, while none have explored gender differences in this regard. Thus, this research study aimed to further examine the association between NSSI and emotion regulation deficits and strategies in young adults. A total of 201 participants (mean age = 21.82 years) were recruited from different support groups dedicated to NSSI and from health care centres and were divided into two groups: a control group (CG, n = 100, mean age = 21.92 years, comprised of 30% males) and an NSSI group (NSSIG, n = 101, mean age = 21.72 years, comprised of 16% males). All participants completed the Deliberate Self-Harm Inventory, the Difficulties in Emotion Regulation Scale, and the Emotion Regulation Questionnaire. The results showed that compared to the CG participants, those from the NSSIG had increased emotion regulation deficits, higher expressive suppression scores, and lower cognitive re-evaluation scores. Within the NSSIG, females had higher impulse control difficulties and limited access to emotion regulation strategies, while males had higher expressive suppression scores. Factors associated with NSSI also differed by gender. These results indicate the necessity to take gender into account when planning treatment, since treatment protocols must be adapted to the specific emotion regulation difficulties concerned.

The Role of Attachment in Gambling Behaviors and Gambling Disorder: A Systematic Review

In recent years, a growing number of attachment-based studies have contributed to the understanding of both substance and behavioral addictions. Although gambling is a form of addictive behavior widespread all over the world, both among young people and adults, the evidence on the association between attachment-related phenomena and gambling has not yet been systematized in literature. The aim of the present study, therefore, is to provide a systematic literature review aimed at summarizing the empirical evidence on this topic. Following the updated 2020 PRISMA guidelines, a systematic search in four electronic scientific databases (Scopus, PubMed, PsycInfo and Web of Science) was conducted. After removing duplicates, 146 records were double-screened, with 12 articles meeting the inclusion criteria. Additionally, by means of a backward search a further article was selected. Altogether, 13 articles were selected for the present systematic review. With few exceptions, the results underline the significant role played by attachment-related phenomena in gambling behaviors, highlighting that specific attachment contexts have a different influence on gambling, also depending on whether gamblers are youths or adults. In particular, while secure attachment has proven to be a protective factor for the onset of gambling behavior, insecure attachment has emerged to be a vulnerability factor in two ways. On the one hand, it directly favors gambling behaviors; on the other, it affects coping strategies and the individual's ability to identify and regulate emotions, which in turn predict gambling. Limitations, strengths, and implications of the present systematic review are discussed.

"I have no control over how much time I play" the metacognitions about online gaming scale: Evidence from a cross-cultural validation among Israeli adolescents

In the current study we evaluated the psychometric properties of the Metacognitions about Online Gaming Scale (MOGS), including its factor structure, reliability, and predictive validity among Israeli adolescents in a six-month prospective study. We also examined the usefulness of the MOGS as a mediator of the effect of attachment patterns on Internet Gaming Disorder (IGD), the preference for online social interactions, and the motives for online gaming. The study population included 1,056 Israeli adolescents (610 males and 446 females, M = 15.77, standard deviation (SD) = 1.43) with an age range of 13-18 years. The participants completed the translated Hebrew version of the MOGS and measures on attachment style, IGD, preference for online social interactions, emotion regulation, and motives for online gaming. The analyses indicated that the factorial structure of the Hebrew MOGS comprised the expected two factors at T1 and T2 (a six-month follow-up). We also found that positive and negative metacognitions significantly mediated the effect of attachment styles on IGD, the preference for online social interactions, and the motives for online gaming. The findings provide evidence that the Hebrew MOGS among Israeli adolescents appears psychometrically appropriate for use by researchers and practitioners dealing with the prevention and treatment of IGD.

Impaired Metacognitive Differentiation, High Difficulty in Controlling Impulses and Non-acceptance of Emotions are Associated With the Severity of Gambling Disorder

The role of metacognition in gambling disorder (GD) is underexplored. To date, only two studies have investigated the role of metacognitive functioning, but among the adolescent population. The first aim of the current research was to assess and compare adult male gamblers with healthy controls (HCs) in relation to metacognition, impulsivity and emotional dysregulation. The second aim was to identify the variables among metacognition, impulsivity and emotional dysregulation associated with the severity of GD by means of linear regression.A total of 116 adult males (58 with GD and 58 HCs) completed self-report questionnaires on gambling severity, metacognition, emotional dysregulation and impulsivity. A linear regression analysis was run to assess the variables associated with gambling severity.Patients with GD exhibited more impaired scores than HCs in all the psychopathological dimensions investigated. More interestingly, gambling severity was significantly associated with metacognitive differentiation/decentration, difficulty in controlling impulses and non-acceptance of negative emotions.According to our results, the severity of gambling is associated with impaired metacognitive differentiation, high difficulty in controlling impulses and non-acceptance of negative emotions, and these findings can lead to new treatment implications. Interventions focused on metacognition and emotion regulation could help patients with GD to avoid maladaptive strategies such as behavioural addictions and, more specifically, to manage their own emotions. This type of treatment could help gamblers to become more aware of their internal state and learn strategies for adaptively managing emotions through functional metacognitive differentiation.

The Reflective Functioning Questionnaire-Revised- 7 (RFQ-R-7): A new measurement model assessing hypomentalization

Although it is a widely used questionnaire, limitations regarding the scoring procedure and the structural validity of the eight-item Reflective Functioning Questionnaire (RFQ-8) were raised. The present study aimed to examine further the latent dimensionality of the RFQ-8 and to examine linear and non-linear associations between mentalization difficulties and maladaptive psychological characteristics. Data from two separate representative samples of young adults (N = 3890; females: 51.68%; mean age: 27.06 years [SD = 4.76]) and adults (N = 1385; females: 53.20%; mean age: 41.77 years [SD = 13.08]) were used. In addition to the RFQ-8, standardized questionnaires measured the levels of impulsivity, sensation seeking, rumination, worry and well-being. Confirmatory factor analysis (CFA) was used to test the model fit of competing measurement models. CFA revealed that a revised, seven-item version of the RFQ (RFQ-R-7) with a unidimensional structure showed the most optimal levels of model fit in both samples. Impulsivity, sensation seeking, rumination and worry consistently presented significant, positive, linear associations with general mentalization difficulties in both samples. Significant quadratic associations were also identified, but these relationships closely followed the linear associations between the variables and increased only marginally the explained variance. The supported unidimensional measurement model and the associations between the general mentalization difficulties factor and maladaptive psychological characteristics indicated that the RFQ-R-7 captures a dimension of hypomentalization ranging between low and high levels of uncertainty. Increasing levels of hypomentalization can indicate a risk for less adaptive psychological functioning. Further revisions of the RFQ-8 might be warranted in the future to ensure adequate measurement for hypermentalization.

An addictive disorders severity model: a chained mediation analysis using structural equation modeling

BACKGROUND

The clinical relevance of the degree of severity in addiction disorders supports the need to investigate the variables underlying this aspect of the phenomenon.

OBJECTIVE

This study aimed to explore the relationships between factors that may influence the severity of addiction disorder, with a particular focus on temperamental disinhibition, emotion dysregulation, interpersonal vulnerability, and their interactions.

METHODS

A clinical sample of 502 (77% males and 22% females) was involved. All participants received a DSM-5 clinical diagnosis of "Substance-Related and Addictive Disorders" and were recruited from the Italian National Health System. The collected data were analyzed by implementing a chained mediation model using structural equation modeling.

RESULTS

The statistical appropriateness of the hypothesized latent 4- factors model was confirmed. Specifically, temperamental disinhibition (composed of impulsiveness, compulsiveness, and obsessiveness), emotion dysregulation (composed of affect dysregulation, alexithymia, and dissociation), interpersonal vulnerability (composed of traumatic experiences, preoccupied, avoidant and unresolved attachment), and Addictive Disorders Severity (composed by substance use severity, alcohol use severity, gambling severity, and Internet use severity) were the four factors which have been identified. Furthermore, a total chained mediation model emerged, where emotion dysregulation and interpersonal vulnerability mediated the relationship between temperamental disinhibition and Addictive Disorders Severity.

CONCLUSIONS

Our findings offer a better understanding of the variables associated with addictive disorder severity, providing important indications for therapeutic interventions.

Shame and Blame in Gambling: Relationship with Emotion Regulation and Gambling Motives

Gambling disorder is a problem that is affecting increasingly more people. It is associated with difficulties in emotion regulation, gambling motives, blame, and shame. This study aims to study the relationship between gambling severity, blame, and shame, independently and together with emotion regulation and gambling motives; to analyse the mediating role of emotion regulation in the relationship between gambling severity and shame; and to compare mean differences in the study variables according to the sample group. For this purpose, a clinical and non-clinical sample of 158 individuals (119 males and 39 females) ranging in age from 12 to 30 years (M = 19.70, SD = 5.35) was divided into three groups. The questionnaires were administered online and on paper. The results showed that blame and shame are related to the severity of gambling. In the case of shame, this relationship was found to be partially mediated by the emotion regulation strategy of self-blame. Gambling severity, blame and shame were also found to be related to various gambling motives and different emotion regulation strategies. All this information can be of great use in the prevention and treatment of gambling problems.

Exploring Addictive Online Behaviors in Patients with Narcolepsy Type 1

BACKGROUND

Narcolepsy type 1 (NT1) is a rare neurological sleep disorder caused by the loss of neurons that produce hypocretin-a peptide that plays a crucial role in addictive behaviors. We aimed to compare, for the first time, levels of problematic online gaming, problematic social media use, and compulsive Internet use between NT1 patients and healthy controls (HC), and to evaluate the association between anxiety, depression, and emotion dysregulation with addictive online behaviors in NT1 patients.

METHODS

A total of 43 patients with NT1 and 86 sex- and age-matched HC participated in an online cross-sectional survey.

RESULTS

NT1 patients did not differ from HC in terms of problematic social media use and compulsive Internet use but displayed higher levels of problematic online gaming compared to HC. Higher levels of emotion dysregulation were significantly associated with higher levels of problematic social media use and compulsive Internet use, while none of the tested factors were associated with problematic online gaming.

CONCLUSION

NT1 patients and HC had similar levels of problematic social media use and compulsive Internet use, but NT1 patients showed higher levels of problematic online gaming. Emotion dysregulation might be an intervention target for reducing compulsive Internet use and problematic social media use.

Abnormal psychological performance as potential marker for high risk of internet gaming disorder: An eye-tracking study and support vector machine analysis

Individuals with high risk of internet gaming disorder (HIGD) showed abnormal psychological performances in response inhibition, impulse control, and emotion regulation, and are considered the high-risk stage of internet gaming disorder (IGD). The identification of this population mainly relies on clinical scales, which are less accurate. This study aimed to explore whether these performances have highly accurate for discriminating HIGD from low-risk ones. Eye tracking based anti-saccade task, Barratt impulsiveness scale (BIS), and Wong and Law emotional intelligence scale (WLEIS) were used to evaluate psychological performances in 57 individuals with HIGD and 52 matched low risk of internet gaming disorder (LIGD). HIGD group showed significantly increased BIS total (t = −2.875, p = 0.005), attention (t = −2.139, p = 0.035), motor (t = −2.017, p = 0.046), and non-planning (t = −2.171, p = 0.032) scores, but significantly decreased WLEIS emotion regulation score (t = 2.636, p = 0.010) and correct rate of eye tracking anti-saccade task (t = 2.294, p = 0.024) compared with LIGD group. BIS total score was negatively correlated with the WLEIS total (r = −0.473, p &lt; 0.001) and WLEIS emotion regulation (r = −0.366, p &lt; 0.001) scores. A combination of the WLEIS emotion regulation score and the correct rate of anti-saccade task could discriminate HIGD from LIGD with 91.23% sensitivity, 82.69% specificity, and 87.16% accuracy. Participants with higher gaming hours daily were 40 times more likely to be high risk than their counterparts (p &lt; 0.001). Hence, psychological performances were worse in HIGD. A combination of abnormal emotion regulation and response inhibition might be a potential marker to identify HIGD individuals.

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.

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.

Is Empathy Associated with Gambling and Its Addiction? A Scoping Review of Empirical Studies

Considering the low levels of empathy associated with substance-related addictions and the similarities between gambling disorder (GD) and substance-related addiction, understanding the relationship between empathy and GD may clarify the mechanism of addiction development. This scoping review aimed to evaluate the empirical evidence for the potential protective role of emotional and cognitive empathy against GD development via internalizing and/or externalizing pathways. We followed the preferred reporting items for systematic review and meta-analyses extension for scoping reviews and 11 articles met the inclusion criteria. Although most of the reviewed studies used correlational designs and non-gambling-specific samples, this review highlights (1) significant relationships between both types of empathy and the neural activity of gambling behaviors, and (2) reduced cognitive empathy (i.e., fantasy and perspective taking) and increased emotional empathy (i.e., personal distress) among problem gamblers than their gambling counterparts. Despite the lack of studies directly testing the protective role of empathy against GD, the existing studies (n = 8) nevertheless shed light on the potential protective effects of both types of empathy on GD development. This review identified research gaps, which can be addressed in future studies by discovering the underlying mechanisms (e.g., internalizing and externalizing pathways) of these relationships. Experimental or longitudinal studies in gamblers investigating how different types of empathy are associated with GD via these pathways are called for as their findings have implications for prevention and intervention designs for GD and other addictive disorders.

Examining the Relationships Between Adolescents' Emotion Regulation Levels and Social Media Addiction

Objective: This study aims to examine the relationship between adolescents’ emotional regulation strategies and social media addiction. Methods: 1151 adolescents aged between 14 and 18 participated in the study (Mage = 14.44, SD =4.97). 63.8% of the participants in the study were girls and 36.2% were male. Researchers used the Emotion Regulation Scale and the Social Media Addiction Scale. In the study, we performed correlation analysis to determine the relationships between the variables. We used the structural equation model to test the predictive relationship between emotion regulation on social media addiction. We used SPSS 22, LISREL 9.1 program for statistical analysis. Results: The results show that there are low-level, negative correlations between social media addiction and reappraisal of emotions. Similarly, there are low-level, positively significant relationships between suppression of emotions and social media addiction. Another result of the study reveals that reappraisal and suppression of emotions have a predictive effect on social media addiction. Conclusion: The results show that reappraisal emotions reduce social media addiction, while suppression increases social media addiction.

Phenotype of Gambling Disorder Patients with Lotteries as a Preferred Form of Gambling

Lottery gambling can become an addictive behavior which can significantly interfere with daily functioning. The objectives of this work were to estimate the prevalence of lottery gambling, to assess the profile related to this gambling type in a large clinical sample of patients who met criteria for gambling disorder (GD), and to compare this profile with the other two non-strategic forms of gambling (slot-machines and bingo). Sample included n = 3,531 patients consecutively attended for treatment-seeking due to gambling-related problems. All the participants met criteria for GD and were into the range of 18 to 85 years old. Sociodemographic variables, GD severity, psychopathological state, and personality traits were assessed. Statistical comparisons between the groups defined by the patients’ gambling preference (lotteries versus other gambling activities) were conducted, with chi-square test and analysis of variance. The prevalence of lotteries as the only gambling activity was 2.5%, 8.9% for lottery gambling as primary activity with other secondary gambling types, and 20.6% for lotteries as primary or secondary gambling activity. Lottery gambling and bingo gambling were more prevalent among women (bingo included the highest percentage of women). Compared to slot machine gambling, lotteries and bingo grouped older patients and those with later age of onset of the gambling-related problems. Bingo gambling showed the highest psychological distress and the most dysfunctional personality traits. This study shows the high frequency of lottery gambling among treatment-seeking for GD patients, and it provides empirical evidence about the profile associated with this gambling activity compared to other non-strategic gambling forms. The likelihood of lottery gambling is higher for women, patients married or living with a stable partner, and those within higher social position indexes.

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.

A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder

Gambling Disorder is a complex and multifaceted phenomenon which requires a careful understanding by analysing both the life experiences and the psychopathological components linked to this type of behaviour. This study aimed to apply a Comprehensive Model of Addiction and to delve deeper the dimensions involved in the vulnerability and maintenance of the disease. Therefore, the effect of alexithymia and traumatic experiences in mediating the relationship between insecure attachment and dissociation, as well as the roles of impulsiveness and compulsiveness in influencing obsessiveness were explored in pathological gamblers. A sample composed of 253 individuals with a mean age of 47.8 years (SD = 12.4) with a diagnosis of Gambling Disorder (82.6% males, 17.4% females) completed the battery of measures. Results showed that alexithymia significantly mediates the relationship between insecure attachment and dissociation, while no significance was found in the effect of complex trauma. Furthermore, a significant impact role of impulsiveness and compulsiveness in determining obsessiveness was found. Therefore, the data suggested that alexithymia may increase the risk of developing a gambling disorder, mediating the association between insecure attachment and dissociation. The model of craving which could have a core role in disease maintenance processes was also confirmed, highlighting a significant influence of impulsiveness and compulsiveness on obsessiveness. Such findings might have relevant implications to increase the effectiveness of both preventive interventions and therapeutic works, favouring positive results for a better mental health of the subjects.

The Mediating Role of Emotion Dysregulation and Problematic Internet Use in the Relationship Between Negative Affect and Excessive Daytime Sleepiness: A Structural Equation Model

PURPOSE

The present study aimed to explore the mediating role of emotion dysregulation and problematic Internet use in the relationship between negative affect and excessive daytime sleepiness.

METHODS

This cross-sectional study included 664 Italian adults aged between 18 and 70 years (M = 32.13; SD = 11.71). Participants were asked to complete the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, the Compulsive Internet Use Scale-7, and the Epworth Sleepiness Scale to assess negative affect, emotion dysregulation, problematic internet use, and excessive daytime sleepiness, respectively.

RESULTS

According to our results there are significant associations between negative affect, emotion dysregulation, problematic Internet use, and daytime sleepiness. Moreover, the structural equation model showed good fit indices. Emotion dysregulation and problematic Internet use partially mediated the relationship between negative mood and excessive daytime sleepiness.

CONCLUSION

By exploring the role of emotion dysregulation on the association between excessive daytime sleepiness and its possible predictors, our study might represent an important step toward the implementation of psychological intervention for reducing excessive daytime sleepiness. Emotion dysregulation appears to play a significant role in explaining the relationship between negative affect, problematic Internet use, and excessive daytime sleepiness. Thus, it should be considered a treatment target for reducing excessive daytime sleepiness.

Emotion regulation-enhanced group treatment for gambling disorder: a non-randomized pilot trial

BACKGROUND

Despite the association of Gambling Disorder (GD) with poor mental health, treatment options generally lack components targeting emotional difficulties. This study investigated the feasibility and acceptability of adding strategies of emotion regulation to an eight-session weekly group treatment.

METHOD

This non-randomized pilot study recruited 21 treatment-seeking adults with GD, (mean age = 36.3, 19% females) from addiction care. In a mixed methods design, measures of within-group changes in self-reported symptoms of GD were complemented with thematic analysis of post-treatment interviews regarding the feasibility of the treatment.

RESULTS

Within-group scores on the Gambling Symptoms Assessment Scale (G-SAS) showed a 47% decrease (β: -0.1599, 95% CI: - 0.2526 to - 0.0500) from pre-treatment to 12-month follow-up, with Hedges' g = 1.07 (CI: 0.57-1.60). The number of GD-symptoms according to the Structured Clinical Interview for Gambling Disorder (SCI-GD) decreased from 7.0 (SD = 1.60) at pre-treatment to 2.1 (SD = 2.36) at 12-month follow-up. Participants completed an average of 6.3 sessions and rated the intervention high in satisfaction and acceptability. Feasibility interviews showed no noticeable negative effects or ethical issues. Furthermore, helpful components in the treatment were: increased awareness of emotional processes and strategies to deal with difficult emotions.

CONCLUSIONS

Adding emotion regulation strategies in the treatment of GD is feasible and acceptable and warrants further investigation in a controlled trial.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov (Identifier NCT03725735 ).

From Emotional (Dys)Regulation to Internet Addiction: A Mediation Model of Problematic Social Media Use among Italian Young Adults

Internet addiction (IA) has mostly been investigated with the fear of missing out and difficulties in emotional regulation. The present study examined the link between IA and variables related to problematic social media use (i.e., fear of missing out, social media addiction), together with emotional (dys)regulation and personality traits, providing new insights and an integrated assessment of IA. In total, 397 participants, aged 18-35 years (M = 22.00; SD = 3.83), were administered a set of questionnaires pertaining to IA, problematic social media use, emotional (dys)regulation, and personality traits. Pearson's correlations showed significant associations between IA and the investigated variables, and the tested mediation model highlighted the crucial role played by emotional (dys)regulation in the fear of missing out and problematic use of social networks. Overall, the findings provide support for a new integrated model for understanding the features, predictors, and risk factors of IA.

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.

Alexithymia, Dissociation, and Family Functioning in a Sample of Online Gamblers: A Moderated Mediation Study

The diffusion of the internet and technological progress have made gambling on online platforms possible, also making it more anonymous, convenient, and available, increasing the risk of pathological outcomes for vulnerable individuals. Given this context, the present study explores the role of some protective and risk factors for problematic gambling in online gamblers by focusing on the interaction between alexithymia, dissociation, and family functioning. A sample of 193 online gamblers (Mage = 28.8 years, SD = 10.59; 17% females, 83% males) completed the South Oaks Gambling Screen, Twenty-Items Toronto Alexithymia Scale, Dissociative Experience Scale-II, and Family Adaptability and Cohesion Evaluation Scales-IV through an online survey. MANOVA, ANOVA and moderated mediation analyses were carried out to analyse the data. Significant differences in cohesive family functioning, alexithymia and dissociation have been found between online gamblers with problematic, at-risk or absent levels of gambling disease. Furthermore, the results showed a significant and positive association between alexithymia and problematic online gambling, partially mediated by dissociation, with the moderation of cohesive family functioning. Such data may have relevant clinical implications, highlighting the interaction of some core personal and environmental variables that may be involved in the etiology of online pathological gambling and could be kept in mind to tailor preventive interventions.

Affective Saturation Index: A Lexical Measure of Affect

Affect plays a major role in the individual's daily life, driving the sensemaking of experience, psychopathological conditions, social representations of phenomena, and ways of coping with others. The characteristics of affect have been traditionally investigated through physiological, self-report, and behavioral measures. The present article proposes a text-based measure to detect affect intensity: the Affective Saturation Index (ASI). The ASI rationale and the conceptualization of affect are overviewed, and an initial validation study on the ASI's convergent and concurrent validity is presented. Forty individuals completed a non-clinical semi-structured interview. For each interview transcript, the ASI was esteemed and compared to the individual's physiological index of propensity to affective arousal (measured by heart rate variability (HRV)); transcript semantic complexity (measured through the Semantic Entropy Index (SEI)); and lexical syntactic complexity (measured through the Flesch-Vacca Index (FVI)). ANOVAs and bi-variate correlations estimated the size of the relationships between indexes and sample characteristics (age, gender), then a set of multiple linear regressions tested the ASI's association with HRV, the SEI, and the FVI. Results support the ASI construct and criteria validity. The ASI proved able to detect affective saturation in interview transcripts (SEI and FVI, adjusted R2 = 0.428 and adjusted R2 = 0.241, respectively) and the way the text's affective saturation reflected the intensity of the individual's affective state (HRV, adjusted R2 = 0.428). In conclusion, although the specificity of the sample (psychology students) limits the findings' generalizability, the ASI provides the chance to use written texts to measure affect in accordance with a dynamic approach, independent of the spatio-temporal setting in which they were produced. In doing so, the ASI provides a way to empower the empirical analysis of fields such as psychotherapy and social group dynamics.

Heart rate variability and interoceptive accuracy predict impaired decision-making in Gambling Disorder

BACKGROUND AND AIMS

Gambling Disorder (GD) entails maladaptive patterns of decision-making. Neurophysiological research points out the effect of parasympathetic arousal, including phasic changes in heart rate variability (HRV), and interoceptive accuracy (IA, i.e., the ability to track changes in bodily signals), on decision-making. Nevertheless, scarce evidence is available on their role in GD. This is the first study exploring the impact in GD of respiratory sinus arrhythmia (RSA), an index of HRV, and IA on decision-making, as measured by the Iowa Gambling Task (IGT).

METHODS

Twenty-two patients experiencing problems with slot-machines or video lottery terminals gambling and 22 gender- and age-matched healthy controls (HC) were recruited. A resting ECG was performed before and after the completion of the IGT. IA was assessed throughout the heartbeat detection task. We conducted a MANCOVA to detect the presence of significant differences between groups in RSA reactivity and IA. A linear regression model was adopted to test the effect of factors of interest on IGT scores.

RESULTS

Patients with GD displayed significantly decreased RSA reactivity (P = 0.002) and IA (P = 0.024) compared to HCs, even after controlling for affective symptoms, age, smoking status, and BMI. According to the linear regression model, cardiac vagal reactivity and IA significantly predict decision-making impairments on the IGT (P = 0.008; P = 0.019).

DISCUSSION AND CONCLUSIONS

Although the exact pathways linking HRV and IA to impaired decision-making in GD remain to be identified, a broader exploration relying upon an embodiment-informed framework may contribute to shed further light on the clinical phenomenology of the disorder.

Alexithymia and Emotion Regulation Strategies in Adolescent Gamblers with and Without At-Risk Profiles

Alexithymia, difficulties in emotion regulation, and negative affect play an important role in adolescents who present pathological gambling. Therefore, the objectives of the present study were, firstly, to analyze the differences between alexithymia, difficulties in emotion regulation, and positive and negative affect in adolescents with and without risk of gambling problems. Secondly, the relationships between all the variables of the study in adolescents with and without risk of problem gambling were analyzed separately. Thirdly, we analyzed the mediating role of positive and negative affect in the relationship between alexithymia and dysfunctional emotion regulation strategies (ERS) in adolescents at risk of gambling problems. The sample was composed of 206 adolescents with ages ranging from 12 to 18 years (M = 15.52; SD = 1.43). They were divided into two groups according to the score obtained in the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA). Thus, 84 were included in the group without risk of gambling problems and 122 in the group at risk of gambling problems. The results obtained revealed higher scores in negative affect and pathological gambling in the group at risk of gambling problems. Likewise, positive relationships between alexithymia, maladaptive emotion regulation strategies (MERS), and affect were found. Mediation analyses showed that difficulties in identifying feelings were indirectly related to greater use of dysfunctional ERS through their relationship with negative affect in at-risk gamblers.

The Level of Gambling Prediction Using Depression and Anxiety in the Romanian Population

The gambling addiction problem, one which is present worldwide and at all social levels, is one of the most pervasive problems in contemporary society. According to the research literature, gambling addiction is determined by other psychiatric disorders. In the present study, we investigate the degree to which gambling can be predicted by depression and anxiety in a Romanian sample. The study has been conducted on a sample of 920 persons in the general population. Results show that depression predicts gambling in proportion of 26.3 percent, while anxiety predicts 31.5 percent of gambling variance. In the discussion portion of the study, we provide a psyhological interpretation of the results.

The Role of ADHD Symptomatology and Emotion Dysregulation in Gambling Disorder

Objectives: Although emotion regulation deficits have been implicated in gambling disorder and ADHD, the interplay between these factors has yet to be systematically studied. We examined relationships between ADHD symptoms, emotion regulation, and gambling disorder severity in a sample of treatment-seeking gambling disorder patients (n = 98). We also examined clinical differences between patients with and without ADHD symptomatology. Method: Structural equation modeling (SEM) evaluated direct and indirect effects of ADHD and emotion regulation on gambling disorder severity. Results: Significant correlations between ADHD symptomatology and emotion regulation and between emotion regulation and gambling disorder severity were identified. Differences in emotion regulation were found between gambling disorder patients with and without ADHD symptomatology. Path analysis revealed emotion regulation to be a mediator between ADHD and gambling disorder. Conclusion: Our findings indicate the presence of ADHD symptomatology to be associated with greater severity of gambling disorder and greater emotional dysregulation.

Gambling and Attachment: The Mediating Role of Alexithymia in Adolescents and Young Adults

Attachment and alexithymia play a central role in the appearance and persistence of pathological gambling and related comorbid addictive behaviours among adolescents and young adults. The aim of the present study was to explore the differences between problem gamblers and non-problem gamblers in gambling severity, spending, video gaming, alcohol and drugs use, attachment, and alexithymia, as well as the interaction among these variables. The study sample included 560 participants non-problem gamblers (mean age = 15.49 years) and 54 problem gamblers (mean age = 16.43 years). Gambling disorder (SOGS-RA), drugs, alcohol, video games and spending (MULTICAGE CAD-4), attachment (IPPA), and alexithymia (TAS-20) were measured. Student's t, Pearson's r, and multiple mediation analyses were conducted. Problem gamblers scored significantly higher in all substance and non-substance addictive behaviours and alexithymia; as well as significantly lower scores in mother and father attachment scales. Moreover, gambling was negatively associated to father and mother attachment, and positively associated to alexithymia. Finally, alexithymia was found to mediate between parental attachment and gambling, spending, videogame, drug and alcohol abuse, especially in the case of mother attachment. This study demonstrated that adolescent and young adult problem gamblers show higher comorbid addictions than non-problem gamblers, in the same way as higher levels of alexithymia and poorer father attachment. Given that higher comorbidity in early ages is associated with worse prognosis and higher psychopathology in adult life, early detection and treatment purposes becomes essential.

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.