A reformulated cognitive-behavioral model of problem gambling. A biopsychosocial perspective

Do breaks in online gambling affect neuropsychological arousal? Conceptual approach and lessons learned from the TESSA-pilot trial

Introduction

Mandatory breaks have been discussed as a harm reduction strategy in the context of gambling for several years, but their effectiveness remains unclear. The TESSA pilot study examines the association of physiological arousal (PA) and mandatory breaks during gambling with an aim to conceptualize the framework for a subsequent randomized controlled trial.

Material and methods

In a one-armed experimental pilot study 28 participants engaged in a simulated online slot game with mandatory breaks. PA, disentangled into fear, anger, joy, attraction, balance, and retraction, was continuously monitored via skin conductivity and skin temperature. The occurrence of PA in distinct phases (phase 1: initiation, phase 2: pre-break, phase 3: post-break) was contrasted by multilevel logistic regression.

Results

Fear and attraction did not change. Compared to phase 1, anger (OR = 0.698; p = 0.015) and joy (OR = 0.714; p = 0.032) were less likely in phase 2, with joy also being less likely in phase 3 (OR = 0.690; p = 0.023). Balance was more likely in phase 2 (OR = 5.073; p < 0.0001) than in phase 1 and less likely in phase 3 (OR = 0.348; p < 0.0001) whilst retraction declined from phase to phase.

Discussion

Mandatory breaks appear suited to offset changes in PA response evolving during gambling, but a sustained effect on initial PA levels should not to be expected. However, to sensitively judge the role of breaks additional framework conditions that impact on gambling behavior (e. g. wins/losses) should be considered.

Winning Exposure and Positive Illusions Among Chinese Lottery Gamblers: Moderating Effects of Lottery Winning Experience and Socioeconomic Status

Positive illusions and winning exposure are key factors leading to problem lottery gambling, but few studies have examined the relationships between them. 402 Chinese lottery gamblers was conducted with the Winning Exposure Questionnaire, the Positive illusion Questionnaire, the Winning Experience Questionnaire, and the Social and Economic Status Questionnaire to investigate the relationship between winning exposure and positive illusions as well as the moderating role of winning experience and socioeconomic status. The results showed that winning exposure can significantly and positively predict the positive illusions (optimism bias, better than average bias, and illusion of control) of lottery gamblers. The highest winning amount and subjective socioeconomic status significantly moderated the relationship between winning exposure and optimism bias. That was to say, for lottery gamblers with smaller maximum winning amount and lower subjective socioeconomic status, the association between winning exposure and optimism bias was stronger. Furthermore, the moderating effect of highest winning amount in the relationship between winning exposure and better than average bias, and the moderating effects of occupational status and subjective socioeconomic status in the relationship between winning exposure and illusion of control were marginally significant.

'Getting addicted to it and losing a lot of money… it's just like a hole.' A grounded theory model of how social determinants shape adolescents' choices to not gamble

BACKGROUND

Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble.

METHODS

Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods.

RESULTS

The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests.

CONCLUSIONS

Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

Cluster analysis in gambling disorder based on sociodemographic, neuropsychological, and neuroendocrine features regulating energy homeostasis

BACKGROUND

The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far.

AIMS

This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features.

METHODS

297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ2) for categorical variables, and analysis of variance (ANOVA) for quantitative measures.

RESULTS

Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2.

CONCLUSIONS

To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.

Behavioural expressions of loss-chasing in gambling: A systematic scoping review

BANERJEE Nilosmita., CHEN Zhang., CLARK Luke., NOËL Xavier. Behavioural expressions of loss-chasing in gambling: A systematic scoping review NEUROSCI BIOBEHAV REV 152(1) XXX-XXX, 2023. - Loss-chasing, the tendency to continue and/or intensify gambling following losses, is a key clinical symptom in gambling disorder and a central feature endorsed by at-risk problem gamblers. Despite its centrality, loss-chasing has been often operationalised across distinct behavioural expressions. The current systematic scoping review aimed to map the heterogeneous operationalisations of loss-chasing in the literature. The reviewed studies defined loss-chasing either between-sessions (n = 39) or within-sessions (n = 38), as a long-recognised distinction. For both categories, further behavioural expressions could be distinguished. Between-session loss-chasing was captured by endorsing an item 'returning another day/time to recoup losses', or behaviourally as the interval between successive sessions, or as increasing stakes in the next session. Within-session loss-chasing was defined as continuing and/or intensifying gambling either by increased risk-taking, stake size, or speed of play. Additionally, much heterogeneity was observed in the gambling contexts examined, the exact definition of loss, and the potential delineation of win-chasing. Open questions and future directions are discussed. Overall, this paper serves as a first step towards more conceptual clarity of loss-chasing.

An Empirical Study of the Pathway Model Link Between Cognitive Distortions and Gambling Problems

This research empirically tests the relationship between gambling-related cognitive distortions and the development of gambling problems. In two separate studies using methodologies designed to support non-experimental causal inference, we demonstrate that holding false beliefs about gambling experiences is related to current and future risk of developing problems with gambling. In our first study, we use an instrumental variable estimation strategy on an internet sample (n = 184) and observe a statistically significant relationship between Gamblers' Belief Questionnaire scores and measures of loss chasing, overspending, and gambling problems. These findings were robust to linear and ordinal estimation strategies and multiple model specifications. In our second study, we examine five-year prospective longitudinal data (n = 1,431) to validate our initial findings and test whether irrational thoughts are also related to future problems with gambling. While controlling for current fallacies, we find that past Gambling Fallacies Measure scores are related to present gambling problems across two survey waves. The effect size of each of the past fallacy levels is roughly half of the effect size of present levels, suggesting meaningful impacts. Our findings support the Pathways Model of Problem and Pathological Gambling.

Gender and maladaptive personality correlates in problem gambling and over-indebtedness: Novel findings from a cross-sectional study in Sweden

Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.

For Better and For Worse: Frequent Gamblers Use Dual Counterfactuals to Justify Continued Gambling

How might frequent gamblers convince themselves to keep playing despite persistent losses or after a win that should be savored? The purpose of this research is to examine the unexplored question of how frequent gamblers' use counterfactual thinking to motivate their desire to continue gambling. Using a sample of n = 69 high and n = 69 low frequency gamblers in a field setting, we found that infrequent gamblers tended to consider how the perceived outcome of losing "could have been better" (i.e., upward counterfactual thinking), and how a winning outcome "could have been worse" (i.e., downward counterfactual thinking). This pattern of counterfactual thinking is considered typical in many settings and may, in a gambling context, support a potentially more responsible approach by helping infrequent gamblers to learn from past mistakes to avoid significant future losses and to savor wins to protect returns gained. Alternatively, we found that frequent gamblers were more likely to generate 'dual counterfactuals' which include both upward and downward counterfactuals in response to losses and wins. We argue that this dual pattern of counterfactual thinking may allow frequent gamblers to more easily justify their desire to continue gambling. Findings suggest that challenging gamblers counterfactual thinking patterns could assist clinicians in moderating the potential for high-risk behaviors.

Not all games are created equal: Adolescents who play and spend money on simulated gambling games show greater risk for gaming disorder

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail.

Autonomic responses during Gambling: the Effect of Outcome Type and Sex in a large community sample of young adults

Psychological theories consider autonomic arousal to be a reinforcer for problem gambling. Structural characteristics such as near-misses, which are non-win events that come close to a real win, have been shown to elicit win-like responses while increasing motivation and gambling persistence. This study investigated the autonomic and subjective responses of young adults to different gambling outcomes. This study also investigated sex differences in autonomic and subjective responses to different gambling outcomes.Participants from Sweden (n = 270) performed a computerized slot machine task that produced wins, near-misses (before and after payline) and full-misses. Phasic measurements of heart rate (HR) and skin conductance responses (SCR) were recorded during gambling performance and ratings of perceived chance of winning, pleasure and motivation to play were collected following each gambling outcome.Autonomic responses differed across slot machine outcomes as indicated by HR and SCR. Compared with other gambling outcomes, near-misses elicited the largest HR accelerations, and they also elicited larger HR decelerations and SCRs relative to full-misses. Near-misses before and after payline elicited differential psychophysiological responses and subjective reports, suggesting different emotional processing of near-miss subtypes. Females showed increased SCRs and motivation following win outcomes compared with males.In conclusion, wins, near-misses and full-misses generate differential physiological and subjective responses among young adults. Autonomic responses to wins differed between male and female players, emphasizing the need to consider sex differences when investigating the role of autonomic arousal in gambling.

Gambling-Related Intimate Partner Violence Against Women: A Grounded Theory Model of Individual and Relationship Determinants

This study aimed to examine how problem gambling interacts with gendered drivers of intimate partner violence (IPV) against women to exacerbate this violence. Interviews were conducted with 48 female victims of IPV linked to a male partner's gambling; 24 female victims of IPV linked to their own gambling; and 39 service practitioners from 25 services. Given limited research into gambling-related IPV, but a stronger theoretical base relating to IPV against women, this study used an adaptive grounded theory approach. It engaged with existing theories on gendered drivers of violence against women, while also developing a grounded theory model of individual and relationship determinants based on emergent findings from the data. Gambling-related IPV against women was found to occur in the context of expressions of gender inequality, including men's attitudes and behaviors that support violence and rigid gender expectations, controlling behaviors, and relationships condoning disrespect of women. Within this context, the characteristics of problem gambling and the financial, emotional and relationship stressors gambling causes intensified the IPV. Alcohol and other drug use, and co-morbid mental health issues, also interacted with gambling to intensify the IPV. Major implications. Reducing gambling-related IPV against women requires integrated, multi-level interventions that reduce both problem gambling and gendered drivers of violence. Gambling operators can act to reduce problem gambling and train staff in responding to IPV. Financial institutions can assist people to limit their gambling expenditure and families to protect their assets. Service providers can be alert to the co-occurrence of gambling problems and IPV and screen, treat, and refer clients appropriately. Public education can raise awareness that problem gambling increases the risk of IPV. Reducing gender inequality is also critical.

Exposure Therapy for Gambling Disorder: Systematic Review and Meta-analysis

Purpose of Review

Cognitive behaviour therapy is the gold standard for the treatment of gambling disorder. Obstacles remain regarding its efficacy, namely relapses and difficulty in implementing cognitive restructuring for some clients. Given these observations, behavioural interventions for gambling disorder, such as exposure therapy, which aims to decrease gambling craving, may be effective as a complementary or alternative intervention to cognitive behaviour therapy. This systematic review and meta-analysis aims to explore how exposure therapy for gambling disorder has been studied and to evaluate its efficacy. To answer these questions, 3406 studies, retrieved using PsycNet, Medline and Google Scholar, were screened.

Recent Findings

After two screenings, 13 papers were selected for the systematic review and five were statistically combined for the meta-analysis. Quantitative results support exposure therapy’s efficacy to decrease gambling craving at post-intervention (g =  − 0.955) and at last follow-up (6 or 12 months; − 1.010). Results also show a large decrease in gambling severity as documented by screening instruments (− 1.087) as well as time spent gambling (− 2.136) at post-intervention. Furthermore, a large decrease in gambling measured via screening instruments (− 1.162) and erroneous beliefs (− 1.308) was found at last follow-up.

Summary

This is the first meta-analysis on behavioural exposure therapy for gambling disorder. Results support that exposure therapy reduces gambling cravings and severity, as well as time spent gambling and erroneous beliefs. These results are discussed in comparison to other therapeutic approaches and are interpreted according to the high risk of bias in included studies.

The role of neurotrophin genes involved in the vulnerability to gambling disorder

Evidence about the involvement of genetic factors in the development of gambling disorder (GD) has been assessed. Among studies assessing heritability and biological vulnerability for GD, neurotrophin (NTF) genes have emerged as promising targets, since a growing literature showed a possible link between NTF and addiction-related disorders. Thus, we aimed to explore the role of NTF genes and GD with the hypothesis that some NTF gene polymorphisms could constitute biological risk factors. The sample included 166 patients with GD and 191 healthy controls. 36 single nucleotide polymorphisms (SNPs) from NTFs (NGF, NGFR, NTRK1, BDNF, NTRK2, NTF3, NTRK3, NTF4, CNTF and CNTFR) were selected and genotyped. Linkage disequilibrium (LD) and haplotype constructions were analyzed, in relationship with the presence of GD. Finally, regulatory elements overlapping the identified SNPs variants associated with GD were searched. The between groups comparisons of allele frequencies indicated that 6 SNPs were potentially associated with GD. Single and multiple-marker analyses showed a strong association between both NTF3 and NTRK2 genes, and GD. The present study supports the involvement of the NTF family in the aetiopathogenesis of GD. An altered cross-regulation of different NTF members signalling pathways might be considered as a biological vulnerability factor for GD.

Association between gambling disorder and emotion (dys)regulation: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to provide a comprehensive evaluation of the role of emotion (dys)regulation in gambling disorder (GD). PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed were systematically searched for articles published until November 3, 2020. Forty-nine studies were considered for the systematic review; of these, 38 comprising 5242 participants met the inclusion criteria for the meta-analysis. Associations were found between GD and specific emotion regulation (ER) deficits, namely (1) nonacceptance of negative emotional states, (2) difficulties in maintaining goal-directed behaviors when faced with intense emotional contexts, (3) lack of clarity about emotional states (poor emotional awareness), (4) low impulse control in reaction to negative emotional states, and (5) difficulties in accessing adaptive ER strategies. We furthermore found that GD is associated with a tendency for emotional suppression, which is known as a maladaptive ER strategy and linked with reduced mindfulness abilities. Additional moderator analyses were conducted regarding age, gender, type of instrument used to measure GD, clinical status of the samples, and quality of the studies. Overall, the data demonstrated consistent and significant associations between GD and ER. This systematic review and meta-analysis mostly supports the conceptualization of GD as an addictive disorder characterized by ER deficits and stresses the need to develop interventions in ER deficits that are tailored to the specificities of GD.

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.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Relationship Between Gambling Problems and the Five-Factor Model of Personality: A Systematic Review and Meta-Analysis

Objectives: The aim of the present meta-analysis was to synthesize results from the association between problem gambling (PG) and dimensions of the five factor model of personality and to identify potential moderators (gambling diagnosis: yes/no, comorbidity: yes/no and trait assessment: four or fewer items vs. five items or more) of these associations in meta-regressions. Methods: Searches were conducted in six databases; Medline, Web of Science, PsychInfo, Google Scholar, OpenGrey, and Cochrane Library (conducted on February, 22, 2021). Included studies: (1) reported a relationship between PG and at least one of the personality traits in the five-factor model, (2) contained information of zero-order correlations or sufficient data for such calculations, and (3) were original articles published in any European language. Case-studies, qualitative studies, and reviews were excluded. All articles were independently screened by two authors. Final agreement was reached through discussion or by consulting a third author. Risk of bias of the included studies was assessed by the Newcastle-Ottawa Scale. Data were synthesized using a random effects model. Results: In total 28 studies, comprising 20,587 participants, were included. The correlations between PG and the traits were as follows: Neuroticism: 0.273 (95% CI = 0.182, 0.358), conscientiousness -0.296 (95% CI = -0.400, -0.185), agreeableness -0.163 (95% CI = -0.223, -0.101), openness -0.219 (95% CI = -0.308, -0.127), and extroversion -0.083 (95% CI = -0.120, -0.046). For all meta-analyses the between study heterogeneity was significant. Presence of gambling diagnosis was the only moderator that significantly explained between-study variance showing a more negative correlation to extroversion when participants had a gambling diagnosis compared to when this was not the case. Discussion: The results indicated some publication bias. Correcting for this by a trim-and-fill procedure showed however that the findings were consistent. Clinicians and researchers should be aware of the associations between personality traits and PG. Previous studies have for example showed neuroticism to be related to treatment relapse, low scores on conscientiousness to predict treatment drop-out and agreeableness to reduce risk of treatment drop-out. Systematic Review Registration: PROSPERO (CRD42021237225).

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

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

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

Proximal and Distal Risk Factors for Gambling Problems Specifically Associated with Electronic Gaming Machines

Electronic gaming machines (EGMs) are widely used and the gambling product most commonly associated with harmful gambling. Understanding factors that increase the risk of problematic EGM play is therefore important. Previous studies into risk factors for EGM gambling have used measures of problem gambling based on an individual's total gambling activity, which therefore do not distinguish harmful gambling specifically associated with EGMs. This study used an EGM-specific measure (PGSI-EGM) to achieve its aim of identifying risk factors specifically associated with problematic EGM play. By removing nuisance effects from other gambling forms that higher-risk gamblers typically engage in, this approach provides a more accurate assessment of the determinants of EGM-related problems. An online survey was completed by 1932 at-least monthly EGM players in Australia. It measured demographics, EGM gambling behaviour, motivations, gambling urges, gambling fallacies, trait self-control, alcohol misuse, and the PGSI-EGM. A penalised regression model identified the most important proximal predictors of higher-risk EGM gambling as: higher gambling urges, higher levels of erroneous cognitions, playing EGMs more frequently, higher session expenditure, longer sessions, usually playing EGMs alone, and playing EGMs in more venues. Lower trait self control was the strongest distal determinant. Higher-risk EGM players tended to be younger, male, more educated, never married, to have higher (although still modest) incomes, and be more likely to have alcohol problems. These findings can inform interventions such as treatment, consumer education and venue interventions.

Stressful life events and gambling: The roles of coping and impulsivity among college students

Substantial research has found a robust relationship between stressful life events and increased negative health outcomes and a greater predisposition to various forms of substance use and gambling behavior; however, less is known about the individual factors that explain this relationship. The present study examines the moderating factors of gambling to cope and individual impulsivity factors (e.g., perseverance, premeditation, and negative urgency) on the relationship between stressful life events over the past year and gambling problems among a sample of college students. Participants included 653 total students (48.57% female; M = 26.31 years old; SD = 8.35 years) enrolled in universities across the United States who scored three or higher on the South Oaks Gambling Screen, an indicator of risk for problematic gambling. We found a positive relationship between stressful life events and gambling problems. Gambling to cope moderated the link between stressful life events and gambling problems such that for those higher in gambling to cope, stressful life events had little impact on gambling problems while those at lower to moderate levels of gambling to cope saw a positive relationship between stressful life events and gambling problems. Moreover, we found two significant three-way interactions between stressful life events, gambling to cope, and impulsivity factors of perseverance and premeditation in predicting problems. These findings suggest that prevention and/or treatment strategies should consider how gambling to cope and impulsivity factors in conjunction with an individual's report of stressful life events relate to problematic gambling and associated consequences.

Cold pressor pain and gambling disorder: implications for the opioid system

OBJECTIVE

Gambling disorder (GD) is a common, disabling condition that often is exacerbated by stressful life events. Under stress, the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis are activated. The question, therefore, arises as to whether an abnormal sympathetic response can be found in individuals with GD.

METHOD

Adult individuals with GD and no current co-occurring mental disorders were enrolled. Participants completed impulsivity and gambling-related questionnaires and underwent cold pressor evaluation. GD participants were compared with controls on measures of heart rate, blood pressure, and pain.

RESULTS

Fifteen people with GD and 18 controls completed the study. Kaplan-Meier analysis indicated that the GD group withdrew their hand from the painful stimulus more rapidly than controls (Wilcoxon chi-square = 3.87, p = 0.049), suggestive of lesser pain tolerance. Subjective pain ratings and cardiovascular measurements did not significantly differ between groups.

CONCLUSIONS

Individuals with GD manifested a relative intolerance to pain on the cold pressor paradigm, even though they physiologically did not seem to experience greater pain. Given the role of the opioid system in pain processing, it would be valuable in future work to examine whether cold pressor measures can predict response to treatments in GD, including with opioid antagonists.

Psychometric Properties of the Italian Versions of the Gambling Urge Scale (GUS) and the Gambling Refusal Self-Efficacy Questionnaire (GRSEQ)

Gambling urges and gambling refusal self-efficacy beliefs play a major role in the development and maintenance of problem gambling. This study aimed to translate the Gambling Urge Scale (GUS) and the Gambling Refusal Self-Efficacy Questionnaire (GRSEQ) from English to Italian (GUS-I, GRSEQ-I) and to test their factor structure, internal consistency, construct validity, concurrent validity, and gender differences in 513 individuals from the Italian community. Factor structure and construct validity were tested through Confirmatory Factor Analysis, internal consistency through Cronbach’s alpha, concurrent validity through correlations with gambling-related cognitions (GRCS-I), probable pathological gambling (SOGS-I), and gambling functioning (GFA-R-I). Results confirmed that the 6 items of the GUS-I load highly on one dimension of Gambling Urge, and each of the 26 items of the GRSEQ-I load highly on their relevant sub-dimension, among the following: situations/thoughts, drugs, positive emotions, negative emotions. Both scales are internally consistent and show concurrent validity with gambling-related cognitions, probable pathological gambling, and gambling functioning. Males score higher than females at the GUS-I; females score higher than males at the GRSEQ-I. The findings from the present study suggest that the GUS-I and the GRSEQ-I are internally consistent and valid scales for the assessment of gambling urges and gambling refusal self-efficacy in Italian individuals from the community, with significant repercussions in terms of assessment, prevention, and intervention.

To chase or not to chase: A study on the role of mentalization and alcohol consumption in chasing behavior

BACKGROUND AND AIMS

Chasing is a behavioral marker and a diagnostic criterion for gambling disorder. Although chasing has been recognized to play a central role in gambling disorder, research on this topic is relatively scarce. This study investigated the association between chasing, alcohol consumption, and mentalization among habitual gamblers.

METHOD

A total of 132 adults took part in the study. Participants were administered the South Oaks Gambling Screen, the Alcohol Use Disorders Identification Test, the Reflective Functioning Questionnaire, and a laboratory task assessing chasing behavior. Participants were randomly assigned to three experimental conditions (Control, Loss, and Win). To deeply investigate chasing behavior, participants were requested to indicate the reasons for stopping or continuing playing at the end of the experimental session.

RESULTS

Logistic regression analysis showed that the choice to stop or continue playing depended on experimental condition and alcohol use. Hierarchical linear regression indicated that chasing propensity was affected by experimental condition, alcohol consumption, and deficit in mentalization. The results of path analysis showed that hypermentalizing predicts chasing not only directly, but also indirectly via alcohol consumption.

CONCLUSIONS

Overall, these results for the first time showed that hypermentalization plays a key role in chasing behavior over and above gambling severity. Since these findings support the idea that chasers and non-chasers are different subtypes of gamblers, clinical interventions should consider the additive role of chasing in gambling disorder.

Emotion Dysregulation Mediating Associations Among Work Stress, Burnout, and Problem Gambling: A Serial Multiple Mediation Model

This study aimed to examine psychological mechanisms underlying work stress and burnout that may increase the risk of problem gambling. A serial multiple mediation model is proposed to specify that work stress (high job demand-low job control) can deplete employee resources and lead to burnout. Employees who have emotion dysregulation may engage in gambling to escape or avoid burnout and negative emotions at work. Over time, these employees may become increasingly rely on gambling to cope with their burnout experience, leading to problem gambling. A total of 1233 full-time employees in the United States completed a web survey on work stress. Results supported the proposed serial multiple mediation model. The indirect effect of work stress on problem gambling first through burnout then through emotion dysregulation was significant. The direct effect of work stress on problem gambling was reduced to nonsignificance after controlling for the two mediators (burnout and emotion dysregulation). When the two mediators were considered together in the specified sequence, the indirect effects of work stress on problem gambling through individual mediators were also reduced to nonsignificance. Gender was a nonsignificant moderator, and pathways of the proposed serial multiple mediation model were similar for men and women. Supplementary analyses did not support an alternate sequence of mediators. The present findings suggest that prevention and treatment programs for work stress, burnout, and problem gambling should include the assessment and enhancement of emotion regulation skills.

Isolating the impact of specific gambling activities and modes on problem gambling and psychological distress in internet gamblers

Background

Gambling disorder is related to high overall gambling engagement; however specific activities and modalities are thought to have stronger relationships with gambling problems. This study aimed to isolate the relationship between specific gambling activities and modalities (Internet and venue/land-based) to gambling disorder and general psychological distress. Past-month Internet gamblers were the focus of this investigation because this modality may be associated with gambling disorders in a unique way that needs to be separated from overall gambling intensity.

Methods

Australians who had gambled online in the prior 30 days (N = 998, 57% male) were recruited through a market research company to complete an online survey measuring self-reported gambling participation, problem gambling severity, and psychological distress.

Results

When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines (EGMs) and venue-based sports betting. Psychological distress was uniquely associated with higher frequency of venue gambling using EGMs, sports betting, and casino card/table games.

Conclusions

This study advances our understanding of how specific gambling activities are associated with disordered gambling and psychological distress in users of Internet gambling services. Our results suggest that among Internet gamblers, online and land-based EGMs are strongly associated with gambling disorder severity. High overall gambling engagement is an important predictor of gambling-related harms, nonetheless, venue-based EGMs, sports betting and casinos warrant specific attention to address gambling-related harms and psychological distress among gamblers.

Problem gambling in adolescents: what are the psychological, social and financial consequences?

BACKGROUND

The paper examines the roles of sociodemographic traits, family quality and risk behaviour in adolescent problem gambling, with focus on the psychological, social and financial consequences from the socio-ecological model approach. This model emphasizes the most important risk-protective factors in the development and maintenance of problem gambling on an individual level, a relationship level, as well as a community and societal level.

METHODS

The research was done using the Canadian Adolescent Gambling Inventory with a sample of 366 participants, 239 females (65.3%) using descriptive statistics and t-test, ANOVA, correlation and hierarchical regression analysis.

RESULTS

Males reported significantly higher gambling consequences on all scales (p < .001) and significantly more risk behaviour (p < .05). Age was significant for psychological consequences (p < .01), problem gambling (p < .01) and risk behaviour (p < .001) with older participants scoring higher. Students with lower school success reported significantly higher psychological consequences of gambling (p < .01), higher risk behaviour activity (p < .001) and lower family life satisfaction (p < .001). The psychological, financial and social consequences were positively correlated with problem gambling (p < .001). Age (p < .05), gender (p < .001), school success (p < .01) and the father's education level (p. < 05) were significant predictors of problem gambling, with older male adolescents who struggle academically and have lower educated fathers being at greater risk.

CONCLUSIONS

Results indicate an important relation between adolescent gambling behaviour and very serious psychological, social and financial consequences. There is a constellation of risk factors that likely place certain individuals at high risk for problem gambling.

Pathological personality facets and emotion (dys)regulation in gambling disorder

A number of researches showed high prevalence of personality disorders among addicted gamblers. However, there are still few studies investigating the role of pathological personality facets in Gambling Disorder (GD). Moreover, the nature of the relationship between GD and pathological personality is not clear. We administered to a group of addicted gamblers (N = 79) and a group of healthy participants (N = 101) a battery of self-report questionnaires encompassing the South Oaks Gambling Screen (SOGS), The Personality Inventory for DSM-V (PID-5), the Difficulties in Emotion Regulation Scale (DERS) and the Emotion Regulation Questionnaire (ERQ). Analyses of variance showed that addicted gamblers, compared to healthy participants, scored higher on most of the subscales of the DERS, on the Suppression Dimension of the ERQ and on the five main domains of the PID-5 whereas they obtained lower scores on the Reappraisal subscale of the ERQ. Moreover, multiple regression analyses indicated that some specific facets of pathological personality, emotion dysregulation and lack of cognitive reappraisal, significantly predict GD's severity. Finally, emotion dysregulation levels and lack of cognitive reappraisal partially mediated the relationship between these and GD's severity. Our results confirmed the central roles played by both pathological personality and deficit in emotion regulation capacities in GD. Specifically, Impulsivity, Lack of Perseverance and Suspiciousness may be important predictors of GD severity. Moreover, emotion dysregulation and lack of adaptive emotion regulation strategies partially explained such relationship. As such, training for emotion regulation abilities appears strategically useful in the treatment of addicted gamblers with pathological personality traits.

Polygenic Risk Scores for Psychiatric Disorders Reveal Novel Clues About the Genetics of Disordered Gambling

Disordered gambling (DG) is a rare but serious condition that results in considerable financial and interpersonal harms. Twin studies indicate that DG is heritable but are silent with respect to specific genes or pathways involved. Existing genomewide association studies (GWAS) of DG have been substantially underpowered. Larger GWAS of other psychiatric disorders now permit calculation of polygenic risk scores (PRSs) that reflect the aggregated effects of common genetic variants contributing risk for the target condition. The current study investigated whether gambling and DG are associated with PRSs for four psychiatric conditions found to be comorbid with DG in epidemiologic surveys: major depressive disorder (MDD), attention-deficit hyperactivity disorder (ADHD), bipolar disorder (BD) and schizophrenia (SCZ). Genotype data and survey responses were analyzed from the Wave IV assessment (conducted in 2008) of the National Longitudinal Study of Adolescent to Adult Health, a representative sample of adolescents recruited in 1994-1995 and followed into adulthood. Among participants classified as having European ancestry based on genetic analysis (N = 5215), 78.4% reported ever having gambled, and 1.3% reported lifetime DG. Polygenic risk for BD was associated with decreased odds of lifetime gambling, OR = 0.93 [0.87, 0.99], p = .045, pseudo-R2(%) = .12. The SCZ PRS was associated with increased odds of DG, OR = 1.54 [1.07, 2.21], p = .02, pseudo-R2(%) = .85. Polygenic risk scores for MDD and ADHD were not related to either gambling outcome. Investigating features common to both SCZ and DG might generate valuable clues about the genetically influenced liabilities to DG.

How learning misconceptions can improve outcomes and youth engagement with gambling education programs

BACKGROUND AND AIMS

Gambling education programs typically focus on promoting gambling as a high-risk activity with harmful effects; however, these programs demonstrate limited effects on the prevention of gambling problems. This paper proposes a clear theoretical framework to inform the content and delivery of gambling education initiatives and draws on psychological and pedagogical research to address some of the practical issues associated with its implementation.

METHODS

Literature was reviewed across fields of psychology, public health, and pedagogy to provide key recommendations to improve the outcomes of gambling education.

RESULTS

Four key recommendations were made for the development of future gambling education programs centering on theoretical approach, specialized content, and delivery.

DISCUSSION AND CONCLUSIONS

Recommended advancements are as follows: (a) evidence suggests shifting away from messages about gambling harms and instead applying a cognitive-developmental framework of problem gambling that may improve youth engagement by increasing personal relevance. (b) The cognitive model of problem gambling suggests that misconceptions about the profitability of gambling games (e.g., the gambler's fallacy) play an important role in the development of problems and should be a key target for education. However, exposing such misconceptions requires the challenge of teaching the mathematical principles that underpin them. (c) The pedagogical field provides valuable insights into teaching complex concepts. Research that applies the conceptual change model to science education suggests misconceptions also facilitate learning new complex information, such as gambling-related mathematical concepts (i.e., randomness and statistics). (d) In addition, improvements in computer-assisted teaching methods provide opportunities to use simulations and visualizations to help teach abstract concepts and correct such misconceptions.

The gambling craving experience questionnaire: Psychometric properties of a new scale based on the elaborated intrusion theory of desire

Both research and clinical practice acknowledge the importance of craving as a maintenance and relapse factor in gambling disorder. The elaborated intrusion theory (EIT; Kavanagh et al., 2005) of desire has been extensively investigated in relation to psychoactive substance or food cravings but, to date, has scarcely been studied in relation to gambling. In such a context, developing an assessment tool of gambling craving based on the EIT is warranted. To fill this gap in the literature, we aimed to develop and test the psychometric properties of a gambling-adapted version of the Craving Experience Questionnaire (CEQ; May et al., 2014), which is the best established measure of craving theoretically anchored in the EIT. An online survey that included the gambling CEQ (g-CEQ) and a craving induction procedure was administered to 274 community participants involved in gambling at least a few times a year. Concurrent and convergent validity were explored through correlations with a scale that measured gambling urge and with a series of questionnaires that measured disordered gambling symptoms, gambling cognitions, and gambling motives. The confirmatory factor analyses supported the validity of the expected three-factor model of the "strength" and "frequency" forms of the g-CEQ and showed better model fit than a one-factor solution, corroborating the initial structure of the CEQ. Furthermore, the scale has good internal consistency and its validity is supported by correlations with gambling-related constructs. The g-CEQ is thus a theoretically and psychometrically sound instrument to measure gambling craving based on the EIT.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

Cue-Reactive Imagery Mediates the Relationships of Reward Responsiveness with Both Cue-Reactive Urge to Gamble and Positive Affect in Poker-Machine Gamblers

Previous research has demonstrated that gambling cues (e.g., flashing lights on poker-machines) can trigger an urge to gamble in poker-machine gamblers. However, the psychological mechanisms that promote the urge to gamble remain poorly understood. The present study explored whether reward responsiveness predicted urge to gamble and positive affect, and whether cue-reactive rationality, volitional control and imagery mediated these relationships. Ninety-three (45% male and 55% female) Australian regular poker-machine gamblers aged between 18 and 77 participated in an online cue-reactivity experiment. Participants initially completed the Problem Gambling Severity Index and Reward Responsiveness scale. Subsequently, at three time points (i.e., baseline, directly after a neutral cue and directly after a gambling cue) participants completed the rationality, volitional control and imagery subscales of the Phenomenology of Consciousness Inventory and two visual analogue scales that measured urge to gamble and positive affect. Analyses indicated that gambling cues triggered statistically significant increases in both urge to gamble and positive affect and these variables were statistically significantly positively correlated with reward responsiveness. Furthermore, only cue-reactive imagery mediated the relationships between reward responsiveness and the two outcome variables (i.e., cue-reactive urge to gamble and positive affect). These findings highlight the potential importance of targeting reward responsiveness and cue-reactive mental imagery in the context of exposure therapies for poker-machine problem gamblers.

Some Neuropsychological Profiles and Personality Traits of Undergraduate Regular Online Football Gamblers (a New Online Gambling Game) in Nigeria

Online football (soccer) gambling is among the relatively new sports betting games in Nigeria that use internet connections. Like other gambling games, some psychological profiles either propel or sustain the behavior. We tested some neuropsychological profiles and personality traits that distinguish the regular online football gamblers from non-gamblers. Using a between group design, we tested 140 (60: online football gamblers; 80: non-gamblers) university undergraduate students between the ages of 18-26 years on specific neuropsychological domains (i.e., attention, inhibition and executive function) and personality traits. The neuropsychological tasks used were the Series Addition Task (a modified version of Paced Auditory Serial Addition Task), Stroop-Word Color Test and Trail Making Test (TMT), Parts A and B. The personality traits were assessed using the Big Five Personality Inventory. The findings showed significant differences between the online football gamblers and non-gamblers, reflecting greater agreeableness, conscientiousness, neuroticism and openness to experience for the football gamblers. However, on the attention tasks, the non-gamblers made significantly fewer errors on forward addition and backward subtraction tasks, but did take more time to complete the backward counting task as compared to gamblers. On the other hand, online football gamblers took significantly less time to complete the Stroop congruence task and made significantly fewer errors on Stroop incongruence task. Similarly, the online football gamblers took less time to complete the TMT B and made fewer errors on TMT A. University undergraduate regular online football gamblers, as compared to non-gamblers, demonstrate stronger personality traits of ambition and gregariousness, and perform better on tasks of executive function, though they had more difficulty on tasks of divided and sustained attention.