Search

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.

Gambling disorder (GD) is a behavioral addiction associated with personal, social and occupational consequences. Thus, examining GD's clinical relationship with its neural substrates is critical. We compared neural fingerprints using diffusion tensor imaging (DTI) in GD subjects undergoing treatment relative to healthy volunteers (HV). Fifty-three (25 GD, 28 age-matched HV) males were scanned with structural magnetic resonance imaging (MRI) and DTI. We applied probabilistic tractography based on DTI scanning data, preprocessed and analyzed using permutation testing of individual connectivity weights between regions for group comparison. Permutation-based comparisons between group-averaged connectomes highlighted significant structural differences. The GD group demonstrated increased connectivity, and striatal network reorganisation, contrasted by reduced connectivity within and to frontal lobe nodes. Modularity analysis revealed that the GD group had fewer hubs integrating information across the brain. We highlight GD neural changes involved in controlling risk-seeking behaviors. The observed striatal restructuring converges with previous research, and the increased connectivity affects subnetworks highly active in gambling situations, although these findings are not significant when correcting for multiple comparisons. Modularity analysis underlines that, despite connectivity increases, the GD connectome loses hubs, impeding its neuronal network coherence. Together, these results demonstrate the feasibility of using whole-brain computational modeling in assessing GD.

Gambling disorder (GD) is a behavioural addiction characterized by impairments in decision-making, favouring risk- and reward-prone choices. One explanatory factor for this behaviour is a deviation in attentional processes, as increasing evidence indicates that GD patients show an attentional bias toward gambling stimuli. However, previous attentional studies have not directly investigated attention during risky decision-making. 26 patients with GD and 29 healthy matched controls (HC) completed a mixed gambles task combined with eye-tracking to investigate attentional biases for potential gains versus losses during decision-making under risk. Results indicate that compared to HC, GD patients gambled more and were less loss averse. GD patients did not show a direct attentional bias towards gains (or relative to losses). Using a recent (neuro)economics model that considers average attention and trial-wise deviations in average attention, we conducted fine-grained exploratory analyses of the attentional data. Results indicate that the average attention for gains in GD patients moderated the effect of gain value on gambling choices, whereas this was not the case for HC. GD patients with high average attention for gains started gambling at less high gain values. A similar trend-level effect was found for losses, where GD patients with high average attention for losses stopped gambling at lower loss values. This study gives more insight into how attentional processes in GD play a role in gambling behaviour, which could have implications for the development of future treatments focusing on attentional training or for the development of interventions that increase the salience of losses.

Background A first approach addressed to ascertain whether emotion regulation (ER) could be a transdiagnostic construct between eating disorders (EDs) and gambling disorder (GD) (through a joint clinical clustering analysis of both disorders) was performed by Munguía et al. (2021). Both conditions were represented by a severe, moderate, and low ER profile subgroups, according to the degree of ER difficulties. Results showed a linear relationship between the severity of ER difficulties and the severity of the disorder and the psychopathological state. Aims Based on the aforementioned cross-sectional study, the objective of this longitudinal research was to explore the treatment response of the different ER subgroups. Methods 459 adult patients (n = 277 ED; n = 182 GD) were included. Several clinical variables, as well as outcome indicators (after completing 16 weeks of cognitive-behavioral therapy), were evaluated. Results The three subgroups found in the previous cross-sectional study were taken for the performance of the present research. ED and GD distribution in each subgroup replicates the one exposed by Munguía et al. (2021), as well as their characterization, considering psychopathology, disorder severity and personality traits. The low ER subgroup reported a better response to treatment, whereas the severe group had the highest rates of non-remission and dropouts. Conclusions Our results suggest that greater difficulties in ER lead to poorer treatment outcomes. Therefore, tailored treatments for patients with poor ER abilities would be recommended to improve adherence and treatment outcomes.

Funder: Finnish Foundation for Alcohol Studies; Id: http://dx.doi.org/10.13039/100016238, Funder: Päivikki and Sakari Sohlberg Foundation; Id: http://dx.doi.org/10.13039/501100004212, Funder: Finnish Cultural Foundation; Id: http://dx.doi.org/10.13039/501100003125, Funder: Turku University Foundation; Id: http://dx.doi.org/10.13039/501100022793, Funder: Michael J. Fox Foundation; Id: http://dx.doi.org/10.13039/100000864, Funder: Finnish Parkinson Foundation, Funder: Province of British Columbia, Funder: British Columbia Lottery Corporation (BCLC), Funder: National Association for Gambling Studies, Funder: National Center for Responsible Gaming; Id: http://dx.doi.org/10.13039/100003977, Funder: GambleAware; Id: http://dx.doi.org/10.13039/501100008625, Funder: Gambling Research Exchange Ontario; Id: http://dx.doi.org/10.13039/501100007553, Funder: Finnish Medical Foundation; Id: http://dx.doi.org/10.13039/100008723, Funder: Instrumentarium Research Foundation, Gambling disorder (GD) is major public health issue. The disorder is often characterized by elevated impulsivity with evidence from analogous substance use disorders underlining prominent roles of brain monoamines in addiction susceptibility and outcome. Critically, GD allows the study of addiction mechanisms without the confounder of the effects of chronic substances. Here, we assessed the roles of striatal dopamine transporter binding and extrastriatal serotonin transporter binding in GD as a function of impulsivity using [123 I]FP-CIT SPECT imaging in 20 older adults with GD (DSM-5 criteria; mean age 64 years) and 40 non-GD age- and sex-matched controls. We focused on GD in older individuals because there are prominent age-related changes in neurotransmitter function and because there are no reported neuroimaging studies of GD in older adults. Volume-of-interest-based and voxelwise analyses were performed. GD patients scored clearly higher on impulsivity and had higher tracer binding in the ventromedial prefrontal cortex than controls (p < 0.001), likely reflecting serotonin transporter activity. The binding in the medial prefrontal cortex positively correlated with impulsivity over the whole sample (r = 0.62, p < 0.001) as well as separately in GD patients (r = 0.46, p = 0.04) and controls (r = 0.52, p < 0.001). Striatal tracer binding, reflecting dopamine transporter activity was also positively correlated with impulsivity but showed no group differences. These findings highlight the role of prefrontal serotonergic function in GD and impulsivity. They identify cerebral coordinates of a potential target for neuromodulation for both GD and high impulsivity, a core phenotypic dimensional cognitive marker in addictions.

Background and aims Skin gambling uses in-game items (skins) acquired in video games, to gamble on esports, games of chance, other competitive events and privately with friends. This study examined characteristics of adolescent skin gamblers, their engagement in monetary gambling, and relationships between skin gambling and at risk/problem gambling. Methods Two samples of Australian adolescents aged 12–17 years were recruited to an online survey through advertisements (n = 843) and an online panel provider (n = 826). Results In both samples, past-month skin gamblers (n = 466 advertisements sample; n = 185 online panel sample) were more likely to have lower wellbeing, score as having an internet gaming disorder on the IGD, engage in more types of monetary gambling, and meet criteria for problem gambling on the DSM-IV-MR-J. Past-month skin gambling uniquely predicted problem gambling when controlling for past-month gambling on 11 monetary forms and the total number of monetary gambling forms. Discussion and conclusions Underage participation in skin gambling is a growing concern. The strong convergence between engagement in skin gambling and monetary gambling suggests common risk factors may increase the propensity of some adolescents to gamble on these multiple forms. Nonetheless, past-month skin gambling predicted problem gambling even when controlling for past-month monetary gambling, indicating its unique contribution to gambling problems and harm. While the study was based on non-probability samples, its results strengthen the case for regulatory reforms, age restrictions and public health education to prevent underage skin gambling and its potentially harmful consequences for children and young people.

Researchers have raised concerns about mental health in elite athletes, including problem gambling, where research hitherto is scarce. While gambling has been assessed in the younger student-athlete population, neither gambling nor the recently recognized behavioral addiction of gaming disorder has been sufficiently addressed in the elite athlete population. The present systematic literature review aimed to summarize research knowledge on the prevalence and correlates of problem gambling and problem gaming in elite athletes. Research papers were searched systematically using the Scopus, PsycINFO, and PubMed/MEDLINE databases and evaluated following a PRISMA paradigm. For the elite athlete population, eight reports on problem gambling and one report on problem gaming were found. While at least five papers indicated an increased risk of problem gambling in elite athletes compared to the general population, one study from Australia indicated the opposite. Problem gambling was generally more common in male athletes. Knowledge of problem gaming prevalence is thus far limited. It is concluded that increased research in problem gambling and problem gaming in elite athletes is warranted.

Altres ajuts: Delegación del Gobierno para el Plan Nacional sobre Drogas (2019I47 and 2021I031). CIBER Fisiología Obesidad y Nutrición (CIBERobn) is an initiative of Intituto de Salud Carlos III. ZD's contribution was supported by the Hungarian National Research, Development and Innovation Ofce (KKP126835, K131635). The online version contains supplementary material available. Few studies have analyzed the clinical profle of treatment-seeking patients with the comorbid presence of schizophrenia (SCZ) and gambling disorder (GD), which warrants new research to assess the network structure of this complex mental condition. The aim of this study was to explore the organization of the symptoms and other clinical correlates of SCZ with GD. Network analysis was applied to a sample of N = 179 SCZ patients (age range: 19-70 years, mean=39.5, SD=9.9) who met clinical criteria for gambling disorder-related problems. Variables included in the network were the core GD symptoms according to the DSM-5, psychotic and paranoid ideation levels, global psychological distress, GD severity measures (debts and illegal behavior related with gambling), substances (tobacco, alcohol, and illegal drugs), and personality profle. The nodes with the highest authority in the network (variables of highest relevance) were personality traits and psychological distress. Four empirical modules/clusters were identifed, and linkage analysis identifed the nodes with the highest closeness (bridge nodes) to be novelty seeking and reward dependence (these traits facilitate the transition between the modules). Identifcation of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat SCZ with GD.

Zusammenfassung. Der Beitrag informiert über die Eingliederung der Suchtstörungen in die 11. Auflage der International Classification of Diseases (ICD-11) der Weltgesundheitsorganisation (WHO). Die Revision der ICD soll einem gewandelten Verständnis der Suchtstörungen und deren Diagnostik Rechnung tragen und die klinische Anwendbarkeit vereinfachen. Im Bereich der substanzbezogenen und nicht substanzbezogenen Störungen sind gegenüber der Vorgängerversion erhebliche Neuerungen eingeführt worden. Die wichtigsten Änderungen betreffen ein erweitertes Angebot an Stoffklassen, deutliche (vereinfachende) Anpassungen in den konzeptuellen und diagnostischen Leitlinien der substanzbezogenen Störungsbilder und insbesondere der „Abhängigkeit“, sowie die Einführung der Kategorie der „abhängigen Verhaltensweisen“ und damit verbunden die Zuordnung der „Glücksspielstörung“ zu den Suchtstörungen sowie die Aufnahme der neuen (bildschirmbezogenen) „Spielstörung“. Zudem findet eine Erweiterung der diagnostischen Optionen für frühe, präklinische Phänotypen der Suchtstörungen („Episodisch Schädlicher Gebrauch“) erstmals Eingang in den ICD-Katalog. Im vorliegenden Beitrag werden die Änderungen Episodisch schädlicher Gebrauch für den Bereich der Suchtstörungen aus kinder- und jugendpsychiatrischer Sicht zusammenfassend dargestellt und diskutiert.

Background and aim Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe. Methods We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status. Results Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB. Discussion and conclusion Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

Gambling disorder (GD) is associated with a higher prevalence of adverse childhood experiences (ACEs). Whether this applies to groups such as U.S. veterans, who already have elevated ACEs, is not known. In this pilot study, we extracted ACEs from the charts of a random sample (n = 19) male veterans in residential GD treatment and compared them to those from a general veteran sample (n =154, 30 females, 124 males). The GD group had an elevated prevalence (79% vs. 37%) of three or more ACEs and a lower prevalence (5% vs. 49%) of one or fewer ACEs. Within groups with elevated ACEs, higher ACE load may still confer a higher risk of adult GD.

Most of the available literature has shown that gambling disorder (GD) is often associated with several psychiatric conditions. Comorbidities with mood disorders, impulsiveness, personality traits, and impairments in cognitive function have also been frequently investigated. However, it is currently uncommon to study this disorder in individuals without comorbid substance abuse; therefore, the primary aim of our study was to compare the psychological profile of individuals with GD with and without substance use disorder. A total of 60 participants (100% male), including 20 individuals with GD, 20 substance-dependent gamblers (SDGs), and 20 healthy controls (HCs), were assessed with several clinical measures to investigate impulsivity, hostility, mood, and personality traits, as well as with cognitive tasks (i.e., decision-making tasks). Our results showed differences in both experimental groups compared with the HC group in mood disorders, impulsivity, and hostility traits. The ‘‘pure’’ GD group differed from the SDG group only in characteristics related to mood disorders (e.g., State-Trait Anxiety Inventory-Y2, Beck Depression Inventory-II, and assault dimension), whereas greater impairment in decision making processes related to risky choices was shown in the SDG group. This study suggests the importance of studying pure GD to clarify the underlying mechanisms without the neurotoxic effects of the substances. This could provide an important contribution to the treatment and understanding of this complex disorder.

E. J. Langer's paper, 'The illusion of control' (1975), showed that people act in ways that suggest they hold illusory beliefs in their ability to control the outcome of chance-determined games. This highly cited paper influenced the emerging field of gambling studies, and became a building block for cognitive approaches to problem gambling. Over time, this work has inspired therapeutic approaches based on cognitive restructuring, preventative programmes focused upon gambling myths and regulatory scrutiny of skill mechanics in modern gambling products. However, the psychological mechanisms underlying the 'illusion of control' remain elusive.

Objective The aim of the present study was to investigate whether the remission of preoperative food addiction is associated with increases or new onset of other addictions within the first year following bariatric surgery. Methods One hundred and twenty-five bariatric surgery patients were assessed before surgery (t1) and at 6 months (t2) and 1 year (t3) follow-ups. The assessments included the Yale Food Addiction Scale 2.0 (YFAS 2.0) and standardized questionnaires to measure symptoms of problematic alcohol use, gambling disorder, internet-use disorder, buying-shopping disorder, hypersexual disorder and exercise dependence. Results Forty-nine (39.2%) patients were assigned to the food addiction (FA+ ) and 76 patients (60.8%) to the non-food addiction group (FA- ) based on their preoperative YFAS scores. Overall, BMI and symptoms of food addiction decreased significantly from baseline to follow-ups. Preoperative food addiction status was not associated with postoperative increases or new onset of other addictions. Elevated symptoms of buying-shopping disorder, internet-use and hypersexual behaviour at baseline in the FA+ -group decreased over time and were comparable to the FA- -group at follow-ups. Conclusion The 'addiction transfer' or 'cross addiction' hypothesis was not supportive for alcohol addiction, gambling addiction or other behaviours that may be addictive. Further studies are needed that investigate larger samples and longer observation periods, as well as other substance-use disorders.

Purpose of review Despite a significant body of literature related to the treatment of gambling disorder, there are still an insufficient number of evaluation studies regarding their effectiveness or firm conclusions on specific treatment elements that contribute to it. The aim of this article was to provide a review of scientific results regarding the treatment of gambling disorder, to present the most commonly applied modalities of treatment and to explore the elements of the most successful therapeutic interventions. Recent findings A substantial body of literature has shown that the most successful therapeutic protocols are psychological interventions, especially based on cognitive-behavioral therapy/methods and/or motivational interviewing. Other interventions with promising results include different self-help interventions and mindfulness. Interventions such as couples therapy and support groups, may have positive effects in terms of increasing therapeutic adherence and retention, while pharmacotherapy is especially useful in patients with comorbidities. Summary Gambling disorder is a complex mental health problem caused by a wide spectrum of different biological, psychological, and social risk factors. Treatment options for gambling disorder need to be wide, flexible, accessible, and economically justified, providing early inclusion, retention, and sustainability of long-term effects of the treatment, that is, abstinence and higher quality of psychosocial functioning.

Background: Gambling disorder is rarely diagnosed in Nigeria. The prevalence and factors associated with gambling disorder in many parts of Nigeria are not known. Our study aimed to evaluate psychometric properties of the Diagnostic and Statistical Manual (DSM)-5 for use as a self-report screening instrument for large-scale studies in Nigeria. Methods: Cross-sectional surveys were done involving two independent sampled populations from a hospital setting and the surrounding community. Instruments administered included a semistructured sociodemographic questionnaire, South Oaks Gambling Screen (SOGS), International Classification of Diseases (ICD) 11 criteria, and a screening questionnaire based on Diagnostic Statistical Manual (DSM-5), which was designed as a self-report measure (Sports betting). Results: The prevalence rate for gambling disorder was 30.5%. The diagnostic accuracy of DSM-5 and ICD-11, and SOGS were comparably similar. Factors associated with gambling disorder (sports betting) were low educational level and poor employment status. Conclusion: The DSM-5-based screening questionnaire showed good psychometric properties, with sensitivity and specificity comparable to that of ICD-11 criteria and SOGS. The study also found a high prevalence of gambling disorder. There is a need to address educational and employment opportunities.

Gambling disorder (GD) occurs at higher rates in U.S. veterans than civilians. The present case series describes the application of a manualized mindfulness treatment used with U.S. veterans seeking outpatient treatment for GD at a Department of Veterans Affairs hospital. Mindfulness-Based Relapse Prevention (MBRP) was developed to treat substance use disorders, but its core principles can be readily applied to the treatment of behavioral addictions. However, there has been little empirical evidence demonstrating its successful application for GD, and none demonstrating its successful implementation with U.S. veterans. Three veterans receiving treatment for GD participated in a 9-session adapted MBRP protocol. Following completion of treatment, the veterans reported less frequent engagement in their gambling behavior, fewer cravings, and less intense craving. The veterans also experienced increased self-efficacy in managing urges, less impulsivity and emotion dysregulation, and improved functioning. Preliminary results provide support for a larger treatment trial for veterans seeking treatment for GD.

Purpose of review The lockdown response to the COVID-19 pandemic has significantly impacted commercial gambling in many jurisdictions around the world. The goal of this review is to systematically identify and describe the survey data and findings to date examining the effect on individual gambling and gambling disorder. Recent findings Of the 17 publications meeting inclusion criteria, the majority reported cross-sectional assessments (n = 11, 65%) and remainder were longitudinal in that they had earlier gambling data for participants (n = 6, 35%). Not surprisingly given the closure of land-based gambling, an overall reduction in gambling frequency and expenditure was reported in all studies. The estimate of the proportion of participants in both the general population and the population that gambles who increased overall gambling or online gambling was variable. The most consistent correlates of increased gambling during the lockdown were increased problem gambling severity, younger age groups, and being male. Summary These results suggest that the impacts of the COVID-19 pandemic on gambling and problematic gambling are diverse – possibly causing a reduction in current or future problems in some, but also promoting increased problematic gambling in others. The longer-term implications of both the reduction in overall gambling, and the increase in some vulnerable groups are unclear, and requires assessment in subsequent follow-up studies. However, in the short term, individuals with existing gambling problems should be recognized as a vulnerable group.

Background and Aims Few meta‐analyses have been conducted to pool the most constant risk factors for problem gambling. The present meta‐analysis summarizes effect sizes of the most frequently assessed problem gambling risk factors, ranks them according to effect size strength and identifies any differences in effects across genders. Method A random‐effects meta‐analysis was conducted on jurisdiction‐wide gambling prevalence surveys on the general adult population published until March 2019. One hundred and four studies were eligible for meta‐analysis. The number of participants varied depending on the risk factor analyzed, and ranged from 5327 to 273 946 (52% female). Weighted mean odds ratios were calculated for 57 risk factors (socio‐demographic, psychosocial, gambling activity and substance use correlates), allowing them to be ranked from largest to smallest with regard to their association with problem gambling. Results The highest odds ratio (OR) was for internet gambling [OR = 7.59, 95% confidence interval (CI) = 5.24, 10.99, P

People can place preponderant importance on a single life domain (e.g., relationships, appearance, financial success). The result is that success (or failure) in that domain has significant influence on the self-concept and thus judgments of self-worth. A focused self-concept has also been shown to be a core feature of various psychiatric disorders, including depression, body image disorders, and obsessive-compulsive and related disorders. Herein, we summarize mounting evidence indicating that a self-concept focused on financial success is important for understanding the etiology and maintenance of disordered gambling. The review indicates that a financially focused self-concept is moderately and positively associated with disordered gambling severity. Specifically, we outline research that has examined how and why financially focused self-concept proliferates and maintains disordered gambling. Based on this research, we put forth the idea that having a financially focused self-concept is an etiological factor that is common to the different gambling disorder subtypes outlined in the Pathways Model—arguably the leading biopsychosocial model of gambling addiction and gambling harm. More research is needed that assesses the antecedents and consequences of possessing a financially focused self-concept. We call on researchers to assess sociocultural, psychological, and environmental factors that may cultivate a financially focused self-concept as well as factors that may help people expand their domains of self-worth. The recovery process from any psychiatric disorder that includes a financial focus as an etiological factor should be aided by an expansion of the life domains from which self-worth is garnered.

OBJECTIVES: The COVID-19 pandemic reduced access to gambling and contributed to widespread psychological distress. Psychological distress is a known risk factor for problem gambling as it can motivate excessive gambling as a coping response. The availability of gambling is considered a factor in maintaining problems. This paper aimed to investigate the impact of the shutdown of gambling venues on Australians, particularly among those vulnerable to mental health problems and gambling disorder. METHODS: Australian adults who had gambled at least once in the past 12 months (N = 764, 85.2% male) completed an online cross-sectional survey. Self-report measures retrospectively assessed typical monthly gambling frequency and expenditure before and after the COVID-19 venue shutdown, problem gambling, and psychological distress. RESULTS: Significant median decreases in gambling frequency were observed, both online and overall. No relationship was found between psychological distress and baseline or increases in gambling. Greater problem gambling severity was related to higher baseline gambling, but not to increases in gambling. Exploratory analysis showed that individuals engaged in moderate-risk gambling, but not problem gambling, were more likely to report increased gambling frequency compared to nonproblem and low-risk gamblers combined. CONCLUSIONS: Findings provide important insights into how changes in availability influence gambling participation, and for understanding the effectiveness of forced restrictions and venue exclusion strategies. Most people moderated their gambling when venue-based gambling was unavailable and opportunities for sports betting were limited. However, harms experienced by individuals with some gambling problems may have been exacerbated during the period of limited access. Policies to enhance prevention and treatment of gambling problems are necessary even when availability is reduced.

Background and aims Purchasing loot boxes in digital games is akin to gambling as it involves risking money for a chance-based reward of uncertain value. Research has linked buying loot boxes to problem gambling amongst adolescents, but has not examined co-occurring gambling participation. This study examined links between loot box purchasing and problem gambling amongst adolescents while controlling for monetary gambling participation. Methods Two survey samples of Australians aged 12–17 years were recruited through advertisements (n = 843) and online panels (n = 826). They included n = 421 and n = 128 adolescents, respectively, who met criteria for problem gambling. Results Past-month loot box purchasing was significantly related to gambling problems in bivariate analyses. When including age, gender and past-month monetary gambling, loot box purchases were still associated with at-risk and problem gambling in both samples. As expected, these other predictors attenuated the predictive value of recent loot box purchases in relation to gambling problems. The odds-ratios, nevertheless, were still in the predicted direction and remained significant. When controlling for monetary gambling, age and gender, recent loot box purchasing increased the odds of problem gambling 3.7 to 6.0 times, and at-risk gambling 2.8 to 4.3 times. Discussion and conclusions While causal relationships between loot box purchasing and problem gambling remain unclear, the results indicate that loot boxes disproportionately attract adolescents experiencing gambling problems, adding to the financial stress already caused by gambling. Consumer protection measures, youth and parental education, and age restrictions on loot box games are needed to protect young people.

BackgroundFrom a clinical perspective, knowledge of the psychological processes involved in maintaining gambling disorder has been lacking. This qualitative study formulated hypotheses on how gambling disorder is maintained by identifying clinically relevant behaviors at an individual level, as a means to guide the development of new cognitive behavioral interventions.MethodsSix individuals from a treatment study, diagnosed with gambling disorder and with diverse symptom profiles of psychiatric comorbidity, were recruited. Participants were interviewed using an in-depth semi-structured functional interview and completed self-report measures assessing gambling behavior.ResultsFunctional analysis was used as a theoretical framework for a thematic analysis, which yielded the following categories: 1) antecedents that may increase or decrease gambling; 2) experiences accompanying gambling; 3) control strategies; 4) consequences of gambling behavior; and 5) events terminating gambling behavior. Few differences were identified in relation to symptom profiles of psychiatric comorbidity, although some gamblers did not report experiencing abstinence when not being able to gamble.ConclusionsGambling is a secluded activity mainly triggered by access to money. Positive and negative emotions could be both antecedents and functions of gambling behavior. Avoidance-based strategies used to control gambling might result in a failure to learn to control gambling behavior. Anticipation, selective attention, and chasing could be important reinforcers, which should be addressed in new developments in cognitive behavioral treatment for gambling disorder.

Background and aimsMoney plays a central role in gambling, and understanding the different attitudes of gamblers towards it might benefit both prevention and treatment of gambling-related problems. This study describes the development of a new German measure of attitudes to money and the differences in these attitudes between male non-gamblers, occasional, frequent and problem gamblers. Furthermore, it investigates the cross-sectional and longitudinal associations between attitudes towards money and the severity of gambling disorder.MethodsAn online study was conducted among 2,584 men aged 18–25 years, recruited via the Munich citizen registry. Additionally, a sample of n = 105 Facebook users was included in part of the analyses. Frequent and problem gamblers were invited to a 12-month follow-up. Apart from gambling participation and related problems, the questionnaire included items from existing scales measuring attitudes to money.ResultsThree factors underlying a new 12-item German Scale of Money Attitudes (SMAG) were identified: success, budgeting and evil. Compared with other groups, participants reporting any gambling problems scored highest in success and lowest in budgeting. Budgeting was associated with gambling-related problems in both cross-sectional and longitudinal analyses and strengthened the relationship between associating money with success and gambling disorder.DiscussionFor problem gamblers, money is important as a personal symbol of success. This attitude has an especially negative effect on gambling-related problems in individuals who handle money irresponsibly. Spending and winning money might play an important role in maintaining self-esteem among gamblers and thus hinder their attempts to quit.

Background and aimsGambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.MethodsIn this study, a total of 283 university students (39.6% females; age = 18–27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.ResultsThe results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = −0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.ConclusionThe findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

Zusammenfassung Ziel Der Beitrag stellt die Verortung von Verhaltenssüchten in der ICD-11 dar und gibt einen Ausblick auf die zukünftige Entwicklung. Methodik Sichtung der Literatur Ergebnisse Auf Basis von Expertenmeetings der Weltgesundheitsorganisation (WHO) wurde ein Vorschlag entwickelt, auf Basis dessen die Gambling und Gaming Disorder in die aktuelle Fassung der International Classification of Diseases (ICD-11) aufgenommen wurden. Beide Störungen werden mit den gleichen 3 Kernmerkmalen beschrieben (Kontrollverlust, Priorität im Leben und Fortsetzung trotz negativer Konsequenzen) und erfordern darüber hinaus das Vorliegen einer funktionalen Beeinträchtigung. Eine Reihe von Studien belegt die klinische Relevanz dieser Entscheidung. Darüber hinaus lassen sich weitere spezifizierte Verhaltenssüchte kodieren, wobei nach Sichtung der Literatur insbesondere Buying-Shopping Disorder, Pornografy Use Disorder und Social Networks Use Disorder hierfür geeignet erscheinen. Schlussfolgerung Insbesondere bei der Computerspielstörung ist zu erwarten, dass die Aufnahme in die ICD-11 die Entwicklung von Diagnostik, Prävention und Therapie diese Störung fördert. Unter Federführung der WHO werden derzeit diagnostische Verfahren für beide Störungen entwickelt, um Standardinstrumente bereit zu stellen.

Objectives:There are no data relating to gambling advertisements shown during live sporting events in Ireland. The aim of the present study was to analyze gambling advertisements shown during live sporting events broadcast in Ireland and to assess these advertisements for responsible gambling (RG) practices.Methods:Sixty-five live televised sporting events comprising Association Football (soccer), Rugby Union, and Gaelic Athletic Association (GAA) matches broadcast in Ireland were analyzed. Pre-match (up to 30 minutes before kick-off), half-time, and post-match (up to 30 minutes after the match has ended) advertisement breaks were analyzed for gambling advertisements, including in-game fixed (static advertising) and dynamic (electronic advertisements changing at regular intervals) pitch-side advertising. Gambling advertisements were studied for evidence of RG practices.Results:A total of 3602 television advertisements, 618 dynamic advertisements, and 394 static advertisements were analyzed. Gambling advertisements were shown in 75.4% (n= 49) games and were the seventh most commonly televised advertisement shown overall. Gambling advertising was more common in football (fourth most common advertisement) compared to rugby (12th most common) and GAA (13th most common). Static and dynamic gambling advertising were common during football matches (second and first most common advertisements, respectively). The majority of advertisements contained RG messaging, an age limit, and an RG organization. No advertisements showing responsible gambling tools were observed.Conclusions:Gambling advertisements are commonly shown during live televised sporting broadcasts in Ireland, especially during live football matches and typically before the adult television watershed. Gambling legislation is required to minimize harm to vulnerable groups including children.

Gambling disorder (GD) is a debilitating mental illness characterized by persistent patterns of dysregulated gambling behaviors. Recent evidence suggests that US military veterans are a high-risk population vulnerable to the development of problem gambling. This systemic review examined the published literature on the rates, correlates, comorbidities, treatment, and genetic contributions to US veterans’ gambling behaviors in 39 studies. Overall, we found that US military veterans have higher rates of GD (including subthreshold problem gambling/at-risk problem gambling) compared with civilian populations. Further, we found that GD often co-occurred with trauma-related conditions, substance use, and suicidality, which may complicate treatment outcomes. We also noted a lack of published interventions tested among US veterans and standardized screening for gambling problems among veterans across US federal agencies (i.e., Department of Defense, Department of Veterans Affairs) is lacking and remains a significant gap for ongoing prevention and treatment efforts. Despite growing evidence that individuals from military backgrounds (active-duty personnel, retired military veterans) are vulnerable to developing problem gambling, limited research has been centered on developing prevention and treatment interventions for affected individuals and their families. The lack of standardized screening for problem gambling among healthcare providers that work directly with US military populations remains a significant barrier to care for problem gamblers.

Background and aimsDue to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.MethodsSample included n = 209 patients aged 18–77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.ResultsCompared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).ConclusionScreening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

An important consequence of adoption of public health approaches in the field of gambling studies has been the increasing emphasis afforded to gambling harm. Reducing or eliminating harm has now become the overt stated mission of many government foundations and funding bodies. A by-product of these developments has been the gradual reduction of references to terms capturing the nature of the primary disorder (problem or pathological gambling or gambling disorder) in preference for what are considered to be more neutral or less ‘stigmatising’ terms (e.g. ‘people with gambling harm’). In this paper, we argue that this conflation of gambling harm with the disorder is misguided. Not only does it fail to acknowledge the validity of the disorder but it is also unjustified by evidence and may have unintended negative consequences for both people affected by gambling and the field more generally. In particular, we focus on the clinical and legal advantages of adherence to an individual-centred, pathology model of gambling disorder.

Military veterans are at greater risk for problem gambling and Gambling Disorder (GD) than are civilians. For veterans and civilians alike, religious and spiritual beliefs and practices have been f...

The relation between neurocognitive dysfunctions and disordered gambling has been firmly established in the last few decades. In this current opinions article, recent classification, translational, and longitudinal studies imply that combinations of cognitive (both neurocognitive and cognitive distortions) and emotional functioning (emotion regulation, stress), are related to more severe patterns of disordered gambling. The first longitudinal studies show that impulsivity is an important factor in treatment drop-out and relapse. These recent studies imply that therapeutic interventions in gambling disorder are needed, targeting cognitive, motivational, and affective factors. Recent developments in therapeutic methods, such as stress modulation, neuromodulation and neurocognitive training targeting these factors, are an emerging research field in addictive disorders, but are largely unexplored in gambling disorder.

Gambling disorder is classified in the DSM-5 as a behavioral addiction. However, the inclusion of tolerance and withdrawal symptoms as diagnostic criteria for the disorder remains poorly understood and characterized by a lack of empirical support. While the need for increasing excitement is considered central to the concept of tolerance in gambling, alternative explanations for the phenomenon exist. Concomitantly, withdrawal may not be limited to neurobiological processes generating adverse subjective and physiological arousal that contribute to persistent gambling. Clarifying the concepts and functional role of tolerance and withdrawal in the addiction process has significant implications for accurate clinical assessment and targeted symptoms in the treatment of gambling disorders.

The aim of this review is to explore the psychobiological substrates of gambling-related cognitions, and their relationship with motivational and emotional processes, to contribute to the understanding of this important facet of disordered gambling. These cognitions promote gambling initiation and maintenance, and gambling games’ structural features are designed to foster them. According to our proposal, individual psychobiological features modulate gambling distortions vulnerability. Abnormal sensitivity to gambling-related rewards promotes the development of unrealistic expectancies, facilitating gambling escalation. As gambling behavior becomes recurrent, gambling cues acquire incentive salience, capable of triggering craving responses. Unsuccessful attempts to control craving generate the perceived inability to stop gambling. A proportion of gamblers use emotion regulation strategies to cope with gambling-related emotions, which fuels cognitive biases.

Understanding how factors promoting recovery from gambling disorder operate is important in gambling studies and treatment programs. The recovery experience may involve multiple positive resources and may be hindered by negative experiences or states. Most prior studies have focused on the latter, generating a gap in understanding the role for positive psychology measures in recovery from gambling disorder. This study investigated the associations between symptom improvement in gambling disorder and positive resources operationalized as recovery capital (internal and external resources that individuals may draw upon during the recovery process) and intrinsic spirituality. Negative experiences and states, including stressful life events, depression, and anxiety, were also considered. One hundred and 40 individuals (101 men) with a lifetime gambling disorder treated in 5 treatment centers in Israel were assessed on DSM-5 diagnostic criteria for gambling disorder (lifetime and past-year), Brief Assessment of Recovery Capital Scale adapted to gambling disorder, Intrinsic Spirituality Scale, Generalized Anxiety Disorder Scale, Patient Health Questionnaire 9 for depression, and Stressful Life Events Scale. Improvement in gambling disorder was calculated by subtracting the criteria count for the previous year from the lifetime count. Although anxiety, stressful life events, and depression were found to be negatively associated with gambling disorder symptom improvement, only recovery capital and spirituality remained significant when all variables were entered together in a multiple regression analysis. These findings highlight the positive role of recovery capital and spirituality in the recovery process and suggest treatment providers should integrate a positive psychology approach in gambling disorder treatment programs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Gambling is a multi-billion-dollar industry that many people engage with on a regular basis with no adverse effects. For many, gambling is a fun hobby that does not negatively impact their lives. There is, however, a significant minority whose gambling is maladaptive and causes significant adverse consequences, which may lead to personal and financial devastation. Stress and how one responds to stress may be a significant factor in determining who may gamble with impunity versus those who lose control and develop gambling disorder. In this paper, we outline three points at which stress and gambling intersect: 1) gambling to escape stress, 2) gambling as a stressor, and 3) altered stress physiology as a predisposing factor for gambling disorder. Below we describe these intersections and how they may influence the development and maintenance of gambling disorder.

In the past several years, there has been an explosion of interest in animal models of risk-based decision-making, a fundamental process associated with gambling disorder. While early work focused on establishing various tasks for assaying decision-making, current studies are determining the (subtle and not-so-subtle) influence of cues in driving risky decisions to better understand problem gambling. In addition, these decision-making paradigms are now being used to investigate comorbid conditions such as substance dependence or brain injury and replicating observations from human patients. These animal models have now developed to a point where therapeutic interventions may be assessed for not just gambling disorder, but also a number of other conditions which engender risky decision-making.

The gambling disorder field has grown substantially in the past few decades, with an explosion of research in numerous areas. Dr. Nancy Petry has been one of the pioneers in this field who helped to influence both its growth and its direction. This review describes Dr. Petry's lasting legacy on the gambling field through her influence on three primary areas: gambling disorder mechanisms of delay and probability discounting; treatment efficacy and effectiveness; and her role in the development of the DSM-5 criteria for gambling disorder. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD). Preliminary findings suggest the application of an adapted, addiction-focused EMDR procedure, AF-EMDR therapy, may also be helpful in treating addictions, such as gambling disorder (GD). In this study eight participants with GD received AF-EMDR therapy, using modules from Markus and Hornsveld's Palette of EMDR Interventions in Addiction (PEIA). A multiple baseline design was used to investigate whether AF-EMDR therapy reduced gambling urge and increased experienced self-control. Six weekly AF-EMDR sessions (treatment phase) were preceded by a 3- to 7-week non-treatment baseline phase. During both phases, participants kept a daily diary. Visual inspection as well as an interrupted time series analysis demonstrated mixed findings. Results showed that three participants experienced spontaneous recovery during the baseline period, two did not respond to treatment, and three others showed improvements during the EMDR phase. No adverse effects were noted. In sum, AF-EMDR therapy may have potential in the treatment of gambling addiction. However, more research is needed regarding the efficacy, contra-indications, focus, and application as well as the optimal dose of AF-EMDR therapy using the PEIA modules.

Here we review emotional regulation and its relationship with gambling disorder. Specifically, we review difficulties individuals with gambling disorder may have in identifying emotional states and selecting and implementing emotional regulation strategies. Difficulties in emotional regulation in individuals with gambling disorder may relate importantly to specific factors, such as gambling-related cognitions, attachment styles, comorbidities and impulsivity. Following a review of these factors, relationships between emotional regulation and treatment approaches for gambling disorder are discussed.

Background and aims There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design Two parallel‐group randomized controlled study comparing two different internet‐based treatments for PG. Follow‐up measures were conducted at treatment finish, and at 3‐, 6‐ and 12‐month post‐treatment. Setting Stockholm, Sweden. Participants A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions A treatment based on BCT was compared with a CBT intervention. Both treatments were internet‐based, with 10 therapist‐guided self‐help modules accompanied by weekly telephone and e‐mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements The primary outcome measures were time‐line follow‐back for gambling (TLFB‐G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM‐IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire‐9 (PHQ‐9), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), the Relation Assessment Scale Generic (RAS‐G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO. Findings The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB‐G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002. Conclusions Differences in the efficacy of internet‐based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group. Funding Agencies|Svenska Spels Independent Research Council [2013-0015]

[Aim] Recently, a machine-learning (ML) technique has been used to create generalizable classifiers for psychiatric disorders based on information of functional connections (FCs) between brain regions at resting state. These classifiers predict diagnostic labels by a weighted linear sum (WLS) of the correlation values of a small number of selected FCs. We aimed to develop a generalizable classifier for gambling disorder (GD) from the information of FCs using the ML technique and examine relationships between WLS and clinical data. [Methods] As a training dataset for ML, data from 71 GD patients and 90 healthy controls (HCs) were obtained from two magnetic resonance imaging sites. We used an ML algorithm consisting of a cascade of an L1-regularized sparse canonical correlation analysis and a sparse logistic regression to create the classifier. The generalizability of the classifier was verified using an external dataset. This external dataset consisted of six GD patients and 14 HCs, and was collected at a different site from the sites of the training dataset. Correlations between WLS and South Oaks Gambling Screen (SOGS) and duration of illness were examined. [Results] The classifier distinguished between the GD patients and HCs with high accuracy in leave-one-out cross-validation (area under curve (AUC = 0.89)). This performance was confirmed in the external dataset (AUC = 0.81). There was no correlation between WLS, and SOGS and duration of illness in the GD patients. [Conclusion] We developed a generalizable classifier for GD based on information of functional connections between brain regions at resting state., 脳機能結合の情報からギャンブル障害の判別器を開発 --人工知能技術の応用により診断や治療に新たな道!--. 京都大学プレスリリース. 2022-04-15.

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).

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

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.

Aims: Compulsivity is a common phenotype among psychiatric disorders, such as obsessive–compulsive disorder (OCD) and gambling disorder (GD). Deficiencies in metacognition, such as the inability to estimate one's performance via confidence judgments could contribute to pathological decision-making. Earlier research has shown that patients with OCD exhibit underconfidence, while patients with GD exhibit overconfidence. Moreover, it is known that motivational states (e.g. monetary incentives) influence metacognition, with gain (respectively loss) prospects increasing (respectively decreasing) confidence. Here, we reasoned that OCD and GD symptoms might correspond to an exacerbation of this interaction between metacognition and motivation. Methods: We hypothesized GD's overconfidence to be exaggerated during gain prospects, while OCD's underconfidence to be worsened in loss context, which we expected to see represented in ventromedial prefrontal cortex (VMPFC) blood-oxygen-level-dependent activity. We tested those hypotheses in a task-based functional magnetic resonance imaging (fMRI) design (27 patients with GD, 28 patients with OCD, 55 controls). The trial is registered in the Dutch Trial Register (NL6171). Results: We showed increased confidence for patients with GD versus patients with OCD, which could partly be explained by sex and IQ. Although our primary analyses did not support the hypothesized interaction between incentives and groups, exploratory analyses did show increased confidence in patients with GD specifically in gain context. fMRI analyses confirmed a central role for VMPFC in the processing of confidence and incentives, but no differences between the groups. Conclusion: Patients with OCD and those with GD reside at opposite ends of the confidence spectrum, while no interaction with incentives was found, nor group differences in neuronal processing of confidence.

Background: More remains to be understood about attitudes towards treatment for gambling disorder and where to seek treatment. Given the low degree of treatment seeking behaviour in this condition, it may be of interest to study people’s perception about where to seek help in case of problem gambling. From a study originally aiming to address health correlates of problem gambling, the present sub-study aimed to examine the general population’s attitudes towards where to advise a person with problem gambling to seek treatment, and correlates of recommending a formal professional treatment modality. Methods: A cross-sectional general population web survey in Sweden (N=2,038, 55% women, 6% lifetime problem gamblers) was conducted. Preferred advice for gambling-related treatment seeking was defined with a question asking about where one would hypothetically advise a friend to seek help for gambling addiction. Advice for professional vs peer support help was compared with respect to individual characteristics, in problem gamblers and non-problem gamblers. Results: Fifty percent preferred to recommend peer support help for gambling, whereas among professional treatment options, the largest share preferred primary care (22%) or psychiatry/addiction psychiatry (18%), while few suggested occupational health-care (6%) or social services (3%). Opting for a professional treatment modality for problem gambling was unrelated to one’s own problem gambling, whereas those recommending professional treatment were younger and more likely to report psychological distress. In problem gamblers specifically, history of indebtedness was associated with recommending professional treatment. Conclusion: Many people may not perceive gambling disorder to require professional treatment, and may recommend peer support outside of formal treatment systems. Younger individuals, as well as those with a personal history of psychological treatment needs, may be more prone to recommending formal treatment. The findings may have implications for treatment trajectories and may facilitate overcoming perceived treatment barriers. (Less)