Problems in Measuring the Effectiveness of Cognitive Therapy for Pathological Gambling

Cognitive therapy is a relatively new approach to the treatment of pathological gambling. Theoretically, there are strong grounds for believing that cognitive treatments will be effective in helping individuals cut back and stop excessive levels of gambling. However, there is evidence that cognitive therapy for pathological gambling is being confused with cognitive-behaviour therapy. In this paper, the distinction between treatments that are cognitive and those that are cognitive-behavioural is highlighted. Such a distinction has strong implications for the manualisation of therapy. Additionally, a range of problems that confront the evaluation of all therapies for pathological gambling is considered. Spontaneous recovery without therapeutic intervention has been documented in both field studies of both problem and non-problem players and controlled trials of cognitive therapy compared to a waiting list control group. The implications of the phenomenon of spontaneous recovery for the evaluation of cognitive therapy are described. Other problems common to all evaluations of psychotherapies are considered in relation to gambling and recommendations made for outcome study designs.     

Reliability,Validity, and Cut Scores of the South Oaks Gambling Screen (SOGS) for Chinese

We examined the reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS) when adopted for use in Chinese. The DSM-IV criteria for pathological gambling served as the standard against which the classification accuracy of the SOGS was tested. A total of 283 Chinese adults in the community and 94 Chinese treatment-seeking gamblers were recruited. The internal reliability of the SOGS was satisfactory for the general sample and acceptable for the gambling sample. The SOGS was correlated with the DSM-IV criteria items as well as psychosocial and gambling-related problems. Relative to the DSM-IV criteria, the SOGS tended to overestimate the number of pathological gamblers in both samples. In general, we were relatively confident that individuals were not pathological gamblers if the SOGS scores were between 0 and 4 and were pathological gamblers if the SOGS were between 11 and 20. There was about 50–50 chance of being pathological gamblers if the SOGS scores were between 8 and 10. However, the probability of individuals being pathological gamblers was about 0.30 if the SOGS scores were between 5 and 7. We proposed a SOGS cut score of 8 to screen for probable pathological gambling in Chinese societies.     

Integrating institutional, relational and embodied structure: an emergentist perspective

This paper begins to develop an emergentist and realist account of normative social institutions. The argument is developed as a response to Lopez and Scott's historical portrait of the debate on social structure as a dialogue between two different concepts of structure: institutional structure and relational structure, integrated more recently through the concept of embodied structure. The paper argues that all these approaches tend to neglect the idea of structure as a whole and suggests that we cannot understand social structures without recognizing the nature of the corresponding wholes, and how they relate to the human individuals that comprise them. Such a perspective makes clear that embodiment alone is inadequate as a means of integrating institutional and relational conceptions of structure. For a fuller resolution, we must set social structure in an emergentist framework, which can reconcile the complementary roles of institutional structure, relational structure, and indeed embodiment, as aspects of the production of social structures as wholes.     

Prevalence of pathological gambling and associated problems in individuals who visit non-gambling video arcades

The objective of the present study was to investigate the gambling behavior of individuals who frequent non-gambling video games arcades. One hundred and twenty two subjects (mean age of 19.2 years (SD=5.5); males constituted 82.8%) who spend time in arcades completed the South Oaks Gambling Screen and the Jacob's Health Survey. The results showed that 10.7% were identified as probable pathological gamblers and 14.8% were problem gamblers. The frequency of visits to arcades for non-gambling activities appeared to be correlated with the extent to which individuals gamble, and is furthermore associated with pathological gambling. The rate of pathological gamblers who frequent arcades is more than twice as high as the rates reported in other studies with adolescents and adults.This research was partially supported by grants from the Fonds Richelieu and Loto-Québec awarded to the first author.     

The factorial structure of pathological gambling

Pathological gambling has been characterised by DSM-III-R and DSM-IV as a disorder of impulse control with a proportion of gamblers identified as meeting criteria for a co-morbid diagnosis of Antisocial Personality Disorder. To date, empirical evidence in support of the notion that pathological gamblers as a group manifest elevated traits of impulsivity remains equivocal. Principal components analysis was used to investigate relationships between the constructs of impulsivity, psychopathy, DSM-III-R criteria for Antisocial Personality Disorder, psychological distress, criminal offending behavior and a range of other common psychological measures employed with pathological gamblers. The sample comprised 115 pathological gamblers, 80 consecutive gamblers seeking treatment from a general hospital psychiatric inpatient behavior therapy unit, and 35 volunteer Gamblers Anonymous attenders. Four primary factors were determined: psychological distress, sensation seeking, crime and liveliness, and impulsive-antisocial. Results suggest that pathological gambling consists of a number of discrete and reproducible factorial structures. The impulsive antisocial factor was found to be associated with gambling behavior and indices of poor psychosocial functioning.     

Examining DSM-IV Criteria for Pathological Gambling: Psychometric Properties and Evidence from Cognitive Biases

We examined the DSM-IV criteria for pathological gambling as assessed with the DSM-IV-based Diagnostic Interview for Gambling Severity (DIGS; Winters, Specker, & Stinchfield, 2002). We first analyzed the psychometric properties of the DIGS, and then assessed the extent to which performance on two judgment and decision-making tasks, the Georgia Gambling Task (Goodie, 2003) and the Iowa Gambling Task (Bechara, Damasio, Damasio, & Anderson, 1994), related to higher reports of gambling pathology. In a sample of frequent gamblers, we found strong psychometric support for the DSM-IV conception of pathological gambling as measured by the DIGS, predictive relationships between DIGS scores and all cognitive performance measures, and significant differences in performance measures between individuals with and without pathological gambling. Analyses using suggested revisions to the pathological gambling threshold (Stinchfield, 2003) revealed that individuals meeting four of the DSM-IV criteria aligned significantly more with pathological gamblers than with non-pathological gamblers, supporting the suggested change in the cutoff score from five to four symptoms. Discussion focuses on the validity of the DSM-IV criteria as assessed by the DIGS and the role of cognitive biases in pathological gambling.     

Treatment Goal Selection for Female Pathological Gambling: A Comparison of Abstinence and Controlled Gambling

The current study was an exploratory investigation of the selection of controlled gambling as a goal of treatment for female pathological gambling. Specifically, it aimed to explore: 1) the popularity of controlled gambling as a goal of treatment; 2) the reasons pathological gamblers select abstinence and controlled gambling as goals of treatment; and 3) the characteristics of pathological gamblers attracted to abstinence and controlled gambling. The sample comprised 85 female pathological gamblers attending a cognitive-behavioural treatment program for pathological gambling. The selection of controlled gambling by one-third (34%) of the sample suggests that, at least in the Australian context, controlled gambling is a relatively popular goal of treatment for female pathological gamblers. In this study, the only differences between treatment-seeking female pathological gamblers selecting abstinence and controlled gambling were that those selecting controlled gambling were older and were less likely to endorse the belief that problematic gambling is a disease or affliction that can only be overcome by lifelong abstinence. Further research investigating the characteristics of pathological gamblers associated with controlled gambling as both a goal and outcome of treatment is required in order to ensure that treatment-seeking pathological gamblers can make an informed decision regarding their goal selection.     

Individual outpatient treatment of pathological gambling

Recovery from pathological gambling is viewed as a process whereby the pathological gambler chooses to lose an addiction to gambling and maintains that choice while mourning the loss of the gambling. The self-induced and self-escalating addictive crisis leading up to that choice is explored, as is the crisis caused by the loss of the gambling itself. It is proposed that gambling provides the gambler with action, a method of dealing with stress aand avoiding unpleasant affect, and a variety of social, psychological, and existential benefits. The loss of gambling is seen as a complicated and significant one which elicits grief responses similar to those seen in response to other types of major loss. It is proposed that in the individual outpatient treatment of pathological gamblers, the therapist helps the recovering gambler to accept the loss of the gambling and learn to live a rewarding life without it. Four phases of treatment are suggested which correspond to stages of grieving and accepting the loss of the gambling.     

The team approach: Developing an experiential knowledge base for the treatment of the pathological gambler

It is not surprising that developing professional competence in treating the pathological gambler is a major problem today, given the scarcity of treatment programs for pathological gambling. This paper explores a learning model which weaves together the experiential knowledge of the recovering pathological gambler with the skills of professional mental health clinicians. An example of this model is the team approach originated at the Johns Hopkins Compulsive Gambling Counseling Center in 1979 and which was evolved into an interdisciplinary treatment model at Taylor Manor Hospital. An examination of this evolving treatment approach is analyzed, reviewed and updated with a focus first on the use of the team approach as a paradigm for developing an experiential knowledge base in the treatment of selected disorders, and second, its use as a model for newly developing treatment programs.     

Reliability and Validity of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS)

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.     

The Effects of Volunteerism on Self-Deception and Locus of Control

This study examines whether volunteering for not-for-profit Organizations (NPOs) which are involved in providing social welfare services and which actively promote sociobehavioral factors like social responsibility, leadership, and self-confidence among its volunteers, reduces an individual’s likelihood of engaging in corrupt practices. We identify two psychological traits: propensity to rationalize (as evidenced by self-deception) and an external locus of control (as compared to an internal LOC) that facilitate unethical behavior. With the help of volunteers from two NPOs, we investigate whether engaging in social welfare activities organized by such NPOs would create awareness about the adverse consequences of corruption faced by large segments of the society, which in turn would make it difficult to rationalize unethical and corrupt acts. Additionally, most NPOs actively strive to develop self-confidence and leadership skills among its volunteers. Prior literature indicates that individuals possessing such qualities are more likely to have an internal LOC and also that individuals possessing an internal LOC are less likely to act in a corrupt manner. The overall results indicate that greater experience with such NPOs leads to a significant reduction in propensity to rationalize and leads to a higher likelihood of having an internal LOC.     

A Comparison of Depression and Styles of Coping in Male and Female GA Members and Controls

Depression and maladaptive coping styles are important components of theories of pathological gambling and are frequently foci of treatment with individuals with gambling problems. The present study aimed to improve understanding and treatment of pathological gambling by comparing levels of depression and styles of coping in male and female members of Gamblers Anonymous (GA) to a group of non-pathological gambling controls matched according to gender, age, education, and income. Pathological gambling was measured by the South Oaks Gambling Scale, depression by the Beck Depression Inventory, and coping styles by the Problem-Focused Styles of Coping inventory. Results showed that GA members reported significantly higher levels of depression and more maladaptive styles of coping than controls. Pathological gamblers' greater use of maladaptive coping was evident even when variance attributable to depression was removed, suggesting that their coping deficits may be pervasive. Female subjects reported significantly greater levels of depression and maladaptive coping thantheir male counterparts. Implications for treating depression and coping styles in pathological gamblers are discussed.     

Treatment of Female Pathological Gambling: The Efficacy of a Cognitive-Behavioural Approach

Given that a substantial proportion of current pathological gamblers are female, it is evident that women are underrepresented in the treatment outcome literature. The current study was designed to redress the limited information on the treatment of female pathological gambling. Although the use of cognitive-behavioural therapy is the most highly recommended approach as ‘best practice’ for the treatment of pathological gambling, no attempt to date has been made to evaluate the efficacy of this approach for female pathological gambling. Nineteen female pathological gamblers with electronic gaming machine problems were treated with a cognitive-behavioural program. While pathological gamblers placed on a waiting list did not show significant improvement on gambling behaviour and psychological functioning measures, the female pathological gamblers showed significant improvement on these measures over the treatment period, and maintained this improvement at the 6-month follow-up evaluation. By the completion of the follow-up period, 89% of participants no longer met diagnostic criteria for pathological gambling. Although further scientific demonstration and replication are required, the outcomes of this study indicate that the therapy that is considered ‘best practice’ in the treatment of pathological gambling is effective for female pathological gambling.     

Prevalence and Correlates of Gambling Problems Among a Nationally Representative Sample of Brazilian Adolescents

The objectives of the study are: (a) to provide the first prevalence estimates of pathological gambling among Brazilian adolescents using an age-specific instrument in a nationally representative sample; (b) to investigate the extent to which adolescents participate in gambling activities in a developing country; and (c) to correlate different levels of gambling behavior with demographic variables. Multistage cluster sampling selected 3,007 individuals over 14 years of age from Brazilian household population. A total of 661 participants were between 14 and 17 years old. The Lie/Bet Questionnaire and the DSM-IV-MR-J were used for assessing problem and pathological gambling. 2.8% scored positive on the screening questionnaire, while 1.6% were classified as problem and pathological gamblers. Factors associated with problem and pathological gambling were male sex, not currently studying and considering religion as not important. Less than 4 months elapsed between the age of regular gambling involvement and the first gambling problem. Prevalence rates were quite similar from recent studies which used nationally representative samples. The association of problem and pathological gambling with male sex, school drop-out and low religiosity supports the Problem Behavior Theory. The fast progression to problem gambling adds evidence that adolescents may be more vulnerable to the effects of gambling.     

Lottery participation by youth with gambling problems: are lottery tickets a gateway to other gambling venues?

The aim of the present study was to investigate the types of gambling activities youths with gambling problems participate in and whether the lottery is a key gambling venue for these young people. Secondly, we sought to ascertain whether youths with gambling problems display similar gambling behaviour with lottery tickets as those addicted to traditional forms of gambling. Participants were 1,072 young people, 10-18 years of age, in Ontario, Canada. Youths with gambling problems reported having a preference for lottery tickets compared to other forms of gambling. Differences were found for the frequency with which probable pathological gamblers reported going to the store specifically to purchase lottery tickets. Furthermore, probable pathological gamblers reported chasing their losses after having played the lottery more than the other gambling groups. This research demonstrates that youths with gambling problems gamble primarily with lottery products and exhibit similar pathological gambling behaviour (e.g., chasing) as those individuals addicted to other forms of gambling venues. Furthermore, the results suggest that lottery tickets are a potentially addictive activity that introduces youth to the exciting properties of gambling.     

Bulimia: A false self identity

This article is based on the author's clinical experience with fifteen bulimic women over the past five years. It covers the family origins, unique characteristics, internal dynamics, and treatment of bulimia. Bulimics have a cohesive, albeit pathological, identity based on the False Self. Relying on D.W. Winnicott's theory of ego splitting between the True Self and False Self, the author elaborates the components of False Self identity. The author concludes with a comparison of the effects of group and individual therapy, and suggests that group is generally more effective than individual, and that a combination of group and individual treatment is optimal.     

A Case Study of a Maltreated Thirteen-Year-Old Boy: Using Attachment Theory to Inform Treatment in a Residential Program

This paper presents therapeutic interventions from an attachment perspective with a thirteen-year-old boy with a history of maltreatment, living in a residential treatment facility. Attachment theory holds that accumulated memories of experiences with caregivers become organized into representational structures called internal working models. The guiding principles of the therapy begin with the critical role played by the individual therapist as an attachment figure. The central purposes of the therapy are conceived as promoting the restructuring of the internal working models of others to reflect expectations of trustworthiness and reliability, and models of the self as worthy to receive care. The approach described is contrasted with common approaches to residential treatment that rely on environmental behavioral contingencies, modeled on social learning theory.     

Community and anti-poverty targeting

The standard theory of anti-poverty targeting assumes individual incomes cannot be observed, but statistical properties of income distribution in broadly defined groups are known. ‘Indicator targeting’ rules are then derived for the forms of transfers conditioned on group membership of individuals. In this literature the motivating notion of a ‘group’ is purely statistical, even when it is groups such as localities and ethnicities. We focus instead on groups which are ‘communities’, meaning thereby collections of individuals who have access to community-specific public goods, from which non-members are excluded. Such differential access constitutes a source of inequality among poor individuals belonging to different communities, which is not captured by monetary earnings. We show that this formulation of what constitutes a group changes many of the basic results of the indicator targeting literature. Optimal targeting for poverty alleviation leads to seemingly paradoxical rules, such as targeting transfers to the community that is richer. Total wealth of non-poor members of a community and its distribution both become relevant for specifying optimal indicator targeting rules. In addition, a poverty measure that is sensitive to the community identities of poor individuals, yet defined on nominal incomes, may be incompatible with some of the basic axioms in the standard literature on poverty measurement.