Response trajectories of gambling severity after cognitive behavioral therapy in young-adult pathological gamblers

Abstract

Background and aims The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory. Methods The sample included n = 192 patients, aged 19–35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis. Results Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness. Discussion and conclusions Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Executive functions in binge spectrum eating disorders with comorbid compulsive buying

“…Interestingly, only a low self‐directedness was significantly associated with more deficits in decision making, and this low neuropsychological performance mediated the relationship between self‐directedness and bad outcome. Self‐directedness indicates the ability to regulate and adapt behaviour to the demands of a situation in order to achieve personally chosen goals and values (Cloninger, 1999), which, according our results, influences the decision making process, and, as has been mentioned in the literature, it is related with difficulties in following therapy goals and achieving a good treatment outcome in BSD and other BA (Fernández‐Aranda et al., 2021; Granero et al., 2020; Wagner et al., 2015). Also, the path‐analysis showed that deficits in cognitive flexibility were positively associated with the presence of the comorbidity.…”

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

“…Previous reports have outlined that low TCI-SD scores are associated with addictive disorders (Anghelescu et al, 2010;Cowie et al, 2019;Gierski et al, 2017;Kovacs et al, 2020;Steingrimsson, Carlsen, Lundstrom, Lundstrom, & Nilsson, 2020), including GD (Claes et al, 2012;Janiri, Martinotti, Dario, Schifano, & Bria, 2007;Moragas et al, 2015;Nordin & Nylander, 2007). However, to our knowledge, only a few studies have explored the role of the selfdirectedness dimension in the course of the disease (Aragay et al, 2015;Granero et al, 2020;Jimenez-Murcia et al, 2015). In particular, it was found that individuals with low TCI-SD scores were at risk of poor outcomes six months after the end of treatment (Granero et al, 2020).…”

“…However, to our knowledge, only a few studies have explored the role of the self-directedness dimension in the course of the disease ( Aragay et al, 2015; Granero et al, 2020; Jimenez-Murcia et al, 2015 ). In particular, it was found that individuals with low TCI-SD scores were at risk of poor outcomes six months after the end of treatment ( Granero et al, 2020 ). Our study is the first to suggest the influence of a high TCI-SD score on sustained recovery.…”

“…For some authors, gambling relapse is defined as "the occurrence of any gambling episode with bets" (Granero et al, 2020;Hodgins & el-Guebaly, 2004;Mallorqui-Bague et al, 2018), as "more than two episodes of gambling or one gambling episode with loss of control" (Aragay et al, 2015) or as "three or more lapse episodes" (Echeburua et al, 2017), while for others, it "involves more than simply a single incidence of resumption of the target behavior" and thus differentiates between a "lapse" (a single episode) and a "relapse" (multiple episodes) (Ledgerwood & Petry, 2006). According to Gambling Research Australia (2010), "relapse is the re-emergence of gambling that may cause harm to the individual, significant others or the community after a period of abstinence or controlled gambling" (Battersby, Oakes, McLaughlin, & Baigent, 2010).…”

The role of contextual factors in avenues to recover from gambling disorder: a scoping review

“…Here, three out of the 34 studies had medical interventions (Memantine; Grant et al, 2010a ; Disulfiram; Mutschler et al, 2010 ; Naltrexone; Ward et al, 2018 ). The most reported psychotherapeutic interventions were cognitive behavioral therapy (CBT, n = 10: Castren et al, 2013 ; Rossini-Dib et al, 2015 ; Tarrega et al, 2015 ; Boughton et al, 2016 ; Smith et al, 2016 , 2018 ; Bouchard et al, 2017 ; Mallorqui-Bague et al, 2018 ; Zhuang et al, 2018 ; Granero et al, 2020 ), which was delivered either in groups or individually, either face to face (F2F) or digitally. This was followed by motivational interviewing (MI, n = 4: Grant et al, 2011 ; Parhami et al, 2012 ; Pasche et al, 2013 ; Stewart et al, 2016 ), mindfulness based interventions ( n = 3: de Lisle et al, 2011 ; Shead et al, 2020 ; van der Tempel et al, 2020 ), dialectical behavior therapy (DBT, n = 1: Christensen et al, 2013 ), acceptance and commitment therapy (ACT, n = 1: Nastally and Dixon, 2012 ), and transcranial magnetic stimulation (TMS, n = 1: Zack et al, 2016 ).…”