Internet-Based Delivery of Cognitive Behaviour Therapy Compared to Monitoring, Feedback and Support for Problem Gambling: A Randomised Controlled Trial.

The aim of this study was to investigate the efficacy of an Internet-based cognitive behavioural therapy program (I-CBT) for the treatment of problem gambling, when compared to a waitlist control and an active comparison condition consisting of monitoring, feedback, and support (I-MFS). Participants (N = 174) were randomly allocated to the three conditions. Variables of interest were gambling outcome and related mental health measures. Participants in the active conditions (I-CBT and I-MFS) completed six online modules. Both I-CBT and I-MFS conditions resulted in significant treatment gains on gambling severity. However, I-CBT was also associated with reductions in a range of other gambling-related and mental health outcomes. Compared with I-MFS, I-CBT produced greater effects across seven outcomes measures, relating to gambling urges, cognitions, stress, and life satisfaction. I-CBT participants also rated the program as significantly more satisfactory. Treatment gains observed for both active conditions were found to be stable through to 12 month follow up. The results indicate that the benefits of I-CBT were more than simply the non-specific effects of engaging in online treatment or receiving motivation, feedback, and support. Online treatments for gambling may be a valuable tool in increasing help-seeking and treatment engagement in this population, and be integrated as part of stepped care approaches to treatment.

Testing the Validity of a Cognitive Behavioral Model for Gambling Behavior.

Currently, cognitive behavioral therapies appear to be one of the most studied treatments for gambling problems and studies show it is effective in treating gambling problems. However, cognitive behavior models have not been widely tested using statistical means. Thus, the aim of this study was to test the validity of the pathways postulated in the cognitive behavioral theory of gambling behavior using structural equation modeling (AMOS 20). Several questionnaires assessing a range of gambling specific variables (e.g., gambling urges, cognitions and behaviors) and gambling correlates (e.g., psychological states, and coping styles) were distributed to 969 participants from the community. Results showed that negative psychological states (i.e., depression, anxiety and stress) only directly predicted gambling behavior, whereas gambling urges predicted gambling behavior directly as well as indirectly via gambling cognitions. Avoidance coping predicted gambling behavior only indirectly via gambling cognitions. Negative psychological states were significantly related to gambling cognitions as well as avoidance coping. In addition, significant gender differences were also found. The results provided confirmation for the validity of the pathways postulated in the cognitive behavioral theory of gambling behavior. It also highlighted the importance of gender differences in conceptualizing gambling behavior.

Gratitude, hope, mindfulness and personal-growth initiative: buffers or risk factors for problem gambling?

The majority of prevention and intervention research in problem gambling (PG) has focused on identifying negative risk factors. However, not all at-risk individuals go on to develop anticipated disorders and many thrive in spite of them. In healthcare settings, PG and other disorders are typically conceptualized from the biomedical perspective that frame disorders as something negative residing within the individual and reduction in negativity is seen as success. Indeed, this problem-focused conceptualization may be adequate in many cases as reducing PG behaviour is undoubtedly an important outcome, but the focus on negativity alone is too narrow to capture the complexity of human behaviour. Hence, this study attempts to bridge the gap in literature by providing an evaluation of the predictive ability of the positive dispositions on problem gambling severity, gambling-related cognitions, and gambling urges. The positive psychological dispositions examined were curiosity, gratitude, hope, personal growth initiative, and mindfulness. Participants consisted of 801 Taiwanese Chinese students and community individuals (Mean age = 25.36 years). Higher levels of gratitude and hope have been found to predict lower PG, gambling-related cognitions, or gambling urges. Meanwhile, higher mindfulness predicted lower PG, but only among Chinese males. However, lower personal growth initiative predicted lower PG, gambling-related cognitions, and gambling urges. These analyses have small to medium effect sizes with significant predictions. Findings of this study have essential implications in understanding and treating Chinese problem gamblers. These positive dispositions should be addressed by mental health professionals in preventative and treatment programs among Chinese individuals. Further implications and suggestions for future research are discussed.

Treatment of Gambling Problems in Asia: Comprehensive Review and Implications for Asian Problem Gamblers.

Much research has been conducted in the treatment of gambling problems. However, very little is reported specifically on treating Asian problem gamblers. Thus, this article reviewed the general problem gambling treatment literature as well as the limited Asian problem gambling treatment literature to provide a discussion of interventions that can be used with Asian problem gamblers. The general literature showed that behavioral, cognitive, and combined cognitive behavioral treatments (CBT) have the most treatment outcome literature and appear to be the most effective in treating gambling problems. Although, pharmacotherapy also looks promising, it may be more suitable for problem gamblers with comorbid mood problems or impulsivity. Research on other forms of treatments also exists (e.g., 12-step and psychodynamic treatment approaches) but are not as robust. Only three studies have reported on the effectiveness of treatment with Asian problem gamblers. The first study is case study. The second study presents data from a treatment program for Asian problem gambling and the last one presents preliminary findings of a telephone delivered treatment program with eight Asian American gamblers. These studies support the general treatment literature in showing that CBT and pharmacotherapy have a role to play in treating Asian problem gamblers. Based on the general and Asian problem gambling treatment literature, a discussion of treatment of Asian problem gamblers is provided including the use of CBT and other forms of treatment, issues to address in treatment, and variables that can assist treatment.

Psychometric evaluation of the Problem Gambling Severity Index-Chinese version (PGSI-C).

The purpose of this study was to examine the psychometric properties of the Chinese 9-item Problem Gambling Severity Index (PGSI) derived from the 31-item Canadian Problem Gambling Index (CPGI) originally developed by Ferris and Wynne (2001). Exploratory factor analysis (EFA; n = 386; Group A data) and confirmatory factor analysis (CFA; n = 387; Group B data) on the Chinese student and community data (Mean age = 25.36 years) showed that a unifactorial model fitted the data with good reliability score (Cronbach's alpha = 0.77). The concurrent validity of the PGSI-C was good in terms of the Chinese data matching the expected correlation between PGSI-C and other variables or scales such as SOGS, gambling frequency, gambling urge, gambling cognitions, depression, anxiety, and stress. The scale also reported good discriminant and predictive validity. In sum, the PGSI-C has good psychometric properties and can be used among Chinese communities to identify at-risk problem gamblers. Implications and suggestions for future research are discussed.

Effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment program for problem gambling: a randomized controlled trial.

BACKGROUND: The study aimed to assess the effectiveness of group and individual formats of a combined motivational interviewing and cognitive behavioral treatment (CBT) program for problem gamblers (PGs) using a randomized controlled design. METHOD: One hundred and two PGs were randomly assigned to individual or group CBT conditions. Twenty-eight of these participants were randomly allocated to a 6-week waitlist control condition prior to receiving the designated treatment. RESULTS: At post-treatment, there were significant improvements in all dependent variables (frequency and amount gambled, gambling urges, gambling cognitions, negative psychological states, and life satisfaction) for both the treatment conditions but not for the waitlist condition. Individuals that completed the individual (compared to group) treatment condition generally had higher effect sizes for gambling correlates. Therapeutic gains for gambling correlates were generally maintained at 6-month follow-up. CONCLUSIONS: A combined motivational interviewing and CBT program applied in group or individual format can improve PG behaviors, as well as gambling correlates.

Gambling behaviours and motivations: a cross-cultural study of Chinese and Caucasians in Australia.

BACKGROUND: Research on gambling behaviours among the Chinese, especially compared to Caucasians, is lacking. AIMS: and METHODS: Gambling behaviours and motivations between community-based Chinese (n = 199) and Caucasians (n = 306) living in Australia were compared. RESULTS: There were significant differences between Caucasians and Australian Chinese in relation to gambling behaviours and types of motivations that could predict problem gambling between the two groups. CONCLUSIONS: The findings provide relevant information in understanding gambling behaviours and motivations among the Chinese, as well as a step towards the development of tailored preventive and treatment interventions for problem gambling in this population.

The relationship between cultural variables and gambling behavior among Chinese residing in Australia.

Cultural variables (e.g., cultural values, acculturation and attitudes towards seeking professional assistance) have been found to play important roles in the initiation and maintenance of numerous mental health and substance related problems. However, there is a significant lack of empirical studies investigating the relationships between these cultural variables and gambling behavior. Thus, this study assessed whether these cultural variables could predict gambling behavior among 233 Chinese residing in Australia. Several questionnaires were used in the study including the South Oaks Gambling Screen (SOGS), the Asian Values Scale (AVS), Attitudes towards Seeking Psychological Help Scale (ATSPHS) and the modified version of the Cultural Life Style Inventory (CLSI). Results showed that although adherence to Asian values could not predict gambling behavior, acculturation (i.e., cultural shift and cultural incorporation) could negatively predict gambling behavior. Furthermore, the interpersonal openness subscale of ATSPHS could predict gambling behavior. Implications of these findings are discussed.

The current status and future direction of self-help treatments for problem gamblers.

The self-help treatment (SHT) studies for other psychological problems significantly outweigh those for problem gambling. Currently, very little is published about the application and efficacy of various forms of SHTs for problem gambling. Thus, this paper reviews the self-help literature (using the PsycINFO database--all years up to April 2008) to stimulate further research in this area for problem gambling. The findings show that SHTs in problem gambling are still in their infancy. Although the problem gambling literature has mainly reported on two forms of SHTs with problem gamblers (i.e. use of self-help manuals and audiotapes), the review discuss utilizing a wide range of SHTs with problem gamblers. These include written materials (e.g. self-help books and treatment manuals), audiotapes, videotapes, computer-based SHTs implemented on palmtop computers, desktop computers, via telephone (Interactive Voice Response systems--IVR) or via the Internet and virtual reality applications. These SHTs would suit those problem gamblers who are not accessing professional treatment due to shame, guilt, fear of stigma, privacy concerns or financial difficulties, as well as those living in rural areas or with less severe gambling problems. The review also suggest future protocols for conducting further research in this area with problem gamblers, highlighting a need for a cohesive theory to guide research.

Gambling among the Chinese: a comprehensive review.

Despite being a significant issue, there has been a lack of systematic reviews on gambling and problem gambling (PG) among the Chinese. Thus, this paper attempts to fill this theoretical gap. A literature search of social sciences databases (from 1840 to now) yielded 25 articles with a total sample of 12,848 Chinese community participants and 3397 clinical participants. The major findings were: (1) Social gambling is widespread among Chinese communities as it is a preferred form of entertainment. (2) Prevalence estimates for PG have increased over the years and currently ranged from 2.5% to 4.0%. (3) Chinese problem gamblers consistently have difficulty admitting their issue and seeking professional help for fear of losing respect. (4) Theories, assessments, and interventions developed in the West are currently used to explain and treat PG among the Chinese. There is an urgent need for theory-based interventions specifically tailored for Chinese problem gamblers. (5) Cultural differences exist in patterns of gambling when compared with Western samples; however, evidence is inconsistent. Methodological considerations in this area of research are highlighted and suggestions for further investigation are also included. (6) Much of gambling research has focused on identifying risk factors and at-risk individuals. It is essential to balance this knowledge with a focus on fundamental character strengths, which act as protective factors and motivate one to refrain from gambling.

Validation of the Chinese version of the Gambling Related Cognitions Scale (GRCS-C).

Gambling cognitions have constantly been associated with the development and maintenance of problem gambling. Despite researchers reporting high rates of gambling and problem gambling among the Chinese, little is known about the role of gambling cognitions among Chinese individuals (Raylu & Oei, 2004a). This is partly because there is a lack of validated instruments to assess gambling cognitions in this population. Thus, the purpose of the present study was to examine and validate the Gambling Related Cognitions Scale-Chinese version (GRCS-C), which was based on the 23-item Gambling Related Cognitions Scale (GRCS; Raylu & Oei, 2004b). Confirmatory Factory Analysis (CFA) using 422 Chinese participants (166 Male, 256 Female; Mean age = 32.28 years) from the general community (221 living in Australia and 201 living in Taiwan) confirmed that a five-factor model was a good fit for the data. The Cronbach's alpha coefficient for the overall scale was .95, and ranged from .83 to .89 for the five factors. Concurrent, discriminant, and predictive validities of the GRCS (Chinese version) were also good suggesting that the GRCS-C is a valid and reliable instrument for assessing gambling cognitions among non-clinical Chinese samples.

The gambling urge scale: development, confirmatory factor validation, and psychometric properties.

The urge to gamble is a physiological, psychological, or emotional motivational state, often associated with continued gambling. The authors developed and validated the 6-item Gambling Urge Questionnaire (GUS), which was based on the 8-item Alcohol Urge Questionnaire (M. J. Bohn, D. D. Krahn, & B. A. Staehler, 1995), using 968 community-based participants. Exploratory factor analysis using half of the sample indicated a 1-factor solution that accounted for 55.18% of the total variance. This was confirmed using confirmatory factor analysis with the other half of the sample. The GUS had a Cronbach's alpha coefficient of.81. Concurrent, predictive, and criterion-related validity of the GUS were good, suggesting that the GUS is a valid and reliable instrument for assessing gambling urges among nonclinical gamblers.

The Gambling Related Cognitions Scale (GRCS): development, confirmatory factor validation and psychometric properties.

AIMS: The aims of this study are to develop and validate a measure to screen for a range of gambling-related cognitions (GRC) in gamblers. DESIGN AND PARTICIPANTS: A total of 968 volunteers were recruited from a community-based population. They were divided randomly into two groups. Principal axis factoring with varimax rotation was performed on group one and confirmatory factor analysis (CFA) was used on group two to confirm the best-fitted solution. MEASUREMENTS: The Gambling Related Cognition Scale (GRCS) was developed for this study and the South Oaks Gambling Screen (SOGS), the Motivation Towards Gambling Scale (MTGS) and the Depression Anxiety Stress Scale (DASS-21) were used for validation. FINDINGS: Exploratory factor analysis performed using half the sample indicated five factors, which included interpretative control/bias (GRCS-IB), illusion of control (GRCS-IC), predictive control (GRCS-PC), gambling-related expectancies (GRCS-GE) and a perceived inability to stop gambling (GRCS-IS). These accounted for 70% of the total variance. Using the other half of the sample, CFA confirmed that the five-factor solution fitted the data most effectively. Cronbach's alpha coefficients for the factors ranged from 0.77 to 0.91, and 0.93 for the overall scale. CONCLUSIONS: This paper demonstrated that the 23-item GRCS has good psychometric properties and thus is a useful instrument for identifying GRC among non-clinical gamblers. It provides the first step towards devising/adapting similar tools for problem gamblers as well as developing more specialized instruments to assess particular domains of GRC.

Role of culture in gambling and problem gambling.

There has been a significant gap in the gambling literature regarding the role of culture in gambling and problem gambling (PG). This paper aims to this such gap by presenting a systematic review of the cultural variations in gambling and PG as well as a discussion of the role cultural variables can play in the initiation and maintenance of gambling in order to stimulate further research. The review shows that although studies investigating prevalence rates of gambling and PG among different cultures are not plentiful, evidence does suggest certain cultural groups are more vulnerable to begin gambling and to develop PG. Significant factors including familial/genetic, sociological, and individual factors have been found in the Western gambling literature as playing important roles in the development and maintenance of PG. These factors need to be examined now in other cultural groups so we can better understand the etiological processes involved in PG and design culturally sensitive treatments. In addition, variables, such as cultural values and beliefs, the process of acculturation, and the influence of culturally determined, help-seeking behaviors need to be also examined in relation to the role they could play in the initiation of and maintenance of gambling. Understanding the contribution of cultural variables will allow us to devise better prevention and treatment options for PG. Methodological problems in this area of research are highlighted, and suggestions for future research are included.

Familial influence on offspring gambling: a cognitive mechanism for transmission of gambling behavior in families.

BACKGROUND: The problem-gambling literature has identified a range of individual, cognitive, behavioral and emotional factors as playing important roles in the development, maintenance and treatment of problem gambling. However, familial factors have often been neglected. The current study aims to investigate the possible influence of parental factors on offspring gambling behavior. METHOD: A total of 189 families (546 individuals) completed several questionnaires including the South Oaks Gambling Screen (SOGS) and the Gambling Related Cognition Scale (GRCS). The relationships were examined using Pearson product-moment correlations and structural equation modeling (SEM) analyses. RESULTS: Results showed that generally parents' (especially fathers') gambling cognitions and gambling behaviors positively correlated with offspring gambling behaviors and cognitions. However, SEM analyses showed that although parental gambling behavior was directly related to offspring gambling behavior, parental cognitions were not related to offspring gambling behavior directly but indirectly via offspring cognitions. CONCLUSION: The findings show that the influence of parental gambling cognition on offspring gambling behavior is indirect and via offspring cognitions. The results suggest a possible cognitive mechanism of transmission of gambling behavior in the family from one generation to the next.

Pathological gambling. A comprehensive review.

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling. (2) Almost all of the studies in the gambling literature are Western-based and the results are often generalized to other ethnic and cultural groups. There is now an urgent need to close this gap. (3) Future studies need to address methodological problems in the current gambling/PG literature. (4) Almost all of the gambling literature has focused on the issue of why people start gambling. It is suggested that looking at variables as to why people stop gambling in a single episode may be a more fruitful area of research then why people start gambling. This is because what motivates one to continue gambling, despite losses in a session and across sessions, is a characteristic that distinguishes nonproblem gamblers from problem gamblers and pathological gamblers (PGs).