A comparative evaluation of resting state proxies of sympathetic and parasympathetic nervous system activity in adolescent major depression.

Major depressive disorder (MDD) is associated with autonomic nervous system (ANS) dysfunction, characterized by decreased parasympathetic (PNS) and increased sympathetic (SNS) activity. Although findings on reduced PNS activity in adult MDD have been replicated in adolescents, comprehensive studies assessing PNS and SNS proxies in underage patients with MDD are scarce. Proxies of resting PNS (heart rate variability (HRV) and SNS activity (skin conductance response [SCR] and salivary alpha amylase [sAA], as well as mixed activity (heart rate [HR]) were collected in adolescents with MDD (n = 29) and non-depressed controls (n = 29). Primary analyses addressed differences between groups and correlations with depression severity. Patients with MDD showed significantly decreased HRV (g = - 0.87; 95% CI [- 1.39; - 0.35]) and increased HR (g = 0.66; 95% CI [0.14; 1.18]). Proxies of pure SNS activity showed no significant differences between groups. HR (positive) and HRV (negative) were significantly correlated with self- and clinician-rated depression severity. Alterations of ANS activity are evident in adolescent MDD, but characterized by decreased PNS activity only. We found no evidence for altered SNS activity. Findings suggest that ANS dysfunction early in the course of MDD might be predominantly driven by decreased PNS activity.

Heterogeneity of smartphone impact on everyday life and its relationship with personality and psychopathology: A latent profile analysis.

BACKGROUND: The relationships between problematic smartphone use and psychological factors have been extensively investigated. However, previous studies generally used variable-centered approaches, which hinder an examination of the heterogeneity of smartphone impact on everyday life. OBJECTIVE: In the present study, we capitalized on latent profile analysis to identify various classes of smartphone owners based on the impact associated with smartphone use (e.g., unregulated usage, preference for smartphone-mediated social relationships) and to compare these classes in terms of established psychological risk factors for problematic smartphone use. METHOD: We surveyed 934 young adults with validated psychometric questionnaires to assess the impact of smartphones, psychopathological symptoms, self-esteem and impulsivity traits. RESULTS: Smartphone users fall into four latent profiles: users with low smartphone impact, users with average smartphone impact, problematic smartphone users, and users favoring online interactions. Individuals distributed in the problematic smartphone user profile were characterized by heightened psychopathological symptoms (stress, anxiety, depression, obsessive-compulsive tendencies) and impulsivity traits. Moreover, users who preferred online interactions exhibited the highest symptoms of social anxiety and the lowest levels of self-esteem. CONCLUSIONS: These findings further demonstrate the multidimensionality and heterogeneity of the impact of smartphone use, calling for tailored prevention and intervention strategies.

Tracing 20 years of research on problematic use of the internet and social media: Theoretical models, assessment tools, and an agenda for future work.

Over the past two decades, there has been increasing interest in the impact of internet use and growing concern about whether problematic use of the internet (PUI) constitutes an addiction. Despite the growing number of studies investigating PUI and PUI subtypes, its conceptualization and inclusion in a classification system have not been possible yet. Several models aimed at inspiring clinical research and practice have proposed possible mechanisms involved in PUI and problematic use of social media, and multiple self-report instruments have been consequentially developed. The diversity of theoretical models and instruments currently hinders standardized assessment procedures across studies and, in turn, their comparability. The purpose of the present overview is to highlight the current conceptualization and assessment of both PUI and problematic use of social media, in order to critically discuss the existing fragmentation in the field and the need to achieve conceptual convergence. Two suggestions for future directions are also provided, i.e., define diagnostic criteria by bottom-up and top-down processes and develop a psychobiological hypothesis including the description of higher-order mechanisms involved in PUI and not other psychopathological conditions (e.g., the multiple available internet-related cues and outcomes that may lead to parallel forms of associative learning; probabilities of obtaining internet-related reinforcements; and intrinsic motivation processes).

Response inhibition in problematic social network sites use: an ERP study.

Given the current literature debate on whether or not Problematic Social Network Sites Use (PSNSU) can be considered a behavioral addiction, the present study was designed to test whether, similarly to addictive behaviors, PSNSU is characterized by a deficit in inhibitory control in emotional and addiction-related contexts. Twenty-two problematic Facebook users and 23 nonproblematic users were recruited based on their score on the Problematic Facebook Use Scale. The event-related potentials were recorded during an emotional Go/Nogo Task, including Facebook-related, unpleasant, pleasant, and neutral pictures. The amplitudes of the Nogo-N2 and the Nogo-P3 were computed as measures of the detection of response conflict and response inhibition, respectively. Reaction times and accuracy also were measured. The results showed that problematic users were less accurate on both Go and Nogo trials than nonproblematic users, irrespective of picture content. For problematic users only, the Nogo-P3 amplitude was lower to Facebook-related, pleasant, and neutral than to unpleasant stimuli, suggesting less efficient inhibition with natural and Facebook-related rewards. Of note, all participants were slower to respond to Facebook-related and pleasant Go trials compared with unpleasant and neutral pictures. Consistently, the Nogo-N2 amplitude was larger to Facebook-related than all other picture contents in both groups. Overall, the findings suggest that PSNSU is associated with reduced inhibitory control. These results should be considered in the debate about the neural correlates of PSNSU, suggesting more similarities than differences between PSNSU and addictive behaviors.

Recovery Capital and Symptom Improvement in Gambling Disorder: Correlations with Spirituality and Stressful Life Events in Younger but Not Older Adults.

Although age-related differences have been reported in gambling disorder, prior studies have not examined how age may influence recovery in gambling disorder. Recovery may be influenced by positive factors (e.g., spirituality and recovery capital) and negative factors (e.g., depression, anxiety, and stressful life events). The current study examined associations between these positive and negative factors and gambling disorder DSM-5 symptom improvement in younger and older adults. Younger (less than 55 years of age; n = 86) and older (55 years or older; n = 54) adults, with lifetime gambling disorder treated currently or within the past 5 years in five treatment centers in Israel were assessed using structured scales on past-year and lifetime DSM-5 gambling disorder, intrinsic spirituality, recovery capital, anxiety, depression and stressful life-events. Among younger adults, recovery capital and intrinsic spirituality were associated with gambling disorder symptom improvement. Among older adults, only recovery capital was associated with gambling disorder symptom improvement. Correlations between recovery capital and spirituality (z = 2.34, p = 0.02) and recovery capital and stressful life events (z = 2.29, p = 0.02) were stronger in younger than in older adults. Recovery capital is an important resource that should be considered across older and younger adults with gambling disorder. Spirituality and stressful life events may operate differently across age groups in gambling disorder. Future studies should investigate whether the findings may extend to other groups and the extent to which promoting recovery capital should be integrated into treatments for gambling disorder.

Reduced approach disposition in familial risk for depression: Evidence from time-frequency alpha asymmetries.

Despite the promising role of alpha and delta power in reflecting reduced approach disposition in depression, to date, it is unclear whether these measures can be employed to identify at-risk individuals. Hence, the present study investigated affective disposition in 32 unaffected individuals with a family history of depression (23 F) and 30 individuals without a family history of depression (21 F) through a data-driven analysis of alpha and delta time-frequency power during the viewing of pleasant, neutral, and unpleasant pictures. Different patterns of posterior alpha asymmetry emerged within each group. Particularly, controls showed greater right posterior alpha desynchronization ~ 600 ms following emotional relative to neutral pictures presentation. Conversely, the group with a family history of depression showed greater posterior left alpha desynchronization only to unpleasant relative to neutral images in a later time window (> 900 ms). Hence, depression vulnerability seems to be characterized by a blunted reactivity to pleasant and delayed reactivity to unpleasant stimuli with a distinct posterior distribution relative to the controls. Finally, the two groups showed a comparable pattern of greater delta power to emotional relative to neutral cues. Overall, initial support was provided for the employment of time-frequency alpha power changes during affective processing in identifying blunted approach disposition in unaffected at-risk individuals.

Impact of Attachment Style and Temperament Traits on the Quality of Life of Patients with Psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease with manifestations that go beyond the visual manifestation, and include psychological aspects. Some mental disorders or personality traits in psoriasis patients have also been highlighted, such as a negative or problematic attitude towards life, impulsive or avoidant behavior, and lower satisfaction with life. The aim of our cross-sectional study was to explore the associations between adult attachment, temperament, and quality of life of patients with psoriasis. METHODS: A sample of 75 patients with psoriasis was evaluated with the Attachment Style Questionnaire (ASQ) to study adult attachment, the Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire (TEMPS-A) to study temperament traits, and the Dermatology Life Quality Index (DLQI) to study the impact of dermatological diseases on patients' lives. RESULTS: Depressive, cyclothymic, and irritable temperaments were found to be significantly positively associated with a need for approval and preoccupation with relationships subscales of the ASQ. The severity of skin disease effect on the patient's life was higher in women than in men. Moreover, a statistically significant effect of the need for approval subscale of the ASQ was found. The positive correlation between the severity of skin disease effect on the patient's life with a need for approval was statistically significant and stronger in women than in men. CONCLUSIONS: A better understanding of the impact of mental comorbidities on psoriasis and vice versa places an ever-greater responsibility on dermatologists involved in the management of psoriasis to recognize these problems and collaborate with psychologists and psychiatrists to help these patients.

Loneliness and problematic social networking sites use in young adults with poor vs. good sleep quality: The moderating role of gender.

Despite the evidence of a relationship between loneliness, problematic social networking sites use (PSNSU), and sleep quality, associations between specific PSNSU symptoms and loneliness in individuals with poor vs. good sleep quality and possible gender differences have yet to be understood. We examined the relationships between loneliness and PSNSU symptoms (i.e., preference for online social interaction - POSI, mood regulation, deficient self-regulation, and negative outcomes), and possible moderating effects of gender for individuals with poor vs. good sleep quality. Seven hundred and sixty-three young adults completed an online survey including self-report measures of sleep quality, loneliness, and PSNSU symptoms. Individuals with poor sleep quality reported higher levels of loneliness and greater scores on all PSNSU domains than those with good sleep quality. Slope analyses revealed that in men vs. women with poor sleep quality, greater deficient self-regulation of social networking sites use was associated with lower levels of loneliness. Conversely, in men vs. women with good sleep quality, greater POSI was associated with higher levels of loneliness. Our findings showed that individuals with poor sleep quality are characterized by higher levels of loneliness and more severe PSNSU symptoms that may be the result of sleep disturbance-related metabolic, neural, and hormonal processes. Moreover, our results highlight gender differences for individuals with poor vs. good sleep quality which may help clarify the nature of the association between loneliness and PSNSU.

Familial risk for depression is associated with reduced P300 and late positive potential to affective stimuli and prolonged cardiac deceleration to unpleasant stimuli.

Despite evidence of abnormal affective processing as a key correlate of depression, specific attentional mechanisms underlying processing of emotions in familial risk for depression have yet to be investigated in a single study. To this end, the amplitude of the P300 and late positive potential (LPP) complex and cardiac deceleration were assessed during the passive viewing of affective pictures in 32 individuals who had family history of depression (without depressive symptoms) and in 30 controls (without depressive symptoms and family history of depression). Individuals with familial risk for depression revealed reduced P300-LPP amplitudes in response to pleasant and unpleasant stimuli relative to controls, and comparable P300-LPP amplitudes in response to pleasant and neutral stimuli. Controls, but not individuals with familial risk for depression, reported cardiac deceleration during the viewing of pleasant vs. neutral and unpleasant stimuli in the 0-3 s time window. Also, only individuals with familial risk for depression showed a prolonged cardiac deceleration in response to unpleasant vs. neutral stimuli. Overall, the present study provides new insights into the characterization of emotion-related attentional processes in familial risk for depression as potential vulnerability factors for the development of the disorder.

Problematic social media use is statistically predicted by using social media for coping motives and by positive reinforcement processes in individuals with high COVID-19-related stress levels.

It is important to understand the relationship between stress and problematic use of social media (PUSM). However, no study to our knowledge has yet investigated the longitudinal relationship between perceived stress and PUSM via positive and negative reinforcement processes. The present study investigated relationships between COVID-19-pandemic-related stress and PUSM and possible moderating effects of motives for using social media (positive and/or negative reinforcement) during and following a COVID-19-pandemic-related lockdown. Six-hundred-and-sixty participants initially completed a survey including self-report measures of PUSM, COVID-19-pandemic-related stress, and motives for using social media (i.e., for negative reinforcement involving coping and conformity or positive reinforcements involving enhancement and social motives). During the COVID-19 outbreak recovery period, 117 participants again completed the survey. Bayesian analyses revealed that PUSM was associated with higher COVID-19-pandemic-related stress levels and use of social media for coping, conformity, and enhancement purposes. Longitudinally, PUSM symptom worsening was associated with increased use of social media for coping motives regardless of levels of perceived stress. Use of social media for conformity and enhancement purposes moderated relationships between stress levels during lockdown and PUSM symptoms worsening after lockdown. Our findings corroborate the hypothesis that negative reinforcement processes may be key factors in PUSM symptom worsening regardless of perceived stress. Concurrently, high levels of stress may worsen PUSM through positive reinforcement processes.

Using Social Media for Social Motives Moderates the Relationship between Post-Traumatic Symptoms during a COVID-19-Related Lockdown and Improvement of Distress after Lockdown.

Previous research reported inconsistent results on the relationship between social media (SM) use and psychological well-being, suggesting the importance of assessing possible moderators, e.g., motives for SM use. However, no longitudinal study has yet investigated whether, among people who use SM, specific motives for using SM may represent protective/risk factors for the development of psychological distress, especially after a stressful event. Our longitudinal study aimed at assessing the moderating role of motives for using SM (i.e., coping, conformity, enhancement, social motives) in the relationship between COVID-19 pandemic-related post-traumatic stress symptoms during the lockdown and changes in general distress after lockdown. At Time 1 (during the first lockdown in Italy), 660 participants responded to an online survey, reporting their post-traumatic symptoms, motives for using SM, and general distress (i.e., anxiety, depression, and stress symptoms). At Time 2 (three months later, following lockdown), 117 participants volunteered to continue with the follow-up survey assessing general distress symptoms again. Results showed that among those who had experienced more severe post-traumatic symptoms at Time 1, using SM for social motives was associated with more improvement of general distress symptoms. No evidence was found of moderating effects of other motives for SM use. The findings suggest that social connections may have helped to cope with stress during forced confinement, and that SM use may be beneficial for mental health when motivated by maintaining social interactions.

Early indicators of vulnerability to depression: The role of rumination and heart rate variability.

BACKGROUND: Despite the evidence of increased levels of rumination and reduced heart rate variability (HRV) in depression, whether these measures can be considered early indicators of vulnerability to depression has yet to be investigated. Therefore, the present study aimed to investigate both levels of rumination and resting HRV in individuals with familial risk for depression that is the most reliable risk factor for the disorder. METHODS: Rumination and vagally-mediated HRV were assessed using the Ruminative Response Scale and a smartphone-based photoelectric volumetric pulse wave assay, respectively, in 25 individuals who had family history of depression (but did not report current depressive symptoms), 15 individuals who reported depressive symptoms (but had no family history of depression), and 25 controls (without depressive symptoms and family history of depression). RESULTS: Individuals with depressive symptoms and those with a family history of depression were characterized by higher levels of rumination and lower cardiac vagal control than controls. LIMITATIONS: Given the small sample size, this study should be used to design larger confirmatory studies; the cross-sectional nature of the study does not allow discussing the results in terms of cause-effect relationships. CONCLUSIONS: Our findings suggested that individuals at risk of developing depression, also in absence of depressive symptoms, are defined by defective self-regulation capacity that may lead to future depression episodes. Increased ruminative thoughts and reduced HRV may represent early indicators of vulnerability to depression. Effective prevention programs designed to reduce rumination and/or increase HRV may reduce the risk of developing a full-blown depressive episode.

EEG time-frequency analysis reveals blunted tendency to approach and increased processing of unpleasant stimuli in dysphoria.

To date, affective and cognitive processing of emotional information in individuals with depressive symptoms have been examined through peripheral psychophysiological measures, event-related potentials, and time-frequency analysis of oscillatory activity. However, electrocortical correlates of emotional and cognitive processing of affective content in depression have not been fully understood. Time-frequency analysis of electroencephalographic activity allows disentangling the brain's parallel processing of information. The present study employed a time-frequency approach to simultaneously examine affective disposition and cognitive processing during the viewing of emotional stimuli in dysphoria. Time-frequency event-related changes were examined during the viewing of pleasant, neutral and unpleasant pictures in 24 individuals with dysphoria and 24 controls. Affective disposition was indexed by delta and alpha power, while theta power was employed as a correlate of cognitive elaboration of the stimuli. Cluster-based statistics revealed a centro-parietal reduction in delta power for pleasant stimuli in individuals with dysphoria relative to controls. Also, dysphoria was characterized by an early fronto-central increase in theta power for unpleasant stimuli relative to neutral and pleasant ones. Comparatively, controls were characterized by a late fronto-central and occipital reduction in theta power for unpleasant stimuli relative to neutral and pleasant. The present study granted novel insights on the interrelated facets of affective elaboration in dysphoria, mainly characterized by a hypoactivation of the approach-related motivational system and a sustained facilitated cognitive processing of unpleasant stimuli.

Emotional processing prospectively modulates the impact of anxiety on COVID-19 pandemic-related post-traumatic stress symptoms: an ERP study.

BACKGROUND: Considering that the elevated distress caused by the COVID-19 pandemic, in some cases, led to post-traumatic stress symptoms (PTSS), it has been proposed as a specific traumatic event. The present longitudinal study investigated pre-pandemic motivated attention to emotional stimuli, as indexed by Late Positive Potential (LPP) amplitude, in relation with the potential differential role of anxiety and depressive symptoms in predicting PTSS severity related to the COVID-19 pandemic. METHODS: A total of 79 university students initially completed self-report measures of depression and anxiety along with a passive viewing task of emotional (pleasant, unpleasant) and neutral pictures while electroencephaloghic activity was recorded. In December 2020, 57 participants completed a questionnaire assessing PTSS. RESULTS: Significant interactions between anxiety and LPP emerged in predicting pandemic-related PTSS, where greater anxiety symptoms predicted PTSS only in individuals with greater LPP to unpleasant or with reduced LPP to pleasant stimuli. LIMITATIONS: The prevalence of the female sex, the relatively young age of the participants, as well as the fact that they were all enrolled in a University course might not allow the generalization of the findings. CONCLUSIONS: Taken together, the present longitudinal study provided novel evidence on EEG predictors of pandemic-related PTSS that might be useful for the prevention and treatment of PTSS. Indeed, assessing anxiety symptoms and pre-trauma LPP to emotional stimuli might be a useful target for identifying individuals that are more vulnerable to the development of PTSS during times of crisis.

Motivated attention to stimuli related to social networking sites: A cue-reactivity study.

BACKGROUND AND AIMS: It has been argued that similar to addictive behaviors, problematic Social Network sites use (PSNSU) is characterized by sensitized reward processing and cue-reactivity. However, no study to our knowledge has yet investigated cue-reactivity in PSNSU. The present study aims at investigating cue-reactivity to Social Network sites (i.e., Facebook)-related visual cues in individuals identified as problematic vs. non-problematic Facebook users by the Problematic Facebook Use Scale. METHODS: The Event-Related Potentials (ERPs) were recorded during the passive viewing of Facebook-related, pleasant, unpleasant, and neutral pictures in 27 problematic and 26 non-problematic users. Moreover, craving for Facebook usage was collected using a Likert scale. RESULTS: Despite problematic users were more likely to endorse higher craving than non-problematic ones, Facebook-related cues elicited larger ERP positivity (400-600 ms) than neutral, and comparable to unpleasant stimuli, in all Facebook users. Only in problematic users we found larger positivity (600-800 ms) to pleasant than unpleasant cues and higher craving to be related with lower later positivity (800-1,000 ms) to pleasant and unpleasant cues. DISCUSSION: Regardless of whether Facebook usage is problematic or non-problematic, Facebook-related cues seem to be motivationally relevant stimuli that capture attentional resources in the earlier stages of "motivated" attentional allocation. Moreover, our results support the view that in higher-craving problematic users, reduced abilities to experience emotions would be the result of defective emotion regulation processes that allow craving states to capture more motivational/attentional resources at the expense of other emotional states.

The Relationship Between Affective and Obsessive-Compulsive Symptoms in Internet Use Disorder.

We investigated the relationships and diagnostic power of symptoms associated with affective disorders, obsessive-compulsive disorder, and drug addictions on Internet use disorder. Moreover, we tested whether Internet use disorder is characterized by a specific network of symptoms. One-hundred-and-four young adults (78 women) were assessed in laboratory using self-report measures of Internet addiction, alcohol use disorder, cannabis abuse, depression, anxiety, and stress symptoms, impulsiveness, and obsessive-compulsive symptoms. Only hoarding, obsessing, and depression symptoms were positively linked to Internet use disorder severity, with hoarding having greater power and accuracy than other obsessive-compulsive and affective symptoms. Only individuals with mild-moderate Internet use disorder were characterized by a network of strong and positive associations of affective and obsessive-compulsive symptoms. These findings may encourage future longitudinal studies aimed at identifying potential clinical criteria for the diagnosis of Internet use disorder and treatment targets.

Disentangling emotional processing in dysphoria: An ERP and cardiac deceleration study.

The present study aimed to investigate emotional processing in dysphoria. To this end, the amplitude of the Late Positive Potential (LPP) and cardiac deceleration were assessed during the passive viewing of affective (pleasant, neutral, and unpleasant) pictures in 26 individuals with dysphoria and in 25 non-depressed controls. The group with dysphoria revealed a smaller LPP amplitude than the group without dysphoria in response to pleasant and neutral, but not unpleasant, stimuli at centro-parieto-occipital sites. Interestingly, whereas both groups showed cardiac deceleration when viewing pleasant compared to neutral pictures (3-6 s time window), only individuals with dysphoria showed a prolonged cardiac deceleration in response to unpleasant stimuli as compared with neutral ones. This study suggests that dysphoria is characterized by reduced motivated attentional allocation to positive information and by sustained intake of unpleasant information. Overall, the present findings provide novel insights into the characterization of valence-specific attentional processes in dysphoria as potential vulnerability factors for clinically significant depression.

A test of the pathway model of problematic smartphone use.

BACKGROUND AND AIMS: Problematic smartphone use (PSU) has been described as a growing public health issue. In the current study, we aimed to provide a unique and comprehensive test of the pathway model of PSU. This model posits three distinct developmental pathways leading to PSU: (1) the excessive reassurance pathway, (2) the impulsive pathway and (3) the extraversion pathway. METHODS: Undergraduate students (n = 795, 69.8% female, mean age = 23.80 years, sd = 3.02) completed online self-report measures of PSU (addictive use, antisocial use and dangerous use) and the psychological features (personality traits and psychopathological symptoms) underlying the three pathways. RESULTS: Bayesian analyses revealed that addictive use is mainly driven by the excessive reassurance pathway and the impulsive pathway, for which candidate etiopathological factors include heightened negative urgency, a hyperactive behavioural inhibition system and symptoms of social anxiety. Dangerous and antisocial use are mainly driven by the impulsive pathway and the extraversion pathway, for which candidate etiopathological factors include specific impulsivity components (lack of premeditation and sensation seeking) and primary psychopathy (inclination to lie, lack of remorse, callousness and manipulativeness). DISCUSSION AND CONCLUSIONS: The present study constitutes the first comprehensive test of the pathway model of PSU. We provide robust and original results regarding the psychological dimensions associated with each of the postulated pathways of PSU, which should be taken into account when considering regulation of smartphone use or tailoring prevention protocols to reduce problematic usage patterns.

Mobile and non-mobile Internet Use Disorder: Specific risks and possible shared Pavlovian conditioning processes. •.

This commentary addresses a recent article by Montag et al. (2019) about the relevance of distinguishing between mobile and non-mobile Internet Use Disorder (IUD). In response to the review, we reflect on the clinical relevance of this distinction and, in parallel, we propose some Pavlovian conditioning processes as possible mechanisms underlying different IUDs. We believe that, from a clinical point of view, it is of fundamental importance assessing both specific "forms" of IUDs and the underlying mechanisms that would be shared across different IUDs, like multiple and parallel classes of Pavlovian responses and the influences of Internet cues on Internet-related addictive behaviors that may be influenced by the probability of obtaining Internet rewards.

Associations between recovery capital, spirituality, and DSM-5 symptom improvement in gambling disorder.

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).