Impulsivity profiles in pathological slot machine gamblers.

INTRODUCTION: In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables. METHODS: 126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles. RESULTS: According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2. CONCLUSIONS: We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches.

The efficacy of Motivational Intervention and Cognitive-Behavioral Therapy for Pathological Gambling. / Eficacia de la intervención Motivacional y la Terapia Cognitivo-conductual para el tratamiento del Juego Patológico.

The aim of the current study is to determine the effectiveness of an individual psychological intervention based on the motivational interview and cognitive-behavioral therapy for the treatment of pathological gambling. A sample of 18 participants, diagnosed of pathological gambling and without any other associated comorbidity, were assessed, attended at the publicly-funded Gambling and Behavioral Addictions Unit (Consorci Sanitari de Terrassa). Median age was 46 years (SD = 12). All the patients achieved abstinence and completed follow-up. The Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), Impulsive Behavior Scale (UPPS-P), Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were administered pre- and posttreatment. Results showed that patients significantly reduced the problems related to gambling behavior according to the NODS score (p < .000). Regarding impulsive behavior (UPPS-P), we found significant differences in negative urgency (p < .001), positive urgency (p < .001), (lack of) premeditation (p < .029) and (lack of) perseverance (p < .048). Some relevant aspects of quality of life as assessed by the Q-LES-Q had improved. In conclusion, the study shows that psychological intervention based on the motivational interview and cognitive-behavioral therapy not only significantly reduces gambling-related behavior problems but also leads to improvements in impulsivity and quality of life. .

El propósito del presente estudio es analizar la eficacia de una intervención psicológica individual basada en Entrevista Motivacional y Terapia cognitivo-conductual en el tratamiento del Juego Patológico, y evaluar la eficacia de esta intervención psicológica sobre la impulsividad y la calidad de vida de los pacientes. La muestra se compone de 18 pacientes atendidos en la Unidad de Juego Patológico del Consorci Sanitari Terrassa, diagnosticados de Juego Patológico, y sin comorbilidad asociada. La media de edad fue de 46 años (SD=12). Todos ellos alcanzaron la abstinencia y se encontraban en fase de seguimiento. Se administraron pre y post tratamiento los siguientes cuestionarios: Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), UPPS-P Impulsive Behavior Scale, Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI), State-trait Anxiety Inventory (STAI). Los resultados muestran una reducción significativa de los problemas asociados a la conducta de juego (p<.000). También se encontraron diferencias significativas en la impulsividad (UPPS-P) pre-post: urgencia negativa (p<.001), urgencia positiva (p<.001), (falta de) premeditación (p<.029) y (falta de) perseverancia (p<.048). Así mismo, hay una mejoría significativa en la calidad de vida (Q-LES-Q) de nuestros pacientes en distintas áreas. En conclusión, el estudio pone de manifiesto que la intervención psicológica basada en Entrevista Motivacional y Terapia Cognitivo-conductual permite una mejora significativa del Juego Patológico que repercute no sólo en la conducta de juego sino que también implica otros aspectos como la impulsividad y la calidad de vida.