Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis.

AIMS: To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up. METHOD: Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. RESULTS: Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. CONCLUSIONS: Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.

Use of a sequential multiple assignment randomized trial to test contingency management and an integrated behavioral economic and mindfulness intervention for buprenorphine-naloxone medication adherence for opioid use disorder.

BACKGROUND: Buprenorphine-naloxone is a medication shown to improve outcomes for individuals seeking treatment for opioid use disorder (OUD); however, outcomes are limited by low medication adherence rates. This is especially true during the early stages of treatment. METHODS: The present study proposes to utilize a sequential multiple assignment randomized trial design to compare two psychological interventions targeting buprenorphine-naloxone adherence: (1) contingency management (CM) and (2) brief motivational interviewing plus substance-free activities session plus mindfulness (BSM). Participants will be N = 280 adults who present to a university-based addictions clinic seeking treatment for OUD. Participants will be randomized to condition to receive 4 sessions of their assigned intervention (CM or BSM). Participants who are adherent, defined as attending physician appointments and having buprenorphine present in urine toxicology, will enter maintenance intervention for an additional 6 months. Those who are not adherent will be re-randomized to receive either the other intervention or both interventions. Follow-up will occur at 8 months post-randomization. CONCLUSIONS: This novel design will examine the benefit of sequential treatment decisions following non-adherence. The primary outcome of this study is buprenorphine-naloxone medication adherence, as assessed by physician visit attendance and presence of buprenorphine in urine. Results will elicit the relative efficacy of CM and BSM compared to one another and whether keeping the initial treatment approach when adding the alternative approach for initially non-adherent individuals is beneficial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04080180.

Effects of cognitive behavioral techniques for gambling on recovery defined by gambling, psychological functioning, and quality of life: A systematic review and meta-analysis.

OBJECTIVE: Individuals who experience gambling harms report that sustained recovery involves changing both gambling behaviors and psychological symptoms, as well as building a meaningful life. However, there is limited understanding about the effect of cognitive behavioral (CB) techniques on psychological symptoms and quality of life. The purpose of the present study was to examine the effect of CB techniques for gambling-related harms on broader recovery outcomes such as psychological symptoms and quality of life. METHOD: A systematic article search was conducted to identify randomized controlled trials of CB techniques with nonactive and minimal treatment control groups that assessed psychological symptoms or quality of life as outcomes. Random-effects meta-analysis was used to examine the effect of CB techniques relative to nonactive and minimal treatment control groups. RESULTS: A total of nine studies representing 658 participants were included. Eight studies reported outcomes on depression and anxiety, three on substance use, and six on quality of life. CB techniques significantly reduced anxiety (g = -0.44) and depression (g = -0.35) at posttreatment, but not substance use. CB techniques also significantly increased quality of life at posttreatment (g = 0.40). There was a large amount of heterogeneity suggesting the magnitude of effects could vary significantly in future randomized trials. CONCLUSIONS: Future studies should examine the longitudinal associations between gambling harms, psychological symptoms, and quality of life and to assess whether changes in gambling harms throughout treatment precede or are a consequence of changes in psychological symptoms and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Veterans Health Administration's integrated model of care increases accessibility and delivery of mental health services.

Depression and posttraumatic stress disorder (PTSD) are two of the most common mental health conditions experienced by veterans. It is unclear what individual and system level factors are associated with receiving mental health treatment for these concerns. Using a national sample of Gulf War Era veterans who endorsed lifetime diagnoses of either depression or PTSD (N = 425), regression analyses were used to predict past-year treatment utilization. Predictor variables were those indicated in the behavioral model of health care utilization, including predisposing demographic variables (e.g., age, race), enabling variables (e.g., service connection, enrollment in Veterans Health Administration [VHA]), and need-based variables (e.g., current symptom severity). VHA enrollment was associated with a three- and five-times higher odds of being treated for depression or PTSD, respectively. Income and symptom severity were also positively associated with treatment utilization. Among individuals with diagnoses of depression and/or PTSD, VHA enrollment was the strongest predictor of receiving mental health treatment for these diagnoses, controlling for all other variables in the model including recent contact with the health care system, current symptom severity, and the presence of other enabling resources. Results suggest that the VHA's integrated model of care increases accessibility and delivery of effective mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder. METHODS: This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey. RESULTS: Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD. LIMITATIONS: This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts. CONCLUSIONS: Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.

Text Comprehension Analyses to Improve Assessment Accuracy: Demonstration Using Gambling Disorder Screening.

Many individuals diagnosed with an addictive disorder are members of disadvantaged groups and obtain a high school education or less, yet self-report questionnaires widely used to identify symptoms of addictive disorders do not use best practices to ensure item clarity and comprehension. In the present study, we explore how advanced text-analysis technology can be used to guide the development of a diagnostic questionnaire with an emphasis on maximizing its readability and then test the accuracy of this questionnaire. In Study 1, a self-report questionnaire for symptoms of gambling disorder was created using best practices for item clarity and comprehension. In study 2 an experimental design was used to test whether the measure with enhanced readability, compared to a commonly used screening instrument, improved diagnostic symptom accuracy among samples of high school and college educated individuals. Subsequent analyses revealed that education was positively related to item comprehension, and participants who completed the maximized readability questionnaire correctly identified more symptoms of gambling disorder than participants who completed the comparison questionnaire, regardless of educational attainment. These studies indicate that the rate at which individuals accurately identify symptoms of psychopathology is strongly related to their educational attainment and the readability of the questionnaire items themselves.

Nonstigmatizing and Precise Terminology to Describe Processes and Outcomes in Addiction Medicine.

ABSTRACT: Scholarly journals and professional organizations in addiction medicine have recently discussed the importance of adopting nonstigmatizing and precise terminology. The present commentary expands that ongoing discussion to terms related to treatment processes and outcomes. Four implicit assumptions of stigmatizing and imprecise terms related to treatment processes and outcomes are overviewed, and research evidence against these assumptions is presented. The commentary ends with recommendations for the use of positive behavioral indicators of processes and outcomes and, more importantly, accompanying them with nonevaluative, objective descriptors of patients' behaviors.

Dropout from face-to-face, multi-session psychological treatments for problem and disordered gambling: A systematic review and meta-analysis.

OBJECTIVE: The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates. METHOD: A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates. RESULTS: The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators. CONCLUSIONS: A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Increased Demographic Representation in Randomized Control Trials for Gambling Disorder in the United States is Needed: A Systematic Review.

Participants in randomized control trials (RCTs) should be representative of those most likely to experience the disorder of focus, yet reviews of psychology research studies consistently find certain demographic groups are overrepresented at the price of others being unincluded. The present review aimed to characterize the demographic representation of US-based RCTs for gambling disorder and compare findings to the population of individuals most likely to experience the disorder. Thirteen US-based RCTs comprising a total of 2,343 participants were reviewed. We found that although gambling disorder is most prevalent among low SES racial minorities, RCTs are mostly conducted among populations who are white, employed, and have some level of college education. Demographic variables that are related to the likelihood of experiencing gambling disorder are not consistently reported, and there are many groups of individuals who experience gambling disorder that have been virtually left out of all treatment study samples to date. We conclude with recommendations for future gambling focused treatment studies, which are geared towards increasing the convergence between characteristics of participants in RCTs and those who experience gambling disorder in the United States.

Frequent Gamblers' Reasons for and Against Completing a Problem Gambling Screener.

Problem gambling screeners are easily accessible and potentially reduce harm for those individuals who engage in risky levels of gambling behavior. However, a recent study found that when frequent gamblers were offered the chance to complete a screener and receive feedback, most chose not to do so. In this paper, secondary analysis was completed on frequent gamblers' open-ended responses to questions regarding reasons for and against completing a problem gambling screener. Participants (N = 262) were individuals who gambled at least once per week and were not currently being treated for gambling problems. A qualitative open-coding procedure independently completed by multiple researchers revealed that the most common reasons for completing the screener were individuals having a desire to check in on their behavior, because they were curious about the screener, because they were experiencing gambling-related harm, or that they were already considering making changes to their gambling. The most common reasons against completing the screener were that they were either avoidant of the experience because they thought it might cause psychological distress, or because they believed that they did not have a problem. This study provides insight into why many individuals who engage in risky levels of gambling behavior do not seek out helping resources. In addition to creating practically accessible helping resources, researchers should focus on techniques that can make help-seeking a less distressing and more acceptable experience.

Can the Behavioral Model of Health Care Utilization Be Used to Predict Completion of a Mental Health Assessment Following Intimate Partner Violence?

Survivors of intimate partner violence (IPV) may experience mental health problems. Although some survivors access mental health resources to address these concerns, many discontinue prematurely. One model of health care utilization that has recently gained attention in the trauma literature is the behavioral model of health care utilization (BMHU). This model considers three groups of variables in predicting health care utilization: immutable predisposing variables (e.g., age), enabling resources (e.g., income), and measures of need (e.g., symptom severity). The current study tested the BMHU's ability to predict completion of a free, multisession mental health evaluation for female survivors of IPV (N = 214). Two models were tested, each assessing a separate need-based predictor: The first model assessed symptoms of depression and the second model assessed symptoms of posttraumatic stress disorder (PTSD). Results were consistent across both models and suggested that younger age and receiving public assistance were both associated with a lower likelihood of completing the evaluation. Contrary to the BMHU's assumed positive relation between symptom severity and health care utilization, greater severity of depression and PTSD symptoms were both associated with a lower likelihood of completing the evaluation. It is possible that following IPV, experiencing psychological distress may engender help-seeking but too much distress may serve as a barrier to continued utilization. Future research should seek to better understand the complex relation between need and access, in the context of mental health care, and develop strategies for retaining IPV survivors who access mental health resources.

Can motivational messages engage individuals at-risk for gambling disorder in an online assessment?

There is a need to better understand how to motivate individuals experiencing addiction-related concerns, such as gambling problems, to engage in help-seeking behaviors. This experiment tested whether online messages based on principles of motivational interviewing (MI) could be used to encourage individuals to complete a problem gambling screener. Participants (N = 805) who gambled at least weekly and were not receiving treatment for gambling problems were recruited via Amazon Mechanical Turk. Participants were randomly assigned to 1 of 3 message conditions that all offered participants the choice to complete either a problem gambling screener or an alternative questionnaire focused on gambling-related attitudes. The first condition was an MI-based interactive message, the second was similar in content but was presented in a noninteractive manner, and the third was a control message that did not include motivational elements. We found that the interactive motivational message yielded significantly higher rates of screener completion (39%) than the noninteractive message (28%) or control message (29%), χ² (2, N = 805) = 8.28, p = .016, Φ = .29. This remained significant after controlling for other study variables. Controlling for message condition, participants were more likely to complete the screener if they gambled more frequently, with more money, were more psychologically distressed and interested in receiving help for gambling problems, or had ever received treatment for gambling problems. These findings provide support for the use of interactive MI-based messages to encourage individuals at-risk for experiencing problems to use helping resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sweetening the pot: Exploring differences between frequent gamblers who do and do not gamble under the influence of cannabis.

The legalization of recreational cannabis for adults is becoming more common across the United States of America, as well as other counties around the world. Previous research has documented shared risk factors between cannabis use and gambling. Experimental studies have shown cognitive effects of cannabis that might influence gambling behavior. The current study explored demographics, gambling behaviors, and mental health differences based on the degree to which individuals use cannabis while they gamble. Individuals (N = 805) who gambled at least weekly completed an online survey. Thirty percent reported gambling under the influence of cannabis. Of these individuals, 41% reported using cannabis 25% of the time that they gambled, 31% reported being under the influence 50% of the time when gambling, 16% were under the influence 75% of the time when gambling, and 13% reported always or almost always gambling under the influence of cannabis. Those who reported gambling while under the influence of cannabis were more likely to be younger, non-white and non-heterosexual. They also reported higher levels of psychological distress, were more likely to have had a diagnosis of ADHD and a history of treatment for gambling, substance use, or other kinds of mental health concerns. Individuals who used cannabis while gambling also reported gambling more frequently than those who did not. This study provides one of the first explorations into who uses cannabis while gambling. Future experimental studies are required to investigate the direct effects of cannabis on gambling behaviors.

Is more better? A meta-analysis of dose and efficacy in face-to-face psychological treatments for problem and disordered gambling.

A growing literature supports the efficacy of cognitive-behavioral therapies, motivational interventions, and personalized feedback to treat problem and disordered gambling. However, there is currently debate as to how much treatment is necessary. Some studies indicate that attending a greater number of sessions is related to enhanced therapeutic outcomes, while other studies indicate that one session produces equivalent therapeutic outcomes to multiple sessions. To contribute to this debate, meta-analysis was used to examine the relation between dose and outcome in studies of cognitive-behavioral, motivational, and personalized feedback interventions (both individual and group treatment formats were included). Fourteen studies of randomized controlled trials representing 1,203 participants across 19 treatment-control comparisons were identified. The intended treatment dose (i.e., the number of sessions prescribed to participants) across the 14 studies ranged from 1 to 30 sessions. Of the 10 studies reporting the received treatment dose (i.e., the number of sessions that participants attended), the weighted mean dose was 6.8 sessions (SD = 2.7). Both intended treatment dose and received treatment dose were positively related to outcome at posttreatment-as the number of sessions increased, so too did the magnitude of the between group effect size. There were an insufficient number of studies reporting outcome at long-term follow up to evaluate the relation between intended dose, received dose, and outcome. Discussion centers on several areas for future research on psychological treatments for problem and disordered gambling. Specific recommendations are made for researchers and practicing clinicians. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Can a motivational letter increase attendance to psychological treatment for gambling disorder?

High rates of treatment refusal and dropout have complicated the delivery of psychological treatment for gambling disorder, which continues accumulating evidence for efficacy. Incorporating motivational interviewing and addressing outcome expectations into psychological treatments has been shown to increase overall attendance. However, no studies have investigated whether motivational interviewing and outcome expectations can increase attendance at the initial and subsequent sessions of psychological treatment for gambling disorder. Participants were 69 prospective clients who contacted an outpatient training clinic requesting treatment services for gambling-related problems. They were randomly assigned to receive a mailed letter that incorporated principles of motivational interviewing and addressed outcome expectancies plus a telephone reminder call or to receive a telephone reminder call only. Clients who received the letter plus reminder call were more likely to attend the initial session than were clients who received the reminder call only. Clients receiving the letter were also more likely to reschedule their initial session and less likely to not show up than were clients receiving the reminder call only. There was no significant difference in attendance at subsequent sessions. These results suggest that mailing a similar letter to prospective clients of psychological treatment for gambling disorder is worthwhile, given the associated ease and low cost. Future investigations should further investigate the value of strengthening the motivation of prospective clients and clinics before initial treatment sessions, and they should investigate the distinction between clients who reschedule versus not show up. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Association Between Posttraumatic Negative Self-Conscious Cognitions and Emotions and Maladaptive Behaviors: Does Time Since Trauma Exposure Matter?

Negative beliefs about the self, self-blame, guilt, and shame have been consistently linked to emotional problems, such as posttraumatic stress disorder and depression, following trauma exposure. To expand understanding of the potential role of negative self-conscious cognitions and emotions in other forms of posttrauma maladjustments, such as maladaptive behaviors, the current study examined the associations between these cognitions and emotions with dissociation, alcohol use, and avoidant problem-solving. As a secondary goal, the influence of time since trauma exposure was considered given recent data suggesting that some posttraumatic responses require lengthier time following trauma to become salient. Multiple-group analysis was conducted in two groups of female survivors of intimate partner violence (IPV): women whose IPV experiences occurred within 3 months prior to assessment (early posttrauma phase [EPP]; n = 67) and those whose experiences occurred 12 months or more prior to assessment (chronic posttrauma phase [CPP]; n = 145). The results suggested model invariance. Posttraumatic negative self-conscious cognitions and emotions were significantly correlated with dissociation (EPP group: ß = .61, p < .001 and CPP group: ß = .48, p < .001), alcohol use (EPP group: ß = .31, p = .014 and CPP group: ß = .30, p < .001), and avoidant problem-solving (EPP group: ß = .58, p < .001 and CPP group: ß = .56, p < .001). The findings highlight the importance of negative self-conscious cognitions and emotions in posttrauma maladjustment and support intervening in these domains shortly after trauma exposure.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La asociación entre cogniciones y emociones negativas auto-conscientes postraumáticas y comportamientos maladaptativos: ¿Influye el Tiempo desde la Exposición al Trauma? COGNICIONES/EMOCIONES Y COMPORTAMIENTOS MALADAPTATIVOS Las creencias negativas acerca de sí mismo, la autoinculpación, la culpa y la vergüenza han sido consistentemente asociados a problemas emocionales, tales como el trastorno de estrés postraumático y la depresión, luego de la exposición a trauma. Para expandir la comprensión del rol potencial de las cogniciones y emociones negativas auto-conscientes en otras formas de inadaptación post-trauma, como comportamientos maladaptativos, el presente estudio examinó las asociaciones entre esas cogniciones y emociones con disociación, uso de alcohol, y estilo evitativo de resolución de problemas. Como un objetivo secundario, se consideró la influencia del tiempo desde la exposición al trauma dados los datos recientes que sugieren que algunas respuestas post-traumáticas requieren un mayor tiempo luego del trauma para hacerse salientes. Se realizó un análisis de grupos múltiples en dos grupos de mujeres sobrevivientes de violencia de pareja (IPV, por su sigla en inglés); aquellas cuyas experiencias de IPV ocurrieron en los últimos 3 meses (fase temprana post-trauma [FTP]; n = 67) y aquellas cuyas experiencias ocurrieron hace 12 meses o más (fase crónica post-trauma [FCP]; n = 145). Los resultados sugirieron invariancia del modelo. Las cogniciones y emociones negativas auto-conscientes se correlacionaron significativamente con disociación (grupo EPP: ß = .61, p < .001 y grupo CPP: ß = .48, p < .001), uso de alcohol (grupo EPP: ß = .31, p = .014 y grupo CPP: ß = .30, p < .001), y estilo evitativo de resolución de problemas (grupo EPP: ß = .58, p < .001 y grupo CPP: ß = .56, p < .001). Los hallazgos destacan la importancia de las emociones y cogniciones negativas auto-conscientes en la inadaptación postrauma y apoyan la intervención en esos dominios prontamente luego de la exposición a trauma.

A Meta-analysis of Brief Personalized Feedback Interventions for Problematic Gambling.

Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual's gambling behavior, often in comparison to others' gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.

Public Stigma Across Addictive Behaviors: Casino Gambling, eSports Gambling, and Internet Gaming.

The negative psychological effects of public stigma on disordered gamblers have been well documented. Public stigma deters treatment-seeking and other help-seeking behaviors, and negatively impacts individuals' view of themselves. Different types of disordered gambling activities may attract different degrees of stigma. One increasingly popular form of gambling involves placing bets on the outcomes of competitive video games, also called eSports gambling. This activity shares characteristics with Internet gaming and gambling. The purpose of this study was to compare the degree of public stigma held towards traditional casino gamblers, eSports gamblers, and Internet gamers, as compared to an individual experiencing comparable levels of impairment and distress due to a financial crisis. Using an experimental between-groups vignette study design, we found that all three types of behavioral addictions were more heavily stigmatized than the control condition. The three behavioral addictions were seen as being highly controllable, engendered a significant amount of anger and blame, and resulted in higher levels of desired social distance. Traditional casino gamblers were seen as significantly more dangerous to be around and created a higher level of desired social distance than the Internet gamer. Differences between the Internet gamer and eSports better were less pronounced. These findings underscore the importance of reducing public stigma for gambling and other behavioral addictions, and provide information that can be used when developing interventions to impact stigma.

A text comprehension approach to questionnaire readability: An example using gambling disorder measures.

Although readability has been traditionally operationalized and even become synonymous with the concept of word and sentence length, modern text analysis theory and technology have shifted toward multidimensional comprehension-based analytic techniques. In an effort to make use of these advancements and demonstrate their general utility, 6 commonly used measures of gambling disorder were submitted to readability analyses using 2 of these advanced approaches, Coh-Metrix and Question Understanding Aid (QUAID), and one traditional approach, the Flesch-Kincaid Grade Level. As hypothesized, significant variation was found across measures, with some questionnaires emerging as more appropriate than others for use in samples that may include individuals with low literacy. Recommendations are made for the use of these modern approaches to readability to inform decisions on measure selection and development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

When Does Premature Treatment Termination Occur? Examining Session-by-Session Dropout Among Clients with Gambling Disorder.

Premature termination challenges the successful outcomes of psychological treatments for gambling disorder. To date, research has primarily identified clients who are at particular risk for dropping out of treatment. A smaller but growing body of literature has investigated when dropout occurs. Typically, those studies have not considered improvement in psychological distress within their operationalizations of dropout and therefore may have misrepresented when dropout occurs. The current study examined when dropout occurs using an operationalization based on the criteria of attaining reliable change in a naturalistic sample of clients with gambling disorder, and the classification rates yielded from that operationalization were compared to the rates from a more common operationalization. Participants (n = 334) were clients meeting diagnostic criteria for gambling disorder at an outpatient private practice who completed a measure of psychological distress at baseline and prior to each subsequent treatment session. A survival analysis was conducted to determine temporal patterns of treatment dropout (i.e., clients who discontinued treatment before realizing reliable changes in psychological distress) and completion (i.e., clients who discontinued treatment after realizing reliable changes in distress) at each treatment session. Forty-nine percent of clients were classified as dropouts, and the majority of those clients did so in the first few sessions. The more common operationalization of dropout classified clients as dropouts when they had improved in their distress and clients as completers when they had not improved in their distress. Discussion centers on the implications of dropout occurring at various stages of treatment and future directions.