Introduction
Cognitive Distortions in Problem and Pathological Gambling
Gambling and Depression
Treatment Gap for Problem and Pathological Gambling
Metacognitive Training
Aim of the Present Study
Methods
Study Design
Participants
Questionnaires
Sociodemographic Questionnaire
Yale-Brown Obsessive Compulsive Scale Adapted for Pathological Gambling (PG-YBOCS)
Gambling Attitudes and Beliefs Scale (GABS)
Patient Satisfaction Questionnaire (German Acronym ZUF-8)
Subjective Appraisal of Modules Questionnaire
Within-Session and Adverse Effects Questionnaire
Intervention
Module | Content |
---|---|
1: Attributional style | Different styles of (dysfunctional) attribution (e.g., self-serving bias) |
Attributional style for problem gambling and consequences: wins are attributed to personal skills, losses are attributed to chance or other circumstances | |
Deducing more realistic attributions by using different sources of attributions (self, others, circumstances) | |
2: Probabilities I | Definition of cognitive distortions |
Gambling-related cognitive distortions focusing on one’s own impact on gambling outcome | |
Near misses and gambler’s fallacy | |
Exercises and information about probabilities in gambling | |
Thought-action fusion | |
3: Self-esteem and mood | Definition and sources of self-esteem |
Identifying personal strengths | |
Influence of mood and self-esteem on gambling behavior | |
Tips to improve mood and self-esteem | |
4: Probabilities II | Definition of cognitive distortions |
Gambling-related cognitive distortions focusing on one’s own impact on gambling outcome | |
Illusion of control and illusory correlations | |
Superstitious thinking, rituals, and lucky charms | |
Quiz on gambling myths | |
5: Memory | Memory capacity and false memories |
Memory biases in problem and pathological gambling: wins are more easily recalled than losses | |
Mood congruency effect and the Pollyanna principle: negative mood evokes negative memories, positive mood evokes positive memories | |
Cognitive distortion in depression: mental filter | |
6: Gambling urge | Triggers of gambling urge, positive and negative consequences of gambling behavior |
Functional analysis of gambling behavior: analyses of triggers and consequences (positive/negative) of gambling behavior in specific situations | |
Triggers and acute urge to gamble | |
Mindfulness meditation | |
7: Debt regulation | Downward spiral of debt and measures to stop it |
Upward spiral of money management: short-term and long-term measures to reduce debt | |
Money-related dysfunctional cognitions and attitudes | |
8: Relapse prevention | Self-determined relapse prevention |
Personal triggers and warning signs of a relapse | |
Emergency plan | |
Depression and gambling |
Statistical Analyses
Results
Variable | Sample (N = 25) | |
---|---|---|
Demographics | ||
Gender | Female | 2 (8%) |
Male | 23 (92%) | |
Age (in years) | 40.16 (12.72) | |
Highest educational level | No school-leaving qualification | 2 (8%) |
Lower secondary school | 2 (8%) | |
Secondary school | 12 (48%) | |
Higher education entrance qualification | 9 (28%) | |
Years of gambling | 12.28 (11.25) | |
Currently employed | 18 (72%) | |
Diagnosis | Pathological gambling | 5 (20%) |
Depression | 5 (20%) | |
Substance-related disorder | 1 (4%) | |
Other | 2 (8%) | |
Other treatment/therapy | Current | 6 (24%) |
Past | 9 (36%) | |
Psychopathology | ||
PG-YBOCS | Thoughts | 9.28 (4.55) |
Behavior | 7.20 (4.80) | |
Total | 16.48 (8.53) | |
GABS | 20.04 (6.41) |
Intention-to-Treat and Per-Protocol Analyses
Variable | Mean (SD) | Paired t-test (two-tailed) | |||
---|---|---|---|---|---|
Baseline | Post | Completers (n = 18) | Per-protocol (n = 12) | Intention-to-treat analyses: MI/LOCF (N = 25) | |
PG Y-BOCS total | 15.50 (8.64) | 8.78 (7.73) | t(17) = 3.10, p = .007, dz = 0.73 | t(11) = 3.40, p = .006, dz = 0.98 | t(24) = 2.36, p = .022, dz = 0.47 |
t(24) = 2.90, p = .008, dz = 0.58 | |||||
PG Y-BOCS thoughts | 8.50 (4.41) | 5.33 (3.68) | t(17) = 2.63, p = .018, dz = 0.47 | t(11) = 2.52, p = .029, dz = 0.73 | t(24) = 2.48, p = .015, dz = 0.50 |
t(24) = 2.51, p = .019, dz = 0.50 | |||||
PG Y-BOCS behavior | 7.00 (4.96) | 3.44 (4.30) | t(17) = 3.08, p = .007, dz = 0.62 | t(11) = 3.70, p = .003, dz = 1.07 | t(24) = 1.83, p = .072, dz = 0.37 |
t(24) = 2.89, p = .008, dz = 0.58 | |||||
GABS | 19.67 (5.65) | 10.06 (8.39) | t(17) = 4.32, p < .001, dz = 1.02 | t(11) = 4.73, p = .001, dz = 1.37 | t(24) = 2.96, p = .004, dz = 0.59 |
t(24) = 3.94, p = .001, dz = 0.79 |
Linear Mixed-Effect Models
Module | Gambling thoughts | Control over gambling | Efforts to resist thoughts | Impairment due to gambling thoughts | Abstinence intention | Abstinence confidence | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Range (intercept) | 1.04–1.37, p < .001 | 1.33–1.45, p < .001 | 1.48–1.66, p < .001 | 0.92–1.21, p ≤ .001 | 0.92–0.97, p < .001 | 0.41–0.50, p ≤ .001–.003 | ||||||
B | p | B | p | B | p | B | p | B | p | B | p | |
Module 1 | − 0.65 | .007 | − 0.16 | .600 | 0.05 | .848 | 0.71 | .027 | 0.00 | .967 | 0.05 | .691 |
Module 2 | 0.96 | .008 | 0.66 | .014 | 0.60 | .067 | − 0.13 | .577 | − 0.02 | .675 | − 0.01 | .921 |
Module 3 | − 0.19 | .438 | 0.47 | .105 | − 0.16 | .519 | − 0.17 | .528 | 0.05 | .470 | 0.09 | .503 |
Module 4 | 0.04 | .885 | − 0.28 | .404 | 0.01 | .963 | − 0.09 | .738 | − 0.03 | .617 | 0.09 | .578 |
Module 5 | − 0.33 | .244 | − 0.03 | .923 | 0.22 | .471 | − 0.32 | .295 | − 0.02 | .747 | − 0.12 | .382 |
Module 6 | 0.09 | .751 | − 0.18 | .572 | − 0.08 | .774 | 0.09 | .738 | − 0.03 | .629 | − 0.03 | .789 |
Module 7 | 0.01 | .959 | − 0.42 | .209 | − 0.16 | .576 | − 0.11 | .697 | 0.03 | .645 | − 0.08 | .548 |
Module 8 | − 0.09 | .742 | − 0.38 | .243 | − 0.61 | .025 | − 0.27 | .346 | − 0.02 | .758 | 0.00 | .988 |
Random parts | ||||||||||||
Time | 0.23–0.62 | 0.86–0.95 | 0.45–0.70 | 0.44–0.71 | 0.04 | 0.12–0.14 | ||||||
Subject | 0.27–0.45 | 0.20–0.29 | 0.34–0.39 | 0.16–0.44 | 0.11–0.12 | 0.06–0.13 | ||||||
ICC | .40–.73 | .18–.25 | .33–.54 | .18–.51 | .75–.78 | .00–.46 | ||||||
NID | 21 | 20 | 21 | 20 | 21 | 20 | ||||||
Observations (N) | 91 | 92 | 94 | 92 | 94 | 93 |
Module | Financial trigger | Sadness | Restlessness | Positive associations | Illusion of control | Chasing | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Range (intercept) | 0.94–1.22, p < .001 | 0.61–0.69, p = .001–.003 | 0.75–0.81, p < .001 | 1.28–1.56, p < .001 | 0.88–1.15, p < .001 | 0.90–1.05, p < .001 | ||||||
B | p | B | p | B | p | B | p | B | p | B | p | |
Module 1 | − 0.49 | .204 | 0.17 | .419 | − 0.14 | .565 | − 0.01 | .963 | − 0.08 | .735 | 0.07 | .618 |
Module 2 | 0.47 | .025 | 0.00 | .987 | − 0.02 | .940 | 0.46 | .025 | 0.39 | .097 | 0.32 | .076 |
Module 3 | − 0.07 | .757 | − 0.41 | .043 | 0.17 | .473 | − 0.20 | .173 | − 0.29 | .126 | − 0.19 | .150 |
Module 4 | 0.08 | .756 | − 0.17 | .449 | − 0.53 | .057 | − 0.28 | .100 | − 0.10 | .546 | 0.10 | .493 |
Module 5 | 0.07 | .790 | 0.31 | .197 | 0.22 | .450 | 0.00 | .987 | − 0.03 | .850 | 0.03 | .866 |
Module 6 | − 0.15 | .536 | − 0.05 | .815 | − 0.05 | .862 | − 0.18 | .240 | − 0.02 | .887 | − 0.10 | .496 |
Module 7 | 0.37 | .174 | 0.17 | .468 | 0.08 | .764 | − 0.01 | .943 | − 0.02 | .896 | − 0.08 | .597 |
Module 8 | − 0.24 | .342 | 0.10 | .677 | 0.10 | .720 | 0.04 | − 0.02 | .896 | − 0.08 | .597 | .186 |
Random parts | ||||||||||||
Time | 0.41–0.59 | 0.44–0.46 | 0.47–0.65 | 0.15–0.23 | 0.08–0.22 | 0.11–0.19 | ||||||
Subject | 0.31–0.63 | 0.12 | 0.06–0.26 | 0.43–0.86 | 0.11–0.71 | 0.31–0.35 | ||||||
ICC | .34–.59 | .21 | .08–.39 | .68–.86 | .50–.82 | .62–.78 | ||||||
NID | 20 | 20 | 20 | 20 | 20 | 20 | ||||||
Observations (N) | 93 | 93 | 91 | 93 | 93 | 93 |
Subjective Appraisal
Item | Completer (n = 18) | |
---|---|---|
Mean (SD) | Positive appraisal | |
How do you rate the quality of the metacognitive training? (excellent, good vs. okay, not good) | 3.22 (0.55) | 94.4% |
Did you receive the type of treatment you expected to receive? (absolutely, a lot vs. a little, not at all) | 3.00 (0.84) | 77.8% |
To what extent did the metacognitive training meet your needs? (absolutely, a lot vs. a little, not at all) | 3.11 (0.90) | 77.8% |
Would you recommend the metacognitive training to a friend with similar symptoms? (yes, probably yes vs. probably not, no) | 3.56 (0.70) | 88.9% |
How satisfied are you with the extent of help you have received through using the metacognitive training? (very satisfied, mostly satisfied vs. somewhat satisfied, dissatisfied) | 3.11 (1.02) | 77.7% |
Did the metacognitive training help you to cope with your problems more successfully? (absolutely, a lot vs. a little, not at all) | 3.56 (0.78) | 83.3% |
How satisfied are you with the metacognitive training in general? (very satisfied, mostly satisfied vs. somewhat satisfied, dissatisfied) | 3.39 (0.85) | 88.9% |
Would you use the metacognitive training again? (yes, probably yes vs. probably not, no) | 3.44 (0.78) | 83.3% |
Item | Module 1 (n = 15) | Module 2 (n = 19) | Module 3 (n = 14) | Module 4 (n = 11) | Module 5 (n = 10) | Module 6 (n = 13) | Module 7 (n = 11) | Module 8 (n = 11) |
---|---|---|---|---|---|---|---|---|
The module was fun | 4.53 (0.52) 100% | 4.42 (0.61) 94.8% | 4.00 (1.04) 64.3% | 4.63 (0.50) 100% | 4.40 (0.70) 90.0% | 4.77 (0.60) 92.3% | 4.64 (0.50) 100% | 4.72 (0.47) 100% |
I learned something new in the module | 3.93 (0.70) 86.6% | 3.84 (1.17) 73.7% | 4.00 (0.78) 71.5% | 3.91 (1.14) 72.8% | 4.40 (0.52) 100% | 4.61 (0.87) 93.3% | 4.45 (0.82) 81.8% | 4.55 (0.52) 100% |
I want to use what I learned in the module in my daily routine | 4.40 (0.63) 93.4% | 4.33 (0.69) 88.8%b | 4.00 (0.68) 78.5% | 4.45 (0.69) 90.9% | 4.30 (0.67) 90.0% | 4.46 (0.52) 100% | 4.64 (0.50) 100% | 4.60 (0.52) 100% |
The metacognitive training helps me to cope with my gambling problems | 4.27 (0.70) 86.7% | 4.06 (0.56) 88.6%c | 3.86 (0.86) 71.4% | 4.18 (0.75) 81.9% | 4.30 (0.67) 90.0% | 4.54 (0.52) 100% | 4.64 (0.50) 100% | 4.64 (0.67) 90.9% |
The content of the module is personally relevant for me | 4.13 (0.74) 93.4% | 4.17 (0.92) 88.9%b | 4.07 (1.07) 85.7% | 4.45 (0.69) 90.9% | 4.20 (0.42) 100% | 4.38 (1.33) 84.6% | 4.73 (0.65) 90.9% | 4.64 (0.67) 90.9% |
I (partially) did not understand the content of the module.** | 1.80 (1.21) 80.0% | 1.11 (0.33) 100%d | 1.75 (1.36) 100%e | 1.18 (0.40) 100% | 1.50 (1.27) 90.0% | 1.15 (0.55) 92.3% | 1.18 (0.60) 100% | 1.00 (0.00) 100% |
I would recommend the metacognitive training to a friend with similar problems | 4.53 (0.52) 100%a | 4.28 (0.67) 88.9%b | 3.85 (1.07) 69.3%f | 4.30 (0.95) 90.0%g | 4.33 (1.12) 77.8%d | 4.64 (0.50) 100%h | 4.80 (0.42) 100%j | 4.60 (0.48) 100%i |
I want to come to the next training session | 4.92 (0.28) 100%a | 4.89 (0.32) 100%b | 4.85 (0.38) 100%f | 4.90 (0.32) 100%g | 4.89 (0.33) 100%d | 5.00 (0.00) 100%h | 5.00 (0.00) 100%j | 4.70 (0.67) 90.0%i |