Community Treatment for Problem Gambling: Sex Differences in Outcome and Process

This study compared sex differences in related treatment outcomes and processes in a community sample of outpatient problem gambling treatment-seekers. Participants attended approximately seven sessions of cognitive-behavioral treatment. Women were more likely to have a history of psychiatric comorbidity, prefer non-strategic/non-skill forms of gambling, and have a more rapid progression towards a gambling problem than did men. At the 6-month post-treatment follow-up, men were found to have improved to a significantly greater degree on measures of gambling severity and rates of abstinence in comparison to women. Moreover, men rated treatment components to be more helpful, whereas women found specific gambling-related treatment interventions (e.g., identification of high-risk situations, gambling beliefs and attitudes) to be less helpful. Implications for identifying treatment needs of women seeking problem gambling treatment are discussed.     

Mechanisms of Action in the Relationship between Mindfulness and Problem Gambling Behaviour

Previous studies have found an inverse relationship between mindfulness and problem gambling severity. This paper presents the findings from two studies of treatment seeking problem gamblers designed to explore the role of mindfulness in problem gambling. Treatment-seeking problem gamblers displayed significantly lower mindfulness scores than adult community members and university students. Mindfulness was significantly related to most indices of gambling, and psychological distress was an important mechanism in these relationships. Rumination, emotion dysregulation and thought suppression were also implicated as mediators in the inverse relationship between mindfulness and psychological distress. Taken together, the findings provide theoretical support for existing models of mindfulness which suggest that mindfulness operates by reducing psychological distress through these cognitive mechanisms. They also suggest that mindfulness training may be a new and innovative avenue for therapy to improve treatment effectiveness for problem gambling.     

A systematic review of mindfulness intervention for individuals with developmental disabilities: Long-term practice and long lasting effects

Can individuals with developmental disabilities learn mindfulness? If so, with what result? A systematic literature review identified 12 studies that taught mindfulness practice to individuals with mild to severe developmental disabilities, demonstrating that mindfulness intervention could significantly reduce the behavioural and/or psychological problems of this population. The majority of these mindfulness intervention studies were longitudinal, featuring long intervention periods and long lasting intervention effects. This paper analyses the characteristics and objectives of mindfulness interventions, along with their effects, focusing on the adjustments made to intervention content and instruction strategies to meet the specific requirements of individuals with developmental disabilities. The potential for improving mindfulness interventions for people with developmental disabilities is also discussed.     

Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the Treatment of Co-occurring Schizophrenia and Pathological Gambling: A Case Study

There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at 3-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.     

Ecological momentary assessment versus standard assessment instruments for measuring mindfulness,depressed mood,and anxiety among older adults

As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25–50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.     

A systematic review of the neurophysiology of mindfulness on EEG oscillations

Mindfulness meditation has been purported to be a beneficial practice for wellbeing. It would therefore be expected that the neurophysiology of mindfulness would reflect this impact on wellbeing. However, investigations of the effects of mindfulness have generated mixed reports of increases, decreases, as well as no differences in EEG oscillations in comparison with a resting state and a variety of tasks. We have performed a systematic review of EEG studies of mindfulness meditation in order to determine any common effects and to identify factors which may impact on the effects. Databases were reviewed from 1966 to August 2015. Eligibility criteria included empirical quantitative analyses of mindfulness meditation practice and EEG measurements acquired in relation to practice. A total of 56 papers met the eligibility criteria and were included in the systematic review, consisting of a total 1715 subjects: 1358 healthy individuals and 357 individuals with psychiatric diagnoses. Studies were principally examined for power outcomes in each bandwidth, in particular the power differentials between mindfulness and a control state, as well as outcomes relating to hemispheric asymmetry and event-related potentials. The systematic review revealed that mindfulness was most commonly associated with enhanced alpha and theta power as compared to an eyes closed resting state, although such outcomes were not uniformly reported. No consistent patterns were observed with respect to beta, delta and gamma bandwidths. In summary, mindfulness is associated with increased alpha and theta power in both healthy individuals and in patient groups. This co-presence of elevated alpha and theta may signify a state of relaxed alertness which is conducive to mental health.     

Major depressive disorders and psychiatric emergencies: a naturalistic study on crisis intervention relevance]

OBJECTIVE: This retrospective study aimed to evaluate the impact of introducing crisis intervention patterns in the emergency unit of a general hospital on the number of admissions and outpatient follow-ups for patients with major depressive disorder. METHOD: The study included all patients with major depressive disorder (DSM-IV criteria) who visited the psychiatric emergency unit in a general hospital during two 8-month periods: before (425 patients) and after (436 patients) crisis interventions were introduced. RESULTS: After crisis interventions were introduced, the voluntary admission rate decreased significantly (from 17.9% to 12.4%), while the number of outpatient follow-ups increased (from 82.1% to 86.2%). Borderline personality disorder was associated with a significant reduction of the admission rate (27.8% against 38.2%), while the admission rate for patients with depressive disorder with psychotic features did not decline after crisis interventions. Crisis interventions were more effective on women. CONCLUSIONS: These outcomes suggest the relevance of crisis intervention in psychiatric emergency settings to improve the management of patients with major depressive disorder. Crisis intervention fosters outpatient multimodal follow-up rather than admission in a psychiatric setting.     

Improving treatment adherence in patients with bipolar disorder and substance abuse: rationale and initial development of a novel psychosocial approach

Patients with comorbid bipolar and substance use disorders are at particularly high risk for treatment nonadherence and a host of negative consequences. However, no previous interventions have been designed specifically to address this problem. In the current study, we describe the rationale for and initial development of an adjunctive psychosocial intervention that targets adherence in patients with bipolar disorder who are substance abusers. The intervention involves brief in-person sessions and follow-up phone contacts with the patient and a significant other/family member. We describe the effects of this novel intervention on adherence and other psychiatric outcomes in a series of cases treated as part of our initial development work. Results suggest that the intervention is feasible and acceptable to patients and could be helpful in enhancing the effects of existing treatments. Given these promising results, we plan to test the intervention further in a randomized clinical trial.     

Mindfulness in severe and persistent mental illness: a systematic review

Abstract

Objective: This systematic review summarises the current state of research on mindfulness in SPMI, given the pressing need to provide alternative, scalable and cost-effective treatment modalities for patients with severe and persistent mental illness (SPMI).

Methods: Articles included mindfulness-based interventions for SPMI. Excluded articles included qualitative studies, acceptance and compassion therapies, case reports and reviews. Studies were identified by searching the databases Medline, Embase and PsycINFO.

Results: Six randomised controlled trials, seven prospective studies and one retrospective study were identified. Clinical improvements were observed on psychotic symptoms, and on improvements of depression symptoms, cognition, mindfulness, psycho-social and vocational factors.

Conclusions: Findings suggest that mindfulness is feasible for individuals with SPMI, and displays potential benefits in outcomes aside from psychotic symptoms. The effects of mindfulness in psychotic symptoms needs further investigation in larger definitive studies using methodological rigor and thorough assessments of other psychiatric populations who are also representative of SPMI.     

Family therapy interventions in India for persons with gambling disorder

Gambling is a popular pastime in India and the number of problem gamblers is on the rise. Although the impact of gambling disorder on families is grossly under‐researched in India, drawing on international evidence it is only reasonable to assume that this is an important area deserving further clinical and research attention. Of the several types of interventions possible with families of persons with gambling disorder, in our clinical experience, the 5‐step intervention is a feasible and culturally adaptable psychotherapeutic intervention. In this paper we have looked at the theoretical aspects of this intervention and also raise some of the practical challenges of offering psychological interventions to families of persons with gambling disorder in India. Albeit limited, we discuss the evidence base to have emerged from India in this field. Finally, we suggest some intervention measures as the way forward.     

Can an Accelerated Gambling Simulation Reduce Persistence on a Gambling Task?

We evaluated an intervention based on a digital slot machine accelerator and whether the accelerator would decrease persistence in play on a subsequent gambling analog task. Ninety college students were randomly assigned to one of three interventions: the digital slot machine accelerator; an educational handout describing probabilities and concepts related to slot machine gambling; a control handout unrelated to gambling. Participants then played a realistic three-reel 5¢ slot machine pre-loaded with 30 credits. Participants could stop playing on any trial and could keep winnings beyond the initial 30 credits. We found that exposure to either the accelerator or educational handout decreased participants’ judgments of the probability of winning. However, only participants in the accelerator condition, not those in the educational handout condition, played significantly fewer trials on the slot machine than controls. Thus, intervention and prevention efforts may be strengthened by advanced gambling simulation that experientially demonstrate the negative long-term outcomes of gambling.     

Mindfulness based interventions for addictive disorders: a review

Introduction

In substance use disorders, the lack of empirically supported treatments and the minimal utilization of available programs indicate that innovative approaches are needed. Mindfulness based therapies have been used in addictive disorders for the last 10 years. Mindfulness can be defined as the ability to focus open, non-judgmental attention to the full experience of internal and external phenomena, moment by moment. Several therapies based on mindfulness have been developed. The aim of this study is to review the existing data on the use of these programs in addictive disorders.

Methods

We have reviewed the literature published from January 1980 to January 2009, using the following keywords: mindfulness, mindfulness based stress reduction program, dialectical behavior therapy, acceptance and commitment therapy, mindfulness based cognitive therapy, addiction, substance use, alcohol and smoking.

Results

Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions. The effectiveness of interventions based on mindfulness and the differential improvement across conditions became greater and was maintained during follow-up when it was long enough. Participants in mindfulness programs were less likely to endorse the importance of reducing emotions associated with smoking and reported significant decreases in avoidance of thoughts which partially mediated alcohol use reduction. Psychiatric symptoms and the level of perceived stress were also significantly reduced.

Discussion

Mindfulness may help substance abusers to accept unusual physical sensations that might be confused with withdrawal symptoms, decentre from a strong urge and not act impulsively. It may reduce an individual's susceptibility to act in response to a drug cue. Practice of mindfulness may develop the ability to maintain perspective in response to strong emotional states and mood fluctuations and increase the saliency of natural reinforcers. Mindfulness based programs require an intensive participation, and should therefore be proposed to highly motivated patients. In smoking cessation, they should be used in patients who were unable to quit with less intensive interventions. Some programs are specifically designed for patients with co-occurring psychiatric disorders.

Conclusion

The first clinical studies testing mindfulness based interventions in substance use disorders have shown promising results. They must be confirmed by larger controlled randomized clinical trials. By developing a better acceptance of unusual physical sensations, thoughts about drugs and distressing emotions, mindfulness may help in reducing the risk of relapse.     

A randomized trial of early psychiatric intervention in residential care: impact on health outcomes

BACKGROUND: The prevalence of psychological and behavioral disturbances among older adults living in residential care facilities is high, and it has been shown previously that people with such symptoms have poorer health outcomes. This study was designed to assess the efficacy of an early psychiatric intervention on the 12-month health outcomes of older adults admitted to residential care facilities in Perth, Western Australia. We hypothesized that subjects in the intervention group would have better mental and physical health outcomes than controls. METHODS: The study was designed as a randomized, single-blinded, controlled trial. All subjects aged 65 years or over admitted to one of the 22/26 participating residential care facilities of the Inner City area of Perth were approached to join the study and were allocated randomly to the intervention or usual care group. Demographic and clinical information (including medications and use of physical restraint) was gathered systematically from all participants at baseline, and at 6 and 12 months. At each assessment, the Geriatric Depression Scale (GDS), the Health of the Nation Outcome Scales for older adults (HoNOS 65+), the Mini-mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered. Subjects in the intervention group who screened positive at the baseline assessment for psychiatric morbidity were reviewed within a 2-week period by the Inner City Mental Health Service of Older Adults (ICMHSOA). If clinically appropriate, mental health services were introduced without the involvement of the research team. RESULTS: One hundred and six subjects and their next of kin consented to participate in the study (53 in each group). Mental health screening and early referral to a psychogeriatric service did not significantly change the average number of medical contacts, self-rated health, use of psychotropic or PRN medication, use of physical restraint, 12-month mortality, or mental health outcomes, as measured by the GDS-15, HoNOS 65+ and NPI (p > 0.05 for all relevant outcomes). CONCLUSION: Systematic mental health screening of older adults admitted to residential care facilities and early clinical intervention does not change 12-month health outcomes. More effective interventions to improve the health outcomes of older adults with psychological and behavioral disturbances admitted to residential care facilities are needed.     

Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: a scoping review

Rehabilitation researchers who investigate complex interventions are challenged to describe the “active ingredients” of their interventions: the reason(s) why a treatment is expected to be effective. Interactive Computer Play (ICP) is an emerging complex intervention in rehabilitation practice and research. The purpose of this scoping review is to identify the active ingredients of ICP interventions that are designed to improve motor outcomes in children with neuromotor impairments. Eleven potential active ingredients were identified with the following foci: ICP system or game properties; intervention effects on the user; and therapist roles. However, few studies explicitly evaluate the impact of particular ingredients on outcomes. Identification of active ingredients in ICP interventions can inform trial design and clinical decision-making. Research and clinical practice will benefit from studies that utilize a framework such as motor learning theory to guide hypotheses and measurement of the active ingredients of complex interventions.     

Predictors of Problem Gambling Severity in Treatment Seeking Gamblers

Problem gambling has become a widespread problem following the rapid expansion of electronic gaming machines into hotels and clubs over the last 10 years. Recent literature indicates that certain factors can influence problem gambling severity, such as psychiatric co-morbidity and personality traits, gambling related cognitions, substance use and gender. This study investigated 127 treatment seeking problem gamblers at baseline, who completed a range of self report measures including gambling severity. Using block-wise multiple regression modelling we found gambling related urge, gambling related cognitions, and depression were significant predictors of problem gambling severity. High levels of anxiety and stress were also found amongst this sample. These results have implications for health practitioners in assessment and treatment planning for problem gamblers and will possibly contribute to further development of gambling related measures.     

La dimension interpersonnelle de la pleine conscience

ObjectiveThe concept of “embodied mindfulness” (Khoury, Dionne, & Grégoire, 2018; Khoury et al., 2017) was recently introduced and discussed according to both Eastern and Western conceptualizations and operationalization of mindfulness. Our previous papers (Khoury et al., 2018; Khoury et al., 2017) proposed embodiment as a common process that integrates mindfulness across the Buddhist traditions and western schools of thoughts. Moreover, it grounded the notion of “embodied mindfulness” in Buddhist philosophy and neurobiology, namely in the integration of top-down and bottom-up processes. This new notion allowed a common understanding of the mechanisms of change of different Western mindfulness practices, namely Western mindfulness meditation and Langerian mindfulness. It also proposed consciousness as an interaction between the mind, the body, and the outside world. This article aims to deepen and broaden the notion of “embodied mindfulness” by taking into account the interpersonal and social contexts, which are often neglected in the theory, practice and research pertaining to mindfulness.MethodIn order to investigate the social dimension of mindfulness, we conducted a thorough qualitative review of theoretical and empirical papers pertaining to the interpersonal, familial, relational, and social aspects of mindfulness and thus, according to both mindfulness-meditation and Langerian mindfulness approaches. Empirical research addressing the interpersonal and social effects of mindfulness in both approaches is presented and discussed. Additionally, we reviewed the state of research in conceptualizing, operationalizing, and measuring the interpersonal/social dimension of mindfulness in both the meditative and Langerian approaches.Results and DiscussionThe results of interpersonal mindfulness are presented and discussed according to the different contexts. In the family context, both correlational and experimental studies have suggested positive effects of mindfulness on relationships between couples (e.g., increase of satisfaction and reduction of reactivity) and on the emotional, social, and behavioral adjustments of children of parents with higher mindfulness disposition or following mindfulness training. The positive outcomes on children were found across different developmental stages (e.g., childhood, early, and late adolescence) and included lower aggressiveness and externalizing behaviors, and more positive interactions with parents and peers, therefore higher self-regulation. The results were also found among both nonclinical and clinical populations, including children with neurodevelopmental disorders such as Attention Deficit and Hyperactivity Disorder and Autism Spectrum Disorder. In psychotherapy context, qualitative and correlational studies suggested that dispositional mindfulness is correlated with an increase in therapeutic alliance and presence, therefore, an increase in therapeutic effectiveness. In addition, an experimental study showed better clinical outcomes among patients seen by therapists practicing meditation than therapists who were in the control group. On the social level, both correlational and experimental studies have suggested positive effects of mindfulness on prosocial behaviors, empathy, altruism, compassion, and reduction in discrimination. These results were obtained in both the meditative and Langerian approaches. According to current research, interpersonal mindfulness, even though globally defined, was only measured in parenting and teaching contexts. Therefore, the need of having a contextually independent measure of interpersonal mindfulness is very high.ConclusionsIn light of the empirical results, we believe that the notion of “embodied mindfulness” would benefit from being extended to include more explicitly its interpersonal dimension. Integrating both intrapersonal and interpersonal/social dimensions in conceptualizing and measuring mindfulness can broaden our understanding of mindfulness and its applications and carry important implications in devising new mindfulness-based interventions, which should consider both the intrapersonal and interpersonal dimensions of mindfulness.     

COMT genotype,gambling activity,and cognition

Neuropsychological studies of adults with problem gambling indicate impairments across multiple cognitive domains. Catechol-O-methyltransferase (COMT) plays a unique role in the regulation of dopamine in the prefrontal cortex, and has been implicated in the cognitive dysfunction evident in problem gambling. This study examined adults with varying levels of gambling behavior to determine whether COMT genotype was associated with differences in gambling symptoms and cognitive functioning. 260 non-treatment-seeking adults aged 18–29 years with varying degrees of gambling behavior provided saliva samples for genotyping COMT val158met (rs4680). All subjects underwent clinical evaluations and neurocognitive assessment of decision-making, working memory, and impulsivity. The Val/Val COMT genotype was associated with the largest percentage of subjects with gambling disorder (31.8%), a rate significantly different from the Val/Met (13.2%) group (p = 0.001). The Val/Val COMT group was also associated with significantly more gambling disorder diagnostic criteria being met, greater frequency of gambling behavior, and significantly worse cognitive performance on the Cambridge Gamble Task (risk adjustment and delay aversion) and the Spatial Working Memory task (total errors). This study adds to the growing literature on the role of COMT in impulsive behaviors by showing that the Val/Val genotype was associated with specific clinical and cognitive elements among young adults who gamble, in the absence of differences on demographic measures and other cognitive domains. Future work should consider using genotyping to explore whether certain polymorphisms predict subsequent development of impulsive behaviors including gambling disorder, and treatment outcomes.     

Mood and Anxiety Disorders Are the Most Prevalent Psychiatric Disorders among Pathological and Recovered Gamblers

Psychiatric disorders among pathological and problem gamblers, especially mood and anxiety, are especially prevalent. Little is known about the rates of psychopathology in active and recovered problem gamblers. The goal of the present study was to compare the rates of lifetime and concurrent psychiatric comorbidity in a sample of problem and recovered gamblers in the community, controlling for severity and duration of the gambling problem. In this study a sample of community-recruited pathological and untreated but recovered gamblers were assessed with a validated structured clinical interview. Consistent with previous research high rates of mood and anxiety disorders, both current and lifetime, were found among current and recovered problem gamblers. Lifetime psychopathology was not a significant predictor of gambling status. The variables that significantly predicted PG or RG were prior history of drug problems and a positive family history for problem gambling.     

Client Engagement Characteristics Associated with Problem Gambling Treatment Outcomes

Previous research examining the factors associated with problem gambling treatment outcomes has examined client factors and to date, treatment characteristics, therapist factors, and client-therapist interactions have essentially remained unexplored. This study aimed to investigate how client engagement variables (client-rated therapeutic alliance, therapist-rated therapeutic alliance, number of sessions attended, and client commitment) relate to treatment outcomes (gambling and general functioning) in a sample of 475 treatment-seeking problem gambling clients using a series of hierarchical regression analyses. Client-rated therapeutic alliance predicted both gambling and general functioning outcomes, but therapist-rated therapeutic alliance only predicted general functioning outcomes. There was no significant relationship between number of sessions and outcomes, but client commitment predicted gambling outcomes. Client satisfaction only mediated the relationships between therapeutic alliance and treatment outcomes. Taken together, the findings indicate that client engagement characteristics, in particular the therapeutic relationship, are active agents of change in psychological interventions for problem gambling.     

Gambling Behaviour and Gambling Risk Factors for Indigenous Australian Women

Minimal detailed research has been conducted into gambling by Indigenous women, despite indications from previous studies that they tend to be highly involved gamblers and a high risk group for gambling problems. This quantitative analysis investigates key aspects of gambling by Indigenous Australian women and determines risk factors underpinning problem gambling. Study participants were 687 Indigenous women recruited from Indigenous sports and cultural festivals. The survey instrument focused on socio-demographic characteristics, age of first gamble, gambling motivations, gambling behaviour, substance use while gambling, problem gambling severity, harms arising from gambling and help-seeking efforts. The findings reveal elevated rates of gambling participation, especially on poker machines, and a high prevalence of gambling problems when compared to the general population. Indigenous women who are motivated to gamble to socialise with friends and family are significantly less likely to be problem gamblers. However, risk factors for problem gambling include gambling on a greater number of gambling forms, high gambling expenditure, early onset of gambling, escape-based gambling motivations, self-reported addiction to gambling, and using alcohol and drugs while gambling. Findings point to an urgent need for culturally appropriate treatment for Indigenous Australian women with gambling problems. Culturally appropriate community education and harm minimisation measures should also be available for Indigenous women who gamble given the seemingly high proportion likely to experience at least some harm from gambling. The cost of such approaches would be returned in the enhanced health and wellbeing of Indigenous Australian women, their families and communities.