Stella Lachance

Cognitive treatment of pathological gambling.

This study evaluated the efficacy of a cognitive treatment package for pathological gambling. Sixty-six gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment or wait-list control conditions. Cognitive correction techniques were used first to target gamblers’ erroneous perceptions about randomness and then to address issues of relapse prevention. The dependent measures used were the South Oaks Gambling Screen, the number of DSM-IV criteria for pathological gambling met by participants, as well as gamblers’ perception of control, frequency of gambling, perceived self-efficacy, and desire to gamble. Posttest results indicated highly significant changes in the treatment group on all outcome measures, and analysis of data from 6- and 12-month follow-ups revealed maintenance of therapeutic gains. Recommendations for clinical interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Experimental manipulations of responsibility: An analogue test for models of Obsessive-Compulsive Disorder

Several authors attribute excessive responsibility a predominant role in Obsessive-Compulsive Disorder (OCD) [Salkovskis, P. M. (1985) Behaviour Research and Therapy, 23, 571-583; Rachman, S. (1993) Behaviour Research and Therapy, 31, 149-154; van Oppen, P. & Arntz, A. (1994) Behaviour Research and Therapy, 32, 79-87]. The present studies aimed at demonstrating the link between different levels of perceived responsibility and checking behaviors by experimentally manipulating responsibility in non-clinical Ss. In the first study, a sound recognition task was used to compare checking behaviors in Ss with high (HR) and low (LR) perceived responsibility. Only one variable was significantly different, Ss from the HR group reporting more anxiety during the task than Ss from the LR group. Results did not support a link between responsibility and checking behavior. In a second study HR and LR Ss were compared on a manual classification task. Subjects from the HR group hesitated and checked more, and reported more preoccupation with errors and anxiety during the task than Ss from the LR group. Since perceived severity of the outcome was the most variable affected by the manipulation, the implications for current models of OCD are discussed and an alternative explanation is attempted. Finally, clinical implications are examined and suggestions are made for future directions of research.

Is control a viable goal in the treatment of pathological gambling

According to a report of National Gambling Impact Study Commission (National Gambling Impact Study Commission (1999). Final report. Washington, DC: Government Printing Office.), 97% of problem gamblers in the United States do not seek treatment. Within the small proportion of problem gamblers who enter into treatment, a high percentage drops out. Despite the fact that some researchers argue against abstinence as the only acceptable treatment goal and that regaining control over gambling behaviour appears to be possible for some pathological gamblers (PG), abstinence has been the only gambling intervention treatment goal. The primary goal of this study was to verify whether controlled gambling is a viable goal for pathological gamblers. The second goal was to identify the characteristics that predicted a successful outcome for treatment with a controlled gambling goal. Eighty-nine PGs were enrolled in cognitive-behavioural treatment aimed at controlled gambling. Six and twelve month follow-ups were conducted in order to evaluate the maintenance of therapeutic gains and to identify significant predictors of successful controlled gambling. Results showed that using the intent-to-treat procedure, 63% had a score of 4 or less on the DSM-IV at the end of treatment. That proportion was 56% and 51% at the 6- and 12-month follow-ups. If we retain only those who completed the treatment, these proportions increased to 92%, 80% and 71% at post-treatment, 6- and 12-month follow-ups, respectively. On the majority of the measures, significant improvements were found at post-treatment and the therapeutic gains were maintained at the 6- and 12-month follow-ups. However, few variables were identified to predict who would benefit from control rather than abstinence. The clinical and philosophical implications of these results are discussed in this paper.

Awareness Training Program on Responsible Gambling for Casino Employees

Over the last years, several comprehensive training programs for problem gambling have been developed and implemented in various casinos around the world. However, the efficacy of these programs has rarely been assessed and evaluated scientifically. A workshop called Des gens qui font la différence (People Making a Difference) was developed to train casino employees about problem gambling and how to offer help to gamblers in crisis. Two thousand four hundred and thirty-two (2,432) employees of the three casinos in the province of Quebec, Canada were enrolled in these training sessions. The employees completed a self-administered questionnaire at the beginning and at the end of the session, and were also invited to participate in a 6-month follow-up. One-thousand six-hundred fifteen (1,615) employees of the three casinos agreed to be contacted by phone for the follow-up. Of this number, 789 answered the questionnaire, which constitutes a participation rate of 32%. The results showed that participants demonstrated a better understanding of the notions of chance and randomness, and of problem gambling. They were more convinced of their role in identifying gamblers in crisis and displayed a greater knowledge of the procedure that has been implemented to help gamblers. At the follow-up, results indicated that participants maintained a good understanding of the notion of randomness and remained convinced about the importance of receiving information about available help and resources. However, some notions about problem gambling and the procedure implemented to help gamblers in crisis were not well maintained. In conclusion, the awareness training session on responsible gambling allowed employees to increase their knowledge about gambling and improve their attitudes regarding gamblers. Since some important components that were taught—such as the established procedure to help gamblers—were not well assimilated, awareness training program planners in casinos need to schedule for additional information to be made available (refresher courses, posters, brochures, videos) to keep employees well informed.

Structured versus free-recall measures: Effect on report of worry themes☆

Abstract Over the past decade, researchers have attempted to measure worry themes. Some have used free-recall measures (e.g., Craske, Rapee, Jackel & Barlow, Behaviour Research and Therapy, 27, 397–402, 1989) whereas others have constructed structured questionnaires (e.g. Tallis, Eysenck & Mathews, Personality and Individual Differences, 13, 161–168, 1992). This study investigates worry themes in a sample of university students using a free-recall measure (Generalized Anxiety Disorder Questionnaire—Modified) and a structured questionnaire (Worry Domains Questionnaire). Overall, results show that worries were closely related to situational characteristics, as worries about studies, finances, work and intimate relationships were most frequent. Comparison of both measures reveals that major worry themes were ranked similarly but correlations between reported themes were weak. Further, stability of number of worries and specific worry themes was moderately to highly stable over a 4 week test-retest period. The advantages and disadvantages of both types of instruments are discussed and the authors suggest that population-specific structured instruments (using free-recall measures to develop them) would be advantageous for researchers and clinicians alike.