Tony Toneatto

Cognitive distortions in heavy gambling

A sample of 38 regular and heavy gamblers, recruited through advertisements and not seeking treatment, were asked to describe special strategies, techniques or rituals that they used to increase their chances of winning at gambling in an open-ended interview. The mean South Oaks Gambling Screen Score for the sample was 7.7 with 64% of the sample scoring higher than 4. Their responses reflected multiple means by which the individual believed they were able to control (i.e., active illusory control, passive illusory control), reframe (i.e., interpretive control), or predict (i.e., probability control, predictive control) gambling outcomes. A larger number of cognitive distortions was associated with playing games in which skill was potentially a component (e.g., cards, sports) than in non-skill games (e.g., lotteries) as well as a positive family history of gambling. There were no sex differences. Implications of these findings for the cognitive psychopathology of gambling are discussed.

Cognitive psychopathology of problem gambling.

Drawing on the available research literature on the cognitive distortions present during gambling, a typology of gambling-relevant cognitive distortions is presented. These include the magnification of gambling skills, minimization of other gamblers skills, superstitious beliefs (including talismanic, behavioral, and cognitive superstitions), interpretive biases (including internal attributions, external attributions, gamblers fallacy, chasing, anthropomorphism, reframed losses, hindsight bias), temporal telescoping, selective memory, predictive skill, illusion of control over luck (including luck as an uncontrollable variable, luck as a controllable variable, luck as a trait variable, luck as a contagion), and illusory correlation. In addition, gambling-relevant beliefs about the self are also discussed, including entitlement, omnipotence, cognitive reasoning, and magical thinking.

Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research.

Objective: To review the impact of mindfulness-based stress reduction (MBSR) on symptoms of anxiety and depression in a range of clinical populations. Method: Our review included any study that was published in a peer-reviewed journal, used a control group, and reported outcomes related to changes in depression and anxiety. We extracted the following key variables from each of the 15 studies identified: anxiety or depression outcomes after the MBSR program, measurement of compliance with MBSR instructions, type of control group included, type of clinical population studied, and length of follow-up. We also summarized modifications to the MBSR program. Results: Measures of depression and anxiety were included as outcome variables for a broad range of medical and emotional disorders. Evidence for a beneficial effect of MBSR on depression and anxiety was equivocal. When active control groups were used, MBSR did not show an effect on depression and anxiety. Adherence to the MBSR program was infrequently assessed. Where it was assessed, the relation between practising mindfulness and changes in depression and anxiety was equivocal. Conclusions: MBSR does not have a reliable effect on depression and anxiety.

Treatment of pathological gambling: a critical review of the literature.

The legalization and availability of new forms of gambling are increasing in most Western countries. This trend has contributed to the fact that more individuals are developing gambling problems. As a result, there is a need for effective treatments. Although gambling treatment dates several decades, few empirically supported treatments for pathological gambling have been developed. This critical review includes only controlled treatment studies. The primary inclusion criterion was randomization of participants to an experimental group and to at least 1 control group. Eleven studies were identified and evaluated. Key findings showed that cognitive-behavioral studies received the best empirical support. Recommendations to improve gambling treatment research include better validated psychometric measures, inclusion of process measures, better definition of outcomes, and more precise definition of treatments.

Do Mindfulness Meditation Participants Do Their Homework? and Does It Make a Difference? A Review of the Empirical Evidence

Mindfulness-based interventions have been shown to alleviate symptoms of a wide range of physical and mental health conditions. Regular between-session practice of mindfulness meditation is among the key factors proposed to produce the therapeutic benefits of mindfulness-based programs. This article reviews the mindfulness intervention literature with a focus on the status of home practice research and the relationship of practice to mindfulness program outcomes. Of 98 studies reviewed, nearly one-quarter (N = 24) evaluated the associations between home practice and measures of clinical functioning, with just over half (N = 13) demonstrating at least partial support for the benefits of practice. These findings indicate a substantial disparity between what is espoused clinically and what is known empirically about the benefits of mindfulness practice. Improved methodologies for tracking and evaluating the effects of home practice are recommended.

Assessing and treating problem gambling: empirical status and promising trends.

Objective: Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment. Methods: We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment. Results: Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak. Conclusions: Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.

Treatment Seeking Among Ontario Problem Gamblers: Results of a Population Survey

OBJECTIVE This study examined help seeking for gambling concerns among people with different levels of gambling problems. METHODS Ontario adults who had gambled more than dollars 100 (N=4,217) and who screened positive for a possible gambling problem (N=1,205) were classified according to gambling problem severity and asked about their experiences with gambling treatment. RESULTS Only 6% of gamblers had ever accessed a service, including a self-help group or self-help materials. With self-help materials excluded, only 3% of gamblers (from 1% of those who met only the initial CLiP screening criteria to 53% of those with pathological gambling) had sought treatment for gambling. CONCLUSIONS Few gamblers sought treatment for gambling problems; greater problem severity was associated with greater likelihood of using treatment, with self-help materials used most often. Further research is needed on why treatment seeking is low and on the effectiveness of self-help resources in reaching gamblers with problems in earlier stages.

Pathological gambling in treatment-seeking substance abusers.

Accumulating evidence suggests that treatment-seeking substance abusers have high rates of gambling problems. However, relatively little is known about the relation between gambling problems and specific psychoactive substances apart from alcohol and methadone-treated opiate addicts. In this study of 580 individuals admitted to a residential addictions program, 10.5% were found to score in the pathological gambling range on the South Oaks Gambling Screen (SOGS) within the past year. The rate of pathological gambling was much higher for cannabis abusers (24%) than for alcohol (4%), cocaine (11.5%), and opiate abusers (4.8%). Men also reported higher rates of pathological gambling (11.9%) than women (7.5%). Individuals with a pathological gambling problem tended to report family histories of gambling problems as well.

Behavioral Assessment and Treatment Planning for Alcohol, Tobacco, and Other Drug Problems: Current Status With an Emphasis on Clinical Applications

Clinical assessments serve several important functions: (1) they provide a clinical picture of the severity of the problem(s) which then can be used to develop treatment plans tailored to the needs of individual clients; (2) if change is not evident during treatment, ongoing assessment information can be used to make systematic changes in the treatment plan; and (3) progress during and after treatment can be assessed. This paper updates an earlier review, with a continuing emphasis on the clinical utility, cost minimization, and user friendliness of the instruments. The review also adds new sections on (a) clinical tools for assessing psychiatric comorbidity; (b) alcohol and drug effect expectancies questionnaires; (c) readiness/commitment to change measures; and (d) measures to assess nicotine use. This review is intended to help practitioners identify methods that will be useful and expedient in their assessment and treatment of alcohol and other drug abusers.

Natural Recovery from Cocaine Dependence

Studies of natural recoveries from alcohol, heroin, and cocaine abuse have indicated that many individuals are able to change their drug or alcohol use when the benefits of using the drug are outweighed by the negatives. The present study investigated the recovery process using 50 abstinent (≥1 year) untreated former cocaine users and 21 untreated and nonrecovered cocaine users. The recovered group did not differ from the untreated, active cocaine users in terms of demographic variables, lifetime substance use history, psychiatric history, or cocaine-related consequences. Recovery was most frequently related to a cognitive evaluation of the pros and cons of continued cocaine use. Discrete life events triggering cessation were less frequently reported by the recovered respondents. Implications of this research for the treatment of cocaine dependence are discussed.