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Medizinische Psychologie und Medizinischen SoziologieKlinik und Poliklinik für Psychosomatische Medizin und Psychotherapie

Pathological gambling:

Findings and new ideas

K. Wölfling & M.E. Beutel


• Neurophysiological correlates of PG

• Aspects of outpatient treatment: „Ambulanz für Spielsucht“

Pathological gambling:

Findings and new ideas


Important role of learning processes in the development of addiction has been demonstrated in several animal and

human studies

1. learning by a model

2. classical conditioning

3. operant conditioning


CR

UCS(drug, gambling)

CS

(drug-associated cues)

UCR

(physical reaction,

euphoria etc.)

craving,drug intake, gambling

conditioned motivational state

Robinson & Berridge, 2003; Everitt et al., 2001

sensitization of the mesolimbicdopaminergic reward-system

INCENTIVE SALIENCE

Classical Conditioning and drug consumption:


Control

Drive

Memory

Reward

Volkow et al. (2003)

Control

Drive

Memory

Reward

Nonaddicted brain Addicted brain


Crockford et al. (2005)

Cue-induced activity

in the DLPFC

and parahippocampal

regions

PG HC comparison


Is there a specific psychophysiological reaction in pathological

gamblers?

Question:

Method: assessment of cue-reactivity in pathological gamblers compared to healthycontrols

Evidence for an Addiction Disorder in „so-called“ non-substance-related conditions:

the perspective of neurosciences


Physiological Methods



4EEG-recording according to international 10-20 System,at 19 electrode sites


4Startle reflex (EMG-recording, M. orbicularis occuli)


4EEG-recording according to International 10-20 System,at 19 electrode sites


positive negative neutral Gambling Alcohol

IAPS # 1710 IAPS # 9584 IAPS # 7010

presentation:

- 5 cues per category

- pseudo randomization in a counterbalanced block design

- 6sec duration of presentation, ISI 12 sec

Method:


Results: cortical processing of the visual stimuli

healthy controls pathological gamblers


healthy controls pathological gamblers

Results: cortical processing of the visual stimuli


Gambling Cues /Pathological Gamblers


Visual Evoked PotentialsHealthy Conrols (HC), Casino Employees (CE), Active (AC) and Abstinent (AB) Pathological Gamblers


4Startle reflex (EMG-recording, M. orbicularis occuli)



Comparison of the Startle reflex in pathological gamblers, cannabis addicts and

healthy controlsWölfling et al. (2008), Grüsser et al. (2008)

Results: sub-cortical processing of the visual stimuli


…similiar neurophysiological patternsare detectable for computer game addiction…


Outpatient department

Ambulanz für Spielsucht

Clinical and sub-clinical characteristics


Pilot-project group therapy

Outpatient treatment programmefor Pathological gamblers and computer game addicts

• a cognitive-behavioral approach (CBT)

principal elements:

• training of problem solving

• behavioral analysis

• roleplaying (verbal and non-verbal communication)

• exposition therapy (in sensu / in vivo)

• skills training to break the gaming and gambling-circles


therapeutic amount:

• 5 individual sessions for diagnostics

• 20 group sessions á 100 min. (8 patients per group)

• 10 concomitant individual sessions á 50 min.

• catamnestic evaluation after 3 and 6 months

Pilot-project group therapy

Outpatient treatment programmefor Pathological gamblers and computer game addicts


Computer-game-addiction (42 patients):

93% male21.5 years (range 13 – 32 years)

Pathological gambling (28 patients):

100% male

34.8 years (range 25 – 44 years)

Patient‘s characteristics overview

Medizinische Psychologie und Medizinischen SoziologieKlinik und Poliklinik für Psychosomatische Medizin und PsychotherapieMedizinische Psychologie und Medizinischen SoziologieKlinik und Poliklinik für Psychosomatische Medizin und Psychotherapie

Scales of SCL-90-R in pathological gamblers

0 0,25 0,5 0,75 1 1,25

somatization

obsessive-compulsive

interpersonal sensitivity

depression

anxiety

hostility

phobic anxiety

paranoid ideation

psychoticismgamblers

control

Differences between pathological gamblers and healthy controls basicallyconcern depression and anxiety. To a lesser degree, there are also differencesin obsessive-compulsive, somatization and psychoticism.


0 0,25 0,5 0,75 1 1,25 1,5

Somatisierung

Soziale Unsicherheit

Depressivität

Ängstlichkeit

Aggressivität

Phobische Angst

Paranoides Denken

Psychotizismus

GSS

CSS

Kontroll

Scales of SCL-90-R in pathological gamblersand computer game addicts


Global Severity Index (GSI) in pathological gamblers and computer game addicts

0 0,25 0,5 0,75 1

GSI

GSS

CSS

Kontroll

Pathological gamblers and computer game addicts compared to healthycontrols show a significantly higher score concerning a symptom-unspecificdegree of pathology.


The Big-Five in pathological gamblers

2,31 2,37

2,40

1,972,41

neuroticism

Concientious-ness extraversion

agreeableness opennessN = 18


The Big-Five in pathological gamblers

0 0,5 1 1,5 2 2,5 3 3,5 4

neuroticism

extraversion

openness

agreeableness

concientiousness

N = 18


group comparison Big Five PG

2,31 2,37

2,40

1,972,41

Neurotizismus

Extraversion

OffenheitVerträglichkeit

Gewissenhaftigkeit


Big Five - Summary

There seems to be a characteristic patternconcerning basic traits of personality in

pathological gamblers.

These differences mainly are related to the

Factor neuroticism, extraversion and – to a lesser degree – openness.


2,082,37

2,29

1,981,56

Neurotizismus

Extraversion

OffenheitVerträglichkeit

Gewissenhaftigkeit

group comparison Big Five CGA


Subscales of Sensation Seeking in pathological

gamblers

N = 18

0 1 2 3 4 5 6 7 8 9 10

Thrill andAdventure Seeking

ExperienceSeeking

Disinhibition

BoredomSusceptibility

Red lines mark average trait-distribution


0 5 10 15 20 25 30 35 40

Sensation Seeking

low highaverage

Sensation Seeking in pathological gamblers

N = 18


Sensation Seeking - Summary

In contradiction to substance-related addiction,

there seems to be no higher implementation of Sensation Seeking in pathological gamblers.

By tendency, pathological gamlers seem to score slightly below average Sensation

Seeking, especially concerning the subscale of „Thrill and Adventure Seeking“.


Thank you very much for your attention!


0 0,25 0,5 0,75 1 1,25 1,5

Somatisierung

Soziale Unsicherheit

Depressivität

Ängstlichkeit

Aggressivität

Phobische Angst

Paranoides Denken

Psychotizismus

GSS

CSS

Kontroll

Scales of SCL-90-R in pathological gamblers and computer game addicts


0 5 10 15 20 25 30 35 40

self-efficacy

N = 18

norm

Global Self-Efficacy in pathological gamblers


Global Self-Efficacy - Summary


Results concerning global self-efficacy showingpathological gamblers scoring below a sample

of male German healthy controls.

So, pathological gamblers don´t perceive their

personal ressources high enough to easily deal with obstacles avoiding them to reach global

goals.


Momentary study


“Assessment Tool to Measure and Evaluate

the Risk Potential of Gambling Products”

Evaluation and Initial Validation


“Assessment Tool to Measure the Risk Potential of Gambling Products”preliminary data

ProblemgamblersN= 158

Normal gamblersN= 148


“Assessment Tool to Measure the Risk Potential of Gambling Products”preliminary data

pathological gambling: findings and new ideas - dhs.de · medizinische psychologie und...

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