Lecture 8: Pathological Gambling Flashcards
how many people that suffer from problematic gambling are in treatment
< 10%
T/F: GD is relatively comorbid with SUDs
true
what are the 9 symptoms of which one needs to have 4 to be diagnosed with gambling disorder
- Need to gamble with increasing amount of money to achieve the desired excitement
- Restless or irritable when trying to cut down or stop gambling
- Repeated unsuccessful efforts to control, cut back on or stop gambling
- Frequent thoughts about gambling
- Often gambling when feeling distressed
- After losing money gambling, often returning to get even (referred to as “chasing” one’s losses)
- Lying to conceal gambling activity
- Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
- Relying on others to help with money problems caused by gambling
compare SUD and GD on their reinforcing effects and mention one similarity
SUD:
- direct reinforcing effects on dopamine system
- predictability; reward is always delivered (when you drink it always has the same effect)
GD:
- indirect reinforcement through (monetary) reward (/loss)
- unpredictable reinforcement rate –> reward uncertainty
Similarity: negative reinforcement –> relief of stress, negative feelings, etc.
explain what was done in the monkey study about receiving lemonade
monkeys learnt that stimuli predict reward (lemonade) with different probability:
- when the lemonade probability was 100%, there was DA only at the presentation of the CS
- when the lemonade probability was 0%, there was DA only at the (surprise) reward
- when the lemonade probability was 50%, there was DA both at CS and at while anticipating (waiting for) the outcome
what are 5 features of machine design of gambling games that make it addictive
1 - reinforcement schedules
2 - timing and stakes; the shorter time between bet and outcome, the more addictive; higher addiction potential with higher stakes
3 - near-miss; outcomes that are perceived as having been close to a win, produce even higher psychophysiological responses than wins, increase the desire to keep playing
4 - audiovisual stimuli
5 - losses disguised as wins
what are 5 features of human design that make gaming addictive
1 - impaired executive function/PFC
2 - gambler’s fallacy = players think a run of the same outcome increases the chance of the other outcome occurring
3 - illusion of control = irrelevant features of a game that create a sense that one is developing some kind of skin over an outcome that is in fact determined by chance
4 - cue reactivity; gamblers show increased activation of the mesolimbic reward system during cue reactivity
5 - distorted reward processing; more reward anticipation in gambling disorder
explain the 4 ways that show evidence for distorted reward processing in gamblers
- gamblers show decreased activation of the mesolimbic reward system during reward anticipation (this is for general rewards)
- gamblers show decreased activation of the mesolimbic reward system after winning in a card game
- gamblers show increased activation of the mesolimbic reward system after near misses
- gamblers show increased activation of the mesolimbic reward system during the anticipation of a gambling outcome (this is for gambling-related rewards)
what are 4 things in executive functions that are impaired in pathological gambling
1 - impaired response inhibition
2 - suboptimal decision making (in Iowa gambling task)
3 - cognitive flexibility is reduced in gablers
4 - steeper delay discounting curve
what are 2 addictive ingredients in gambling according to Redish et al.
1 - decision uncertainty
2 - potential for bivalent outcomes (gains/losses)
what is considered the most effective treatment for GD and what are the 7 most important components
CBT:
1 - focus on request for help and motivation
2 - psychoeducation
3 - functional analysis
4 - exerting ‘stimulus control’ to stop gambling and regain control over the behaviour in the short term
5 - challenging gambling illusions or irrational thoughts
6 - relapse prevention
7 - substitute healthier non-gambling behaviours
explain the big win hypothesis
= many people with GD report getting major payouts in their first few times, these create positive prediction errors that will activate reinforcement learning –> decision uncertainty because learning from prediction errors only occurs in uncertain environments
what are two kind of reinforcement schedules and which one is used in casinos
-
ratio schedules = when you get a reward is dependent on the number of responses
- fixed: reward after certain number of responses
- variable: reward after differing number of responses -
interval schedules = when you get a reward is dependent on the amount of time that goes by
- fixed: reward after certain interval of time (eg. 2 minutes)
- variable: reward after differing timings (eg. once after 2 minutes, then after 10)
what are 3 subtypes of gambling and what do they entail
- conditioned = little psychopathology, driven by social influences, cognitive distortions
- emotional vulnerability = depressive/anxiety, low impulsive, regulate dysphoric feelings
- antisocial and impulsive = high impulsive, sensation seeking, enhance positive feelings
explain the asymmetry between good and bad outcomes in gambling
financial gains (pos pred errors) promote learning acquisition but financial losses (neg pred errors) do not trigger unlearning → instead they promote state splitting (hindsight bias) which is the explaining away of losses that does not influence the player’s belief in their ability to win → potential for bivalent outcomes
