module 7 Flashcards
(17 cards)
DSM 5 GD
To be diagnosed, meet four of the following criteria during past year:
1. Need to gamble with increasing amount of money to achieve the desired excitement
2. Restless or irritable when trying to cut down or stop gambling
3. Repeated unsuccessful efforts to control, cut back on or stop gambling
4. Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble)
5. Often gambling when feeling distressed
6. After losing money gambling, often returning to get even (referred to as “chasing” one’s losses)
7. Lying to conceal gambling activity
8. Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
9. Relying on others to help with money problems caused by gambling
treatment of GD
CBT en MI
measurement GD
- Problem gambling severity index (PGSI)
9 items based on DSM criteria. ‘have you bet more than you could really afford to lose’. Often for general population. - South oak gambling screen (SOGS)
16 items based on DSM + gambling specific questions (type of gambling, amount of money in one day, parents). often for clinical population
Dopamine release SUD vs GD
sud: Every time drugs is presented, dopamine is released. Direct reinforcing effects + reward is always delivered
GD: indirect reinforcement through rewards such as dopamine + reward uncertainty increases DA
similarities
negative reinforcement relief of stress / other negative feelings.
- Another similarity is that they’re highly comorbid with Alcohol use disorder, drug use disorder and nicotine dependence. Meaning, there is probably an underlying mechanism leading to occurrence of SUD and GD.
- Risk factors: male and young
- Effective treatment CBT / nalmefene
- Neuropsychological processes
what makes gambling addictive
anticipation of winning, reward uncertainty, excitement/arousal, stress release, escaping reality.
probability study reward uncertainty
After extended training of learning that a cue predicted lemonade 100%, dopamine was released during cue only. But with extended training of learning that a cue predicted lemonade 50%, dopamine was released during cue and also when lemonade was presented. This might be true for gambling as well
Reinforcment schedules
How often a behaviour is rewarded (reinforced)
VR: reward is given after unpredictable number of response (highly addictive). Leads to highest number of responses, with lowest number of rewards this is in a casino
FR: reward is given after fixed number of responses
VI: reward is given after unpredictable time intervals
FI: reward is given after a fixed time. as you see in the table, this results in less responses. Because why work hard if receive a reward anyways.
Near- miss
Almost winning. Has same brain effect as winning…. Increased NuAcc activity
executive functions - Response inhibition
Response inhibition was impaired. Gamblers showed decreased PFC activation during response inhibition + slower reaction times (stop signal task).
executive functions - decision making
suboptimal decision making on the iowa gambling task. Also steeper curve in delay discounting task.
executive functions - cognitive flexibility
is reduced in gamblers. Score worse on WCST task (set-shifting. Greater interference on incongruent trials of the stroop task than controls.
cognitive distortions
- gamblers fallacy
- illusion of control
- incentive sensitisation / cue reactivity
- reward anticipation / processing / reward deficiency syndrome
Gambling disorder subtypes
- Behaviourally Conditioned gamblers: little psychopathology, driven by social influences, cognitive distortions. Also through classical and operant conditioning. Habit formation.
- Emotional vulnerability gamblers: As a coping mechanism. depressive / anxiety, low impulse and regulate dysphoric feelings negative reinforcement. Gambling is symptomatic of underlying psychological distress.
- Antisocial & impulsive: highly impulsive, sensation seeking and antisocial traits. Enhance positive feelings. Onset risky behaviour. Neurobiological dysfunction in reward and control systems.
important components CBT
- Prepare for change (MI)
- SMART goal setting
- Self control measures
- emergency measures
- functional analysis
- dealing with craving (urge-surfing)
7 changing thoughts
8 refusal of offered resources (roleplay)
Arguments against food is an addiction (fletcher)
- Lack of clear addictive substance
- Differences from substance addiction
Substance addiction is characterized by specific pharmacological effects on the brain that are not clearly replicated by food. Substance addiction involves distinct withdrawal and tolerance mechanisms that are not well-evidenced in food consumption. - Overlapping with eating disorders
Food is conflated with other eating disorders like binge-eating disorder. Food addiction may be a behavioural symptoms of underlying psychological issues rather than standalone addiction - Neurobiological evidence is inconsistent
Many studies don’t replicate findings and often rely on associative rather than causal evidence. - Risk of pathologizing normal behaviour (passion / hobbies)
Arguments in favour of food is an addiction (kenny)
- Behavioural overlap with SUD
Cravings, compulsive consumption, inability to reduce intake despite adverse consequences, and relapse after periods of abstinence - Neurobiological parallels
Consumption of highly palatable foods triggers brain regions similar to those activated by drugs. The striatum shows altered activity in response to food cues in people who overeat, similar to substance users. - Rodent models support the concept
- Brain changes resembling drug addiction
- Evidence of cross-addiction therapies
