A reformulated cognitive–behavioral model of problem gambling: A biopsychosocial perspective
Introduction
Pathological gambling was included as an Impulse Control Disorder in DSM III (American Psychiatric Association, 1980), and since that time, there has been considerable growth in research into the factors associated with gambling behavior. However, although the empirical knowledge base has grown, there remain relatively few theoretical accounts that explain the etiology and maintenance of problematic levels of gambling. Early models were predominantly behavioral in nature and took into account factors associated with the taxonomy of gambling (e.g., reinforcement schedules). However, it was clear that reinforcement schedules alone were insufficient to fully account for the development and maintenance of a complex disorder, where a gambler continues to gamble in the face of the punitive consequences, which usually accompany pathological gambling (Dickerson, 1989).
Secondary reinforcement schedules in the form of arousal associated with the gambling behavior were then considered. McConaghy (1980) proposed the behavioral completion mechanism, which argued that gamblers develop an aversive brain state prior to gambling. It was argued that the reduction in that aversive state negatively reinforced the gambling behavior through a mechanism similar to a drive reduction hypothesis (Leary & Dickerson, 1985). Brown (1987) has also argued that arousal is important and applied reversal theory to problem gambling. Reversal theory suggests that some individuals are more prone to boredom and prefer a higher level of arousal and subsequently seek out heightened levels of sensation. Gambling was argued to be one behavior through which vulnerable individuals may achieve an optimal level of arousal. However, results of the research investigating sensation seeking have been contradictory and have generally failed to support these contentions (e.g., Blaszczynski, Wilson, & McConaghy, 1986). While there is considerable evidence linking arousal and gambling behavior, none of these theories can fully explain why some individuals gamble to the point of jeopardising important aspects of their lifestyles.
Sharpe and Tarrier (1993) proposed a heuristic cognitive and behavioral model of pathological gambling. Their model attempted to bring together hypotheses derived from behavioral theories with cognitive elements to explain the maintenance of gambling behavior amongst problem gamblers. However, many of the predictions derived from their model were speculative. Indeed, the model was explicitly developed to generate testable hypotheses for future research and treatment.
A comprehensive theory needs to explain both the acquisition of a behavior, as well as its maintenance. Moreover, the model should have some specificity in that it explains why people develop problems with gambling rather than other disorders. The present paper aims to integrate the past decade of research into a model for that purpose. It aims to propose a comprehensive model, which accounts for the acquisition of gambling behavior, the development of problematic levels of gambling and the maintenance of gambling once the behavioral pattern is already established.
In their model, Sharpe and Tarrier (1993) argued that there was likely to be a vulnerability for some individuals towards developing problems with gambling. This was argued to interact with the format of gambling games to produce associations between arousal and cognitive biases to produce a pattern whereby gamblers continued to play win or lose. The focus of their work was on the patterns that maintained gambling levels amongst problem gamblers. They argue that control over gambling was mediated by a set of coping skills, which were in turn affected by the negative consequences that frequently accompanied problematic levels of gambling. The present paper will build upon the major components of this model. In addition, the mechanisms that appear to influence the development, as well as maintenance of problem gambling, will be described.
Section snippets
Vulnerability to gambling
Gambling is a behavior that over 85% of most Western samples report taking part in at some stage (Eisen et al., 1999). However, only a minority develops problems with gambling. It has been argued that there is likely to be a vulnerability towards the development of pathological gambling. Carlton and Manowicz (1984) found that adult pathological gamblers had a higher than average rate of childhood attention deficit hyperactivity disorder. Their study was retrospective and, thus, its validity can
Availability of gambling
Throughout different countries and not uncommonly within countries, different legislation governs the availability of gambling and the venues in which gambling is accessible. In prevalence studies, it has been demonstrated that countries with a high level of availability (e.g., Australia) have among the highest prevalence rates of pathological gambling. Indeed, availability of gambling is correlated with the prevalence of pathological gambling Campbell & Lester, 1999, Walker, 1992. The problem
Nature of gambling games
It has long been recognized that the nature of gambling itself contributes to the development of problems in vulnerable individuals. All gambling operates on a payout system, which is representative of a variable and intermittent pattern of reinforcement. Small wins are paid regularly, with jackpots remaining elusive. It is well documented that variable and intermittent reinforcement schedules lead to fast acquisition of behavior, which is subsequently resistant to extinction. Although these
Arousal and gambling
Arousal has been hypothesized to be associated with gambling in both behavioral Brown, 1987, McConaghy, 1980 and cognitive–behavioral (e.g., Sharpe & Tarrier, 1993) accounts of problem gambling. Numerous studies have investigated the relationships between arousal and gambling with different methodologies, which complicates conclusions about the role of arousal in gambling. Arousal has been found to be associated with numerous forms of gambling, including casino betting (Anderson & Brown, 1984),
Cognitive biases in gambling
The interest in cognitive biases has a long history in the study of problem gambling and Bergler (1958, p. 3), in his predominantly psychodynamic text on the psychology of gambling, claimed “The gambler is apparently the last optimist.” Bergler describes numerous beliefs that are endorsed by gamblers, which would correspond to what are now considered irrational thoughts. However, the role of cognitions in problem gambling has received increasing interest in the past two decades.
The first
Association of arousal and cognitive factors
The previous discussion has focused on the independent role of arousal and cognitions in gambling behavior. However, in reality the two are likely to interact (Sharpe & Tarrier, 1993). Coloumbe et al. (1992) were the first to demonstrate that number of irrational verbalizations and heart rate were correlated during play, suggesting that cognitive events are likely to mediate arousal. Indirect evidence for this was also found in Sharpe et al.'s (1995) study. They found that when experimental
Methodological issues
The literature that has been reviewed above has attempted to bring together discrete areas of research relevant to the explanation of why some people develop problems with gambling and others do not. Moreover, it has aimed to understand why problems with gambling become entrenched and are maintained in the face of enormous social and personal costs. A huge contribution has been made to the literature investigating gambling behavior in the past decade. Our knowledge base is certainly now more
The continuum model: the role of analogue samples
One of the primary issues in research is the populations from which samples are drawn. Numerous authors (e.g., Coventry & Constable, 1999, Coventry & Norman, 1997, Coventry & Norman, 1998, Dickerson et al., 1987, Dickerson et al., 1991, Kyngdon & Dickerson, 1999) have relied upon analogue populations (of high- and/or low-frequency gamblers) to investigate the relationships between variables. Others have focused exclusively on gamblers from clinical settings Blaszczynski et al., 1986, Steel &
Laboratory vs. naturalistic settings
The other major methodological debate that is often discussed in the literature is the ecological validity of laboratory experiments vs. the naturalistic environment. Anderson and Brown (1984) argued, in their early study of arousal, that laboratory tasks (even those with high face validity) led to significantly lower levels of arousal in comparison to the real situation. The shift of research then drifted towards naturalistic studies, which by definition are more ecologically valid but often
A comprehensive model
With these methodological considerations in mind, the purpose of the present paper is to bring together the diverse areas of research into gambling behavior into a comprehensive model. Much of the early gambling research can be criticised for a failure to be theoretically driven. However, theoretical accounts of gambling have certainly lagged behind recent empirical advances in knowledge. For an area of research to further our understanding of complex clinical problems, there must be a firm
A biopsychosocial cognitive–behavioral model of pathological gambling
Evidence now suggests that there is likely to be a genetic vulnerability to pathological gambling. The specific phenotype through which such vulnerability is expressed remains unknown. However, one suggestion is that the genetic vulnerability could be conferred through biological changes in neurotransmitters, such as the dopaminergic, noradrenergic, and/or serotonergic system. Further, the vulnerability may be associated with psychological traits, such as impulsivity. Whether this vulnerability
Treatment implications
This model allows some recommendations to be made about treatment strategies that are likely to be useful in the management of clients with problematic levels of gambling (for a full review of the literature on treatment outcome, see Lopez-Viets & Miller, 1997). It must be noted that the degree to which each factor is involved in the development of problems in gambling for individual clients is likely to differ. Clinicians need to develop individual formulations to guide the choice of
Conclusions
The aim of the present paper has been to consolidate the recent literature in the area of gambling behavior in terms of its relevance to the development and maintenance of problem gambling. The proposed model is an integrative one. It builds upon the cognitive–behavioral model proposed by Sharpe and Tarrier (1993), incorporating recent empirical findings. Problem gambling is a complex problem and recent research has demonstrated that there are biological, psychological, and social determinants
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