Behaviour research and therapy

Background Various psychological therapies for pathological and problem gambling have been evaluated in randomised trials. A synthesis of best-quality evidence is required. Objectives The objective was to synthesise evidence from randomised trials of psychological therapies for pathological and problem gambling (cognitive-behaviour therapy (CBT), motivational interviewing therapy, integrative therapy, other psychological therapy), in order to indicate the efficacy of therapies and durability of therapy effects, relative to control conditions. Search methods We conducted a search of the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR), which includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (The Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also carried out complementary searches of MEDLINE, EMBASE, PsycINFO, LILACS and CENTRAL for studies published between January 1980 and October 2011. We examined the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov and also conducted manual searches of selected journals and reference lists of included studies. Selection criteria Included studies were clinical trials using random allocation to groups, considering pathological or problem gamblers, and evaluating a psychological therapy for pathological or problem gambling. Control conditions included 'no treatment' controls, referral to Gamblers Anonymous and non-specific treatment component controls. Data collection and analysis We systematically extracted data on the characteristics and results of studies. Primary outcomes were measures of gambling symptom severity, financial loss from gambling and frequency of gambling. Secondary outcomes were occurrence of pathological gambling diagnoses and depression and anxiety symptoms. Treatment effects were defined by comparisons between therapy and control conditions at post-treatment assessments (conducted from 0 to 3 months following completion of treatment) and follow-up assessments (conducted from 9 to 12 months following completion of treatment), respectively, using the standardised mean difference (SMD) or risk ratio (RR). We synthesised results through random-effects meta-analysis. Main results Fourteen studies (n = 1245) met the inclusion criteria. Eleven studies compared CBT with control and comparisons at 0 to 3 months post-treatment showed beneficial effects of therapy that ranged from medium (when defined by financial loss from gambling: SMD -0.52; 95% confidence interval (CI) -0.71 to -0.33, n = 505) to very large (for gambling symptom severity: SMD -1.82; 95% CI -2.61 to -1.02, n = 402). Only one study (n = 147) compared groups at 9 to 12 months follow-up and produced smaller effects that were not significant. Four studies of motivational interviewing therapy were identified and mainly considered samples demonstrating less severe gambling (relative to studies of pathological gamblers). Data suggested reduced financial loss from gambling following motivational interviewing therapy at 0 to 3 months post-treatment (SMD -0.41; 95% CI -0.75 to -0.07, n = 244), although comparisons on other outcomes were not significant. The effect approached zero when defined by gambling symptom severity (SMD -0.03; 95% CI -0.55 to 0.50, n = 163). Studies compared groups at 9 to 12 months follow-up and found a significant effect of motivational interviewing therapy in terms of frequency of gambling (SMD -0.53; 95% CI -1.04 to -0.02, n = 62), with comparisons on other outcomes that were not significant. Two studies of integrative therapies also considered samples demonstrating overall low gambling severity, and found no significant effects of therapy at 0 to 3 months post-treatment. Comparisons at 9 to 12 months follow-up suggested a medium effect from therapy in terms of gambling symptom severity, with no significant differences for other outcomes. One study (n = 18) considered another psychological therapy (i.e.Twelve-Step Facilitated Group Therapy) and suggested beneficial effects in terms of most outcomes at 0 to 3 months post-treatment. The evidence supporting these various classes of therapy ranged from very low to low quality. Authors' conclusions This review supports the efficacy of CBT in reducing gambling behaviour and other symptoms of pathological and problem gambling immediately following therapy. However, the durability of therapeutic gain is unknown. There is preliminary evidence for some benefits from motivational interviewing therapy in terms of reduced gambling behaviour, although not necessarily other symptoms of pathological and problem gambling. However, the findings are based on few studies and additional research is needed to inform conclusions. There is also evidence suggestive of some possible benefit from integrative therapies, and other psychological therapies for pathological and problem gambling. However, there are too few studies and evidence is insufficient to evaluate these therapies. The majority of studies in this review varied in risk of bias, and much of the evidence comes from studies with multiple limitations. The current data may thus reflect overestimates of treatment efficacy.

Psychological therapies for pathological and problem gambling

Continuously monitoring schizophrenia patients’ psychiatric symptoms is crucial for in-time intervention and treatment adjustment. The Brief Psychiatric Rating Scale (BPRS) is a survey administered by clinicians to evaluate symptom severity in schizophrenia. The CrossCheck symptom prediction system is capable of tracking schizophrenia symptoms based on BPRS using passive sensing from mobile phones. We present results from an ongoing randomized control trial, where passive sensing data, self-reports, and clinician administered 7-item BPRS surveys are collected from 36 outpatients with schizophrenia recently discharged from hospital over a period ranging from 2-12 months. We show that our system can predict a symptom scale score based on a 7-item BPRS within ±1.45 error on average using automatically tracked behavioral features from phones (e.g., mobility, conversation, activity, smartphone usage, the ambient acoustic environment) and user supplied self-reports. Importantly, we show our system is also capable of predicting an individual BPRS score within ±1.59 error purely based on passive sensing from phones without any self-reported information from outpatients. Finally, we discuss how well our predictive system reflects symptoms experienced by patients by reviewing a number of case studies.

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Predicting Symptom Trajectories of Schizophrenia using Mobile Sensing

Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule ra...

A scoping review of co-morbidity in individuals with disordered gambling

The purpose of this study is to evaluate the influence of emotional induction and level of immersion on knowledge acquisition and motivation. Two conditions were used for immersion modulation: a high immersive condition, which consisted of the viewing of educational content through a head-mounted-display; and a low immersive condition, which was achieved through direct viewing on a tablet. The emotional conditions, created through video simulation, consisted of a positive versus neutral mood induction procedure. The participants were 56 high school students enrolled on a social science course. The results indicate a significant effect of the positive emotion/high immersive condition in knowledge acquisition while positive emotion induction had a positive effect on the interest subscale of the motivation assessment tool used for both immersive conditions.

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Mobile Virtual Reality as an Educational Platform: A Pilot Study on the Impact of Immersion and Positive Emotion Induction in the Learning Process

Many studies have examined the factors that influence academic performance in primary and secondary education as well as at university, with the purpose of enhancing learning at these stages and reducing drop-out rates. It is within this research framework that we want to emphasise the deficient performance of students enrolled on the statistics course in the Faculty of Psychology at the University of Barcelona. Consequently, this paper attempts to determine the factors that affect student performance in this subject by undertaking an analysis of a structural equation model and determining its stability over time. In order to accomplish our objective, we worked with two samples of students enrolled statistics classes. The first group comprised 211 students enrolled in the academic year 2000–2001, while the second comprised 287 students enrolled in the academic year 2001–2002. By administering a questionnaire, we obtained information concerning such variables as demographic data, previous academic record, information related to the subject and the degree of satisfaction with it, and the final mark obtained by the students in the subject. The parameters for each group of students were estimated separately and the goodness of fit of the proposed structural model was assessed. The data analysis showed a good fit with both data bases, but the set of estimated parameters differed in the two academic years under consideration.

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Montserrat Freixa

Papers

Factors Related to the Academic Performance of Students in the Statistics Course in Psychology

Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: a pilot study.

Prediction of Relapse After Cognitive-Behavioral Treatment of Gambling Disorder in Individuals With Chronic Schizophrenia: A Survival Analysis.

Multi-episode survival analysis: an application modelling readmission rates of heroin dependents at an inpatient detoxification unit.