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Eliciting and Addressing Cognitive Distortions in Gambling Treatment
For instance, the most common distortion about gambling, "gambler's fallacy," refers to gamblers who assume that machines that have produced several losing outcomes are more likely to produce a win on the next bet. Some of these beliefs include the following: "If you take your time, or ask the bartender, you will find out the machine that has taken too much money that day. That machine is due!" or "It is best to go to the casinos when they are about to close because by then the machines are full and they have to give back some of the money they've taken." To deal with such misconceptions, we play the following exercise: 1 patient sits in a corner of the room, holding 3 stacks of plastic chips, while another holds a die in the opposing corner. The therapist assumes the role of a desperate gambler about to place a bet, while the patients represent different parts of the machine. The die keeper is the computer with its random number generator; the stack holder represents the money compartment. The therapist explains to the "machine" that it has taken a lot of money from several people including himself, and now it is time to pay back. The following is a session's excerpt:
Therapist: How are you feeling John?
The therapist may allow some die throws for further illustration. In 1 situation, a patient threw the die several times, and the number 6 came up in the first 2 throws, prompting cheers from other group members and more distorted statements such as, "I feel lucky! Does anyone want to rub me?" These statements illustrate what Toneatto has called superstitious beliefs and perception of luck as contagious. The strategy to deal with this particular situation was to allow the client to throw the die more times until losses had clearly outnumbered wins. A cotherapist took note of all distorted statements prompted by the prolonged exercise, and they were addressed at subsequent sessions. In the same way, immediately following the group session, for the patient who threw the die, a brief 20-minute individual session was performed to prevent a relapse triggered by potential insufficient debriefing.
Integrating Behavioral and Cognitive Perspectives
Integrative models usually result in additional interventions that attempt to address the shortcomings of the cognitive-behavioral approach (for example, acknowledging the roles of individual differences, personality, and emotions). Blaszczynski and Silove noted that, if principles of behavioral conditioning sufficed, all subjects exposed to gambling would become pathological gamblers. The same can be said of misconceptions about randomness, whereby a game as simple as coin tossing can induce gambling in normal subjects. Brown adds to the classical conditioning model the components of optimum level of arousal theory, and the dissociation properties of gambling. According to Brown, excitement and temporary relief from negative emotional states would constitute the main reinforcements of gambling, but what remains to be explained is how these reinforcements could keep their strength in the face of obvious progressive damage. One possible explanation is that most often the positive outcomes of gambling are immediate, whereas negative consequences are delayed in time. Using a discount—delay paradigm, Petty has demonstrated that gamblers have difficulty refusing smaller gratification in the face of a bigger-but-postponed reward, indicating difficulties in appraising long-term consequences of their choices. This and other studies stress the association between impulsivity and problem gambling and thus could explain the vulnerability to behavioral conditioning by gambling.
Cognitive-Behavioral vs Traditional Addiction Approaches—What Is New?
Cognitive psychology has provided the gambling field with original content by considering the unique features of gambling activity. Even so, several points remain to be clarified. Both problem and nonproblem gamblers have distortions. Why do some individuals act upon these false beliefs and others not? Jacobs suggests that, to establish an addiction, the substance or the behavior has to provide wishful compensatory fantasies to an identity previously harmed by poor parenting or environment misfit. Understanding the role of cognitive distortions in filling developmental voids could lead to better treatments. Likewise, it remains to be clarified whether cognitive restructuring treatment is better than other nonspecific therapeutic approaches.
In summary, when treating pathological gamblers, clinicians should introduce techniques to address cognitive distortions toward gambling. A better understanding of gambling and chance processes foster treatment compliance. With the current explosion in gambling opportunities, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by gambling triggers. Notably, such techniques were developed by working groups addressing different cultures (that is, cognitive restructuring by Ladouceur's group in Canada, in vivo exposure by Echeburua in Spain, and imaginal desensitization by McConaghy in Australia). Such "regionalisms" call for an appraisal of the suitability of these techniques to the patient's sociocultural background before they are introduced in the treatment.
- Tavares H, Zilberman ML, el-Guebaly N, Are there cognitive and behavioral approaches specific to the treatment of pathological gambling? Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 2003 Feb, Vol. 48, Issue 1
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