An empirical investigation of the Pathways Model of problem gambling through the conjoint use of self-reports and behavioural tasks

Background and aims Blaszczynski and Nower (2002) conceptualized their Pathways Model by postulating the existence of three subtypes of problem gamblers who share common characteristics, but also present specific ones. Methods This study investigated how the psychological mechanisms postulated in the Pathways Model predict clinical status in a sample that combined treatment-seeking gamblers (n = 59) and non-problematic community gamblers (n = 107). To test the Pathways Model, we computed a hierarchic logistic regression in which variables associated with each postulated pathway were entered sequentially to predict the status of the treatment-seeking gambler. Self-report questionnaires measured gambling-related cognitions, alexithymia, emotional reactivity, emotion regulation strategies and impulsivity. Behavioural tasks measured gambling persistence (slot machine task), decision-making under uncertainty (Iowa Gambling Task) and decision-making under risk (Game of Dice Task). Results We showed that specific factors theorized as underlying mechanisms for each pathway predicted the status of clinical gambler. For each pathway, significant predictors included gambling-related cognitive distortions and behaviourally measured gambling persistence (behaviourally conditioned pathway), emotional reactivity and emotion regulation strategies (emotionally vulnerable pathway), and lack of premeditation impulsivity facet (impulsivist-antisocial pathway). Discussion and conclusions Our study adds to the body of literature confirming the validity of the Pathways Model and hold important implications in terms of assessment and treatment of problem gambling. In particular, a standardized assessment based on the Pathways Model should promote individualized treatment strategies to allow clinicians to take into account the high heterogeneity that characterizes gambling disorder

The joint role of impulsivity and distorted cognitions in recreational and problem gambling: A cluster analytic approach

The Pathways Model (Blaszczynski & Nower, 2002) posits that problem gambling is a heterogeneous disorder with distinct subgroups (behaviorally conditioned gamblers, emotionally vulnerable gamblers, and antisocial-impulsivist gamblers). Impulsivity traits and gambling-related cognitions are recognized as two key psychological factors in the onset and maintenance of problem gambling. To date, these constructs have been explored separately, and their joint role in determining problem gambling subtypes has received little attention. The goal of our study was to identify subgroups of gamblers based on impulsivity traits and gambling-related cognitions, and to determine whether this approach is consistent with the Pathways model. Gamblers from the community (N = 709) and treatment-seeking pathological gamblers (N = 122) completed questionnaires measuring gambling habits, disordered gambling symptoms, gambling-related cognitions, and impulsivity traits. Cluster analyses revealed that three clusters globally aligned with the pathways proposed by Blaszczynski & Nower (2002). Two other clusters emerged: (1) impulsive gamblers without cognitive-related cognitions; and (2) gamblers without impulsivity or gambling-related cognitions. Gamblers with both heightened impulsive traits and gambling-related cognitions had more severe problem gambling symptoms. We successfully identified, based on an a priori theoretical framework, different subtypes of gamblers that varied in terms of problem gambling symptoms and clinical status. The diversity of the cluster profiles supports the development of personalized prevention strategies and psychological interventions

Positive and Negative Urgency as a single coherent construct: Evidence from a large‐scale network analysis in clinical and non‐clinical samples

Aims: Negative and positive urgency are emotion-related impulsivity traits that are thought to be transdiagnostic factors in psychopathology. However, it has recently been claimed that these two traits are closely related to each other and that considering them separately might have limited conceptual and methodological value. The present study aimed to examine whether positive and negative urgency constructs constitute separate impulsivity traits. Methods: In contrast to previous studies that have used latent variable approaches, this study employed an item-based network analysis conducted in two different samples: a large sample of non-clinical participants (N = 18,568) and a sample of clinical participants with psychiatric disorders (N = 385). Results: The network analysis demonstrated that items denoting both positive and negative urgency cohere as a single cluster of items termed “general urgency” in both clinical and non-clinical samples, thereby suggesting that differentiating positive and negative urgency as separate constructs is not necessary. Conclusion: These findings have important implications for the conceptualization and assessment of urgency and, more broadly, for future research on impulsivity, personality, and psychopathology

Towards a cross-cultural assessment of binge-watching: Psychometric evaluation of the “watching TV series motives” and “binge-watching engagement and symptoms” questionnaires across nine languages

In view of the growing interest regarding binge-watching (i.e., watching multiple episodes of television (TV) series in a single sitting) research, two measures were developed and validated to assess binge-watching involvement (“Binge-Watching Engagement and Symptoms Questionnaire”, BWESQ) and related motivations (“Watching TV Series Motives Questionnaire”, WTSMQ). To promote international and cross-cultural binge-watching research, the present article reports on the validation of these questionnaires in nine languages (English, French, Spanish, Italian, German, Hungarian, Persian, Arabic, Chinese). Both questionnaires were disseminated, together with additional self-report measures of happiness, psychopathological symptoms, impulsivity and problematic internet use among TV series viewers from a college/university student population (N = 12,616) in 17 countries. Confirmatory factor, measurement invariance and correlational analyses were conducted to establish structural and construct validity. The two questionnaires had good psychometric properties and fit in each language. Equivalence across languages and gender was supported, while construct validity was evidenced by similar patterns of associations with complementary measures of happiness, psychopathological symptoms, impulsivity and problematic internet use. The results support the psychometric validity and utility of the BWESQ and WTSMQ for conducting cross-cultural research on binge-watching

Oncological Outcomes of Metastasis-Directed Therapy in Oligorecurrent Prostate Cancer Patients Following Radical Prostatectomy

Several retrospective and a few prospective studies have shown that metastasis-directed therapy (MDT) could delay clinical progression and postpone the initiation of systemic treatment in oligorecurrent prostate cancer (PCa) patients. However, these endpoints are strongly influenced by variables such as concomitant use of androgen deprivation therapy (ADT) and follow-up imaging protocols. The aim of this manuscript was to assess palliative ADT- and metastatic castration-resistant prostate cancer (mCRPC)-free survival as long-term oncological outcomes in oligorecurrent PCa treated by MDT. We retrospectively identified consecutive post-prostatectomy oligorecurrent PCa patients treated by MDT (salvage lymphadenectomy, radiotherapy, or metastasectomy) at our tertiary referral center. Patients were eligible for inclusion if they developed recurrence following radical prostatectomy, had ≤5 metastatic lesions on imaging and had a serum testosterone >50 ng/dL or a testosterone suppression therapy-free interval of >2 years prior to the first MDT as an assumption of recovered serum testosterone (if no testosterone measurement available). Patients with castration-resistant or synchronous oligometastatic PCa at the time of first MDT were excluded. Repeated MDTs were allowed, as well as a period of concomitant ADT. Kaplan–Meier analyses were performed to assess palliative ADT-free and mCRPC-free survival. We identified 191 eligible patients who underwent MDT. Median follow-up from first MDT until last follow-up or death was 45 months (IQR 27–70; mean 51 months). Estimated median palliative-ADT free survival was 66 months (95% CI 58–164) and estimated median mCRPC-free survival was not reached (mean 117 months, 95% CI 103–132). In total, 314 MDTs were performed and 25 patients (13%) received ≥3 MDTs. This study demonstrated that (repeated) MDT is feasible and holds promise in terms of palliative ADT-free and mCRPC-free survival for patients with oligorecurrent PCa. However, these findings should be confirmed in prospective randomized controlled trials

Impulsivity and gambling-related cognitions in problem gambling : a multi-methods exploration

The goal of this PhD thesis was to disentangle the role of impulsivity traits and gambling-related cognitions in problem gambling, as it has been established that these two constructs play a pivotal role in the onset of problem gambling and gambling disorder. Three studies investigated psychological mechanisms underlying these two constructs (e.g., inhibition, emotions and motives) through the use of laboratory tasks in “real” context. The last study investigated the heterogeneity in problem gambling suggested by the most widely accepted model in gambling: The Pathways Model (Blaszczynski & Nower, 2002). First, in two studies, by capitalizing on a realistic slot machine task, we explored the role of prepotent response inhibition and negative emotion (e.g., sadness) in persistent playing. Second, in Study 3, we focused on gambling-related variables (motives) that have been linked either to impulsivity or gambling-related cognitions. Finally, in Study 4, we investigated the conjoint role of impulsivity traits and gambling-related cognitions in problem gambling and gambling disorder through a cluster analysis approach. Results showed that problem gamblers with lower inhibition capacities (Study 1) or higher level of negative emotion (e.g., sadness; Study 2) displayed greater persistence. Study 3 validated in French the most widely used questionnaire in motives. Moreover, results highlighted significant correlations between the motives scale and constructs related to problem gambling (impulsivity traits and gambling-related cognitions). Regarding group comparisons, our results showed that, compared with the groups of regular and occasional gamblers, treatment-seeking gamblers had higher scores on three of the four GMQ-F subscales (all except the social motive). The last study identified three clusters that were globally similar to the three pathways proposed by Blaszczynski and Nower (2002). Moreover, we extended the model by adding two other clusters: (1) a cluster that included impulsive gamblers not characterized by gambling cognitions; it was a new finding as the Pathways Model postulated gambling-related cognitions as a prerequisite for problem gambling, and (2) a cluster of gamblers who displayed neither impulsivity nor gambling cognitions. These findings suggest to develop tailored interventions in gambling disorder based on heterogeneity in disorder patients and specific gambling practices. Future research should investigate this heterogeneity in longitudinal studies and in gambling disorder patients.(PSYE - Sciences psychologiques et de l'éducation) -- UCL, 202

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Induced sadness increases persistence in a simulated slot machine task among recreational gamblers.

Gambling may constitute a strategy for coping with depressive mood, but a direct influence of depressive mood on gambling behaviors has never been tested via realistic experimental designs in gamblers. The current study tested whether experimentally induced sadness increases persistence on a simulated slot machine task using real monetary reinforcement in recreational gamblers. Sixty participants were randomly assigned to an experimental (sadness induction) or control (no emotional induction) condition, and then performed a slot machine task consisting of a mandatory phase followed by a persistence phase. Potential confounding variables (problem gambling symptoms, impulsivity traits, gambling cognitions) were measured to ensure that the experimental and control groups were comparable. The study showed that participants in the sadness condition displayed greater gambling persistence than control participants. These data support the causal role of negative affect in decisions to gamble and persistence, which bears important theoretical and clinical implications

The effects of induced sadness, stress sensitivity, negative urgency, and gender in laboratory gambling

Previous research indicates that the invigorating effect of stress sensitivity on gambling behavior might be moderated by individual differences. The current preregistered study tested whether gender and negative urgency (i.e. an emotion-related impulsivity trait) moderate the relationship between perceived stress and laboratory gambling following experimentally induced sadness. One hundred twenty college students were randomly assigned to a sadness versus a control condition before completing a laboratory gambling task. Although the distribution of the main study variables forced us to slightly deviate from the preregistered data analysis plan, we were able to show that heightened stress sensitivity affects gambling behavior and that this effect differs by gender (but not in terms of negative urgency) under conditions of sadness versus neutral mood. Men with high stress sensitivity gambled more money and more frequently selected the riskier betting option in the sadness condition, whereas women with heightened stress sensitivity display the same pattern in the neutral condition. Our study is relevant from a methodological standpoint and answers recent calls for endorsing open-science practices in gambling research. Findings also suggest that more research into female gambling is warranted and that emotion-regulation skills should be a central component of problem gambling prevention

Preclinical Models in Prostate Cancer: Resistance to AR Targeting Therapies in Prostate Cancer

Prostate cancer is an androgen-driven tumor. Different prostate cancer therapies consequently focus on blocking the androgen receptor pathway. Clinical studies reported tumor resistance mechanisms by reactivating and bypassing the androgen pathway. Preclinical models allowed the identification, confirmation, and thorough study of these pathways. This review looks into the current and future role of preclinical models to understand resistance to androgen receptor-targeted therapies. Increasing knowledge on this resistance will greatly improve insights into tumor pathophysiology and future treatment strategies in prostate cancer