Cognitive versus exposure therapy for problem gambling: Randomised controlled trial

© 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Background Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial. Aims To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service. Methods Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up. Findings Of eighty-seven participants who were randomised and started intervention (CT = 44; ET = 43), 51 (59%) completed intervention (CT = 30; ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference −0.18, 95% CI: −4.48–4.11) and 6 month follow-up (mean difference 1.47, 95% CI: −4.46–7.39). Conclusions Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out

Experiences and Perceptions of Problem Gamblers on Cognitive and Exposure Therapies When Taking Part in a Randomised Controlled Trial: A Qualitative Study

Author version made available in accordance with publisher copyright policy.In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients’ urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-sample of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants’ comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge–cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of “rational thought” from their program of therapy and CT participants had “taken-over” their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out

Two-group randomised, parallel trial of cognitive and exposure therapies for problem gambling: a research protocol

BACKGROUND: Problem gambling is a serious public health concern at an international level where population prevalence rates average 2% or more and occurs more frequently in younger populations. The most empirically established treatments until now are combinations of cognitive and behavioural techniques labelled cognitive behaviour therapy (CBT). However, there is a paucity of high quality evidence for the comparative efficacy of core CBT interventions in treating problem gamblers. This study aims to isolate and compare cognitive and behavioural (exposure-based) techniques to determine their relative efficacy. METHODS: A sample of 130 treatment-seeking problem gamblers will be allocated to either cognitive or exposure therapy in a two-group randomised, parallel design. Repeated measures will be conducted at baseline, mid and end of treatment (12 sessions intervention period), and at 3, 6 and 12 months (maintenance effects). The primary outcome measure is improvement in problem gambling severity symptoms using the Victorian Gambling Screen (VGS) harm to self-subscale. VGS measures gambling severity on an extensive continuum, thereby enhancing sensitivity to change within and between individuals over time. DISCUSSION: This article describes the research methods, treatments and outcome measures used to evaluate gambling behaviours, problems caused by gambling and mechanisms of change. This study will be the first randomised, parallel trial to compare cognitive and exposure therapies in this population. ETHICS AND DISSEMINATION: The study was approved by the Southern Adelaide Health Service/Flinders University Human Research Ethics Committee. Study findings will be disseminated through peer-reviewed publications and conference presentations.<br /

Observational Tests and Predictive Stellar Evolution II: Non-standard Models

We examine contributions of second order physical processes to results of stellar evolution calculations amenable to direct observational testing. In the first paper in the series (Young et al. 2001) we established baseline results using only physics which are common to modern stellar evolution codes. In the current paper we establish how much of the discrepancy between observations and baseline models is due to particular elements of new physics. We then consider the impact of the observational uncertainties on the maximum predictive accuracy achievable by a stellar evolution code. The sun is an optimal case because of the precise and abundant observations and the relative simplicity of the underlying stellar physics. The Standard Model is capable of matching the structure of the sun as determined by helioseismology and gross surface observables to better than a percent. Given an initial mass and surface composition within the observational errors, and no additional constraints for which the models can be optimized, it is not possible to predict the sun's current state to better than ~7%. Convectively induced mixing in radiative regions, seen in multidimensional hydrodynamic simulations, dramatically improves the predictions for radii, luminosity, and apsidal motions of eclipsing binaries while simultaneously maintaining consistency with observed light element depletion and turnoff ages in young clusters (Young et al. 2003). Systematic errors in core size for models of massive binaries disappear with more complete mixing physics, and acceptable fits are achieved for all of the binaries without calibration of free parameters. The lack of accurate abundance determinations for binaries is now the main obstacle to improving stellar models using this type of test.Comment: 33 pages, 8 figures, accepted for publication in the Astrophysical Journa

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 1: Factors that ‘Push’ Towards Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine problem gambling. In this paper the authors describe part one of a two part, linked relapse process: the ‘push’ towards relapse. In this two-part process, factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behavioural events that ends with relapse when the ‘push’ overcomes ‘pull’ (part one); or as described in part two, continued abstinence when ‘pull’ overcomes ‘push’. In the second paper, the authors describe how interacting factors ‘pull’ the problem gambler away from relapse. Two theories emerged: (1) each relapse episode comprised a sequence of mental and behavioural events, which evolves over time and was modified by factors that ‘push’ this sequence towards relapse and (2) a number of gamblers develop an altered state of consciousness during relapse described as the ‘zone’ which prolongs the relapse

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 2: Factors that ‘Pull’ the Gambler Away from Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine (EGM) problem gambling (PG) by describing the processes and factors that ‘pull’ the problem gambler away from relapse contrasted with the ‘push’ towards relapse. These conceptualisations describe two opposing, interacting emotional processes occurring within the problem gambler during any relapse episode. Each relapse episode comprises a complex set of psychological and social behaviours where many factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behaviour events that end (1) with relapse where ‘push’ overcomes ‘pull’ or (2) continued abstinence where ‘pull’ overcomes ‘push’. It was established that vigilance, motivation to commit to change, positive social support, cognitive strategies such as remembering past gambling harms or distraction techniques to avoid thinking about gambling to enable gamblers to manage the urge to gamble and urge extinction were key factors that protected against relapse. Three complementary theories emerged from the analysis. Firstly, a process of reappraisal of personal gambling behaviour pulls the gambler away from relapse. This results in a commitment to change that develops over time and affects but is independent of each episode of relapse. Secondly, relapse may be halted by interacting factors that ‘pull’ the problem gambler away from the sequence of mental and behavioural events, which follow the triggering of the urge and cognitions to gamble. Thirdly, urge extinction and apparent ‘cure’ is possible for EGM gambling. This study provides a qualitative, empirical model for understanding protective factors against gambling relapse

Stellar Hydrodynamics in Radiative Regions

We present an analysis of the response of a radiative region to waves generated by a convective region of the star; this wave treatment of the classical problem of ``overshooting'' gives extra mixing relative to the treatment traditionally used in stellar evolutionary codes. The interface between convectively stable and unstable regions is dynamic and nonspherical, so that the nonturbulent material is driven into motion, even in the absence of ``penetrative overshoot.'' These motions may be described by the theory of nonspherical stellar pulsations, and are related to motion measured by helioseismology. Multi-dimensional numerical simulations of convective flow show puzzling features which we explain by this simplified physical model. Gravity waves generated at the interface are dissipated, resulting in slow circulation and mixing seen outside the formal convection zone. The approach may be extended to deal with rotation and composition gradients. Tests of this description in the stellar evolution code TYCHO produce carbon stars on the asymptotic giant branch (AGB), an isochrone age for the Hyades and three young clusters with lithium depletion ages from brown dwarfs, and lithium and beryllium depletion consistent with observations of the Hyades and Pleiades, all without tuning parameters. The insight into the different contributions of rotational and hydrodynamic mixing processes could have important implications for realistic simulation of supernovae and other questions in stellar evolution.Comment: 27 pages, 5 figures, accepted to the Astrophysical Journa

Risks for comorbidity in children with atopic disorders: an observational study in Dutch general practices

OBJECTIVE: This study aimed to investigate both atopic and non-atopic comorbid symptoms and diseases in children with physician-diagnosed atopic disorders (atopic eczema, asthma and allergic rhinitis).METHODS: All children aged 0-18 years listed in a nationwide primary care database (the Netherlands Institute for Health Services Research-Primary Care Database) with routinely collected healthcare data in 2014 were selected. Children with atopic disorders were matched on age and gender with non-atopic controls within the same general practice. A total of 404 International Classification of Primary Care codes were examined. Logistic regression analyses were performed to examine the associations between the presence of atopic disorders and (non-)atopic symptoms and diseases by calculating ORs.RESULTS: Having one of the atopic disorders significantly increased the risk of having other atopic-related symptoms, even if the child was not registered as having the related atopic disorder. Regarding non-atopic comorbidity, children with atopic eczema (n=15 530) were at significantly increased risk for (infectious) skin diseases (OR: 1.2-3.4). Airway symptoms or (infectious) diseases (OR: 2.1-10.3) were observed significantly more frequently in children with asthma (n=7887). Children with allergic rhinitis (n=6835) had a significantly distinctive risk of ear-nose-throat-related symptoms and diseases (OR: 1.5-3.9). Neither age nor gender explained these increased risks.CONCLUSION: General practitioners are not always fully aware of relevant atopic and non-atopic comorbidity. In children known to have at least one atopic disorder, specific attention is required to avoid possible insufficient treatment and unnecessary loss of quality of life