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Gioco d'azzardo, guida pratica di intervento: manuale per l'operatore

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  • Azienda ULSS 2 Marca Trevigiana
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Offers transtheoretical therapy as one alternative when seeking a synthesis for the increasing proliferation of therapeutic systems. From a comparative analysis of 18 leading systems, 5 basic processes of change were identified by the present 1st author (1979). They are consciousness raising (feedback, education), conditional stimuli (counterconditioning, stimulus control), catharsis (corrective emotional experiences, dramatic relief), choosing (self-liberation, social liberation), and contingency control (reevaluation, contingency management). Each process can be applied at the level of either the individual's experience or environment. The present authors (see record 1982-31158-001) have identified the following stages of change: contemplation, termination, action, and maintenance. The verbal processes of change—consciousness raising, catharsis, and choosing—are most important during the 1st 2 stages, while behavior therapies (conditional stimuli and contingency control) are needed once a commitment is made. It is suggested that in the transtheoretical model, cognitive restructuring is seen as the result of the individual effectively applying the appropriate processes of change during each of the appropriate stages of change. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This chapter provides an outline of the theoretical framework, assessment process, specific treatment methods, and measurement of treatment outcomes of the Flinders Therapy Service for Problem Gamblers. A case example and outcome data are provided to demonstrate the treatment model and its effectiveness. An overview of treatment outcomes for problem gambling assessing different modalities is discussed.
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The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.
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This chapter discusses the range of behavioral and situational factors that can contribute to both gambling as well as disordered gambling and how these factors are taken into account in intervention strategies. It focuses principally on the psychological and conditioning processes that maintain and trigger gambling episodes. Then, it proceeds to some discussion of social and environmental factors (e.g., the role of families, peers and culture) that can influence gambling. The chapter provides a review of existing knowledge concerning the nature and effectiveness of behavioral interventions for disordered gambling. It also considers the importance of broader social work, counseling, pre-commitment and self-help strategies. Such strategies can also assist gamblers and their families to restructure their lives and behavior so as to reduce opportunities for gambling, control expenditure, and reduce potential harm. Behavioral interventions are now recognized as an important element of best-practice therapies for problem gambling.
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L’incremento dell’interesse degli studiosi per il gioco d’azzardo patologico, a partire dalla sua introduzione nelle categorie diagnostiche del DSM-III (APA, 1980), ha determinato la proliferazione di numerosi protocolli terapeutici, prevalentemente derivati da un adattamento dei preesistenti modelli utilizzati per il trattamento delle dipendenze da sostanze (Blume e Tavares, 2003). In effetti, contrariamente all’attuale collocazione nosografica tra i disturbi del controllo degli impulsi, un numero sempre maggiore di autori si riferisce al gioco d’azzardo patologico come ad una “dipendenza senza sostanze” o “dipendenza comportamentale” (Dickerson, 1989; Griffiths, 1996) e la maggior parte dei criteri diagnostici che definiscono il gioco d’azzardo patologico, sono palesemente sovrapponibili ai criteri per i disturbi correlati all’uso di sostanze (APA, 1994). Anche la tradizione terapeutica cognitivo-comportamentale relativa al gioco patologico si è sviluppata a partire dalla parziale sovrapposizione tra quest’ultimo e le dipendenze da sostanze, dai primi approcci di stampo comportamentale degli anni ’60 (con un utilizzo prevalente della terapia avversiva), fino ai più recenti contributi della terapia cognitiva, che hanno recuperato la dismissione comportamentista dei processi interni, rinnovando nel contempo l’interesse per gli interventi comportamentali. Gli autori che maggiormente hanno contribuito allo sviluppo del moderno approccio cognitivo-comportamentale al trattamento del gioco patologico, hanno pescato a piene mani dal paniere delle numerose tecniche terapeutiche comportamentali e cognitive tradizionali messe a punto per altre forme di disturbi, approdando però ad un modello di intervento all’interno del quale sono riconoscibili anche strategie specifiche per il gioco eccessivo. Il presente contributo intende descrivere brevemente l’evoluzione del trattamento cognitivo-comportamentale, dalle prime sperimentazioni nate in ambito comportamentale, attraverso i più recenti approcci di stampo cognitivo che si focalizzano sull’identificazione e sulla modificazione delle convinzioni erronee del giocatore, fino ai più moderni protocolli di trattamento cognitivo-comportamentale che utilizzano diverse tipologie di tecniche (comportamentali e cognitive) in un unico modello integrato di intervento, modulabile in base alle valutazioni e alle esigenze espresse dal singolo caso.
Article
The past decade has witnessed an expanded accessibility and popularity of gambling worldwide, and in Italy the phenomenon significantly increased. Nevertheless, little is known about the role of gambling cognitions among Italian individuals, and few scales assessing problem gambling have been validated. The purpose of the present study was to examine and validate the Gambling Related Cognitions Scale-Italian version (GRCS-I), based on the 23-item Gambling Related Cognitions Scale (GRCS). Two-tailed t tests, ANOVA, MANOVA, Pearson's correlation, and multiple regression analyses were used for continuous variables, while χ(2) tests with Yates's correction for categorical variables. Cronbach's α was utilized to determine the internal consistency, and logistic regression analysis and the receiver operating characteristic curve analysis to determine discriminant validity. Principal axis factoring with Oblimin rotation was applied, and then confirmatory factor analysis was used to cross-validate the factor structures. We extracted a five-factor solution that accounted for 60 % of variance. All 23 items had communalities and factor loadings were satisfactory, and the factor structures were similar to the original version of the measure. The Cronbach's α coefficients were adequate, and concurrent and discriminant validities of the GRCS were also confirmed. GRCS-I presented good psychometric properties and it demonstrated good validity and reliability, providing a valid and suitable tool for the assessment of gambling related cognitions among Italian individuals.
Article
A hypothesis which attempts to account for extinction following partial reinforcement in terms of certain sequential aspects of nonreinforced and reinforced trials was considered. The central assumptions are that nonreinforced trials occasion a specific and distinctive internal stimulus and that this stimulus is progressively modified by successive nonreinforcements. Stimulus modification was indicated as exerting its effects on extinction through 3 sequential variables: N-length, number of different N-lengths, and number of occurrences of each N-length. The operation of these variables and the stimulus modification mechanism was elaborated by considering certain salient and representative partial reinforcement investigations. This detailed survey of critical experimental findings suggested that the better known nonsequential variables which form the basis of most current partial reinforcement hypotheses exercise little or no control over extinction and that a theory of extinction must be based on a sequential analysis. Experimental evidence was considered which suggests that: (1) the modification mechanism may be applicable to all partial reinforcement situations, whether classical or instrumental, appetitive or aversive; and (2) the present hypothesis may be able to deliver certain types of rate-of-extinction predictions. These particular rate predictions, while relatively primitive, do appear to be something of an improvement over the current greater-than type prediction. (2 p. ref.)
Article
A heuristic model to account for the development and maintenance of problem gambling is provided with the aim of directing clinical management and future research. Previous explanations of problem gambling have been limited in two main ways. Firstly, the models have been primarily descriptive, and secondly they have generally lacked clinical value. Most explanations have ignored the mechanisms through which this behaviour becomes problematic, and have not identified the relationships between different variables.
Article
The aims of this study are to develop and validate a measure to screen for a range of gambling-related cognitions (GRC) in gamblers. A total of 968 volunteers were recruited from a community-based population. They were divided randomly into two groups. Principal axis factoring with varimax rotation was performed on group one and confirmatory factor analysis (CFA) was used on group two to confirm the best-fitted solution. The Gambling Related Cognition Scale (GRCS) was developed for this study and the South Oaks Gambling Screen (SOGS), the Motivation Towards Gambling Scale (MTGS) and the Depression Anxiety Stress Scale (DASS-21) were used for validation. Exploratory factor analysis performed using half the sample indicated five factors, which included interpretative control/bias (GRCS-IB), illusion of control (GRCS-IC), predictive control (GRCS-PC), gambling-related expectancies (GRCS-GE) and a perceived inability to stop gambling (GRCS-IS). These accounted for 70% of the total variance. Using the other half of the sample, CFA confirmed that the five-factor solution fitted the data most effectively. Cronbach's alpha coefficients for the factors ranged from 0.77 to 0.91, and 0.93 for the overall scale. This paper demonstrated that the 23-item GRCS has good psychometric properties and thus is a useful instrument for identifying GRC among non-clinical gamblers. It provides the first step towards devising/adapting similar tools for problem gamblers as well as developing more specialized instruments to assess particular domains of GRC.