Traitement du jeu pathologique à l'aide de la réalité virtuelle : la verbalisation de stratégies face aux situations à risque / Virtual Reality Relapse Prevention for Pathological Gamblers: Strategies for Dealing with Risky Situations

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Il est d’usage, au cours d’un traitement, d’aider les joueurs pathologiques à développer et à mettre en pratique différentes stratégies pour prévenir les rechutes. Le traitement du jeu pathologique a connu des avancées dans les dernières années en utilisant la réalité virtuelle (RV) pour exposer les joueurs à leur envie de jouer. L’influence de cette modalité de traitement sur les stratégies de prévention des rechutes reste toutefois à évaluer. Notre étude visait donc à identifier et à classifier les stratégies proposées par les joueurs pour gérer leur envie de jouer lorsqu’ils sont confrontés à des situations à risque d’une exposition à la RV. Des enregistrements de dix joueurs pathologiques ayant pris part à une séance de prévention de la rechute en RV ont été transformés en verbatim. Le contenu du verbatim a fait l’objet d’une analyse de type déductif et inductif validée par une procédure d’accord interjuges. Les résultats ont révélé six stratégies comportementales et sept stratégies cognitives proposées par les joueurs, avec une moyenne de dix stratégies différentes par joueur. Les stratégies cognitives montrent l’influence possible de la restructuration cognitive qui a eu lieu lors de la thérapie. De plus, l’évitement semble être l’une des stratégies comportementales clés pour les participants, lorsque confrontés à un environnement de bar. Cette étude appuie le potentiel de RV en prévention de la rechute. La spécificité des stratégies provenant de la RV, en comparaison avec l’exposition en imagination, ainsi que l’efficacité des stratégies abordées en séance de RV devraient faire l’objet d’autres études.AbstractIt is common practice, during treatment, to help pathological gamblers develop and implement different strategies to prevent relapses. Treatment for pathological gambling has made progress in recent years and now uses virtual reality (VR) to make gamblers aware of their gambling urges. However, the impact of this treatment method on relapse prevention strategies has yet to be evaluated. This study aims to identify and classify strategies to manage gambling urges as proposed by gamblers when faced with risky situations during exposure in virtual reality. Recordings taken of ten pathological gamblers during a virtual reality relapse prevention session were transcribed verbatim. The verbatim was the subject of a deductive and inductive analysis validated by a procedure agreed upon by the judges. The results reveal six behavioural and seven cognitive strategies proposed by the players with an average of ten strategies per player. The cognitive strategies show that the cognitive restructuring used during treatment had a possible impact. Furthermore, in bars, avoidance seems to be one of the key behavioural strategies for the participants. This study supports the potential of virtual reality in relapse prevention. The specificity of the strategies proposed during VR exposure compared with imaginary exposure as well as the effectiveness of the strategies addressed in VR sessions should be studied further.

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Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist’s office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program.
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Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.
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Aims: Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n = 3), exposure (n = 3) or both (n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.
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Les recherches, qu'elles soient de nature quantitative ou qualitative, visent la description, l'exploration, l'évaluation, l'explication ou la prédiction du monde-vie (Schultz) tel que nous le percevons et le construisons socialement. Camper la recherche qualitative dans le domaine exploratoire représente une amputation de son pouvoir d'intelligibilité de la réalité. Il est plutôt souhaitable de qualifier l'ambition descriptive, exploratoire, évaluative, explicative ou prédictive d'une recherche. C'est pourquoi, dans ce texte, nous tentons de répondre à cette question : la recherche qualitative est-elle nécessairement exploratoire? Nous délimitons d'abord la notion de recherche exploratoire. Ensuite, à l'aide d'une recherche-intervention sur la santé mentale au travail conduite auprès de travailleurs cols blancs, nous tentons de montrer qu'une recherche qualitative n'a pas nécessairement un caractère exploratoire, bien que certaines de ses parties puissent être de cet ordre. Enfin, nous précisons le concept de recherche exploratoire en proposant des repères sur les visées et les modalités de recherche.
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Le but de cet article est de décrire l'approche inductive générale d'analyse de données qualitatives telle que proposée par Thomas (2006). Cet article s'adresse autant aux étudiants-chercheurs peu familiers avec cette approche qu'aux chercheurs expérimentés qui souhaitent avoir une vue d'ensemble de l'analyse inductive communément utilisée dans les études de nature qualitative et exploratoire. Les objectifs liés à l'utilisation de l'analyse inductive sont : (1) de condenser des données brutes dans un format résumé, (2) d'établir des liens entre les objectifs de la recherche et les catégories découlant de l'analyse des données brutes et (3) de développer un cadre de référence ou un modèle à partir des nouvelles catégories émergentes. Ce type d'analyse, qui permet de donner un sens à un corpus de données brutes, requiert un ensemble de procédures relativement simples qui seront détaillées dans le présent article. Notre objectif est de faciliter la tâche du chercheur qui désire produire des résultats respectant les critères de validité de la recherche qualitative en fonction des objectifs de recherche visés.
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Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
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A general inductive approach for analysis of qualitative evaluation data is described. The purposes for using an inductive approach are to (a) condense raw textual data into a brief, summary format; (b) establish clear links between the evaluation or research objectives and the summary findings derived from the raw data; and (c) develop a framework of the underlying structure of experiences or processes that are evident in the raw data. The general inductive approach provides an easily used and systematic set of procedures for analyzing qualitative data that can produce reliable and valid findings. Although the general inductive approach is not as strong as some other analytic strategies for theory or model development, it does provide a simple, straightforward approach for deriving findings in the context of focused evaluation questions. Many evaluators are likely to find using a general inductive approach less complicated than using other approaches to qualitative data analysis.
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A prospective design was used to explore the precipitants of relapse in a naturalistic sample of pathological gamblers (N = 101) who had recently quit gambling. Relapse rates were high; only 8% were entirely free of gambling during the 12-month follow-up. Relapses were highly variable but occurred most frequently in the evening, when the person was alone and thinking about finances. Moods prior to the gambling were as likely to be positive as negative. The most frequently reported attributions, particularly for major relapses, were cognitions about winning and feeling the need to make money, unlike substance abuse relapses that tend to be attributed to negative affect. Some gender differences were found, but the precipitants of shorter and longer relapses did not differ.
Gamblers engage with a broad range of resources and strategies to limit or reduce their gambling. However, there is limited research examining the uptake and helpfulness of the full range of strategies gamblers employ. The aim of this study was to compile a comprehensive inventory of change strategies and then group these using principal component analysis based on perceived helpfulness. We also aimed to determine whether there are differences in the helpfulness of strategies by demographic, gambling severity, and readiness indicators. The Change Strategies Questionnaire-Version 1 contained 99 strategies, and 489 gamblers (including 333 problem gamblers) identified the most frequently endorsed strategy as remind yourself of negative consequences of gambling (92%) and think about how money could be better spent (92%). Principal components analysis identified 15 strategy groupings: cognitive, well-being, consumption control, behavioral substitution, financial management, urge management, self-monitoring, information seeking, spiritual, avoidance, social support, exclusion, planning, feedback, and limit finances. There were differences in the helpfulness of strategies by age and gambling severity. Few strategies were correlated with confidence to manage an urge to gamble. Overall, change strategies were viewed as moderately helpful. The top five strategies were all used by at least 90% of gamblers, and these strategies were all cognitive in nature. This study provides important information for the development of interventions targeting gambling behavior. Furthermore, it suggests that interventions for problem gambling should target cognitive, feedback, planning, and urge management strategies.
Dysfunctional thoughts contribute to the development and maintenance of gambling disorder. Although studies in the gambling field have mostly documented dysfunctional thoughts specific to gambling (gambling-specific thoughts; GSTs), gamblers also manifest thoughts that have been documented for other addictions (addiction-related thoughts [ARTs]), such as relief-oriented thoughts. Improvements in the efficiency of cognitive restructuring in gamblers requires better access to their dysfunctional thoughts, which may be achieved through exposure to a gambling situation in virtual reality (VR) or in imagination (IM). Although VR appears to present advantages in prompting gamblers to verbalize dysfunctional thoughts, no studies have compared VR to IM to verify these advantages. This study documents GSTs and ARTs as verbalized by individuals with gambling disorder during a gambling session in VR (n = 16) or in IM (n = 13). It also compares the number of GSTs and ARTs verbalized by gamblers in both conditions, as well as the different types of GSTs. Qualitative data were first analyzed and then transformed into quantitative data for frequency theme analyses and t tests. Results show that exposure to a gambling situation in VR allows access to more GSTs, as well as to a greater diversity of GSTs, than does exposure to gambling in IM; however, VR does not allow access to more ARTs, which suggests that these thoughts may be more automatic in gamblers, or that the VR environment was not designed to evoke these thoughts. Overall, the findings suggest that VR in a clinical context could help increase the efficiency of cognitive restructuring in gamblers. © 2018, Centre for Addiction and Mental Health. All rights reserved.
Background: There is evidence supporting the use of cognitive-behavioral therapy (CBT) in the treatment of problem gambling. Despite this, little is known about how CBT works and which particular approach is most effective. This paper aims to synthesize the evidence for current CBT and propose a more unified approach to treatment. Methods: A literature review and narrative synthesis of the current research evidence of CBT for the treatment of problem gambling was conducted, focusing on the underlying mechanisms within the treatment approach. Results: Several CBT approaches were critiqued. These can be divided into forms of exposure therapy (including aversion techniques, systematic desensitization and other behavioral experiments) those focusing on cognitive restructuring techniques (such as reinforcement of nongambling activity, use of diaries, motivational enhancement and audio-playback techniques and third wave techniques including mindfulness. Findings, in relation to the treatment actions, from this synthesis are reported. Conclusions: The debate surrounding the treatment of problem gambling has been conducted as an either/or rather than a both/and discourse. This paper proposes a new, unified approach to the treatment of problem gambling that incorporates the best elements of both exposure and cognitive restructuring techniques, alongside the use of techniques borrowed from mindfulness and other CBT approaches.
Relapse prevention (RP) is an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self-efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model.
The value of any scientific study greatly depends on the researcher’s ability to demonstrate that his or her findings are credible. To do this, researchers rely on criteria based on the epistemology underlying their work. It is not unusual for these criteria to be comparable from one study to the next. However, variety in these criteria and in the terminology used by researchers makes any comparison difficult. The aim of this article is to review and explain the scientific criteria used by qualitative researchers.
Psychological therapies have been proposed for the treatment of pathological and problem gambling, and this review summarised current evidence for these therapies. It included best-quality randomised trials, where therapy was compared with conditions including 'no treatment’ controls or referral to Gamblers Anonymous. It considered categories of therapy including: (1) cognitive-behaviour therapy (CBT); (2) motivational interviewing therapy; (3) integrative therapy; and (4) other psychological therapy. The search identified 14 studies and we combined data from these. Data from nine studies indicated benefits of CBT in the period immediately following treatment. However, there were few studies across longer periods of time (e.g. 12 months) after treatment, and little is known about whether effects of CBT are lasting. Data from three studies of motivational interviewing therapy suggested some benefits in terms of reduced gambling behaviour, but not necessarily other symptoms of pathological and problem gambling. However, the data come from few studies and conclusions regarding motivational interviewing therapy require further research. There were also few studies that provided evidence on integrative therapies (two studies) and other psychological therapies (one study), and there is currently insufficient data to evaluate the efficacy of these therapies
The purpose of this book is to describe and explain methodology and research design in clinical psychology. The book elaborates the methods of conducting research and the broad range of practices, procedures, and designs for developing a sound knowledge base. It also focuses on the underpinnings, rationale, and purposes of these practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study provides a descriptive exploration of the reason(s) why individuals who experienced a gambling relapse terminated the relapse episode and how they did so. Thirty-eight males and 22 females were administered the Relapse Experience Interview (Marlatt & Gordon, 1989). Participants (N = 60) cited a mean of 1.5 reasons for terminating relapse, with monetary factors, affective factors, reappraisal and external constraints emerging as central factors in relapse termination. Participants reported using a mean of 1.7 strategies for stopping a gambling episode. The strategies used were identified as either cognitive or behavioural and were classified according to the processes of change model (Prochaska, DiClemente & Norcross, 1992). Stimulus control, self-liberation, counterconditioning and helping relationships were the main strategies used to terminate gambling relapse. Participants showed a preference for using either cognitive or behavioural strategies rather than both.
This paper describes qualitative data regarding psychological factors that may affect gambling behavior among treatment-seeking pathological gamblers. Participants (n = 84) diagnosed with pathological gambling were treated in a clinical trial examining the efficacy of cognitive behavioral therapy (CBT). Qualitative data were collected from participants during each of 8 structured CBT sessions. Specific gambling-related psychological factors that were assessed include triggers, consequences, high-risk situations, craving experiences, assertiveness skills, cognitive distortions, and coping strategies. The most commonly reported triggers for gambling were lack of structured time and negative emotional state, which were similar to the high-risk times for gambling. The most frequently listed positive consequences of gambling were enjoyment associated with winning and use of gambling as an escape. Negative consequences of gambling included depressed mood, financial problems, and conflict with family. Coping strategies changed during treatment, as participants reported relying less upon avoidance and distraction, and became better able to utilize support networks and cognitive coping skills. These data are important to better understand the factors associated with the development, maintenance, and cessation of pathological gambling.
Despite the prevalence of gambling world-wide, relatively few individuals become problem gamblers. Additionally many problem gamblers recover without professional assistance. The current study aim was to examine how individuals self-manage their gambling through (a) assessing frequency of use of a range of self-regulation strategies (b) examining how these strategies cluster and (c) exploring relationships between strategies, gambling frequency, amount spent and problem gambling severity. A sample of 303 gamblers was recruited, over-sampling for problem gamblers as assessed by the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index (mean age 26.4 years, SD = 10.1 years; 119 males, 184 females; 238 social gamblers, 63 problem gamblers, 2 unclassified). They rated extent of usage of 27 gambling self-management techniques and completed the PGSI and other gambling measures. Factor analysis of items produced five factors, named Cognitive Approaches, Direct Action, Social Experience, Avoidance and Limit Setting. The relationships between these factors and key gambling variables were consistent with hypotheses that problem gamblers trying to reduce their gambling would be more likely to use the strategies than other gambler groups. The potential for developing the factors into a Gambling Self-regulation Measure was explored.
Ce travail s'inscrit dans le domaine du traitement automatique du langage naturel et traite plus spéci?quement de l'application de ce dernier à la segmentation thématique de texte. L'originalité de cette thèse consiste à intégrer dans une méthode non-supervisée de segmentation thématique de texte de l'information syntaxique, sémantique et stylistique. Ce travail propose une approche linéaire de la segmentation thématique s'appuyant sur une représentation vectorielle issue de l'analyse morpho-syntaxique et sémantique de la phrase. Cette représentation est ensuite utilisée pour calculer des distances entre segments thématiques potentiels en intégrant de l'information stylistique. Ce travail a donné lieu au développement d'une application qui permet de tester les di?érents paramètre de notre modèle, mais qui propose également d'autres approches testées dans ce travail. Notre modèle a été évaluer de deux manières di?érentes, une évaluation automatique sur la base de textes annotés et une évaluation manuelle. Notre évaluation manuelle a donné lieu à la dé?nition d'un protocole d'évaluation s'appuyant sur des critères précis. Dans les deux cas, les résultats de notre évaluation ont été au niveau, voir même au dessus, des performances des algorithmes les plus populaires de la littérature.
Problem gambling is of serious public, social and clinical concern, especially so because ease of access to different types of gambling is increasing. A systematic review and meta-analysis was carried out to determine whether Cognitive-Behavioural Therapies (CBT) were effective in reducing gambling behaviour. Twenty-five studies which met the inclusion criteria were identified. Overall, there was a highly significant effect of CBT in reducing gambling behaviours within the first three months of therapy cessation regardless of the type of gambling behaviour practiced. Effect sizes were also significant at six, twelve and twenty-four month follow-up periods. Sub-group analysis suggested that both individual and group therapies were equally as effective in the 3 month time window, however this equivalence was not clear at follow-up. All variants of CBT (cognitive therapy, motivational interviewing and imaginal desensitization) were significant, although there was tentative evidence that when different types of therapy were compared cognitive therapy had an added advantage. Meta-regression analyses showed that the quality of the studies influenced the effect sizes, with those of poorer quality having greater effect sizes. These results give an optimistic message that CBT, in various forms, is effective in reducing gambling behaviours. However, caution is warranted because of the heterogeneity of the studies. Evaluation of treatment for problem gambling lags behind other fields and this needs to be redressed in the future.
Eighteen pathological gamblers reporting abstinence at a 2-9-year follow-up period were classified into two samples; those reporting complete abstinence, or those abstinent with intermittent relapse episodes. Results indicated that both samples improved significantly on post-treatment psychological and demographic measures, and did not differ from each other. It was concluded that a subgroup of gamblers may experience intermittent brief relapses that are not invariably associated with a continued return to addictive gambling habits. Complete abstinence as a criterion for successful treatment outcome may be too stringent in that it fails to acknowledge the possibility of continued abstinence following brief episodes of relapse.
Recent habituation literature is reviewed with emphasis on neuro-physiological studies. The hindlimb flexion reflex of the acute spinal cat is used as a model system for analysis of the neuronal mechanisms involved in habituation and sensitization (i.e., dishabituation). Habituation of this response is demonstrated to follow the same 9 parametric relations for stimulus and training variables characteristic of behavioral response habituation in the intact organism. Habituation and sensitization appear to be central neural processes and probably do not involve presynaptic or postsynaptic inhibition. It is suggested that they may result from the interaction of neural processes resembling "polysynaptic low-frequency depression," and "facilitatory afterdischarge." "Membrane desensitization" may play a role in long-lasting habituation. (6 p. ref.)
This study investigates the influence of coping on the outcome of a relapse crisis for a sample of 125 treated alcoholics during the first 12 weeks following treatment completion. Both number and type of coping responses were examined. Results indicated that survival of a relapse crisis was most strongly related to the number of coping strategies used. Termination of a drinking episode was also related to number of coping responses. In addition, the type of coping strategy influenced survival, with the exclusive use of active coping strategies significantly associated with abstinence outcome compared with the exclusive use of avoidant strategies. Combining active and avoidant strategies appeared to be most effective for terminating a drinking episode. Results are discussed in the context of the cognitive-behavioral model of relapse, the general literature on coping behavior and the findings of other relapse studies.
An exploratory study was conducted to understand the process of recovery from gambling problems. Media recruitment was used to identify a resolved (n = 43) and a comparison group of active pathological gamblers (n = 63). Participants showed evidence of significant problems related to gambling as well as high rates of co-morbid mood and substance use disorders. The median length of resolution was 14 months with a range of 6 weeks to 20 years. Resolved gamblers reported a variety of reasons for quitting gambling, related mainly to emotional and financial factors. They did not experience a greater number of precipitating life events compared with active gamblers but did report an increase in positive and a decrease in negative life events in the year after resolution. Both resolved and active gamblers who had relatively more severe problems were more likely to have had treatment or self-help involvement, whereas those with less severe problems, if resolved, were "naturally recovered". The results support the need for a continuum of treatment options for problem gamblers and provide helpful information about recovery processes.
This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach's alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.
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