Decision making, cognitive distortions and emotional distress: A comparison between pathological gamblers and healthy controls

https://doi.org/10.1016/j.jbtep.2016.08.012Get rights and content

Highlights

  • Decision making, irrational beliefs and mood in gamblers and controls were assessed.

  • Pathological gamblers showed poor decision making compared to controls.

  • Pathological gamblers reported high cognitive distortions and negative emotions.

  • Negative correlations between decision making and cognitive distortion levels were present.

  • Irrational beliefs and poor decision making are predictors of gambling disorder.

Abstract

Background and objectives

The etiology of problem gambling is multifaceted and complex. Among others factors, poor decision making, cognitive distortions (i.e., irrational beliefs about gambling), and emotional factors (e.g., negative mood states) appear to be among the most important factors in the development and maintenance of problem gambling. Although empirical evidence has suggested that cognitive distortions facilitate gambling and negative emotions are associated with gambling, the interplay between cognitive distortions, emotional states, and decision making in gambling remains unexplored.

Methods

Pathological gamblers (N = 54) and healthy controls (N = 54) completed the South Oaks Gambling Screen (SOGS), the Iowa Gambling Task (IGT), the Gambling Related Cognitions Scale (GRCS), and the Depression Anxiety Stress Scale (DASS-21).

Results

Compared to healthy controls, pathological gamblers showed poorer decision making and reported higher scores on measures assessing cognitive distortions and emotional distress. All measures were positively associated with gambling severity. A significant negative correlation between decision making and cognitive distortions was also observed. No associations were found between poor decision making and emotional distress. Logistic regression analysis indicated that cognitive distortions, emotional distress, and poor decision making were significant predictors of problem gambling.

Limitations

The use of self-report measures and the absence of female participants limit the generalizability of the reported findings.

Conclusions

The present study is the first to demonstrate the mutual influence between irrational beliefs and poor decision making, as well as the role of cognitive bias, emotional distress, and poor decision making in gambling disorder.

Introduction

Gambling disorder has been defined as a “persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress” (American Psychiatric Association, 2013, p.585). The negative consequences arising from gambling (e.g., occupational, relationship, and/or financial problems) do not necessarily deter problem gambling. In fact, counter intuitively, many individuals with a gambling disorder are typically unable to cease the problematic behavior and are prone to chasing losses in an attempt to recover the money lost (Lesieur, 1979, Linnet et al., 2006). Furthermore, it has been empirically demonstrated that problem gamblers show a foreshortened time horizon, since they are likely to consider the immediate consequences rather than the long-term outcomes (Ciccarelli, Malinconico et al., 2016, Cosenza et al., 2016, Nigro et al., 2016).

Although the etiology of gambling disorder is complex and multifaceted, several studies have identified poor decision making (Wiehler & Peters, 2015), cognitive distortions (Goodie & Fortune, 2013), and emotional distress (Lorains, Cowlishaw, & Thomas, 2011) as among the most critical factors associated with problem gambling. However, no study to date has taken into account the interplay of these factors when examining gambling disorder. A large body of research has indicated that problem gamblers perform more poorly than healthy controls in behavioral decision making tasks (see Wiehler & Peters, 2015 for a review), such as the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994). The IGT is a laboratory task that mimics real-life decisions in conditions of reward and punishment, as well as decision making under uncertainty.

Originally, the IGT was developed to capture decision making fallacies in patients with ventromedial cortex damage (Bechara et al., 2005, Bechara et al., 1994). These patients showed a compromised ability to experience and/or to express appropriate emotions, as well as impaired decision making ability, while preserving a normal intellect. Starting from these observations, Damasio, Tranel, and Damasio (1991) formulated the somatic marker hypothesis (SMH; Damasio, 1994). The SMH states that emotions are important features in choice processing as they can guide or bias (consciously or unconsciously) decision making behavior. The SMH postulates that decision making process can be assisted by somatic markers (i.e., specific types of feelings expressed through somatic states). The somatic markers are represented and regulated in the ventromedial prefrontal cortex, which associates the implicit representations of affects with the explicit representations of potential actions and outcomes. In this way, the somatic markers influence decisions, acting as alarms for bad choices or incentives for good choices (Damasio, 1994).

Similarly to ventromedial prefrontal patients, gamblers appear unable to consider long-term benefits, probably due to a lack of response flexibility or chasing losses (see Goudriaan et al., 2005, Kertzman et al., 2011, Linnet et al., 2006). According to other authors, poor decision making stems from a decreased reward sensitivity (Goudriaan, Oosterlaan, de Beurs, & van den Brink, 2006), an excessive response to cues predicting immediate and large monetary rewards (Brevers, Bechara, Cleeremans, & Noël, 2013, p. 9; see also Lakey, Goodie, & Campbell, 2007), an anomalous reward processing (Lorains et al., 2014), or disrupted basic emotional processing (Brevers et al., 2012).

Cognitive distortions concern misbeliefs about gambling outcomes and the likelihood of influencing them (Clark et al., 2013, Goodie and Fortune, 2013, Griffiths, 1994, Jacobsen et al., 2007), such as skill misperceptions, illusion of control, superstitious beliefs, selective memory for wins, and interpretative biases (Toneatto, 1999).

Converging evidence from studies examining the association between cognitive distortions and problematic gambling have demonstrated that gamblers tend to misattribute cause-and-effect relationships to unlinked events, and believe they can influence gambling outcomes (e.g., Cosenza and Nigro, 2015, Joukhador et al., 2004, Myrseth et al., 2010). Interestingly, several studies suggest that the appropriate use of mathematical and probabilistic rules in daily life do not appear to be a protective factor from gambling (Benhsain and Ladouceur, 2004, Delfabbro et al., 2006, Sévigny and Ladouceur, 2003). However, even though non-problem gamblers are unable to profit from the knowledge of probabilistic rules (e.g., Joukhador, Maccallum, & Blaszczynski, 2003), many aspects differentiate them from problematic gamblers in terms of quantity (e.g., Ciccarelli, Griffiths et al., 2016, Miller and Currie, 2008) and quality of distorted beliefs (e.g., Källmen, Andersson, & Andren, 2008). However, arguably the most relevant aspect regards the insensitivity to disconfirming evidence (Ladouceur, 2004).

Finally, research has indicated that problem gambling is frequently associated with negative affective states, such as negative mood (Griffiths, 1995, Matthews et al., 2009) and/or anxiety disorders (e. g., Kessler et al., 2008, Petry et al., 2005). More specifically, some epidemiological surveys suggest that nearly half of all problem gamblers suffer from mood disorders (e.g., Kim et al., 2006, Lorains et al., 2011), and that pathological gamblers undergoing treatment report severe depression (Ladouceur et al., 2006). Other studies have provided evidence that individuals may use gambling for mood modification, that is to find relief from negative states and to increase arousal when bored (e.g., Nower and Blaszczynski, 2010, Stewart et al., 2008, Wood and Griffiths, 2007, Wulfert et al., 2005). Gee, Coventry, and Birkenhead (2005) found higher levels of anxiety during and after gambling and concluded that gambling could result in mood modification. Finally, experimental studies attempting to clarify the causal relationship between mood and gambling severity have highlighted differences in mood before and after gambling, but have failed to find effects of induced mood on gambling (e.g., Hills et al., 2001, Mishra et al., 2010).

Given that no study to date has ever examined the relationship among decision making, cognitive distortions, and negative affective states in pathological gambling, the aim of the present study was to investigate the interplay among these variables by comparing pathological gamblers and healthy controls. It was hypothesized that compared to healthy controls, pathological gamblers would show (a) poorer decision making ability, (b) higher levels of cognitive distortions, and (c) higher levels of emotional distress. It was also hypothesized that there would be strong correlations between these variables and gambling severity.

Section snippets

Participants

The sample comprised 108 males aged 24–65 years (mean age = 41.56 years; SD = 10.94). Of these, 54 were pathological gamblers (PGs) with a DSM-5 (APA, 2013) diagnosis of gambling disorder, and recruited from Local Health Trusts. The pathological gamblers were matched with 54 healthy controls (HCs) recruited from the community. No pathological gamblers had comorbid mental disorders, neurological and/or medical illnesses, or were undergoing any pharmacological treatment. Healthy controls had no

Results

Zero-order correlations revealed significant positive associations between all measures and problem gambling severity, as well as between IGT and GRCS scores (Table 1).

For analyzing the profile of the IGT performances of the two groups per block, a 2 × 5 repeated measures ANOVA was run, with group (HCs versus PGs) as a between-subjects factor and scores on the five subsequent IGT blocks as dependent variables. The analysis revealed a significant within-subjects effect of block (F4, 103 = 8.27; p

Discussion

The present study addressed an identified gap in literature regarding the relationship between pathological gambling, decision making, cognitive distortions, and emotional factors (i.e., depression, anxiety and stress). This was achieved in an experimental task comparing a group of confirmed pathological gamblers with a group of healthy controls, and determining which of these factors most accounted for gambling disorder. As expected, a negative correlation between IGT scores and problem

Conclusions

The present study is the first ever to simultaneously examine the relationship between decision making, cognitive distortions, and emotional distress in a confirmed sample of pathological gamblers (compared to healthy controls).

In line with previous literature, the present study demonstrated that pathological gamblers showed deficits in decision making processes, and reported more irrational beliefs and higher levels of anxiety and depression compared to healthy controls. Additionally, the

Declaration of interest

All other authors declare that they have no conflicts of interest.

Role of funding organizations

No funding was provided for this study.

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