Abstract
Impulsive choice, measured by delay discounting (DD) tasks, has been shown in patients with gambling disorders (GD). However, the impact of DD and treatment outcome has been scarcely explored in GD patients. The aims of this study were: (1) to examine the baseline association between DD and clinical variables in GD patients depending on their age and gambling preferences (strategic vs. non-strategic); and (2) to estimate the predictive role of DD on poorer outcomes of cognitive-behavioral therapy (CBT) when considering also the effect of other clinical variables. 133 treatment-seeking male GD patients were evaluated at baseline with a DD task and measures of GD severity, personality traits and psychopathology. Treatment outcome was measured in terms of dropout from CBT and relapses. Results showed baseline associations between DD and GD severity (correlation coefficient R = 0.408 among strategic gamblers and R = 0.279 among mixed gamblers) and between DD and positive/negative urgency (R = 0.330 for the youngest patients, R = 0.244 for middle age, and around R = 0.35 for gamblers who reported preferences for strategic games). Other personality traits such as high harm avoidance and low cooperativeness were also related to DD at baseline (R = 0.606 among strategic gamblers). Regarding treatment outcome, a steeper discount rate predicted a higher risk of relapses in strategic gamblers (odds ratio OR = 3.01) and middle-age ones (OR = 1.59), and a higher risk of dropout in younger gamblers (OR = 1.89), non-strategic gamblers (OR = 1.70) and mixed gamblers (R = 4.74). GD severity mediated the associations between age, DD, personality traits and poor CBT outcome. In conclusion, impulsive choice affects treatment response in individuals with GD and may interfere with it to a significant extent. Considering DD in GD, patients seeking treatment could help control its impact on treatment adherence and relapses.
Highlights
Gambling Disorder (GD) is characterized by a persistent and recurrent urge to gamble that causes clinical distress or impairment in family, professional or personal areas
A delay discounting (DD) task was adopted to explore the relation between discount rates and short-term response to cognitive-behavioral therapy (CBT) in a large sample of male GD patients
Baseline discount rates were associated with GD severity and with emotional impulsive traits, in GD patients of young/middle age and with preferences for strategic gambling
Summary
Gambling Disorder (GD) is characterized by a persistent and recurrent urge to gamble that causes clinical distress or impairment in family, professional or personal areas. In terms of personality traits, the UPPS [14] is a widely adopted model which divides impulsivity into four dimensions: (i) lack of premeditation, involving acting without thinking; (ii) lack of perseverance, representing the tendency to not finish tasks; (iii) sensation seeking, encompassing behavior tendencies to try new and exciting activities or sensations; (iv) as well as positive and negative urgency and a tendency to act rashly in response to extreme negative or positive emotions. This is a validated model across different age samples and from which the UPPS-P Scale was developed [14]
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