ACT on Gambling

Ravi Iyer

Gambling Counsellor

Melbourne Counselling Service

Gambler’s Help City and Inner North

1. ACT Model

2. Current state of research

3. Case Studies

1. The ACT Model

Based on modern behavioural psychology:

‘relational frame theory’

applies mindfulness and acceptance processes

commitment & behaviour change processes

creation of psychological flexibility

Hayes, Luoma, Bond, Masuda and Lillis, 2006

“

”

ACT

processes

Relational Frame Theory

Functional Contextualism

Functional Contextualism

Context is everything

Pragmatic truth

Workability

Relational Frame Theory

Metaphor

Anxiety Quicksand

Psychological

Struggle

Physical

Struggle

Equivalent

Increasing arousal Increasing arousal

Don’t

struggle Don’t

struggle

ACT Hexaflex

ACT processes

Psychological

Flexibility

Away

Toward

Let Go

Be Present

Get Moving

Defusion

Acceptance

Present

Moment

Self as

Context

Values

Committed

Action

Dr Kevin Polk

http://drkevinpolk.blogspot.com.au/p/matrix-and-hexaflex.html

2. State of the research

2. State of the research

Comparatively new therapy in Gambling – 7 years

Dixon, Nastally, Jackson & Habib, 2009: Near miss effect

Addictions more generally – 10 years

Heffner, Eifert, Parker, Hernandez & Sperry, 2003: Alcohol dependence

Gifford et al., 2004: Smoking cessation – 76 smokers

Hayes et al., 2004: polysubstance abusers – 138 ORT patients

Experiential Avoidance

Marotta, 2002: Experiential avoidance as a functional

process in gambling

Rosenthal, 1994: Psychodynamic theory –

defense against internal affects

Ruiz, 2010

Deliberate efforts to avoid and escape from private events

such as affects, thoughts memories and bodily sensations

which are experienced as aversive

Psychological inflexibility

Studies reviewed either equally efficacious or better than CBT

Weighted correlation r=0.55 Depression; r=0.52 Anxiety & EA

“

”

Review of ACT evidence

Maynard, Wilson, Labuzienski, & Whiting,, 2015

• Individual studies not individually significant

• When combined, yielded a significant pooled effect size

Experiential

Avoidance Thought Suppression Mindfulness

Problematic Gambling

Systematic review & Meta-analysis: Mindfulness & Gambling

Riley, 2014

103 Gamblers

de Lisle, Dowling & Allen, 2011

Important for gamblers to incorporate a mindful practice into daily routines

Gamblers come on board only after consequences outweigh benefits

Important to identify mindfulness practices that suit the client

Can be framed as a personal challenge

Need to be used with caution,

particularly with psychosis

Review of mindfulness & problem gambling

de Lisle, Dowling & Allen, 2014

Low mindfulness

= high emotional dysregulation

= psychological distress

o Thought suppression common to gamblers

o Problem gamblers have low levels of mindfulness

o Mindfully attending to negative emotions may lead

to gradual extinction of gambling

Study 1 = 78 gamblers Study 2 = 205 Gamblers

Dixon and colleagues, 2016

Following treatment, gamblers reported higher engagement

In psychological flexibility and mindfulness behaviors

Amygdala

Cuneus

Ventral Striatum

Middle & prefrontal gyrus

Inferior parietal lobe

Precuneus

ACT treated gamblers observed

winning reals differently

PRE POST

10 students (ACT) + 8 (untreated)

3. Case Studies

ACT Triflex

Case studies: 60 YO female

o Experienced teenage pregnancy

o Black sheep of the family

o Embezzled substantial amount over several years

Acceptance OPEN

UP

Psychological

Flexibility

Case study: 25 YO male

o Lives for each pay

o Dominated by self critical thoughts, perceived judgements

o Future hope / past failures

BE PRESENT

Psychological

Flexibility

Case study: 32 YO Male (Schizophrenia)

o Positive symptoms well managed

o Can discuss thoughts & feelings

o Concern about developing a name for himself

o Unsure of how to move forward

Values

DO WHAT

MATTERS

Psychological

Flexibility

de Lisle, SM., Dowling, NA., & Allen, JS. (2011). Mindfulness and

problem gambling: A review of the literature. Journal of Gambling Studies,

DOI: 10.1007/s 10899-011-9284-7

de Lisle, S., Dowling, N., & Allen, S. (2014). Mechanisms of action in the

relationship between mindfulness and problem gambling behaviour.

International Journal of Mental Health Addiction, 12: 206-225.

Dixon, MR, Nastally, BL, Jackson JE, Habib R. (2003).

Altering the near-miss effect in slot machine gamblers. J Appl Behav Anal. 2009

Winter;42(4):913-8. doi: 10.1901/jaba.2009.42-913.

REFERENCES

Dixon, MR., Wilson, AN., Habib, R. (2016) Neurological evidence of

acceptance and commitment therapy effectiveness in college-age gamblers.

Journal of Contextual Behavioral Science 5 (2016) 80–88

Gifford, EV., Kohlenberg, BS., Hayes, SC., Antonuccio, DO., Piasecki, MM.,

Rasmussen-Hall, ML., & Palm, KM. (2004). Acceptance-based treatment for

smoking cessation. Behaviour Therapy, 35(4): 689-705

Heffner, M., Eifert, G. H., & Parker, B. T. (2003).

Valued directions: Acceptance and commitment therapy in the treatment of

alcohol dependence. Cognitive and Behavioral Practice, 1(4), 378-383.

Hayes, S.C., Luoma, J.B., Masuda, A., & Lillis, J. (2006). Acceptance and commitment

Therapy: Model, processes and outcomes. Psychology Faculty Publications, Paper101

Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V.,

Byrd, M., & Gregg, J. (2004). A preliminary trial of Twelve-Step Facilitation and

Acceptance and Commitment Therapy with polysubstance-abusing methadone-

maintained opiate addicts. Behavior Therapy, 35(4), 667-688.

Marotta JJ (2002). Experiential avoidance as a functional process in gambling,

in Marotta JJ, Cornelius JA, and Eadington WR. (Eds). The downside: Problem and

pathological gambling, University of Nevada Press

Maynard, B.R., Wilson, A.N., Labuzienski, E., & Whiting, S.W. (2015).

Mindfulness-based approaches in the treatment of disordered gambling:

A systematic review and meta-analysis. Research on social work practice, 1-15.

Rosenthal, RJ & Rugle, LJ. (1994). A psychodynamic approach to the treatment of

pathological gambling: Part I. Achieving abstinence, Journal of Gambling Studies,

10(1): 21-42

Ruiz, FJ. (2010). A review of acceptance and commitment therapy (ACT)

Empirical evidence: Correlational, experimental, psychopathological, component

and outcome studies. International Journal of Psychology and psychological

therapy, 10(1): 125-162.

Riley, Ben (2014). Experiential avoidance mediates the association between

thought suppression and mindfulness with problem gambling. Journal of

Gambling Studies, 30: 163-171.