Mena-Moreno Teresa, Testa Giulia, Mestre-Bach Gemma, Miranda-Olivos Romina, Granero Rosario, Fernández-Aranda Fernando, Menchón José M, Jiménez-Murcia Susana
Department of Psychiatry, University Hospital of Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Clin Med. 2022 Mar 14;11(6):1611. doi: 10.3390/jcm11061611.
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.
通过延迟折扣（DD）任务衡量的冲动选择，已在患有赌博障碍（GD）的患者中得到证实。然而，DD与GD患者治疗结果之间的影响几乎未被探讨。本研究的目的是：（1）根据年龄和赌博偏好（策略性与非策略性），检查GD患者中DD与临床变量之间的基线关联；（2）在考虑其他临床变量影响的情况下，估计DD对认知行为疗法（CBT）较差结果的预测作用。133名寻求治疗的男性GD患者在基线时接受了DD任务以及GD严重程度、人格特质和精神病理学测量。治疗结果通过CBT退出率和复发率来衡量。结果显示，DD与GD严重程度之间存在基线关联（策略性赌徒的相关系数R = 0.408，混合赌徒的R = 0.279），以及DD与积极/消极紧迫感之间存在关联（最年轻患者的R = 0.330，中年患者的R = 0.244，报告偏好策略性游戏的赌徒约为R = 0.35）。其他人格特质，如高回避伤害和低合作性，在基线时也与DD相关（策略性赌徒中的R = 0.606）。关于治疗结果，更高的折扣率预测策略性赌徒（优势比OR = 3.01）和中年赌徒（OR = 1.59）复发风险更高，以及年轻赌徒（OR = 1.89）、非策略性赌徒（OR = 1.70）和混合赌徒（R = 4.74）退出风险更高。GD严重程度介导了年龄、DD、人格特质与CBT不良结果之间的关联。总之，冲动选择会影响GD患者的治疗反应，并可能在很大程度上干扰治疗反应。在GD患者中考虑DD，寻求治疗的患者可能有助于控制其对治疗依从性和复发的影响。
