ACT on Gambling Ravi Iyer Gambling Counsellor Melbourne - - PowerPoint PPT Presentation

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

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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

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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

• Thought suppression common to gamblers
• Problem gamblers have low levels of mindfulness
• 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

• Experienced teenage pregnancy
• Black sheep of the family
• Embezzled substantial amount over several years

Acceptance

OPEN UP

Psychological Flexibility

Case study: 25 YO male

• Lives for each pay
• Dominated by self critical thoughts, perceived judgements
• Future hope / past failures

BE PRESENT

Psychological Flexibility

Case study: 32 YO Male (Schizophrenia)

• Positive symptoms well managed
• Can discuss thoughts & feelings
• Concern about developing a name for himself
• 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.