|
 |
Introduction
In a meta-analytic study of gambling disorders in Canada
and the United States, Shaffer, Hall and Vander Bilt (1997) estimated
that the lifetime prevalence rate of pathological gambling for women
in the general population is approximately 1%. Another 3% of women experience
a variety of adverse consequences from their gambling activities, despite
not meeting diagnostic criteria for pathological gambling. Their analyses,
which included studies spanning 20 years of empirical research, suggested
that up to a third of pathological and problem gamblers in the general
population were women.
The vast majority of empirical studies on gambling have
either included only male gamblers or an insufficient number of women
to permit meaningful comparisons. Mark and Lesieur (1992), in reviewing
this literature, found very few studies that addressed pathological gambling
in women. Furthermore, where sizeable numbers of female gamblers have
been studied, differences in sampling, methodology, representativeness
(e.g., GA membership) and assessment have made comparisons with other
studies including women difficult. The available data suggest that women
when compared to men generally experience a later onset of gambling (Lesieur & Rosenthal,
1991), report a shorter duration between non-problem and problem gambling
(Rosenthal, 1992; Lesieur, 1988), tend to gamble within a social context,
focus on games that are not considered to require skill (e.g., bingo,
slot machines) or intended to enhance social functioning or self-esteem
(Lorenz, 1990; Rosenthal, 1992), tend to wager smaller amounts and adopt
gambling as a means to cope with dysphoric emotions (Rosenthal, 1992).
This suggests that there may be important gender differences in problem-solving
behaviours that may produce different patterns and characteristics of
gambling behaviour. The purpose of the current study is to compare the
problem-solving skills of male and female gamblers.
Cognitive behaviour therapy (CBT) is among the most validated
treatment approaches to addictive behaviours (e.g., Walters, 2000). CBT
interventions tend to be goal-oriented, practical and problem-focused.
Commonly, distortions in thinking and perception and/or behavioural deficiencies
or excesses are targeted. Motivational interventions intended to reduce
ambivalence are also routinely used. Cognitive-behavioural treatment
of alcohol problems often target deficits in problem-solving skills (Heather,
1995). While the evidence to date is not yet strong, a recent review
of randomized control studies found CBT to be the most effective therapeutic
modality for problem gambling (Toneatto & Ladouceur, in press).
Since CBT can be viewed as a form of problem-solving therapy, a greater
understanding of the problem-solving characteristics of problem gamblers
might be important in informing CBT approaches for problem gambling and
may guide the development of gambling-specific CBT interventions. Unfortunately,
little is known about the problem-solving behaviours of problem gamblers.
After a CBT intervention that included a specific problem-solving training
component, Ladouceur and Sylvain (1999) found that treatment outcomes
improved in pathological gamblers compared to a wait-list control group.
Clearly, more research is needed to directly examine problem-solving
skills in gamblers.
Method
Participants
In total, 148 female and 112 male gamblers, age 18 or
older, volunteered to participate in a confidential survey about gambling.
Participants were recruited primarily from advertisements placed in major
urban newspapers seeking people concerned about their gambling.
Procedure
Individuals interested in the study contacted the research
coordinator by telephone. The coordinator described the study, answered
any questions and screened individuals to see if they met the primary
study criteria:
Are they concerned about their gambling behaviour? Those consenting to
participate were mailed a self-administered questionnaire booklet. Participants
who returned completed booklets received $40 in gift certificates.
Measures
Gambling severity
The Diagnostic and Statistical Manual (American Psychiatric
Association, 1994) criteria for pathological gambling was used to assess
gambling severity. Participants answered 10 questions related to symptoms
experienced within the past 12 months. Scores ranged from zero to10,
and individuals scoring five or higher met criteria for pathological
gambling. For the current study, gamblers were categorized into one of
three levels of gambling-problem severity based on their DSM-IV gambling
scores: asymptomatic (score of 0), problem (1 to 4) and pathological
(5 or higher).
Problem-solving skills
The Problem Solving Inventory (PSI) (Heppner, 1988) was
administered as the key measuring device of problem-solving skill. The
PSI is a 35-item instrument measuring how individuals believe they react
to personal problems encountered in their daily lives. The instrument
consists of three sub-scales: Problem-Solving Confidence (scores range
from 11 to 66), Approach-Avoidance Style related to problem-solving activities
(scores range from 16 to 96) and degree of Personal Control of emotions
and behaviours while engaging in problem-solving activities (scores range
from 5 to 30). Low scores are associated with a positive view of problem-solving
skills. This instrument possesses good internal consistency (alphas range
from .72 to .85 on the sub-scales and .90 on the entire test) and there
is good test-retest reliability. The validity of the PSI has been evaluated
in various populations including adolescents, psychiatric populations
and university students. For example, validity studies have shown that
the PSI is linked to psychological well-being (e.g., Heppner & Anderson,
1985); symptoms of generalized anxiety disorder (Ladouceur, Blais, Freeston, & Dugas,
1998); hopelessness, depression severity and dysfunctional attitudes
in depressed outpatients (Cannon et al., 1999; Otto et al., 1997)' depression,
hopelessness, and psychosocial impairment in patients with chronic low
back pain (Witty, Heppner, Bernard, & Thoreson, 2001).
Current psychiatric distress
The Brief Symptom Inventory (BSI) (Derogatis, 1993; Derogatis & Melisaratos,
1983) consists of 53 symptoms designed to measure nine dimensions of
psychopathology experienced by individuals within the past week. The
Global Severity Index (GSI), based on the mean rating for all 53 items,
is scored on a five-point scale, ranging from zero, meaning "not at all," to
four, meaning "extremely," and provides an overall index of current emotional
distress. Internal consistency coefficients for the nine sub-scales cluster
around .80 with test-retest correlations ranging from .68 to .91 over
a two-week period (Derogatis & Melisaratos, 1983). The GSI has a
stability coefficient of .90 over a two-week period.
Data analysis
A series of 2x3 analyses of covariance (ANCOVAs) were
conducted to explore the effects of gender and gambling severity on each
of the measures of problem-solving skills while controlling for current
psychiatric distress (measured by the GSI on the BSI) that may confound
coping activities (Stanton, Danoff-Burg, Cameron, & Ellis, 1994).
The alpha level was set at .05 for main effects and interaction effects.
Observations that were two or more standard deviations away from the
mean were considered outliers, and were excluded from the analyses of
covariance. A regression analysis using the STEPWISE method (SPSS 10.0)
was also conducted to determine whether self-perception of problem-solving
skills predicted DSM-IV scores when other demographic variables, psychiatric
variables and gambling frequency were included in the regression equation.
Results
Demographic characteristics of the sample are found in
Table 1. There were significantly more unmarried men (68.8%) than women
(54.1%) in the sample (c2 ,
p = .016).
Table 1. Demographic characteristics by gender
|
N
|
Males
|
Females
|
Total sample
|
Age (M years [SD]) |
260
|
42.9 (11.4)
|
44.2 (12.4)
|
43.6 (12.0)
|
Marital status:1 n (%) |
260
|
|
|
|
Married/partnered |
|
35 (31.3%)
|
68 (45.9%)
|
103 (39.6%)
|
Not married/partnered |
|
77 (68.8%)
|
80 (54.1%)
|
157 (60.4%)
|
Education level: 2 n (%) |
260
|
|
|
|
Secondary or less |
|
50 (44.6%)
|
79 (53.4%)
|
129 (49.6%)
|
Post-secondary |
|
62 (55.4%)
|
69 (46.6%)
|
131 (50.4%)
|
Employment status: 3 n (%) |
258
|
|
|
|
Employed |
|
59 (53.6%)
|
76 (51.4%)
|
135 (52.3%)
|
Not employed |
|
51 (46.4%)
|
72 (48.6%)
|
123 (47.7%)
|
Gross annual income ($); n (%) |
258
|
|
|
|
< 20 000 |
|
44 (39.6%)
|
78 (53.1%)
|
122 (47.3%)
|
20 000 39
000 |
|
32 (28.8%)
|
44 (29.9%)
|
76 (29.5%)
|
40 000 59000 |
|
23 (20.7%)
|
19 (12.9%)
|
42 (16.3%)
|
60 000 + |
|
12 (10.8%)
|
6 (4.1%)
|
18 (7.0%)
|
Gambling categories n (%) |
260
|
|
|
|
Asymptomatic |
|
16 (14.3%)
|
18 (12.2%)
|
34 (13.1%)
|
Problem |
|
44 (39.3%)
|
57 (38.5%)
|
101 (38.8%)
|
Pathological |
|
52 (46.4%)
|
73 (49.3%)
|
125 (48.1%)
|
1 ×2, p =
.016
2 ×2 , p =
.163
3 ×2 , p =
.716
Otherwise, there were no other gender differences. About
half of the sample was employed, reported some post-secondary education
and earned more than $20,000 per year. The proportion of men and women
whose gambling severity was asymptomatic, problem and pathological is
also reported in Table 1. Within each severity category, there were comparable
proportions of men and women. Almost half of the sample consisted of
gamblers whose problem severity was pathological while approximately
13% were asymptomatic.
Table 2 shows the frequency of gambling behaviours for
the male and female participants. Lottery, scratch tickets, casino slot
machines and bingo were popular gambling activities.
Table 2. Description of gambling behaviour by gender
|
Number of times per year
Mean (SD)
|
Gambling activity |
N
|
Males
|
N
|
Females
|
|
|
|
|
|
Lottery |
97
|
97.6 (69.4)
|
129
|
126.3 (131.4)
|
Scratch tickets |
64
|
104.2 (108.8)
|
101
|
130.6 (147.3)
|
Pull tabs |
25
|
106.5 (129.2)
|
50
|
76.6 (116.0)
|
Card games (private) |
34
|
54.9 (62.7)
|
28
|
45.0 (72.7)
|
Casino card games |
37
|
56.9 (87.3)
|
22
|
31.1 (48.6)
|
Casino table games |
19
|
58.2 (74.5)
|
8
|
40.3 (69.1)
|
Casino slot machines |
42
|
54.6 (77.6)
|
79
|
61.7 (89.4)
|
Casino video gambling |
11
|
55.3 (112.0)
|
16
|
37.2 (53.1)
|
Stock market |
10
|
45.3 (33.8)
|
11
|
23.5 (53.1)
|
Race track |
39
|
50.7 (84.8)
|
29
|
59.8 (123.0)
|
Real estate |
2
|
3.0 (1.4)
|
2
|
53.0 (72.1)
|
Sports lotteries |
53
|
148.4 (125.0)
|
16
|
91.4 (123.0)
|
Sports betting |
25
|
92.6 (116.3)
|
5
|
56.1 (61.3)
|
VLTs |
9
|
129.7 (145.1)
|
12
|
44.0 (50.2)
|
Bingo |
25
|
41.2 (64.3)
|
98
|
96.3 (85.2) 1
|
Charity |
15
|
76.4 (99.5)
|
15
|
47.7 (99.5)
|
Internet gambling |
1
|
4 (--)
|
3
|
160.3 (183.1)
|
1 excludes one extreme outlier
Male and female participants playing lottery, scratch
tickets or pull tabs were playing on average between 1.5 and 2.5 times
per week. Participants also reported playing a variety of casino games
between 30 and 60 times per year. About twice as many women reported
playing bingo than men. Few participants engaged in real estate or Internet
gambling. The gambling activities that were identified as causing the
biggest concern for men were casino card games (23.2%), lotteries/scratch
tickets (13.7%), sports lotteries (13.7%) and race track betting (12.6%).
For women, the gambling activities that caused the most concern were
bingo (34.1%), casino card games (27.8%) and lotteries/scratch tickets
(15.0%).
Treatment by a psychiatrist was reported by 40.2% of
the sample while 45.6% reported receiving treatment by a psychologist
or other mental health professional. Almost one-third had been prescribed
anti-anxiety medication, 42.9% prescribed anti-depressants and 7.7% prescribed
anti-psychotic medication or mood regulators. Almost one-fifth (18%)
of the sample reported having been hospitalized for a mental health problem.
No gender differences were found on any of these variables.
Figure 1 displays the mean scores for problem-solving
confidence, personal control and approach-avoidance sub-scales of the
PSI by gender and gambling severity. Results of the ANCOVA on the Problem-Solving
Confidence sub-scale revealed that there was a significant main effect
of gambling severity (F2,250 = 5.02, p = .007) and no significant
gender or interaction effects. Simple contrasts of the severity subgroups
revealed that the pathological gamblers rated themselves as significantly
less confident in their problem-solving skills than both the asymptomatic
subgroup (mean difference = 4.41; 95%CI = 1.52 to 7.30; p=.003) and the
problem gambler subgroup (mean difference = 2.20, 95%CI = 0.16 to 4.23;
p=.035). The difference in confidence scores between the asymptomatic
and problem groups was not significant (p >.10).
Figure 1. PSI problem-solving confidence, personal control
and approach-avoidance style sub-scale scores by gender and gambling
severity.

Click for larger image

Click for larger image

Click for larger image
On the Personal Control sub-scale, there was also a significant
effect of gambling severity (F2,247 = 13.09, p<.001), but
no significant gender or interaction effects. Simple contrasts revealed
that pathological gamblers felt significantly less personal control during
problem-solving than the problem gamblers (mean difference = 1.66; 95%CI=
0.67 to 2.65; p=.001), and the problem subgroup, in turn, reported less
control than the asymptomatic subgroup (mean difference = 1.83, 95%CI
= 0.49 to 3.18; p=.008).
Figure 1 shows that the pathological gambling subgroup
had a higher mean score on the Approach-Avoidance Style sub-scale (higher
scores signify a more avoidant style to problem-solving activities) than
the other gambling subgroups; however, the ANCOVA revealed no significant
effects of gambling severity (p=.13), gender, and gender by severity
interaction effects.
To examine whether problem-solving skills predicted DSM-IV
scores for pathological gambling, the following variables were entered
into a stepwise regression: age, gender, employment status, GSI from
the BSI, history of treatment by psychiatrist (yes/no), gambling frequency
(frequency of the gambling activity with the highest level of participation
within the past year) and total score on the PSI. The PSI total score
measures perception of general problem-solving abilities and was included
instead of the individual PSI sub-scale scores to avoid problems of multicollinearity.
(Pearson correlation coefficients ranged from .51 to .69 among the various
sub-scales in this sample.) The Global Severity Index, gambling frequency
and total PSI score were the only variables retained in the final regression
model (Table 3). Higher psychiatric distress, higher gambling frequency
and more negative views of
Table 3.
Predictors of DSM-IV pathological gambling scores
|
Stepwise multiple regression2
|
Predictors1 |
Step
|
b
|
D
R2
|
df
|
Total R2
|
Adjusted R2
|
BSI „ Global Severity Index |
1
|
.370
|
-
|
1,251
|
.227
|
.224
|
Gambling frequency measure |
2
|
.223
|
.062
|
1,250
|
.288
|
.283
|
PSI total score |
3
|
.183
|
.026
|
1,249
|
.315
|
.306
|
1 Variables entered into the stepwise regression
but excluded from the final regression equation include: age, gender,
employment status, psychiatric treatment.
2 b denotes
standardized beta coefficients of the final regression equation.
problem-solving ability predicted higher DSM-IV scores.
The final regression model explained 31.5% (adjusted R2 =
30.6%) of the variance in DSM-IV gambling scores, with PSI scores contributing
to a small (D R2 = 2.6%) but
significant increase in explained variance. If instead the three sub-scales
scores (in place of the PSI total score) are allowed to compete for entry
into the regression, the Personal Control sub-scale enters as the third
step in the model following the BSI global index severity and gambling
frequency, and predicts 4.4% of the total (33.2%) explained variance.
Discussion
This study revealed that there were differences in perceived
problem-solving skills among gamblers with different levels of problem
severity. However, there were no significant gender differences. Both
male and female pathological gamblers reported being less self-assured
while trying to solve problems they encountered in their lives and felt
less in control over their emotions and behaviours during problem-solving
activities than either the asymptomatic or problem gamblers. The problem
gamblers perceived themselves to have less control over their emotions
and behaviours during problem-solving compared to the asymptomatic gamblers.
A comparison of PSI scores observed in the pathological
gamblers, and to some extent the problem gamblers, were quite similar
to those reported in other clinical populations (e.g., inpatient males
with alcohol problems, Larson & Heppner, 1989; generalized anxiety
disorders, Ladouceur, et al., 1998). These clinical populations tended
to have more negative appraisals of problem-solving skills than undergraduate
student populations or adult populations. This suggests that pathological
gamblers and patients with substance use disorders or psychiatric disorders
might benefit from interventions addressing these deficits. Both male
and female gamblers in this study appear to require some problem-solving
skills training.
The absence of significant gender differences in various
aspects of problem-solving skills also suggests that CBT gambling-treatment
interventions for men and women do not need to be drastically different
with respect to problem-solving skills training. CBT interventions for
problem gamblers and especially pathological gamblers may also benefit
from targeting problem-solving skills that need attention (e.g., enhancing
emotional and behavioural control when handling high-risk gambling situations).
The relatively high avoidance scores observed in the pathological gamblers
also seem to indicate that CBT interventions may be a good treatment
approach in teaching gamblers a more effective style of dealing with
problems.
A limitation of the study is that the PSI measures perceived
and not actual problem-solving skills; however, there is some evidence
that they are related (Heppner, Hibel, Neal, Weinstein & Rabinowitz,
1982). Furthermore, there does seem to be a pattern among clinical populations
to report negative appraisals of problem-solving skills, suggesting that
these problem-solving skills warrant attention. While Dixon, Heppner,
Burnett, Anderson and Wood (1993) found that PSI scores were both an
antecedent and predictor of a depressed mood, it not possible in this
study to determine whether deficits in problem-solving appraisal was
a symptom of or precursor to gambling problems. Deficits in problem-solving
skills may contribute to vulnerability in the development of gambling
problems, or conversely, having a gambling problem may, over time, negatively
influence problem-solving skills. The current study was correlational
in nature, and additional controlled research is needed to further explore
problem-solving abilities in problem gamblers.
References
- American Psychiatric Association. (1994).
- Diagnostic and Statistical Manual of Mental Disorders (4th
ed.). Washington, D.C.: Author
- Cannon, B., Mulroy, R., Otto, M.W., Rosenbaum, J.F.,
Fava, M.& Nierenberg, A.A. (1999).
- Dysfunctional attitudes and poor problem solving skills predict hopelessness
in major depression. Journal of Affective Disorders, 55 (1),
45–49.
- Derogatis, L.R. (1993).
- Brief Symptom Inventory (BSI): Administration, Scoring, and Procedures
Manual (3rd. ed.). Minneapolis, MN: National Computer Systems.
- Derogatis, L.R. & Melisaratos, N. (1983).
- The Brief Symptom Inventory: An introductory report. Psychological
Medicine, 13, 595–605.
- Dixon, W.A., Heppner, P.P., Burnett, J.W., Anderson,
W.P. & Wood, P.K. (1993).
- Distinguishing among antecedents, concomitants, and consequences
of problem-solving appraisal and depressive symptoms. Journal of
Counseling Psychology, 40, 357–364.
- Heather, N. (1995).
- Treatment Approaches to Alcohol Problems. Copenhagen: World
Health Organization, Regional Office for Europe.
- Heppner, P.P. (1988).
- The Problem Solving Inventory: Manual. Palo Alto, CA: Consulting
Psychologists Press.
- Heppner, P.P. & Anderson, W.P. (1985).
- The relationship between problem-solving self-appraisal and psychological
adjustment. Cognitive Therapy & Research, 9 (4),
415–427.
- Heppner, P.P., Hibel, J.H., Neal, G.W., Weinstein, C.L. & Rabinowitz,
F.E. (1982).
- Personal problem solving: A descriptive study of individual differences. Journal
of Counseling Psychology, 29, 580–590.
- Ladouceur, R., Blais, F., Freeston, M.H. & Dugas,
M.J. (1998).
- Problem solving and problem orientation in generalized anxiety disorder. Journal
of Anxiety Disorders, 12 (2), 139–152.
- Ladouceur, R. & Sylvain, C. (1999).
- Treatment of pathological gambling: A controlled study. Anuário
de Psicologia, 30 (4), 127–135.
- Larson, L.M. & Heppner, P.P. (1989).
- Problem-solving appraisal in an alcoholic population. Journal
of Counseling Psychology, 36 (1), 73–78.
- Lesieur, H.R. (1988).
- Altering the DSM-III criteria for pathological gambling. Journal
of Gambling Behavior, 4 (1), 38–47.
- Lesieur, H.R. & Rosenthal, R.J. (1991).
- Pathological gambling: A review of the literature. Journal of
Gambling Studies, 7 (1), 5–39.
- Lorenz, V. (1990).
- Compulsive Gambling Hotline: Fiscal Year 1990, Final Report.
Baltimore, MD: National Center for Pathological Gambling, Inc.
- Mark, M. & Lesieur, H. (1992).
- A feminist critique of problem gambling research. British Journal
of Addiction, 87, 549–565.
- Otto, M.W., Fava, M., Penava, S.J., Bless, E., Muller,
R.T. & Rosenbaum, J.F. (1997).
- Life event, mood, and cognitive predictors of perceived stress before
and after treatment for major depression. Cognitive Therapy and
Research, 21 (4), 409–420.
- Rosenthal, R.J. (1992).
- Pathological gambling. Psychiatric Annals, 22 (2),
72–78.
- Shaffer, H.J., Hall, M.H. & Vander Bilt, J. (1997).
- Estimating the Prevalence of Disordered Gambling in the United
States and Canada: A Meta-Analysis. Boston, MA: President and
Fellows of Harvard College.
- Stanton, A.L., Danoff-Burg, S., Cameron, C.L. & Ellis,
A.P. (1994).
- Coping through emotional approach: Problems of conceptualization
and confounding. Journal of Personality and Social Psychology, 66 (2),
350–362.
- Toneatto, T. & Ladouceur, R. (in press).
- Treatment of pathological gambling: A critical review of the literature.
- Walters, G.D. (2000).
- Behavioral self-control training for problem drinkers: A meta-analysis
of randomized control studies. Behavior Therapy, 31, 135–150.
- Witty, T.E., Heppner, P.P., Bernard, C.B. & Thoreson,
R.W. (2001).
- Problem-solving appraisal and psychological adjustment of persons
with chronic low-back pain. Journal of Clinical Psychology in Medical
Settings, 8 (3), 149–160.
|
 |