In the past several years, cognitive therapy has emerged as an effective treatment approach for a wide variety of clinical disorders, in particular, anxiety disorders and non-psychotic mood disorders. It may be uniquely suitable for people affected by problem gambling, given their highly dysfunctional cognitive processes, though its efficacy has not yet been demonstrated. This section outlines a cognitive approach to treating problem gambling.
Some have suggested that problem gambling may be better understood as a disorder of thinking since people affected by problem gambling appear to have unique and some would say quite unusual beliefs and attitudes about control, luck, prediction and chance (Ladouceur & Walker, 1998). In other words, when the gambler is in “action” (e.g., placing a wager, depositing money in a slot machine) he or she is faced with a series of decisions that can be powerfully affected by thinking (“cognitive”) biases, distorted reasoning, and errors in judgment (Corney & Cummings, 1985; Kahnemann & Tversky, 1982; Toneatto, 1999). Since cognitive approaches to treatment have been successfully applied (e.g., Beck et al., 1993) to many other clinical problems in which cognitive distortions play an important role (e.g., anxiety, depression, substance abuse), there is good reason to expect that a cognitive approach would be effective for a problem gambler.
From what we know about the cognitive traits of people affected by problem gambling (briefly summarized below), such knowledge may be important in developing effective treatments for problem gambling.
Brief Literature Review
Over the past few years we have learned how easy it is for non-gamblers and non-problem gamblers to quickly develop incorrect assumptions about how much control they have over outcomes that are largely determined by chance. Langer (1983) suggested that serious gamblers eventually develop an “illusion of control”; they tend to believe that there is a greater probability of obtaining an outcome determined by chance than is actually the case. In Langer’s research, subjects quickly began to believe that they were able to influence chance-determined outcomes, even when the experiment had been so arranged that they had no control at all. Two examples — subjects placing a higher monetary value on lottery tickets they chose than on tickets randomly assigned, or believing that they had a special skill when they were successful in predicting coin-tossed “heads” or “tails”— implied beliefs that skill was involved.
Ladouceur and his colleagues (Gaboury & Ladouceur, 1989; Ladouceur et al., 1991; Ladouceur et al., 1988) have shown a high rate of erroneous verbalizations (e.g., attributing causal significance to variables correlated with gambling outcomes — predicting outcomes and explaining losses on the basis of the situation but explaining wins on the basis of personal skill) during episodes of gambling (e.g., blackjack, slot machines, video poker) in which outcomes were not under the control of the subjects. Gilovich and Douglas (1986) have also described similar cognitive characteristics in sports betting where losses during sporting events were attributed to unlikely or random events and wins were attributed to skill in choosing the winning team.
Griffiths (1996), studying adolescent slot-machine gamblers, found evidence for distortions similar to those identified by Ladouceur and his colleagues. Regular slot-machine players were more likely to believe that skill was as important as chance in determining outcomes and believed that they had above-average skill at playing slot machines, as opposed to non-regular players. Griffiths (1993) has also described how many physical features of slot machines themselves have been designed to reinforce beliefs that winning at slot-machines needs some skill (e.g., near misses, “nudge” and “hold” buttons, bettor involvement, pay-out interval).
Much of what we know about cognitive factors in gambling has been based on non-problem gamblers, university students or adolescents. Less is known about cognitive distortions in adult people affected by problem gambling. Recently, Toneatto (Toneatto et al., 1997; Toneatto, 1999) has described a wide range of cognitive distortions in a sample of heavy gamblers, including attributional biases, illusion of control, selective recall, instrumental beliefs about luck, misinterpreting cues (internal and external), and misunderstanding probability.
Core Cognitive Distortion
The distortions listed in Gambling-related cognitive distortions may be viewed as automatic thoughts, or cognitive expressions, of the core primary cognitive distortion in people affected by problem gambling: the belief in the ability to predict or control the outcome of a future event that is either randomly determined (e.g., slot machines) or about which insufficient knowledge is available to make accurate predictions (e.g., race tracks) (Ladouceur and Walker, 1998). Gamblers strongly believe that not only is there a way to predict the outcome of a future gambling event, but also that they possess or can discover such knowledge. They also tend to exaggerate their own ability to predict or control gambling outcomes and to behave in such a way as to suggest that they possess knowledge about gambling that no one can possess. These beliefs may be the result of a view of themselves as special, unique or superior to others (Rosenthal, 1992). Surprisingly, this belief tends to be unaffected by actual wins or losses. Indeed, it may be formed only on the basis of early and large wins in their gambling career.
Cognitive Approach to Treatment
The actual foundation for the various strategies and beliefs that gamblers may have about what affects gambling outcomes (as listed in Gambling-related cognitive distortions ) is at best very weak. Knowing this helps to make a cognitive approach to treatment quite natural since cognitive models of therapy suggest it is important to examine the evidential, or formative, basis of a distorted belief. The weak basis of the belief can be made obvious by presenting new, discounted or unconsidered evidence, explaining occasions when predictions do not go as planned, or urging open-minded observation. Slusher and Anderson (1989) suggest that addressing the thought processes that lead to biased beliefs and attitudes is central to changing dysfunctional beliefs that are otherwise hard to change. They argue that individuals who espouse strong beliefs are good at finding selective evidence to confirm or support a belief, re-interpreting new evidence to fit in with a preferred belief, and denigrating, dismissing or ignoring inconsistent evidence. Thus, the way the individual thinks encourages the development of certain cognitive biases. To correct such biasing tendencies, the thinking processes that appear to underlie the unique and sometimes bizarre beliefs that people affected by problem gambling have about how outcomes occur have to be corrected and brought into line with what the gambler actually knows. For example, wagering occurs in the almost complete absence of any reliable knowledge of the factors that determine gambling outcomes. Even worse, people affected by problem gambling may have an exaggerated confidence in the validity of the little knowledge that they may possess (e.g., card system). Frequently, sophisticated knowledge about the game itself (e.g., expert at poker rules, sports statistics) may be mistakenly viewed as proof that the individual knows how to predict wins. Cognitive interventions help the problem gambler become aware that his beliefs are based on errors in thinking and not on any firm basis in reality.
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