Abstract
Behavioral addictions have been related with biased emotional reactions to risky choices. However, few studies have analyzed the role of both explicit and implicit emotional expression in gambling disorder (GD). This pilot study aims to examine emotion regulation in treatment-seeking patients with GD. The sample included n = 35 participants classified into three groups: patients with current GD, patients with GD in remission, and a control group without GD. Implicit emotional expressions were evaluated through a serious videogame (Playmancer) and explicit emotions were measured through self-reports. Patients in the current GD group had, compared to the remission and control groups, lower levels of implicit emotion expression and higher levels of explicit emotion expression. The patients in GD remission group endorsed better emotion regulation capacity in comparison to patients with current GD. We conclude that differences in emotion expression profiles (such as anger and anxiety) should be considered both in the development of screening and diagnostic measures and in the planning of prevention and treatment programs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aïte, A., Barrault, S., Cassotti, M., Borst, G., Bonnaire, C., Houdé, O., et al. (2014). The impact of alexithymia on pathological gamblers’ decision making. Cognitive And Behavioral Neurology, 27(2), 59–67. https://doi.org/10.1097/WNN.0000000000000027.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Aymamí, N., Granero, R., Penelo, E., Fernández-Aranda, F., Krug, I., Gunnard, K., et al. (2014). Anger in pathological gambling: Clinical, psychopathological, and personality correlates. The Spanish Journal of Psychology, 17, E39. https://doi.org/10.1017/sjp.2014.40.
Barrault, S., & Varescon, I. (2013). Cognitive distortions, anxiety, and depression among regular and pathological gambling online poker players. Cyberpsychology, Behavior and Social Networking, 16(3), 183–188. https://doi.org/10.1089/cyber.2012.0150.
Challet-Bouju, G., Bruneau, M., Victorri-Vigneau, C., Grall-Bronnec, M., & IGNACE Group. (2017). Cognitive remediation interventions for gambling disorder: A systematic review. Frontiers in Psychology, 8, 1961. https://doi.org/10.3389/fpsyg.2017.01961.
Christou-Champi, S., Farrow, T. F. D., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition and Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213.
Ciccarelli, M., Griffiths, M. D., Nigro, G., & Cosenza, M. (2017). Decision making, cognitive distortions and emotional distress: A comparison between pathological gamblers and healthy controls. Journal of Behavior Therapy and Experimental Psychiatry, 54, 204–210. https://doi.org/10.1016/j.jbtep.2016.08.012.
Claes, L., Jiménez-Murcia, S., Santamaría, J. J., Moussa, M. B., Sánchez, I., Forcano, L., et al. (2012a). The facial and subjective emotional reaction in response to a video game designed to train emotional regulation (Playmancer). European Eating Disorders Review, 20(6), 484–489. https://doi.org/10.1002/erv.2212.
Claes, L., Soenens, B., Vansteenkiste, M., & Vandereycken, W. (2012b). The scars of the inner critic: Perfectionism and nonsuicidal self-injury in eating disorders. European Eating Disorders Review, 20(3), 196–202. https://doi.org/10.1002/erv.1158.
Conconi, A., Ganchev, T., Kocsis, O., Papadopoulos, G., Fernández-Aranda, F., & Jiménez-Murcia, S. (2008). PlayMancer: A serious gaming 3D environment. In International conference on automated solutions for cross media content and multi-channel distribution (pp. 111–117). https://doi.org/10.1109/AXMEDIS.2008.29.
Delfabbro, P., Thomas, A., & Armstrong, A. (2018). Gender differences in the presentation of observable risk indicators of problem gambling. Journal of Gambling Studies, 34(1), 119–132. https://doi.org/10.1007/s10899-017-9691-5.
Echeburúa, E., Báez, C., Fernández, J., & Páez, D. (1994). Cuestionario de juego patológico de South Oaks (SOGS): Validación española (South Oaks Gambling Screen (SOGS): Spanish validation). Análisis de Modificación de Conducta, 20, 769–791.
Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous emotion regulation during evaluated speaking tasks: Associations with negative affect, anxiety expression, memory, and physiological responding. Emotion, 6(3), 356–366. https://doi.org/10.1037/1528-3542.6.3.356.
Ehring, T., Tuschen-Caffier, B., Schnülle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563–572. https://doi.org/10.1037/a0019010.
Etkin, A., Prater, K. E., Hoeft, F., Menon, V., & Schatzberg, A. F. (2010). Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. The American Journal of Psychiatry, 167(5), 545–554. https://doi.org/10.1176/appi.ajp.2009.09070931.
Fagundo, A. B., Santamaría, J. J., Forcano, L., Giner-Bartolomé, C., Jiménez-Murcia, S., Sánchez, I., et al. (2013). Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa. European Eating Disorders Review, 21(6), 493–499. https://doi.org/10.1002/erv.2259.
Fagundo, A. B., Via, E., Sánchez, I., Jiménez-Murcia, S., Forcano, L., Soriano-Mas, C., et al. (2014). Physiological and brain activity after a combined cognitive behavioral treatment plus video game therapy for emotional regulation in bulimia nervosa: A case report. Journal of Medical Internet Research, 16(8), e183. https://doi.org/10.2196/jmir.3243.
Fenton-O’Creevy, M., Lins, J. T., Vohra, S., Richards, D. W., Davies, G., & Schaaff, K. (2012). Emotion regulation and trader expertise: Heart rate variability on the trading floor. Journal of Neuroscience, Psychology, and Economics, 5(4), 227–237. https://doi.org/10.1037/a0030364.
Fernández, E., & Scott, S. (2009). Anger treatment in chemically-dependent inpatients: Evaluation of phase effects and gender. Behavioural and Cognitive Psychotherapy, 37(4), 431–447. https://doi.org/10.1017/S1352465809990075.
Fernández-Aranda, F., Jiménez-Murcia, S., Santamaría, J. J., Gunnard, K., Soto, A., Kalapanidas, E., et al. (2012). Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study. Journal of Mental Health, 21(4), 364–374. https://doi.org/10.3109/09638237.2012.664302.
Finner, H. (1993). On a monotonicity problem in step-down multiple test procedures. Journal of the American Statistical Association, 88, 920–923. https://doi.org/10.1080/01621459.1993.10476358.
Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire: Psychometric features and prospective relationships with depression and anxiety in adults. European Journal of Psychological Assessment, 23, 141–149. https://doi.org/10.1027/1015-5759.23.3.141.
Giner-Bartolomé, C., Fagundo, A. B., Sánchez, I., Jiménez-Murcia, S., Santamaría, J. J., Ladouceur, R., et al. (2015). Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study. Frontiers in Psychology, 6, 982. https://doi.org/10.3389/fpsyg.2015.00982.
Goudriaan, A. E., Oosterlaan, J., de Beurs, E., & Van den Brink, W. (2004). Pathological gambling: A comprehensive review of biobehavioral findings. Neuroscience and Biobehavioral Reviews, 28(2), 123–141. https://doi.org/10.1016/j.neubiorev.2004.03.001.
Grecucci, A., Giorgetta, C., Vant Wout, M., Bonini, N., & Sanfey, A. G. (2013). Reappraising the ultimatum: An fMRI study of emotion regulation and decision making. Cerebral Cortex (New York, N.Y.: 1991), 23(2), 399–410. https://doi.org/10.1093/cercor/bhs028.
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation. New York: Guilford Press.
Guillén-Riquelme, A., & Buela-Casal, G. (2011). Psychometric revision and differential item functioning in the State Trait Anxiety Inventory (STAI). Psicothema, 23(3), 510–515.
Gyurak, A., Gross, J. J., & Etkin, A. (2011). Explicit and implicit emotion regulation: A dual-process framework. Cognition and Emotion, 25(3), 400–412. https://doi.org/10.1080/02699931.2010.544160.
Hills, A. M., & Dickerson, M. (2002). Emotion, implicit decision making and persistence at gaming. Addiction, 97(5), 598–599. https://doi.org/10.1046/j.1360-0443.2002.t01-4-00134.x.
Hills, A. M., Hill, S., Mamone, N., & Dickerson, M. (2001). Induced mood and persistence at gaming. Addiction, 96(11), 1629–1638. https://doi.org/10.1080/09652140120080750.
Jauregui, P., Estévez, A., & Urbiola, I. (2016). Pathological gambling and associated drug and alcohol abuse, emotion regulation, and anxious-depressive symptomatology. Journal of Behavioral Addictions, 5(2), 251–260. https://doi.org/10.1556/2006.5.2016.038.
Jiménez-Murcia, S., Álvarez-Moya, E. M., Granero, R., Aymami, M. N., Gómez-Peña, M., Jaurrieta, N., et al. (2007). Cognitive-behavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome. Psychotherapy Research, 17, 544–552. https://doi.org/10.1080/10503300601158822.
Jiménez-Murcia, S., Aymamí, M. N., Gómez-Peña, M., Álvarez-Moya, E. M., & Vallejo, J. (2006). Protocols de tractament cognitiuconductual pel joc patològic i d’altres addicions no tòxiques [Guidelines of cognitive-behavioral treatment of pathological gambling and other non-toxic addicitions]. Barcelona: Hospital Universitari de Bellvitge, Departament de Salut, Generalitat de Catalunya.
Jiménez-Murcia, S., Fernández-Aranda, F., Kalapanidas, E., Konstantas, D., Ganchev, T., Kocsis, O., et al. (2009a). Playmancer project: A serious videogame as an additional therapy tool for eating and impulse control disorders. Studies in Health Technology and Informatics, 144, 163–166. https://doi.org/10.3233/978-1-60750-017-9-163.
Jiménez-Murcia, S., Stinchfield, R., Álvarez-Moya, E., Jaurrieta, N., Bueno, B., Granero, R., et al. (2009b). Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling. Journal of Gambling Studies, 25(1), 93–104. https://doi.org/10.1007/s10899-008-9104-x.
Jonsson, J., Munck, I., Volberg, R., & Carlbring, P. (2017). GamTest: Psychometric evaluation and the role of emotions in an online self-test for gambling behavior. Journal of Gambling Studies, 33(2), 505–523. https://doi.org/10.1007/s10899-017-9676-4.
Kelley, K., & Preacher, K. J. (2012). On effect size. Psychological Methods, 17(2), 137–152. https://doi.org/10.1037/a0028086.
Kornreich, C., Saeremans, M., Delwarte, J., Noël, X., Campanella, S., Verbanck, P., et al. (2016). Impaired non-verbal emotion processing in Pathological Gamblers. Psychiatry Research, 236, 125–129. https://doi.org/10.1016/j.psychres.2015.12.020.
Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144(9), 1184–1188. https://doi.org/10.1176/ajp.144.9.1184.
Maniaci, G., Picone, F., van Holst, R. J., Bolloni, C., Scardina, S., & Cannizzaro, C. (2017). Alterations in the emotional regulation process in gambling addiction: The role of anger and alexithymia. Journal of Gambling Studies, 33(2), 633–647. https://doi.org/10.1007/s10899-016-9636-4.
Martin, L. N., & Delgado, M. R. (2011). The influence of emotion regulation on decision-making under risk. Journal of Cognitive Neuroscience, 23(9), 2569–2581. https://doi.org/10.1162/jocn.2011.21618.
Matthews, N., Farnsworth, B., & Griffiths, M. D. (2009). A pilot study of problem gambling among student online gamblers: Mood states as predictors of problematic behavior. CyberPsychology & Behavior, 12(6), 741–745. https://doi.org/10.1089/cpb.2009.0050.
Medeiros, G. C., Sampaio, D. G., Leppink, E. W., Chamberlain, S. R., & Grant, J. E. (2016). Anxiety, gambling activity, and neurocognition: A dimensional approach to a non-treatment-seeking sample. Journal of Behavioral Addictions, 5(2), 261–270. https://doi.org/10.1556/2006.5.2016.044.
Mestre-Bach, G., Fernández-Aranda, F., Jiménez-Múrcia, S., & Potenza, M. N. (2020). Emotional regulation in gambling disorder. Current Opinion in Behavioral Sciences, 31, 12–18. https://doi.org/10.1016/j.cobeha.2019.10.014.
Miguel-Tobal, J. J., Casado-Morales, M. I., Cano-Vindel, A., & Spielberger, C. D. (2001). Inventario de Expresión de la Ira Estado-Rasgo (STAXI-2). Madrid: TEA Ediciones.
Navas, J. F., Torres, A., Vilar, R., Verdejo-García, A., Catena, A., & Perales, J. C. (2015). Nonmonetary decision-making indices discriminate between different behavioral components of gambling. Journal of Gambling Studies, 31(4), 1545–1560. https://doi.org/10.1007/s10899-014-9482-1.
Navas, J. F., Verdejo-García, A., López-Gómez, M., Maldonado, A., & Perales, J. C. (2016). Gambling with rose-tinted glasses on: Use of emotion-regulation strategies correlates with dysfunctional cognitions in gambling disorder patients. Journal of Behavioral Addictions, 5(2), 271–281. https://doi.org/10.1556/2006.5.2016.040.
Nigro, G., Cosenza, M., & Ciccarelli, M. (2017). The blurred future of adolescent gamblers: Impulsivity, time horizon, and emotional distress. Frontiers in Psychology, 8, 486. https://doi.org/10.3389/fpsyg.2017.00486.
Nikolaidou, M., Fraser, D. S., & Hinvest, N. (2016). Physiological markers of biased decision-making in problematic Internet users. Journal of Behavioral Addictions, 5(3), 510–517. https://doi.org/10.1556/2006.5.2016.052.
Phillips, M. L., Ladouceur, C. D., & Drevets, W. C. (2008). A neural model of voluntary and automatic emotion regulation: Implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Molecular Psychiatry, 13(9), 829. https://doi.org/10.1038/mp.2008.65.
Poole, J. C., Kim, H. S., Dobson, K. S., & Hodgins, D. C. (2017). Adverse childhood experiences and disordered gambling: Assessing the mediating role of emotion dysregulation. Journal of Gambling Studies, 33(4), 1187–1200. https://doi.org/10.1007/s10899-017-9680-8.
Raylu, N., & Oei, T. P. S. (2004). The Gambling Related Cognitions Scale (GRCS): Development, confirmatory factor validation and psychometric properties. Addiction, 99(6), 757–769. https://doi.org/10.1111/j.1360-0443.2004.00753.x.
Savazzi, F., Isernia, S., Jonsdottir, J., Di Tella, S., Pazzi, S., & Baglio, F. (2018). Engaged in learning neurorehabilitation: Development and validation of a serious game with user-centered design. Computers & Education, 125, 53–61. https://doi.org/10.1016/j.compedu.2018.06.001.
Schreiber, L. R. N., Grant, J. E., & Odlaug, B. L. (2012). Emotion regulation and impulsivity in young adults. Journal of Psychiatric Research, 46(5), 651–658. https://doi.org/10.1016/j.jpsychires.2012.02.005.
Schwebel, D. C., Severson, J., Ball, K. K., & Rizzo, M. (2006). Individual difference factors in risky driving: The roles of anger/hostility, conscientiousness, and sensation-seeking. Accident; Analysis and Prevention, 38(4), 801–810. https://doi.org/10.1016/j.aap.2006.02.004.
Serret, S., Hun, S., Thümmler, S., Pierron, P., Santos, A., Bourgeois, J., et al. (2017). Teaching literacy skills to French minimally verbal school-aged children with autism spectrum disorders with the serious game SEMA-TIC: An exploratory study. Frontiers in Psychology, 8, 1523. https://doi.org/10.3389/fpsyg.2017.01523.
Sokol-Hessner, P., Camerer, C. F., & Phelps, E. A. (2013). Emotion regulation reduces loss aversion and decreases amygdala responses to losses. Social Cognitive and Affective Neuroscience, 8(3), 341–350. https://doi.org/10.1093/scan/nss002.
Spielberger, C. D. (1999). Professional manual for State-Trait Anger Expression Inventory-2 (STAXI-2). Odessa, FL: Psychological Assessment Resources.
Spielberger, C. D., Gorsuch, R. L., Cubero, N. S., & Lushene, R. E. (1982). STAI: Cuestionario de ansiedad Estado/Rasgo, manual. Madrid: TEA Ediciones.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). The State-Trait Anxiety Inventory Manual. https://doi.org/10.1037/t06496-000.
Stata-Corp. (2019). Stata statistical software: Release 16. College Station, TX: StataCorp LLC.
Stewart, S. H., Zack, M., Collins, P., & Klein, R. M. (2008). Subtyping pathological gamblers on the basis of affective motivations for gambling: Relations to gambling problems, drinking problems, and affective motivations for drinking. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 22(2), 257–268. https://doi.org/10.1037/0893-164X.22.2.257.
Stieler-Hunt, C., Jones, C. M., Rolfe, B., & Pozzebon, K. (2014). Examining key design decisions involved in developing a serious game for child sexual abuse prevention. Frontiers in Psychology, 5, 73. https://doi.org/10.3389/fpsyg.2014.00073.
Stinchfield, R. (2003). Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling. American Journal of Psychiatry, 160(1), 180–182. https://doi.org/10.1176/appi.ajp.160.1.180.
Takeuchi, H., Kawada, R., Tsurumi, K., Yokoyama, N., Takemura, A., Murao, T., et al. (2016). Heterogeneity of loss aversion in pathological gambling. Journal of Gambling Studies, 32(4), 1143–1154. https://doi.org/10.1007/s10899-015-9587-1.
Tárrega, S., Castro-Carreras, L., Fernández-Aranda, F., Granero, R., Giner-Bartolomé, C., Aymamí, N., et al. (2015). A serious videogame as an additional therapy tool for training emotional regulation and impulsivity control in severe gambling disorder. Frontiers in Psychology, 6, 1721. https://doi.org/10.3389/fpsyg.2015.01721.
Tárrega, S., Fagundo, A. B., Jiménez-Murcia, S., Granero, R., Giner-Bartolomé, C., Forcano, L., et al. (2014). Explicit and implicit emotional expression in bulimia nervosa in the acute state and after recovery. PLoS ONE, 9(7), e101639. https://doi.org/10.1371/journal.pone.0101639.
van der Kuil, M. N. A., Visser-Meily, J. M. A., Evers, A. W. M., & van der Ham, I. J. M. (2018). A usability study of a serious game in cognitive rehabilitation: A compensatory navigation training in acquired brain injury patients. Frontiers in Psychology, 9, 846. https://doi.org/10.3389/fpsyg.2018.00846.
Williams, A. D., Grisham, J. R., Erskine, A., & Cassedy, E. (2012). Deficits in emotion regulation associated with pathological gambling. British Journal of Clinical Psychology, 51(2), 223–238. https://doi.org/10.1111/j.2044-8260.2011.02022.x.
Yahyaoui, H., & Menelas, B. A. J. (2017). Towards the development of a serious game that targets psychological stressors of the workplace. In IEEE 5th international conference on serious games and applications for health, SeGAH 2017. https://doi.org/10.1109/SeGAH.2017.7939278.
Yang, Q., Tang, P., Gu, R., Luo, W., & Luo, Y. (2015). Implicit emotion regulation affects outcome evaluation. Social Cognitive and Affective Neuroscience, 10(6), 824–831. https://doi.org/10.1093/scan/nsu124.
Acknowledgements
We want to thank CERCA Programme/Generalitat de Catalunya for institutional support and Fondo Europeo de Desarrollo Regional (FEDER) “Una manera de hacer Europa”/“a way to built Europe”. We also thank the all members of the Playmancer Project Consortium for their support.
Funding
Financial support was received through the Support was given by the Playmancer Project (FP7-ICT-215839-2007), which was funded by the FP7 of the European Commission. The project also received support from the Ministerio de Economía y Competitividad (Grant PSI2015-68701-R). FIS PI14/00290, FIS PI17/01167, and 18MSP001 - 2017I067 received aid from the Ministerio de Sanidad, Servicios Sociales e Igualdad. CIBER Fisiología Obesidad y Nutrición (CIBERobn) and CIBER Salud Mental (CIBERSAM), both of which are initiatives of ISCIII. GMB is supported by a predoctoral AGAUR Grant (2018 FI_B2 00174), grant co-funded by the European Social Fund (ESF) “ESF”, investing in your future. With the support of the Secretariat for Universities and Research of the Ministry of Business and Knowledge of the Government of Catalonia. TMM and MLM are supported by a predoctoral Grant of the Ministerio de Educación, Cultura y Deporte (FPU16/02087 and FPU15/02911).
Author information
Authors and Affiliations
Contributions
RG, DG-V, FF-A, JMM and SJ-M designed the experiment based on previous results and the clinical experience of NM-B, GM-B, NA, MG-P, AP-G, MB and LM. RG, VM-R GM-B, TM-M, ZA, CV-A, ML-M, ST, FF-A and SJ-M conducted the experiment, analyzed the data, and wrote a first draft of the manuscript. RG, GM-B, FF-A, JMM, and SJ-M further modified the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
The study was carried out according to the latest version of the Declaration of Helsinki and it was approved by the Ethics Committee of the University Hospital. Written informed consent was obtained from all participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Guerrero-Vaca, D., Granero, R., Fernández-Aranda, F. et al. Explicit and Implicit Emotional Expression in Gambling Disorder Measured by a Serious Game: A Pilot Study. J Gambl Stud 37, 467–481 (2021). https://doi.org/10.1007/s10899-020-09945-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10899-020-09945-2