Our research

Our clinicians are actively involved in conducting research and collaborating with other researchers. With your consent, you may be asked to participate in any ongoing research that is being undertaken whilst attending sessions. Your Clinical Psychologist will always seek your written permission for this to occur.

Should you have questions about our current research program please contact us.

Some of our recent conference presentations and recent publications:

Cognitive behaviour therapy and mindfulness interventions for the treatment of Problem Gambling.

Authors: McIntosh C, O’Neill, K, & Crino, R.

Presented at National Association of Gambling Studies Australia Conference, Adelaide 2015.

Aim

The current study tested the effectiveness of three interventions to treat PGs: 1. case formulation driven Cognitive Behaviour Therapy (CBT); 2. manualised CBT; and 3. a mindfulness-based treatment. This was the first RCT to jointly explore the effectiveness of the above interventions in a treatment-seeking PG sample. All three interventions tested returned large ES improvements in PG behaviour after seven sessions (Cohen’s d range 1.46-2.01), at post-treatment and at three and six-month follow-up. Secondary measures also improved and the pattern of improvement is discussed below. This study confirmed the effectiveness of CBT in both of the forms that it was administered. This study also established that a mindfulness-based intervention was effective in reducing PG behaviour. All of the interventions were rated as acceptable by participants at post-treatment. This study suggests that manualised CBT is a highly effective treatment approach for PGs who meet PG DSM criteria for reducing gambling behaviour, and that individually tailored CBT and mindfulness-based interventions are also effective for treating PG behaviour and secondary dysfunction. Further research is recommended, particularly taking into account the heterogeneity of PGs.

Reliability issues in the use of DSM-IV criteria to diagnose pathological gambling
Authors: Walker, M., Milton, S., Anjoul, F., Scheftsik, M., Allcock, C., Amey, O. & Grant, E.
Presented at Developing Strategic Alliances ? Adelaide 1999

The DSM-IV criteria are generally recognised as the standard by which pathological gambling is diagnosed. Unfortunately, neither the validity nor the reliability of DSM-IV assessments of pathological gambling has been established. Furthermore, there is reason to believe that DSM-IV assessments based on unstructured interviews are relatively unreliable. It was this unreliability that led to the development of structured clinical interviews for DSM-IV categories (SCIDs). A structured interview for pathological gambling has been developed at the University of Sydney for the assessment of pathological gambling. Data are presented comparing the reliability of assessments on the same clients by different clinicians using the unstructured interview format and the SCIP. Furthermore, the variability of assessments about the DSM-IV scores provided by two experienced counsellors are examined.

Reliability of the South Oaks Gambling Screen (SOGS-R)
Authors: Thompson, A., Walker, M. and Milton, S.
Presented at Developing Strategic Alliances ? Adelaide 1999

Ladouceur and his colleagues claim that subjects frequently do not fully understand the SOGS items when they complete the questionnaire. They claim that clarifying the meaning of the items leads to a reduction in scores. Such a claim, if true, has important implications for estimates of the prevalence of pathological gambling that are based on the use of the SOGS. However, the work of Ladouceur and his colleagues is open to a number of methodological criticisms. A new study, which avoids these problems, is reported in which casual and heavy gamblers completed the SOGS-R with and without clarification. The results of the studies conducted by Ladouceur et al are compared with the results obtained from this new study. 

An Empirical Investigation of DSM-IV Criteria for Pathological Gambling
Authors: Anjoul, F., Milton S. and Roberts, R.D.
Presented at International Conference on Gaming and Risk Taking - Las Vegas 2000

To date, no study has investigated the latent dimensional structure of the DSM-IV criteria for Pathological Gambling. Nor has any investigation measured the manifest frequency of each respective criterion in a clinical sample using a clinician-administered structured interview. Consistent with the notion that the criteria constitute a syndrome, it was hypothesized that a single factor model would best account for the data. The Structured Clinical Interview for Pathological Gambling (SCIP), developed at the University of Sydney, was administered to 130 individuals attending treatment for Pathological Gambling at the University Clinic. The SCIP contains a set of behaviorally anchored operations that allow a practitioner to determine the presence (or absence) of each DSM-IV diagnostic criterion for Pathological Gambling. Exploratory and confirmatory factor analysis were conducted to analyze the underlying factor structure of the criteria. In addition, reliability and frequency analyses were conducted. The results suggested that the DSM-IV uni-dimensional structuring of the criteria for Pathological Gambling is less then optimal. Furthermore, considerable variation in frequency of endorsement across the criteria was observed. Preoccupation and failed attempts to stop (or control) gambling were frequently reported. Tolerance and withdrawal, as delineated in the DSM-IV, were infrequently reported. Arguments are presented suggesting there is insufficient substantive evidence for including withdrawal in the criteria, and that tolerance is possibly related to an escalating forbearance for losing (rather than increased betting for desired excitement). These preliminary results provide a basis for future decisions about the structure and content of Pathological Gambling criteria. 

Deciding to cut back or stop gambling: Does cognitive therapy help?
Authors: Walker, M., Milton, S. & Anjoul, F.
Presented at International Conference on Gaming and Risk Taking - Las Vegas 2000

If excessive gambling is caused in part by a misunderstanding the nature of the game and false beliefs in relation to the role of luck and skill, then it would be expected that change towards an accurate set of beliefs will induce a reduction in gambling. Cognitive therapy is a means of moving the client towards an accurate set of beliefs concerning gambling. In this paper, the results will be presented of a program designed to measure the effectiveness of cognitive therapy in reducing the amount of gambling of clients in a problem gambling clinic. The subjects in the study were randomly allocated to two programs: cognitive therapy and client centred supportive counselling.  

PUBLISHED PAPERS

Williams, A. D., Grisham, J. R., Erskine, A. and Cassedy, E. (2012). Deficits in emotion regulation associated with pathological gambling. British Journal of Clinical Psychology, 51: 223–238.

Objectives. The concept of emotion regulation features in many models of psychopathology and it has been proposed that individuals with poorly regulated emotions often engage in maladaptive behaviours to escape from or down-regulate their emotions, creating risk for a range of disorders. One such disorder may be pathological gambling. To our knowledge, no study had assessed the use of emotion-regulation strategies in this population. The goal of the present study was therefore to examine emotion-regulation difficulties among a sample of pathological gamblers (n= 56), a mixed clinical comparison group (n= 50), and a sample of healthy community controls (n= 49).

Design. Multivariate analysis of variance controlling for age.

Methods. Participants were recruited from the community and a gambling treatment unit in Australia and completed clinical diagnostic interviews (ADIS-IV; SCIP), self-report measures of psychopathology (DASS-21), substance use (AUDIT), and emotion-regulation difficulties (DERS; ERQ).

Results. Pathological gamblers and the clinical comparison group reported significantly less use of reappraisal as an adaptive emotion-regulation strategy, and reported a greater lack of emotional clarity and more impulsivity than individuals in the healthy community comparison group. Pathological gamblers reported a greater lack of emotional awareness compared to the healthy control group and reported differences in access to effective emotion-regulation strategies compared to both comparison groups.

Conclusions. The results support specific deficits of emotion regulation in pathological gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy.

Simon Milton, Rocco Crino, Caroline Hunt and Emma Prosser (2002)
The Effect of Compliance-Improving Interventions on the Cognitive-Behavioural Treatment of Pathological Gambling. 
Journal of Gambling Studies 18(2) 207-229.

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic.? Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance.? Compliance was indicated by the completion of all treatment sessions.? Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled.? Logistic regression analyses identified pre-treatment characteristics predicting compliance and outcome.? Compliance improving interventions significantly reduced dropout rates, resulting in superior outcomes at post-treatment compared to the cognitive-behavioural treatment alone.? At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change.? Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance.? Poor outcome was predicted by comorbid problem drinking.? The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.