Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling

Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling


J Psychiatry Neurosci 2011;36(3):165-75

Eva M. Álvarez-Moya, PhD; Cristian Ochoa, BS; Susana Jiménez-Murcia, PhD; Maria Neus Aymamí, BS; Mónica Gómez-Peña, BS; Fernando Fernández-Aranda, PhD; Juanjo Santamaría, BS; Laura Moragas, BS; Francesca Bove, BS; José M. Menchón, MD

Álvarez-Moya, Jiménez-Murcia, Fernández-Aranda — CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Spain; Álvarez-Moya, Jiménez-Murcia, Aymamí, Gómez-Peña, Fernández-Aranda, Santamaría, Moragas, Bove, Menchón — Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Ochoa — Department of Psych iatry and Clinical Psychobiology, University of Barcelona, Spain; Menchón — CIBER Mental Health (CIBERSAM), Instituto Salud Carlos III, Spain


Background: Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling.

Methods: We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive–behavioural therapy (CBT) for pathologic gambling.

Results: We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended.

Limitations: Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample.

Conclusion: Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.

Submitted Aug. 4, 2009; Revised Apr. 23, July 3, 2010; Accepted July 6, 2010.

Acknowledgments: Dr. Álvarez-Moya was supported by a Juan de la Cierva fellowship (Ministry of Science and Innovation, Spanish government; Ref. 1048). Financial support for this study was partially received from the Spanish Fondo de Investigación Sanitaria (PI081573; PI081714). CIBER is an initiative of Instituto de Salud Carlos III.

Competing interests: None declared.

Contributors: Drs. Álvarez-Moya, Ochoa, Jiménez-Murcia and Fernández-Aranda designed the study. Drs. Álvarez-Moya, Ochoa, Aymamí, Gómez-Peña, Santamaría and Moragas acquired the data, which Drs. Álvarez-Moya, Bove and Menchón analyzed. Drs. Álvarez-Moya, Ochoa, Jiménez-Murcia, Santamaría and Moragas wrote the article, which Drs. Jiménez-Murcia, Aymamí, Gómez-Peña, Fernández-Aranda, Bove and Menchón critically reviewed. All authors approved publication of the article.

DOI: 10.1503/jpn.090095

Correspondence to: Dr. E.M. Álvarez-Moya, CIBERObn and Department of Psychiatry, University Hospital of Bellvitge, c/Feixa Llarga, s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain; eva.alvarez@uab.cat