Biomedical subjects

Robert Ladouceur

Publications and source records attributed to Robert Ladouceur.

At least 19 recordsLinked to original sources

PubMed2007

Self-exclusion program: a longitudinal evaluation study.

Few self-exclusion programs have been evaluated and their long-term impact remains unknown. This study has two main goals: (1) to assess changes in gambling behaviour and gambling problems for self-excluded patrons, and (2) to follow self-excluded gamblers for a two-year period (during and after the self-exclusion period). Individuals who excluded themselves (N = 161 at the initial stage) participated in telephone interviews after signing the self-exclusion agreement and were followed at 6, 12, 18 and 24-months. Results show that according to the DSM-IV, 73.1% of the participants were pathological gamblers. The self-exclusion program has many positive effects. During the follow-ups, the urge to gamble was significantly reduced while the perception of control increased significantly for all participants. The intensity of negative consequences for gambling was significantly reduced for daily activities, social life, work, and mood. The DSM score was significantly reduced over time. This reduction also took place between the baseline and the 6-month follow-up. The clinical implications of the results are discussed in relation to the effectiveness of the program. Suggestions are provided in order to increase compliance of self-excluded patrons.

Adult↗

PubMed2006

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry.

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.

Adolescent↗

PubMed2006

Flow and dissociation: examination of mean levels, cross-links, and links to emotional well-being across sports and recreational and pathological gambling.

To examine whether flow (Csikszentmihalyi (1990). Flow: The psychology of optimal experience. NY: Harper & Row) and dissociation (Jacobs (1986). Journal of Gambling Behavior, 2, 15-31) are experienced across sports and recreational and pathological gambling, we assessed a sample of 511 college students (256 females and 255 males, M age = 19.54) that was comprised of 14 pathological gamblers, 21 non-addicted gamblers, and 476 athletes. The findings showed that both flow and dissociation lay on a continuum of subjective experiences across activity groups. Specifically, pathological gamblers experienced lower levels of flow than athletes, whereas recreational gamblers lay in between the previous groups in this regard. In contrast, pathological gamblers experienced higher mean levels of dissociation than athletes and recreational gamblers who, in turn, were similar in this regard. A LISREL model showed that flow was positively associated with general emotional well-being, whereas dissociation was negatively associated with well-being.

Adult↗

PubMed2006

Pathological gamblers: inpatients' versus outpatients' characteristics.

Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.

Adult↗

PubMed2006

Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy.

This study evaluated the specific effectiveness of cognitive-behavior therapy (CBT) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder (GAD) patients by using a nonspecific therapy control group. Sixty-one patients who had used benzodiazepines for more than 12 months were randomly assigned to the experimental conditions. Nearly 75% of patients in the CBT condition completely ceased benzodiazepine intake, as compared with 37% in the control condition. Results of the 3-, 6-, and 12-month follow-ups confirmed the maintenance of complete cessation. Discontinuation rates remained twice as high in the CBT condition. The number of patients who no longer met GAD criteria was also greater in the CBT condition. The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD.

Adolescent↗

PubMed2006

A framework for reporting outcomes in problem gambling treatment research: the Banff, Alberta Consensus.

OBJECTIVE: The objective is provide a framework concerning the minimum features of reporting efficacy of treatment in the problem gambling field. Research to date has not used uniform outcome measures and it is, therefore, difficult to compare the relative efficacy of various approaches. Some studies emphasize self-reported behavioural measures such as frequency and intensity of gambling whereas others emphasise change with respect to the criteria used to diagnose problem gambling or use composite measures of symptom severity in multiple domains involving gambling-related thoughts, urges, and behaviours. METHODS: An expert panel consensus. RESULTS: The proposed minimum features of reporting the efficacy of treatment outcome studies are: measures of gambling behaviour - the net expenditure each month, the frequency (in days per month) with which gambling takes place, and the time spent thinking about or engaged in the pursuit of gambling each month; measures of the problems caused by gambling - especially problems in the areas of personal health, relationships, financial, and legal; these measures can be complemented by additional measures of quality of life. measures of the processes of change - whatever mechanisms of change are assumed to occur. CONCLUSIONS: We believe that these guidelines are broad enough to allow clinical research conducted from diverse perspectives to allow valid cross study evaluations of intervention studies. Such conditions will facilitate the development of empirically validated best practice guidelines for use by clinicians in the management of problem gambling.

Behavior, Addictive↗

PubMed2006

[Comorbidity in generalized anxiety disorder: prevalence and course after cognitive-behavioural therapy].

OBJECTIVE: To evaluate the prevalence and course of Axis I concurrent disorders in a population of patients who underwent cognitive-behavioural therapy (CBT) to treat their generalized anxiety disorder (GAD). METHOD: This study is a secondary analysis combining patients from 3 treatment studies done at Université Laval. A total of 90 patients with a DSM-IV consistent GAD diagnosis received from 12 to 16 CBT sessions to treat GAD. Symptomatology was assessed at pretest, posttest, and 6 months after treatment, with the Anxiety Disorders Interview Schedule, a structured diagnostic interview. RESULTS: Seventy-three per cent of patients had both GAD and a concurrent diagnosis. The most common diagnoses were simple phobia, social phobia, panic disorder, and major depression. CBT applied to GAD decreases the number of concurrent diagnoses. A panic disorder or a greater number of concurrent diagnoses at pretest is associated with a less efficient treatment at follow-up 6 months later. CONCLUSION: Patients with GAD have a high comorbidity rate with other Axis I disorders, but these significantly decrease after a short CBT aimed at GAD. Implications for GAD treatment and mechanisms that might explain these findings are discussed.

Adult↗

PubMed2006

A prospective study of the impact of opening a casino on gambling behaviours: 2- and 4-year follow-ups.

OBJECTIVE: It is widely believed that the rate of pathological gambling is related to the accessibility and availability of gambling activities. Few empirical studies have yet been conducted to evaluate this hypothesis. Using a longitudinal prospective design, the current study evaluates the impact of a casino in Canada's Hull, Quebec region. METHOD: A random sample of respondents from Hull (experimental group) and from Quebec City (comparison group) completed the South Oaks Gambling Screen (SOGS) and gambling- related questions before the opening of the Hull Casino (pretest), 1 year after the opening (posttest), and on follow-up at Years 2 and 4. RESULTS: Although, 1 year after the opening of the casino, we did observe an increase in playing casino games and in the maximum amount of money lost in 1 day's gambling, this trend was not maintained over time (2- and 4-year follow-ups). In the Hull cohort, the rate of at-risk and probable pathological gamblers and the number of criteria on the SOGS did not increase at the 2- and 4-year follow-ups. The residents' reluctance to open a local casino was generally stable over time following the casino's opening. CONCLUSION: The discussion raises different explanatory factors and focuses on the context of the Regional Exposure Model as a potentially more applicable measure of studying the expansion of gambling.

Adolescent↗

PubMed2006

Responsible gambling tools: pop-up messages and pauses on video lottery terminals.

The authors examined the effect of messages and pauses, presented on video lottery terminal screens, on erroneous beliefs and persistence to play. At posttest, the strength of erroneous beliefs was lower for participants who received messages conveying information about randomness in gambling as compared to those who received pauses. Pauses also diminished the strength of erroneous beliefs, and there was no difference between the effects of pauses and messages on the number of games played. The authors discuss these results in terms of the use of messages and pauses on video lottery terminals as a strategy for promoting responsible gambling.

Computer Terminals↗

PubMed2005

Joint trajectories of gambling, alcohol and marijuana use during adolescence: a person- and variable-centered developmental approach.

The usefulness of Moffitt's (1993) [Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.] theory of antisocial behavior was examined regarding gambling, alcohol and marijuana use. We assessed 903 Caucasian boys' developmental trajectories of these behaviors annually from age 11 through age 16. Severity of problems with these behaviors were assessed at ages 17 and 23. As correlates of these behaviors, teacher-rated personality and self-reported parenting were assessed at age 10. Self-reported autonomy was measured at ages 11 and 14. A cluster analysis on the correlates yielded two clusters. Membership in the cluster without adult problems was associated with either late onset of gambling and/or alcohol use trajectories or consistently low involvement in each of the behaviors. This cluster may correspond to Moffitt's adolescence-limited group and uninvolved adolescents, respectively. Membership in the cluster with subsequent adult problems was associated with early initiation of at least one of the three behaviors and involvement in each of them during adolescence. This cluster may correspond to Moffitt's life-course-persistent group. Findings indicate that early assessment of correlates used in the cluster analysis may be useful for screening and preventive purposes.

Adolescent↗

PubMed2005

Treating problem gamblers: working towards empirically supported treatment.

There is an urgent need for mental health professionals to develop effective treatments for pathological gambling. A scientific meeting was held in Quebec City in June 2002 where 13 specialists in the treatment of gamblers pursued the objectives of making the "State of the art" statement concerning the procedures and the methodology to be used in future treatment outcome studies. This paper introduces this special issue of the Journal of Gambling Studies and identifies some of the key issues that confront clinicians and researchers interested in evidence based treatment for gambling related disorders.

Congresses as Topic↗

PubMed2005

Controlled gambling for pathological gamblers.

Despite its high prevalence, pathological gambling often remains untreated. It is estimated that only 10% of the pathological gamblers identified in prevalence studies will enter treatment. Within this small proportion, a high percentage will drop out. Despite the facts that some researchers argue against abstinence as the unique treatment goal and that regaining control appears to be possible for some pathological gamblers, abstinence has been the only treatment goal in most problem gambling interventions thus far. This paper examines the avenue of controlled gambling embedded in a harm reduction context as a viable solution for some pathological gamblers.

Adult↗

PubMed2005

Structural characteristics of video lotteries: effects of a stopping device on illusion of control and gambling persistence.

Two studies investigated the effects of a video lottery terminal stopping device on gamblers' thoughts and behavior. This structural characteristic allows players to voluntarily stop the spinning of the reels. The first study investigated the effect of this device on the development of illusions of control. It was predicted that players using the stopping device would believe that (1) symbols displayed could differ depending on when the game is stopped, (2) there is a possibility of controlling the outcome of the game, (3) skills may be a factor influencing the results, and finally (4) a stopping device would improve the probability of personal success (i.e., developing the illusion of control). The second study aimed to further evaluate the effects of the stopping device on gambling behavior. It was hypothesised that using the stopping device would encourage players to increase the number of games played in a session. Results confirmed all predictions and showed that offering a stopping device on video lottery terminals modifies gamblers' cognition and behavior. The theoretical and practical implications of these results are discussed in the context of responsible gambling policies.

Female↗

PubMed2005

Modifying youths' perception toward pathological gamblers.

This study evaluates the effectiveness of a video specifically designed to provide relevant information on gambling and to correct the perceptions that adolescents have about pathological gamblers. Results indicate that the video significantly improved participants' knowledge about gambling and corrected their misconceptions toward excessive gamblers. The implications of these results for the prevention of gambling problems are discussed.

Adolescent↗

PubMed2005

Further validation of a cognitive-behavioral model of generalized anxiety disorder: diagnostic and symptom specificity.

The goal of this study was to investigate the diagnostic and symptom specificity of a model of GAD that has four main features: intolerance of uncertainty, positive beliefs about worry, poor problem orientation, and cognitive avoidance. The authors compared 17 patients with non-comorbid generalized anxiety disorder (GAD) to 28 patients with non-comorbid panic disorder with agoraphobia (PDA) and found that only intolerance of uncertainty showed evidence of diagnostic specificity, i.e., intolerance of uncertainty scores were higher in the GAD group relative to the PDA group. In terms of symptom specificity, when both groups were combined, all model variables were significantly related to worry but unrelated to fear of bodily sensations, agoraphobic cognitions, and behavioral avoidance. Taken together, these findings provide further support for the link between intolerance of uncertainty and GAD and underscore the importance of pursuing the issue of specificity from both a diagnostic and symptom perspective.

Adult↗

PubMed2005

Self-efficacy and compliance with benzodiazepine taper in older adults with chronic insomnia.

Better understanding of compliance with BZD taper is warranted. Compliance with a taper program and perceived self-efficacy (SE) in being able to comply with hypnotic reduction goals was monitored weekly in 52 older adults (mean age: 63.0 years) with chronic insomnia (average duration: 21.9 years) who underwent a 10-week physician-supervised medication tapering. One group received cognitive- behavior therapy for insomnia during discontinuation, whereas the other did not. Compliant patients showed higher SE ratings at Weeks 6, 8, 9, and 10. Medication-free patients at the end of the treatment also reported higher mean SE ratings at those 4 weeks. Differences remained significant when withdrawal symptoms and sleep efficiency were controlled for. These results have important clinical implications because SE may indicate key time points when patients are experiencing more difficulty during discontinuation.

Aged↗

PubMed2005

Concordance between the SOGS-RA and the DSM-IV criteria for pathological gambling among youth.

This study assessed the possible differences in the classification of adolescent gamblers when using the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA; K. C. Winters, R. D. Stinchfield, & J. Fulkerson, 1993) versus a clinical interview that was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) criteria for pathological gambling. A total of 631 adolescents ages 15-17 years participated in the two phases of the study. Results revealed that of the 93 adolescents who had been screened as problem gamblers according to the SOGS-RA, only 7 could be clinically confirmed as pathological gamblers according to the criteria used at present to define pathological gambling. The need to clarify the construct of pathological gambling among youth is discussed.

Adolescent↗

PubMed2005

A national survey of gambling problems in Canada.

OBJECTIVE: The 1990s saw widespread expansion of new forms of legalized gambling involving video lottery terminals (VLTs) in community settings (that is, in bars and restaurant lounges) and permanent casinos in several Canadian provinces. To date, there has never been a national survey of gambling problems with representative interprovincial data. Using a new survey, we sought to compare prevalence figures across the 10 Canadian provinces. METHOD: Using the Canadian Problem Gambling Index, we investigated the current 12-month prevalence of gambling problems in the Canadian Community Health Survey: Cycle 1.2--Mental Health and Well-Being, in which a random sample of 34,770 community-dwelling respondents aged 15 years and over were interviewed. The response rate was 77%. The data are representative at the provincial level and were compared with the availability of VLTs per 1000 population and with the presence of permanent casinos for each province. RESULTS: Manitoba (2.9%) and Saskatchewan (also 2.9%) had the highest prevalence of gambling problems (specifically, moderate and severe problem levels combined). These 2 provinces had significantly higher levels than the 2 provinces with the lowest prevalence of gambling problems: Quebec (1.7%) and New Brunswick (1.5%). CONCLUSIONS: The 12-month prevalence of gambling problems in Canada was 2.0%, with interprovincial variability. The highest prevalence emerged in areas with high concentrations of VLTs in the community combined with permanent casinos. These findings support earlier predictions that the rapid and prolific expansion of new forms of legalized gambling in many regions of the country would be associated with a considerable public health cost.

Adolescent↗