Neurobiological considerations in understanding behavioral treatments for pathological gambling

Abstract

Pathological gambling (PG), a disorder currently categorized as an impulse-control disorder but being considered as a nonsubstance addiction in Diagnostic and Statistical Manual of Mental Disorders (5th ed.) discussions, represents a significant public health concern. Over the past decade, considerable advances have been made with respect to understanding the biological underpinnings of PG. Research has also demonstrated the efficacies of multiple treatments, particularly behavioral therapies, for treating PG. Despite these advances, relatively little is known regarding how biological measures, particularly those assessing brain function, relate to treatments for PG. In this article, we present a conceptual review focusing on the neurobiology of behavioral therapies for PG. To illustrate issues related to study design, we present proof-of-concept preliminary data that link Stroop-related brain activations prior to treatment onset to treatment outcome in individuals with PG receiving a cognitive-behavioral treatment incorporating aspects of imaginal desensitization and motivational interviewing. We conclude with recommendations about current and future directions regarding how to incorporate and translate biological findings into improved therapies for individuals with nonsubstance and substance addictions.

Trial registration: ClinicalTrials.gov NCT00967005.

2013 APA, all rights reserved

Figures

Figure 1. Saggital, axial and coronal views of regional brain activation during Stroop task performance and correlations with PG-YBOCS scores

a) At baseline, brain slices highlight the correlation with a cluster in the left ventral striatum (-15, 12, -9; n = 7 subjects); b) Absolute changes in PG-YBOCS scores (end of treatment vs pre-treatment) correlate with a cluster in the vmPFC (3, 48, -21; n = 6 subjects); c) Absolute changes in PG-YBOCS scores (end of treatment vs pre-treatment) correlate with a cluster in the ventral striatum (21, 9, -15; n = 6 subjects). Orange/yellow indicates areas of positive correlations and blue/green indicates areas of negative correlations between PG-YBOCS scores and % BOLD signal changes in the incongruent versus congruent contrast. All maps are thresholded at an uncorrected level of p < 0.05 and two-tailed FWE-corrected at p < 0.05 with a cluster threshold of 90. Right side of the brain is on the right. Scatterplots (bottom of figure) demonstrate the distribution of individual scores in the correlation between absolute changes in PG-YBOCS scores and % BOLD signal change during incongruent versus congruent stimuli presentation during Stroop task performance. BOLD = blood oxygenation level-dependent; FWE = family-wise error; MNI = Montreal Neurological Institute; PG-YBOCS = Yale-Brown Obsessive Compulsive Scale modified for Pathological Gambling; r = Pearson correlation coefficient; vmPFC = ventral medial prefrontal cortex