Transcript Bridging the Gap between Research and Practice

Bridging the Gap between
Research and Practice
Mark R. Dixon & Alyssa Wilson
Southern Illinois University
The Road to Somewhere…..
• Casino laboratory
• College students as
subjects in research
• Computerized versions of
actual casino games
Bench
Translational
• Answering basic
psychological processes
with a clinical/sub-clinical
sample
• In the field research or
clients entered into lab
• Real pathological gamblers
• Real gambling problems
• Real treatment that YOU
can take with you today
Bedside
Problem gambling is not the problem.
• Problem gambling is the outcome of deeper
rooted clinical problem.
• Treatment should be designed to treat what
the “cause” of the gambling is, not just the
gambling itself.
• Life is not just “fine” except for problems with
gambling.
Popular Treatment Approaches
•
Gamblers Anonymous
–
–
–
–
•
Disease model
Client is a victim
You never “beat” the disease
No active treatment. Social support group.
Self-Exclusion Programs
– Self or court orders gambler to be banned from gaming establishments
– No way to ban online or illegal local gambling
•
Medication
– Certain dopamine blockers can be effective at suppressing gambling for some people
– Remove the medication, the problem returns
•
Psycho-educational
– Teach people about game odds
– Teach about risk to self or others from repeated gambling
Classic Behavioral Treatments
• Aversive Conditioning
• Thought suppression
• Self-monitoring/reinforcement
Contemporary Behavioral
Contributions
• Contingency-based Models
Response Cost
Behavioral Contributions
• Contingency-based Models
• Language-based Models
– External rules
Dixon (2000) – The Psychological
Record
• Subjects: 5 Recreational roulette players
• Baseline: Wagered on numbers they picked or the
experimenter picked.
• Intervention: Provided rules to the subjects
– Roulette is easy to win; the more you play the more you
win; the best way to win is to pick your own numbers
– Roulette is a losing game; the more you play the more you
lose; the experimenter can not predict good/bad numbers
• Outcome: relative rise and decline in wagers while
contingencies remained the same
• Conclusion: Rules matter – contingencies do not
Dixon, Hayes, & Aban (2000) – The
Psychological Record
• Subjects: 45 Recreational roulette players
• Baseline: Wagered on numbers they picked or the
experimenter picked.
• Intervention: Provided one set of rules to the subjects
– Roulette is easy to win; the more you play the more you win; the
best way to win is to pick your own numbers
– OR--– Roulette is a losing game; the more you play the more you lose;
the experimenter can not predict good/bad numbers
• Outcome: relative rise and decline in wagers while
contingencies remained the same
• Conclusion: Rules matter – contingencies do not
Behavioral Contributions
• Contingency-based Models
• Language-based Models
• Delivered Rules
• Self-Rules
Recent Attention Paid to
Near-Miss
Procedure
• Participants – 18 recreational slot machine
players
• Setting - small room, computer, video camera,
observation mirror. Three computerized slot
machines available concurrently.
• Method –
– 100 trials w/ 20% chance of a win on every trial
– 100 trials w/ 0% chance of a win on every trial
• Various densities of near-misses on each “slot machine”
• Reinforcement densities were constant on each slot machine
What we know:
• Subjects will rate near-miss displays as:
– Closer to wins
– More pleasurable / less aversive to look at
• Subjects will prefer near-misses in concurrent operant
preparations
– Density effect of NM
– Extinction conditions alter preference
• Neurological traces of the near-miss
– Near-misses produce different levels of dopamine in brain
– Pathological gamblers react neurologically different than nonpathological
What we don’t know:
• What behavioral process produces a near-miss
effect?
• Will the near-miss effect be demonstrated
with other casino games?
• Can the near-miss effect be assessed
independently of the by-chance reinforcers
that occur during gambling
What Actually is the Near-Miss Effect?
• Product of Stimulus Generalization
– Current display looks structurally similar to a
reinforced display, and thus it serves reinforcing
function
• A Discriminative Stimulus
– Signals the availability of an upcoming reinforcer
• Product of Verbal Construction
Or, an interaction of all the above?
Almost winning…
A verbal event
“Almost”
Verbal Construction
Antecedent
Speaker
Listener
Math Time
“What is 9 + 4 ?”
Behavior
“What is 9 + 4 ?”
“9 + 4 = 14”
Consequence
“9 + 4 = 14”
“Almost” +
GCR
Note: GCR might be < for “almost” than for “correct”
Looking for House #34
Antecedent
See House #26
Behavior
“Almost There”
Consequence
Arrive Soon at House
#34
Looking for House #34
Antecedent
See Gas Station
See Sign for Off
Ramp
See Sign for Sunset
Blvd
See
House
#26
Behavior
Consequence
“Almost There”
Arrive Soon at House
#34
“Almost”
Desired
Outcome
In Close
Proximity
Methods
• 16 participants with history of gambling
• Rating of 100 various slot machine displays
– Near miss - loss
1 (not at all)
5
- win
10 (very much like a win)
Methods
• Phase 1:
– Rate slot machine images
• Phase 2:
– Develop 3 three member stimulus classes
– Attempt to derive “almost” to non-near miss
display
• Phase 3:
– Repeat exposure to Phase 1 task
Stimulus 1
Stimulus 2
Stimulus 3
A Stimuli
WIN
B Stimuli
C Stimuli
Almost
Lose
Win
Loss
Pre-Test
Near-Miss
10
Likert Ratings (1 = loss -- 10 = win)
8
6
4
2
0
76
112
113
115
123
169
195
211
339
357
769
771
772
773
774
776
Post-Test
10
8
6
4
2
0
76
112
113
115
123
169
195
211
339
357
769
Participant Number
771
772
773
774
776
More than Slots
• Many more types of near misses occur while
gambling:
– Blackjack
– Roulette
– Craps
Blackjack
Near Miss: Blackjack
• Participants:
– 5 undergrads with history
of playing cards for
money
– Paid 50 dollars in lotto
drawing based on # of
chips left
• 50 trials (1o practice
trials)
• Data Collection
• Self-recorded data
• Experimenter IOR on 30%
trials
• End of trial – circle
number 1-9 on how close
their hand was to a win
– 1 = no chance ; moderate
chance; good chance (as
anchors)
– Record their score, dealer’s
Results
• 2 factor Near-Miss Effect
– Non-bust loss
– Mathematical difference between dealer and
player
Minimal Difference
between player and
dealer cards
Minimal Difference
between player and
dealer cards
Non-Bust
(under 21)
Near
Miss
Bust
(over 21)
No Near
Miss
Average Loss Trials
All Loss Trials (all players combined)
Roulette
Near Miss: Roulette
• Participants:
– 28 College Undergraduates (run concurrently)
– Extra credit value based on winnings
• First 5 students to hit a number = 10 x points
• Next 5 = 5 x points
• Remainder of students = 1 x point
• Played 60 trials of roulette
– 1 single bet on a single number (1:38 odds of winning)
– Rating of outcome
10
Avg Subjective Rating
9
8
7
6
5
4
3
2
1
- numerical value of bet and win
0
1
6
11
16
21
26
31
10
Avg Subjective Rating
9
8
7
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9
- between Location of Bet and Win on Board
10
Alternative Methods
• Self-reports of:
– How close to win
– How much do you like
• Preference for near-misses during
gambling
– Interaction between display and
superstitious reinforcement
Paired-Choice Near- Miss
• Participants
– 34 College
Undergraduates
– Awarded course extra
credit
– Randomly assigned to 2
groups of 17
– Instructed to choose
between two slot images.
• “Which one would you
rather see if you were
playing a slot machine?”
• Procedures
– Exposure to 120 trials of
3 trial types
• Win vs Loss
• Win vs Near Miss
• Near Miss vs Loss
– Experimental Group
• 5 min intervention
– Control Group
• 5 min break in hallway
Intervention Details
• Prior research suggests that rules are effective
ways of altering gambling behavior
– Dixon (2000); Dixon, Aban, & Hayes (2000)
– Dixon & Delaney (2006)
• Prior research also suggests that the
deliteralization of language can alter the
current functions of a specific verbal stimulus
– Aka: defusion in therapy contexts
Experimental Intervention: (one slide)
• Almost winning is not winning at all
• Almost winning is a trick played on you by the
slot machine
• Almost winning makes you feel good, but it is
false feeling
• Losing is losing is losing is losing is losing is losing
– Repeat for 2 minutes
Which One??
A
B
Which One??
A
B
Which One??
A
B
% Choices for Win
100
80
60
Exp
40
Control
20
0
Pre
Post
% Choices for N.M.
100
80
60
Exp
40
Control
20
0
Pre
Post
% Choices for Loss
100
80
60
Exp
40
Control
20
0
Pre
Post
Variations of Effect
• The Near-Miss effect varies
• Not based exclusively on physical characteristics of the
stimulus
• Core behavioral process rests on altering of
psychological function of the stimulus (stimuli)
• Altering psychological function will alter the type of
stimulus that is considered a near-miss
Variations of Assessment
• The Near-Miss Effect can be assessed with
novel methods and produce similar effects
• Verbally based interventions for
gamblers who are under control of
near-misses appear promising
Nastally and Dixon (2011):
The Psychological Record
• N=3 Pathological gamblers
• MBL across participants
• Baseline Computerized slot machine play
– 50, 70, 90 trials at baseline
– Report out loud how close each outcome was to a
win
– 1 (very far from a win) to 10 (very close to a win)
SIMULATION
Visible Symbols
on Wheel
SIMULATION
Treatment
• Intervention
– ACT intervention targeted each of the 6
components
– Intervention delivered via PowerPoint
presentation each 5 min in length
– Slides consisted of words/pictures in form of
directions + experiential exercises
– Each component was delivered at equal length of
time
Contact with the
Present Moment
Acceptance
Values
Psychological
Flexibility
Defusion
Committed
Action
Self as
Context
Client 1
Baseline Play and
Self-Ratings
30 min
ACT
Post-Treatment Play and Self Ratings
Client 2
Baseline Play and SelfRatings
30 min
ACT
Post-Treatment Play and Self Ratings
Client 3
Baseline Play and Self-Ratings
30 min
ACT
Time
Post-Treatment Play and Self Ratings