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# Gambling and COVID-19: Swedish national gambling data from a state-owned gambling sports and casino operator

Authors:
Marianne Balem
,
Anna Karlsson
,
Carolina Widinghoff
,
Bastien Perrot
,
Gaëlle Challet-Bouju
, and
Anders Håkansson

## Abstract

### Background and aims

The lockdown of sports and gambling venues during the coronavirus disease 2019 (COVID-19) pandemic caused a fear of increased gambling on other online gambling types, with a risk for transfer to more addictive gambling than otherwise. This study aimed to estimate changes in gambling activity during COVID-19-affected periods among all gamblers at a Swedish state-owned gambling operator and to analyse observable sex differences.

### Methods

This study included gambling tracking data from the Swedish state-owned gambling operator Svenska Spel Sports & Casino (sports betting, online bingo, casino and poker). All individuals (n = 616,245) who gambled at least once from February 10 to July 19, 2020, were included. The study period was divided into four periods according to their expected level of COVID-19 impact on gambling opportunities: one pre-COVID period and three COVID-affected periods (sports cancellation, emerging return of sports, substantial return of sports).

### Results

Sports betting experienced an apparent decrease, followed by a gradual normalization and an end level substantially below prepandemic levels. For online bingo, gambling levels increased upon sports interruption and then decreased with the return to normality in sports events but remained higher than baseline levels. We observed a similar trend for online poker during the interruption of sports, but with a lower level than baseline levels when sports events normalized. We noticed a trend favouring online casinos during the sports interruption period regarding gambling intensity but not wagering levels.

### Discussion and conclusions

Dramatic changes in the content of the gambling market may divert some gamblers to other gambling types, but maintained effects could not be demonstrated.

Open access

# View, meditation, action: A Tibetan framework to inform psychedelic-assisted therapy

Journal of Psychedelic Studies
Author:
Colin H. Simonds

## Abstract

Whether occasioned through careful, consistent meditative practice or through quicker means like the ritual ingestion of psilocybin or ayahuasca, global contemplative practices have established effective systems of implementing, directing, and integrating the very kinds of non-ordinary experiences central to psychedelic use. However, contemplative traditions are largely absent from the present discourse on psychedelic therapy. This paper addresses this gap and offers a novel analysis of psychedelic-assisted therapy through the lens of the Tibetan Buddhist contemplative tradition. It first establishes a baseline for comparing the non-ordinary experience occasioned by Tibetan Buddhist meditation and the psychedelic experience by referencing the phenomenological literature of both. It then articulates the Tibetan contemplative framework of view, meditation, action (Tib. lta sgom spyod gsum) as the way Tibetan Buddhism directs its non-ordinary meditative experience towards its desired ends and suggests how this framework may be applied to psychedelic-assisted therapy. Finally, this paper uses this Tibetan Buddhist lens of analysis to compare and assess two protocols for psychedelic-assisted therapy and to make recommendations for future clinical protocols. Given the phenomenological similarity of Tibetan Buddhist meditative experience and the psychedelic experience, this article suggests that a more intensive preparatory session where maladaptive conceptual narratives are worked through and beneficial ones are introduced, repeated dosing sessions, and a more directed psychedelic experience may increase the efficacy of psychedelic-assisted therapy. It thus argues that the insights of the Tibetan framework of view, meditation, action can improve future protocols and allow for psychedelic-assisted therapy to be of even greater benefit.

Open access

# Safer esports for players, spectators, and bettors: Issues, challenges, and policy recommendations

Authors:
Andrea Czakó
,
Orsolya Király
,
Patrik Koncz
,
Shu M. Yu
,
Harshdeep S. Mangat
,
Judith A Glynn
,
Pedro Romero
,
Mark D Griffiths
,
Hans-Jürgen Rumpf
, and
Zsolt Demetrovics

## Abstract

The present paper provides an overview of the possible risks, harms, and challenges that might arise with the development of the esports field and pose a threat to professional esports players, spectators, bettors and videogame players, including underage players. These include physical and mental health issues, gambling and gambling-like elements associated with videogames and esports, the challenges arising from pursuing a career in esports, the unique difficulties women face, and a need for supporting professional esports players. It briefly discusses possible responses and suggestions regarding how to address and mitigate these negative consequences. It emphasizes the need for cooperation and collaboration between various stakeholders: researchers, policymakers, regulators, the gaming industry, esports organizations, healthcare and treatment providers, educational institutes and the need for further evidence-based information.

Open access

# The associative learning roots of affect-driven impulsivity and its role in problem gambling: A replication attempt and extension of Quintero et al. (2020)

Authors:
Ismael Muela
,
José M. Ventura-Lucena
,
Juan F. Navas
, and
José C. Perales

## Abstract

### Background and aims

Negative/positive urgency (NU/PU) refers to the proneness to act rashly under negative/positive emotions. These traits are proxies to generalized emotion dysregulation, and are well-established predictors of gambling-related problems. We aimed to replicate a previous work (Quintero et al., 2020) showing NU to be related to faulty extinction of conditioned stimuli in an emotional conditioning task, to extend these findings to PU, and to clarify the role of urgency in the development of gambling-related craving and problems.

### Methods

81 gamblers performed an acquisition-extinction task in which neutral, disgusting, erotic and gambling-related images were used as unconditioned stimuli (US), and color patches as conditioned stimuli (CS). Trial-by-trial predictive responses were analyzed using generalized linear mixed-effects models (GLME).

### Results

PU was more strongly related than NU to craving and severity of gambling problems. PU did not influence acquisition in the associative task, whereas NU slightly slowed it. Extinction was hampered in individuals with high PU, and a follow-up analysis showed this effect to depend on relative preference for skill-based and casino games.

### Discussion and conclusions

Results suggest that resistance to extinction of emotionally conditioned cues is a sign of malfunctioning emotion regulation in problematic gambling. In our work, the key effect was driven by PU (instead of NU), and gambling craving and symptoms were also more closely predicted by it. Future research should compare the involvement of PU and NU in emotion regulation and gambling problems, for gamblers with preference for different gambling modalities (e.g., pure chance vs skill games).

Open access

# The role of executive function deficits, delay aversion and emotion dysregulation in internet gaming disorder and social media disorder: Links to psychosocial outcomes

Authors:
Lorrayne Soares
,
Lisa B. Thorell
,
Martina Barbi
,
Giulia Crisci
,
Sissela B. Nutley
, and
Jonas Burén

## Abstract

### Background and aims

It has been argued that it is important to consider underlying mechanisms of mental health problems. Previous studies have shown that executive deficits, delay aversion, and emotion dysregulation are related to Internet Gaming Disorder (IGD) and Social Media Disorder (SMD). However, the present study is the first to investigate whether these neuropsychological deficits show additive effects or if they interact. The present study also investigated whether these deficits mediate the association between IGD/SMD and psychosocial outcomes.

### Methods

The study involved 995 university students who completed a survey measuring IGD/SMD symptom severity, neuropsychological functions, and psychosocial outcomes. Both dimensional and categorical analyses were used to assess the associations between neuropsychological functions and IGD/SMD. Simple and multiple mediation analyses were conducted to examine if neuropsychological functioning mediates the association between IGD/SMD and psychosocial outcomes.

### Results

All neuropsychological functions were significantly associated with both IGD and SMD symptom severity. However, only inhibition and emotion regulation, as well as delay aversion for SMD, remained significant when controlling for the overlap between different functions. Associations were significantly stronger for men compared to women for IGD. In the categorical analyses, individuals with IGD/SMD were more likely to have neuropsychological deficits (odds ratios between 3.33 and 8.81). Finally, all neuropsychological functions, except inhibition, were significant mediators in the link between IGD/SMD and psychosocial outcomes.

### Discussion and conclusions

These results shed light on the neuropsychological underpinnings of IGD/SMD, which can be used to identify more homogenous subgroups and provide more individualized treatment options.

Open access

# Structural brain differences related to compulsive sexual behavior disorder

Authors:
Per Görts
,
Josephine Savard
,
Katarina Görts-Öberg
,
Cecilia Dhejne
,
Stefan Arver
,
Jussi Jokinen
,
Martin Ingvar
, and
Christoph Abé

## Abstract

### Background and aims

Compulsive sexual behavior disorder (CSBD) has been included as an impulse control disorder in the International Classification of Diseases (ICD-11). However, the neurobiological mechanisms underlying CSBD remain largely unknown, and given previous indications of addiction-like mechanisms at play, the aim of the present study was to investigate if CSBD is associated with structural brain differences in regions involved in reward processing.

### Methods

We analyzed structural MRI data of 22 male CSBD patients (mean = 38.7 years, SD = 11.7) and 20 matched healthy controls (HC; mean = 37.6 years, SD = 8.5). Main outcome measures were regional cortical thickness and surface area. We also tested for case-control differences in subcortical structures and the effects of demographic and clinical variables, such as CSBD symptom severity, on neuroimaging outcomes. Moreover, we explored case-control differences in regions outside our hypothesis including white matter.

### Results

CSBD patients had significantly lower cortical surface area in right posterior cingulate cortex than HC. We found negative correlations between right posterior cingulate area and CSBD symptoms scores. There were no group differences in subcortical volume.

### Conclusions

Our findings suggest that CSBD is associated with structural brain differences, which contributes to a better understanding of CSBD and encourages further clarifications of the neurobiological mechanisms underlying the disorder.

Open access

# Brain structural co-development is associated with internalizing symptoms two years later in the ABCD cohort

Authors:
Yihong Zhao
,
Martin P. Paulus
, and
Marc N. Potenza

## Abstract

### Background and aims

About 1/3 of youth spend more than four hours/day engaged in screen media activity (SMA). This investigation utilized longitudinal brain imaging and mediation analyses to examine relationships among SMA, brain patterns, and internalizing problems.

### Methods

Data from Adolescent Brain Cognitive Development (ABCD) participants with baseline and two-year follow-up structural imaging data that passed quality control (N = 5,166; 2,385 girls) were analyzed. Joint and Individual Variation Explained (JIVE) identified a brain co-development pattern among 221 brain features (i.e., differences in surface area, thickness, or cortical and subcortical gray-matter volume between baseline and two-year-follow-up data). Generalized linear mixed-effect models investigated associations between baseline SMA, structural co-development and internalizing and externalizing psychopathology at two-year follow-up.

### Results

SMA at baseline was related to internalizing psychopathology at year 2 ( $β = 0.020 , S E = 0.008 , P = 0.014$ ) and a structural co-development pattern ( $β = 0.015 , S E = 0.007 , P = 0.029$ ), where the co-development pattern suggested that rates of change in gray-matter volumes of the brainstem, gray-matter volumes and/or cortical thickness measures of bilateral superior frontal, rostral middle frontal, inferior parietal, and inferior temporal regions were more similar than those in other regions. This component partially mediated the relationship between baseline SMA and future internalizing problems (indirect effect = 0.020, P-value = 0.043, proportion mediated: 2.24%).

### Discussion and conclusions

Greater youth engagement in SMA at ages 9–10 years statistically predicted higher levels of internalizing two years later. This association was mediated by cortical-brainstem circuitry, albeit with relatively small effect sizes. The findings may help delineate processes contributing to internalizing behaviors and assist in identifying individuals at greater risk for such problems.

Open access

# The concept of recovery in gaming disorder: A scoping review

Authors:
Belle Gavriel-Fried
,
Meytal Serry
,
Dana Katz
,
Dorottya Hidvégi
,
Zsolt Demetrovics
, and
Orsolya Király

## Abstract

### Background

Recovery from mental health and behavioral disorders is classically defined as a reduction in symptoms. More recent definitions see it as a process in which individuals improve their health, wellness and other life domains. The inclusion of gaming disorder (GD) in the 11th International Classification of Diseases in 2019 prompted growing interest in GD. However, relatively little is known about recovery from GD, and there is scant literature describing or assessing its course.

### Objectives

This scoping review was designed to explore the state of the art on recovery from GD (e.g., terminology and measures used to assess recovery, main topics in studies about recovery from GD).

### Methods

PubMed, Web of Science, and Scopus databases were searched and critically reviewed according to PRISMA guidelines. We included empirical studies in English covering individuals across all age groups who met the diagnostic criteria of GD/internet gaming disorder (IGD) according to valid scales that relate to recovery or any change, and were published before February 2022.

### Results

A total of 47 out of 966 studies met the inclusion criteria. Recovery as a concept is not explicitly mentioned in GD studies. Rather, changes in subjects' disorders are described in terms of decreases/reductions in symptom severity, or improvement/increases. These changes are primarily measured by scales that evaluate symptom reduction and/or improvement in GD and other psychopathologies.

### Conclusions

The concept of recovery is included in the GD field but is not clearly mentioned or used. Therapists and researchers should aim to promote and integrate the notion of recovery in GD.

Open access

# Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI)

Authors:
Joshua B. Grubbs
,
Rory C. Reid
,
Beáta Bőthe
,
Zsolt Demetrovics
,
Eli Coleman
,
Neil Gleason
,
Michael H. Miner
,
Johannes Fuss
,
Verena Klein
,
Karol Lewczuk
,
Mateusz Gola
,
David P. Fernandez
,
Elaine F. Fernandez
,
Stefanie Carnes
,
Michal Lew-Starowicz
,
Drew Kingston
, and
Shane W. Kraus

## Abstract

### Background and aims

The World Health Organization's International Classification of Diseases (ICD-11) includes Compulsive Sexual Behavior Disorder (CSBD), a new diagnosis that is both controversial and groundbreaking, as it is the first diagnosis to codify a disorder related to excessive, compulsive, and out-of-control sexual behavior. The inclusion of this novel diagnosis demonstrates a clear need for valid assessments of this disorder that may be quickly administered in both clinical and research settings.

### Design

The present work details the development of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) across seven samples, four languages, and five countries.

### Setting

In the first study, data were collected in community samples drawn from Malaysia (N = 375), the U.S. (N = 877), Hungary (N = 7,279), and Germany (N = 449). In the second study, data were collected from nationally representative samples in the U.S. (N = 1,601), Poland (N = 1,036), and Hungary (N = 473).

### Findings

Across both studies and all samples, results revealed strong psychometric qualities for the 7-item CSBD-DI, demonstrating evidence of validity via correlations with key behavioral indicators and longer measures of compulsive sexual behavior. Analyses from nationally representative samples revealed residual metric invariance across languages, scalar invariance across gender, strong evidence of validity, and utility in classifying individuals who self-identified as having problematic and excessive sexual behavior, as evidenced by ROC analyses revealing suitable cutoffs for a screening instrument.

### Conclusion

Collectively, these findings demonstrate the cross-cultural utility of the CSBD-DI as a novel measure for CSBD and provide a brief, easily administrable instrument for screening for this novel disorder.

Open access