And now for “real treatment”…

3. And now for “real treatment”… • Development of an 8-week managed care model • 1 session per week • 50 min in length • 8 weeks

4. Traditional Cognitive Behavioral Therapy • Focus on identifying “triggers” or antecedents • Developing strategies for engaging in alternative behaviors that lead to similar reinforcers • Learning how to control urges (by thinking of alternative behaviors) • Avoidance of gambling establishing operations

5. Pathological Gamblers w/ co-occurring Brain Injury • Brain injury often results in development of impulse control disorders • Our data have shown that in a survey of over 200 persons with brain injury the rate of problem gambling was 20% • Unsure if gambling problems were in life prior to brain injury or as a result of the injury • Captive population allowing for cleaner experimental control

6. Guercio, Johnson, & Dixon (in press, JABA) • Participants: 3 participants with acquired brain injury • Method: • Baseline: Trips taken to casino and lab-casino and given 20 dollars to gamble • Intervention: 8 weeks of 1 hour therapy sessions. Allowed lab-casino gambling immediately after therapy session. • DV: money spent on gambling, self-reports of gambling severity

10. Behavioral Treatment Works • Does it work well enough? • Have we really “fixed” the problem? • Is CBT the “best” we can do? • When compared to alternative behavioral models it often falls short • Avoidance of gambling related stimuli is harder to do as gambling opportunities continue to expand • Is there an alternative to “avoiding” life?

11. Acceptance and Commitment Therapy • Alternative to traditional CBT • Acceptance not suppression of thoughts (forced exposure to private events and aversive stimuli) • Contacting life in the moment (responding relationally to temporal relations of here-now; not before-after) • Creating distance between your discrimination of “self” (and overt/covert verbal behavior that describes yourself) Move Over Fred

12. The ACT Question In this moment are you Willing to show up to whatever you are experiencing without defenses Freely chose a direction you want to head in Psychological Flexibility See things for what they are, and not what they say they are And gently return to that direction when you find yourself off track Not the stories you tell about yourself, but you

13. Number of ACT Empirical Publications

14. Number of ACTRCTs

15. ACT Outcomes Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcome. Behaviour Research and Therapy, 44, 1-25.

16. Present Study • Participants • 7 pathological gamblers seeking treatment • 3 wait-list control gambler seeking treatment • Paid total of 200 dollars for participating in study • Setting • Gambling therapy clinic • Carbondale Memorial Hospital • Procedure • Pre-screening • Baseline evaluation (behavioral/neurological) • 8 hours of 1:1 ACT therapy • Treatment evaluation (behavioral/neurological)

17. Setting and Experimental Task Self-referral to treatment Program Intake with therapist in clinic within aprox 7 day of call Completion of battery of psychometric tests and actual gambling exposure Final Scanning in fMRI at Hospital Initial Scanning in fMRI at Hospital 8 hours of 1:1 therapy delivered in clinic

18. T

20. Component analysis; frequency count

21. Valued Living Questionnaire – Rate on Scale 1-10

22. fMRI Scanner Task • 5 blocks of exposure to 2.5 sec of slot machine reels spinning & 2.5 sec of slot machine outcome • 20 near-miss outcomes • 20 total loss outcomes • 20 win outcomes • Participants asked to rate on scale of 1-5 how pleasurable each outcome was. • 1 not at all pleasurable • 5 very pleasurable

48. Treatment Content Assessment 4836

49. Treatment Content Assessment 4841

50. Treatment Content Assessment 4338