A cognitive approach to gambling craving : conceptualization, assessment and intervention

Cornil, Aurélien [UCL]

Research has highlighted the pivotal role of craving in the onset and perpetuation of gambling disorder. This has led to a growing interest about craving in research and in clinical practice, even though it is not included as a diagnostic criterion in international nosography manuals. Craving was systematically studied by reusing existing models and assessment instruments related to substance-use disorders and by applying a confirmatory approach, which might have resulted in neglecting the unique features of gambling craving. In this PhD thesis, we instead adopted an exploratory approach to improve the conceptualization, assessment, and treatment of gambling craving. In a first study, a mixed-method approach was used to explore the phenomenology of gambling craving. The results were put into perspective with the elaborated intrusion theory (EIT) of desire, an increasingly popular cognitive theory of desire and craving that has been applied to substance and food craving in the recent years. This first study supports the relevance of the EIT to account for gambling craving. The next two studies investigated the properties of two instruments that aim to assess gambling craving. On the one hand, the gambling craving scale is a widely used tool that is used to evaluate gambling craving in research. Yet, we found that this scale rather measures urge, a motivational component of craving that corresponds to positive and negative expectations. On the other hand, and by capitalizing on the results from our first study, we adapted and validated in the context of gambling the Craving Experience Questionnaire, which is theorized in the EIT. Our gambling version of the questionnaire presented the same factorial structure as the original one. In a fourth study composed of two experiments, we tested the effect of interference-based methods, also grounded in the EIT, on laboratory induced gambling craving. We found that these interventions successfully diminished laboratory-induced gambling. These encouraging results should be reproduced in clinical samples. The final chapter consists in a study protocol presenting a multiple single-case design that aims to test the interference-based methods among clinical gamblers and in a real clinical setting. Overall, this PhD thesis offers perspectives of tailored assessment and psychological intervention among individuals presenting problematic gambling patterns, and it supports the relevance for further clinical investigation.

(fre) Le trouble lié au jeu d’argent est reconnu comme un trouble addictif dans les dernières éditions des principaux manuels diagnostiques. Bien qu’il ne soit pas inclus comme un critère diagnostique, de nombreuses études considèrent le craving comme un facteur favorisant ce trouble. Dans cette thèse, nous avons investigué la phénoménologie du craving au jeu d’argent avec une méthode mixte dans une optique exploratoire. Les résultats ont été mis en perspective avec une théorie cognitive du craving : la théorie de l’intrusion élaborée, démontrant la pertinence de cette dernière pour rendre compte du craving au jeu. Les propriétés psychométriques de deux échelles ont ensuite été investiguées afin de mesure adéquatement ce phénomène. Finalement, nous avons testé la méthode d’interférence, une intervention visant à réduire le craving au jeu d’argent. Cette thèse offre des perspectives d’interventions adaptées pour les personnes souffrant d’un trouble lié au jeu d’argent et encourage à poursuivre la recherche en population clinique.