1. Bridging the Gap between Research and Practice Mark R. Dixon & Alyssa Wilson Southern Illinois University

2. The Road to Somewhere….. Casino laboratory College students as subjects in research Computerized versions of actual casino games Bench Answering basic psychological processes with a clinical/sub-clinical sample In the field research or clients entered into lab Translational Real pathological gamblers Real gambling problems Real treatment that YOU can take with you today Bedside

3. 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.

4. 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

5. Classic Behavioral Treatments Aversive Conditioning Thought suppression Self-monitoring/reinforcement

6. Contemporary Behavioral Contributions Contingency-based Models

7. Response Cost

9. Behavioral Contributions Contingency-based Models Language-based Models – External rules

10. 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

11. 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

12. Behavioral Contributions Contingency-based Models Language-based Models Delivered Rules Self-Rules

13. Recent Attention Paid to Near-Miss

16. 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

19. 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 non- pathological

20. 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

21. 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?

22. Almost winning… A verbal event “Almost”

23. “9 + 4 = 14” Antecedent “Almost” + GCR “What is 9 + 4 ?” Speaker Listener Math Time Behavior Consequence “What is 9 + 4 ?” Verbal Construction Note: GCR might be < for “almost” than for “correct”

24. Looking for House #34 See House #26 “Almost There” Arrive Soon at House #34 AntecedentBehavior Consequence

25. Looking for House #34 See Gas Station “Almost There” Arrive Soon at House #34 AntecedentBehavior Consequence See Sign for Off Ramp See Sign for Sunset Blvd See House #26

26. “Almost” Desired Outcome In Close Proximity

28. Methods 16 participants with history of gambling Rating of 100 various slot machine displays – Near miss- loss - win HOW CLOSE IS THIS DISPLAY TO A WIN? 1 (not at all) 5 10 (very much like a win)

29. 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

32. More than Slots Many more types of near misses occur while gambling: – Blackjack – Roulette – Craps

33. Blackjack

34. 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 score and if they won or not on that given hand

35. Results 2 factor Near-Miss Effect – Non-bust loss – Mathematical difference between dealer and player Minimal Difference between player and dealer cards Non-Bust (under 21) Near Miss Minimal Difference between player and dealer cards Bust (over 21) No Near Miss

36. Average Loss Trials

37. All Loss Trials (all players combined)

38. Roulette

40. 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 “How close to a win was this outcome for you?” Scale 1 to 10

43. 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 Can we show a “preference” for near-misses absent of the reinforcement interaction?

44. 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

45. 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

46. 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

47. Which One?? A B

48. A B

49. A B

53. 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

54. 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

55. 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)

56. SIMULATION

57. Visible Symbols on Wheel

58. 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 Return to computerized slot machine play

59. Psychological Flexibility

60. Baseline Play and Self-Ratings 30 min ACT Post-Treatment Play and Self Ratings Time Client 1 Client 2 Client 3