Physiotherapy in Managing Symptomatology in Gambling Disorder Patients: History
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Pablo Carrascosa-Arteaga
,
Remedios López-Liria
,
Daniel Catalán-Matamoros
,
Patricia Rocamora-Pérez

Physiotherapy in mental health (PMH) is a specialty within physiotherapy that covers a wide spectrum of techniques aimed at improving or evaluating mental disorders, among which are addiction disorders. It is fundamentally based on the “body–mind” concept and is justified based on the symptoms that psychiatric disorders cause in the body and vice versa; likewise, treatment by the body can influence the baseline condition. The possible positive results of various PMH methods in treating addiction, including aerobic exercise, non-invasive brain stimulation (NIBS), and relaxation exercises, among patients with gambling disorder (GD). 

  • physical therapy
  • physiotherapy
  • gambling disorder
  • pathological gambler
  • behavioral addiction

1. Introduction

Gambling is a socially accepted form of recreation. Despite the fact that its prevalence has remained fairly stable in recent years (Great Britain, the Netherlands, Germany), the expansion of legalized gambling poses a public health problem. In 2015, the global prevalence of problematic gambling or pathological gambling ranged from 0.12% to 5.8%; on the other hand, the European prevalence ranged from 0.12 to 3.4%. However, due to a lack of help-seeking, which typically only takes place after financial, social, or family problems have already manifested, the percentage could be much higher. The variability in prevalence rates quoted is likely to be due to different methodologies for identifying gambling disorder (GD) rather than an increase in the problem [1]. Despite some variations in prevalence rates, in most European countries, there were consistent results with regard to socio-demographic characteristics: men, single or divorced, young, low level of education, belonging to an ethnic minority or born abroad, unemployed, or with a low income. According to the “European School Survey Project on Alcohol and Other Drugs” (ESPAD) report, 22% of students had gambled in the last 12 months, and 7.9% had placed bets online [2].
GD has been classified within non-substance-related addictive disorders since 2013 in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) [3] and since 2018 in the revision of the International Classification of Diseases—11 (ICD-11) [4], where it was previously included as an impulse control disorder. This change was agreed upon based on the behavioral similarities, the alteration of the reward system, and the efficacy of common treatment pathways with substance-related disorders [3][5].
DSM-5 [3] defines GD as “persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period (where the gambling behavior is not better explained by a maniac episode): needs to gamble with increasing amounts of money in order to achieve the desired excitement; is restless or irritable when attempting to cut down or stop gambling; has made repeated unsuccessful efforts to control, cut back, or stop gambling; is often preoccupied with gambling; often gambles when feeling distressed; after losing money gambling, often returns another day to get even; lies to conceal the extent of involvement with gambling; has jeopardized or lost a significant relationship, job, educational or career opportunity because of gambling; relies on others to provide money to relieve desperate financial situations caused by gambling”. Based on the previous definition, it can be observed that the diagnostic criteria do not focus on the losses/winnings, the amounts bet, or the gambling practices. These diagnostic criteria focus on the consequences and how the game affects the person over a period of time.
The social and clinical consequences of this disorder seriously affect the person involved and their family, including bankruptcy, unemployment, domestic violence, breakup of personal relationships, suicidal ideation, and other comorbidities such as mood disorder, anxiety, or substance use disorder [6][7][8][9]. Martínez [10] cites some studies estimating that 50%, 30%, and 20% of this population also have an addiction to tobacco, alcohol, and illicit drugs, respectively. Suicidal ideation in clinical settings and in the general population is highly prevalent and is even higher when other comorbidities appear. Specifically, half of the population undergoing treatment present suicidal ideation, and around 17% have made a suicide attempt [5][11][12][13].
The socio-neuro-behavioral pattern of pathological gambling favors the concept that gambling is a socially learned behavior implemented by the individual to cope with stress, mood, and dysphoric emotions. In addition, it is well established in many studies that mood regulation (for example, anxiety) is not only one of the main reasons for gambling but also a predictor of disorder severity and relapse of GD [14].
Neurobiology affirms that craving in GD is explained by the alteration of the dopaminergic mesolimbic system, which explains the sensitivity to reward; the alteration of the orbitofrontal system, which balances benefits and losses, causing hyposensitivity to punishment; and abnormal functioning of the dorsolateral and dorsomedial prefrontal systems, which are in charge of inhibitory control and impulse regulation [15][16].
The participation of neurotransmitters in certain brain areas has influenced the development and maintenance of behavioral addictions (e.g., serotonin, opioids, or dopamine). Dopamine is the neurotransmitter that is most involved since it participates in all stages, including the initiation of addiction, maintenance, abstinence, and relapse [17][18][19].
The interventions with the most evidence compiled are psychological and pharmacological therapies, highlighting cognitive behavioral therapy, motivational interviews, and the combination of psychological and pharmacological therapy [5][20]. There are authors who advocate total abstinence from gambling, while others advocate control over gambling behavior. Currently, the latest studies involve a wide range of domains, evidencing a multidimensional recovery, so besides recovery from symptoms, aspects associated with the mental, physical, and social well-being of the patients should also be analyzed [5].
To date, there is no definitive drug treatment for GD. However, positive effects have been found with opioid receptor antagonists, which aim to reduce the desire to play and increase periods of withdrawal; selective serotonin reuptake inhibitors, which treat depressive and anxiety symptoms; and mood stabilizers, which modulate impulsive behaviors [21].
Psychosocial interventions are another therapy of choice for GD. The most successful treatments are those based on cognitive behavioral therapy, which aims for cognitive correction, decision-making/reward processing, and physical or psychological responses associated with gambling. On the other hand, there is the motivational interview that, through the verbalized intention of the desire, reasons, and need for change, presents a greater probability of behavior change [21][22]. Two meta-analyses have been found showing the efficacy of cognitive behavioral therapy [23][24] and another two for motivational interviewing [23][25].
Physiotherapy in mental health (PMH) is a specialty within physiotherapy that covers a wide spectrum of techniques aimed at improving or evaluating mental disorders, among which are addiction disorders. It is fundamentally based on the “body–mind” concept and is justified based on the symptoms that psychiatric disorders cause in the body and vice versa; likewise, treatment by the body can influence the baseline condition. The PMH posits that the body influences both establishing and maintaining mental symptoms. The impact on the body can be observed, for example, with depression or anxiety, which have a somatic musculoskeletal component. Anxiety is related to joint pain, back pain, abdominal pain, headache, or fatigue, while depression is associated with a kyphotic posture with internally rotated shoulders or decreased tone, in addition to generalized pain or fatigue [26][27]. Donaghy and Durward [28] defined the mental health physiotherapist as “the professional who offers a wide arsenal of physical treatment approaches aimed at relieving symptoms and improving quality of life. Therefore, the physiotherapist provides support in the evaluation and treatment of mental patients that is normally offered in conjunction with the prescribed pharmacological and psychotherapeutic treatment, in the context of an interdisciplinary team”.

2. Physiotherapy in Managing Symptomatology in Gambling Disorder Patients

2.1. Interventions or Techniques Applied

Aerobic Physical Exercise

Two studies [9][29] applied aerobic exercise in their interventions and examined the maximum heart rate (MHR). Both performed a group physical exercise intervention lasting 50 min. Penna [9] performed two weekly sessions at 70–85% of MHR for 8 weeks and compared the results with a control group (CG) that performed stretching. In the second case, Angelo [29] performed eight sessions at 65–70% MHR spread over 4 or 8 weeks, which was then compared to a CG without treatment.

Non-Invasive Brain Stimulation (NIBS)

Four studies applied different types of NIBS in different brain areas: high-frequency repetitive transcranial magnetic stimulation (rTMS) [30][31], low-frequency rTMS [30], high-frequency continuous theta burst stimulation (cTBS), and transcranial direct current stimulation (tDCS). All studies perform stimulation in the dorsolateral prefrontal cortex (DLPFC), except Zack [32], who performed rTMS in the medial prefrontal cortex (mPFC), in addition to cTBS in the DLPFC. Sauvaget [30] and Gay [31] performed a single rTMS session in the DLPFC, albeit in different hemispheres, and a sham session with a 1-week interval to avoid any carryover effect; Dickler [33] applied tDCS to the right DLPFC in a single session together with another sham stimulation session with a 1-week interval; and Zack [32] performed three sessions with a 1-week interval, applying cTBS on the right DLPFC or rTMS on the mPFC group.

Relaxation Exercises

Linardatau [14] and Sharma [34] applied Jacobson’s progressive muscle relaxation technique (PMR) (the latter also included diaphragmatic breathing in the intervention), as well as advice and education on exercise and other related aspects.
Linardatau [14] applied PMR sessions and breathing relaxation (RB) exercises to a Gamblers Anonymous group by means of a guided CD twice a day for 8 weeks. A session of 10 min of RB was applied (deep diaphragmatic breathing followed by slow prolonged exhalations) and 15 min of PMR (contractions and relaxations of different muscle groups with a sequence from bottom to top). A follow-up was carried out to verify the adequate performance of the exercises. The CG received psychotherapeutic treatment.

2.2. Effectiveness of the Interventions in the Experimental Group Compared to the Control

Effects of Aerobic Physical Exercise

Both Penna [9] and Angelo [29] found improvements by applying group aerobic exercise programs. Both studies evaluated the severity of GD with the Gambling Follow-up Scale Self Report Version, observing significant differences in the experimental group (EG) compared to the baseline. However, Penna [9] found that the CG had a similar benefit in reducing the severity of gambling. Also, Penna [9] observed benefits to psychiatric comorbidity, yet no benefits were obtained in relation to craving or to thoughts related to the game.
Angelo [29] found an improvement in craving, and symptoms of anxiety and depression; however, he did not observe a significant alteration in the levels of ACTH, prolactin, or cortisol.

Effects of Non-Invasive Brain Stimulation

The effects of NIBS interventions have been highly heterogeneous. As regards craving, Zack [32] and Gay [31] observed a significant improvement in the rTMS group compared to the CG. Furthermore, Zack [32] and Dickler [33] did not observe an improvement in this variable when applying cTBS and tDCS, respectively, compared to CG. Finally, Sauvaget [30] found a significant improvement in craving in both groups, with no statistically significant differences between the rTMS group and CG.
The interventions carried out by Dickler [33] and Zack [32] did not obtain a significant reduction in impulsive behaviors.
Gay [31] had the only study that evaluated the severity of the disorder without finding statistically significant improvements.
Regarding the physiological measures of HR and BP, Sauvaget [30] did not find significant differences between groups. In contrast, while Zack [32] did find a decrease in BP in the cTBS group, but no changes were obtained in the rTMS group.

Effects of Relaxation Techniques

Linardatau [14] and Sharma [34] agreed that relaxation techniques produced a reduction in anxiety and depression symptoms compared to the CG. Linardatau [14] obtained positive results in relation to stress, life satisfaction, sleep quality and routine. Sharma [34] observed beneficial effects in the IG of death anxiety, obsession, hysteria, and somatization, yet symptoms related to phobia increased after the intervention.

The possible positive results of various PMH methods in treating addiction, including aerobic exercise, non-invasive brain stimulation (NIBS), and relaxation exercises, among patients with gambling disorder (GD). In conclusion, the field of physiotherapy for addiction provides a range of interventions that can assist in an interdisciplinary or transdisciplinary approach to address the needs of individuals with GD.

This entry is adapted from the peer-reviewed paper 10.3390/healthcare11142055

References

  1. Calado, F.; Griffiths, M.D. Problem gambling worldwide: An update and systematic review of empirical research (2000–2015). J. Behav. Addict. 2016, 5, 592–613.
  2. ESPAD Group. ESPAD Report 2019: Results from the European School Survey Project on Alcohol and Other Drugs, EMCDDA Joint Publications; Publications Office of the European Union: Luxembourg, 2020.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), 5th ed.; American Psychiatric Association: Arlington, TX, USA, 2013.
  4. World Health Organization. International Classification of Diseases 11th Revision (ICD-11), 11th ed.; World Health Organization: Geneva, Switzerland, 2019.
  5. Mestre-Bach, G.; Valenciano-Mendoza, E.; Mora-Maltas, B.; Fernández-Aranda, F.; Jiménez-Murcia, S. Adicción al juego: ¿mito o realidad? Evidencias científicas sobre el trastorno de juego. Mètode SSJ 2021, 2, 73–80.
  6. Black, D.W.; Shaw, M.C.; McCormick, B.A.; Allen, J. Marital status, childhood maltreatment, and family dysfunction: A controlled study of pathological gambling. J. Clin. Psychiatry 2012, 73, 1293–1297.
  7. Fong, T.W. The biopsychosocial consequences of pathological gambling. Psychiatry 2005, 2, 22–30.
  8. Gainsbury, S.; Hing, N.; Suhonen, N. Professional help-seeking for gambling problems: Awareness, barriers and motivators for treatment. J. Gambl. Stud. 2014, 30, 503–519.
  9. Penna, A.C.; Kim, H.S.; Cabrita de Brito, A.; Tavares, H. The impact of an exercise program as a treatment for gambling disorder: A randomized controlled trial. Ment. Health Phys. Act. 2018, 15, 53–68.
  10. Martínez, M.K.; Agost-Felip, M.R.; Martin, A.L. Prevalence of Pathological Gambling in the University Population from Valencian Community, Spain. Rev. Hosp. Psiq. Hab. 2019, 16, 15–31.
  11. Hakansson, A.; Karlsson, A. Suicide attempt in patients with gambling disorder-associations with comorbidity including substance use disorder. Front. Psychiatry 2020, 11, 593533.
  12. Battersby, M.; Tolchard, B.; Scurrah, M.; Thomas, L. Suicide ideation and Behavior in People with Pathological Gambling Attending a Treatment Service. Int. J. Ment. Health Addict. 2006, 4, 233–246.
  13. Kim, H.S.; Salmon, M.; Wohl, M.J.A.; Young, M. A dangerous cocktail: Alcohol consumption increases suicidal ideations among problem gamblers in the general population. Addict. Behav. 2016, 55, 50–55.
  14. Linardatou, C.; Parios, A.; Varvogli, L.; Chrousos, G.; Darviri, C. An 8-week stress management program in pathological gamblers: A pilot randomized controlled trial. J. Psychiatr. Res. 2014, 56, 137–143.
  15. Antons, S.; Müller, S.M.; Liebherr, M.; Brand, M. Gaming disorder: How to translate behavioral neuroscience into public health advances. Curr. Behav. Neurosci. Rep. 2020, 7, 267–277.
  16. Schluter, M.G.; Hodgins, D.C. Reward-related decision-making in current and past disordered gambling: Implications for impulsive choice and risk preference in the maintenance of gambling disorder. Front. Behav. Neurosci. 2021, 15, 758329.
  17. Limbrick-Oldfield, E.H.; Mick, I.; Cocks, R.E.; McGonigle, J.; Sharman, S.P.; Goldstone, A.P.; Stokes, P.R.A.; Waldman, A.; Erritzoe, D.; Bowden-Jones, H.; et al. Neural substrates of cue reactivity and craving in gambling disorder. Transl. Psychiatry 2017, 7, e992.
  18. Volkow, N.D.; Morales, M. The brain on drugs: From reward to addiction. Cell 2015, 162, 712–725.
  19. Antons, S.; Brand, M.; Potenza, M.N. Neurobiology of cue-reactivity, craving, and inhibitory control in non-substance addictive behaviors. J. Neurol. Sci. 2020, 415, 116952.
  20. Bodor, D.; Ricijas, N.; Filipcic, I. Treatment of gambling disorder: Review of evidence-based aspects for best practice. Curr. Opin. Psychiatry 2021, 34, 508–513.
  21. Sam-Wok, C.; Young-Chul, S.; Dai-Jin, K.; Jung-Seok, C.; Seohee, K.; Seung-Hyun, K.; HyunChl, Y. Treatment modalities for patients with gambling disorder. Ann. Gen. Psychiatry 2017, 16, 23.
  22. Di Nicola, M.; De Crescenzo, F.; D’Alò, G.L.; Remondi, C.; Panaccione, I.; Moccia, L.; Molinaro, M.; Dattoli, L.; Lauriola, A.; Martinelli, S.; et al. Pharmacological amd Psychosocial treatment of adults with gambling disorder: A meta-review. J. Addict. Med. 2020, 14, e15–e23.
  23. Cowlishaw, S.; Merkouris, S.; Dowling, N.; Anderson, C.; Jackson, A.; Thomas, S. Psychological therapies for pathological and problem gambling. Cochrane Database Syst. Rev. 2012, 11, CD008937.
  24. Gooding, P.; Tarrier, N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets? Behav. Res. Ther. 2009, 47, 592–607.
  25. Yakovenko, I.; Quigley, L.; Hemmelgarn, B.R.; Hodgins, D.C.; Ronksley, P. The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis. Addict. Behav. 2015, 43, 72–82.
  26. Catalán, D.J. Fisioterapia en Salud Mental: Antecedentes históricos. Rev. Colomb. Rehabil. 2019, 18, 162–180.
  27. Estruch, R.; Sacanella, E. Alcohol: ¿tónico o tóxico cardiovascular? Clin. Investig. Arterioscl. 2005, 17, 183–195.
  28. Donaghy, M.; Durward, B. A Report on the Clinical Effectiveness of Physiotherapy in Mental Health; Chartered Society of Physiotherapy: London, UK, 2000.
  29. Angelo, D.L.; Tavares, H.; Zilberman, M.L. Evaluation of physical activity program for pathological gamblers in treatment. J. Gambl. Stud. 2013, 29, 589–599.
  30. Sauvaget, A.; Bulteau, S.; Guilleux, A.; Leboucher, J.; Pichot, A.; Valrivière, P.; Vanelle, J.M.; Sébille-Rivain, V.; Grall-Bronnec, M. Both active and sham low-frequency rTMS single sessions over the right DLPFC decrease cue-induced cravings among pathological gamblers seeking treatment: A randomized, double-blind, sham-controlled crossover trial. J. Behav. Addict. 2018, 7, 126–136.
  31. Gay, A.; Boutet, C.; Sigaud, T.; Kamgoue, A.; Sevos, J.; Brunelin, J.; Massoubre, C. A single session of repetitive transcranial magnetic stimulation of the prefrontal cortex reduces cue-induced craving in patients with gambling disorder. Eur. Psychiatry 2017, 41, 68–74.
  32. Zack, M.; Cho, S.S.; Parlee, J.; Jacobs, M.; Li, C.; Boileau, I.; Strafella, A. Effects of high frequency repeated transcranial magnetic stimulation and continuous theta burst stimulation on gambling reinforcement, delay discounting and stroop interference in men with pathological gambling. Brain Stimul. 2016, 9, 867–875.
  33. Dickler, M.; Lenglos, C.; Renauld, E.; Ferland, F.; Edden, R.A.; Leblond, J.; Fecteau, S. Online effects of transcranial direct current stimulation on prefrontal metabolites in gambling disorder. Neuropharmacology 2018, 131, 51–57.
  34. Sharma, M.G.; Upadhyay, A.; Sharma, V. Mental health management of pathological gamblers by counseling and relaxation practices. J. Evid. Based Soc. Work 2013, 10, 505–508.
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