Understanding the aetiology and treatment of disordered gambling: exploring the interaction of products, environment, and individual susceptibility

赌博被认为是一种精神疾病。在DSM-5中，赌博被从冲动控制障碍重新分类为成瘾障碍，但是尽管之前的研究已经确定了赌博障碍和物质使用障碍之间的相似性，但关于不同形式赌博的动机特性、赌博环境、个体易感性、赌博相关危害之间的相互作用，以及这些因素如何与寻求治疗和治疗结果相关，我们所知甚少。该研究组合将通过推进用于调查赌博行为的传统实验范式，通过利用与赌博治疗提供者和经验专家的现有关系，更好地了解赌博相关的危害和有助于积极和消极治疗结果的因素，通过更好地了解赌博线索在赌博障碍中的作用，来解决这一知识差距，通过开发一种新的治疗方法来支持那些寻求治疗赌博障碍的人。因此，拟议的工作将在四个主要目标上发展和扩大，这将进一步了解赌博障碍的发展、治疗，并最终为政策提供信息，减少赌博相关的伤害。首先，我将使用虚拟现实来更好地理解赌博时发生的事件如何影响赌博行为。例如，在老虎机上，赌徒可以体验到一种被称为“差一点”的事件，即卷轴排列成一个看起来接近获胜的配置。这些类型的事件鼓励继续赌博，但背后的心理机制尚不清楚。研究还可以关注赌博中其他重要事件，如游戏速度和赌注大小限制，所有这些都是在安全，逼真的虚拟环境中进行的，并确定可以调整哪些产品功能以减少赌博危害。这对于更好地了解特定赌博产品的特征如何影响赌博行为以及赌博相关危害非常重要。其次，该研究旨在对赌博相关的危害和治疗结果有更深入的了解。赌徒自己和他们身边的人所经历的伤害可能是极具破坏性的；与英国一些最大的治疗提供者合作，这项研究旨在更好地了解危害，以及它们与治疗结果的关系。我们还将努力计算赌博的社会和经济成本，这将进一步揭示社会不同部分无序赌博的负面影响。第三，我将使用各种方法来了解赌徒对特定赌博线索的反应。我将使用不同的结果测量方法，比如皮肤电导、心率和眼球追踪。这一点很重要，因为对赌博线索的生理唤醒是产生渴望的一个重要因素，这可能导致赌徒在康复过程中赌博增加或复发。通过更好地了解这些机制，我们可以减少与赌博相关的危害。第四，该研究将结合虚拟现实工作，以及通过与专家和治疗提供者合作产生的知识，开发一种新的治疗无序赌博的方法。该研究将通过现有的治疗提供者进行试点，与更传统的治疗提供方法相比，研究将检查在虚拟环境中提供治疗的结果，虚拟环境可以根据个人的具体情况进行定制。

Gambling is acknowledged as a mental health disorder. In the DSM-5, gambling was reclassified from an Impulse Control Disorder to an Addictive Disorder, but although previous research has identified similarities between gambling disorder and substance use disorders, less is known regarding the interaction between the motivational properties of different forms of gambling, the gambling environment, individual susceptibility, gambling related harms, and how these factors are related to treatment seeking and treatment outcomes. This portfolio of research will address this knowledge gap by advancing the traditional experimental paradigms used to investigate gambling behaviour, by utilising existing relationships with gambling treatment providers and experts by experience to better understand gambling related harms and factors that contribute to positive and negative treatment outcomes, by better understanding the role of gambling cues in gambling disorder, and by developing a novel treatment methodology to support those seeking treatment for gambling disorder. Therefore, the proposed body of work will be developed and expanded across four major objectives that will further understanding of gambling disorder development, treatment and ultimately inform policy and reduce gambling related harm. First, I will use virtual reality to better understand how events that happen whilst gambling, influence gambling behaviour. For example, on a slot machine, a gambler can experience an event called a near-miss where the reels line up in a configuration that appears close to winning. These types of events encourage continued gambling, however the psychological mechanisms behind this are unclear. The research can also look at other events important in gambling such as speed of play, and stake size limits, all in safe, realistic virtual environments and establish which product features can be adjusted to decrease gambling harm. This is important to better understand how specific gambling product features influence gambling behaviour, and gambling related harm. Second, the research aims to generate a deeper understanding of gambling related harms, and treatment outcomes. Harms experienced by the gambler themselves and those close to them can be extremely damaging; working with some of the biggest treatment providers in the UK, this research aims to better understand harms, and how they relate to treatment outcomes. We will also work to calculate the social and economic costs of gambling which will further reveal the negative impact of disordered gambling across different parts of society. Third, I will use a variety of measures to understand how gamblers react to specific gambling cues. I will use different outcome measures, such as skin conductance, heart rate, and eye tracking. This is important as physiological arousal to gambling cues is an important factor in craving, which can lead to increased gambling or relapse in gamblers in recovery. By better understanding these mechanisms, we can reduce gambling related harm. Fourth, the research will combine the virtual reality work, and the knowledge generated through working with experts and treatment providers to develop a new treatment methodology for disordered gambling. To be piloted through existing treatment providers, the research will examine outcomes for treatment delivered in virtual environments that can be tailored to the specific circumstances of the individual, compared to more traditional treatment delivery methodologies.