A process-based analysis of the pathways model of problem gambling through clinical case formulations

ABSTRACT

Blaszczynski and Nower conceptualized in 2002 an integrative Pathways Model leading to gambling disorder by postulating three subtypes of individuals with problem gambling characterized by common and specific characteristics (sociodemographic features, comorbidities, psychological factors). Here we propose a clinical illustration that fits each subtype. For each pathway, we (1) describe a corresponding clinical case, (2) propose a symptom-based clinical description, and (3) elaborate a process-based case formulation to explain the development and maintenance of the problematic gambling behavior. We argue that the clinical work with patients benefited from this two-level approach (symptoms vs. psychological processes) combined with a more holistic approach that takes into account intrapersonal (e.g. personality), interpersonal (e.g. family functioning), and environmental variables (e.g. life events). Crucially, our approach not only considers psychopathological dimensions (e.g. symptoms, diagnostic criteria), but it also views as central individual differences (personality traits) and cognitive and affective processes postulated to mediate relationships between biopsychosocial antecedents and psychopathological symptoms. In the current paper, we aim to demonstrate how the Pathways Model can be used as a framework to embrace a holistic perspective that promotes individualized and process-centered psychological interventions for individuals with gambling problems.

KEYWORDS:

• Gambling disorder
• pathways model
• symptoms
• psychological processes
• process-based approach
• problem gambling

Ethics approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. All patients gave written consent stating their agreement to the use of data collected as part of their treatment for their gambling disorder. They have all read the parts of the article concerning them and have therefore given their informed consent. In the article, all relevant ethical safeguards have been met in relation to the protection of subjects. The names and sociodemographic characteristics of the patients were modified to guarantee anonymity, and we have voluntarily restricted the case description to aspects that are relevant for the purposes of the current article.

Funding sources

No funding sources were declared by the authors in relation to this manuscript.

Constraints on publishing

No constraints on publishing were declared by the authors in relation to this manuscript.

Competing interests

No competing interests were declared by the authors in relation to this manuscript.

Preregistration statement

No preregistration was declared by the authors in relation to this manuscript.

Data availability statement

No data set was declared by the authors in relation to this manuscript.

Supplementary material

Supplemental data for this article can be accessed here

Notes

1. When Jeanne says ‘we,’ this refers to the general group of ‘gamblers.’ We interpret this as a distancing technique.

Additional information

Notes on contributors

Céline Bonnaire

Dr. Celine Bonnaire is a PhD of clinical psychology and psychopathology. Her areas of research include: 1) Psychological (intra and interpersonal) factors involved in the etiology of addictive behaviors (especially gambling and gaming) with a particular focus on personality, identity and emotional processes; 2) Effectiveness of psychotherapeutic and preventive interventions in individuals with addictive behaviors.

Joël Billieux

Dr. Joël Billieux is an Associate Professor of clinical psychology, psychopathology, and psychological assessment at the University of Lausanne, Switzerland. His areas of research include the psychological factors involved in the etiology of addictive behaviors, the conceptualization and diagnosis of behavioral addictions, and the effects of emerging technologies on human behaviour.