Dr. Michael Wohl - Advances in Motivating Change Among Disordered Gamblers: Why and How Memories of...
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Transcript of Dr. Michael Wohl - Advances in Motivating Change Among Disordered Gamblers: Why and How Memories of...
Dr. Michael Wohl
Professor, Carleton University
Dr. Michael Wohl
Professor
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Andrew Kim Melissa SalmonDr. Chris Davis Dr. Jamey Lister
objectives
1. Discuss barriers to change
2. Advances in understanding barriers
3. Using knowledge to overcome those
barriers
4. Review new research on factors that
facilitate change
5. Future directions.6
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Transtheoretical Model of
behavioral change
Readiness to change
Pre-contemplation: Will deny advantage of
quitting
Contemplation: Characterized by ambivalence
Preparation: May be trying to anticipate barriers.
Action: Continues to anticipate and deal with
barriers.
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Barriers to Help-Seeking (Pulford et al., 2009)
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78%
73%
84%85%
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68
70
72
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76
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82
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Pride Shame
Seekers
Non Seekers
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Facilitating change with the self-concept
Authenticity
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There is but one cause of human failure.
And that is man’s lack of faith in his true
self.
—William James
Authenticity
19Lister, Wohl, & Davis, in press, JGS
_________________________
Part of people’s self-concept
(sense of self) is derived
from their membership in
social groups.
The Dark Side of Authenticity
Sports betters who were watching the
Stanley Cup Playoffs
Measures:
1.Authenticity while gambling
2.Identification as a gambler
3.Readiness to change
Lister, Wohl, & Davis, in prep
Authenticity
while gambling
Readiness to
Change
Identification
as a Gambler
.20
2.01**-.13*
.20
95% CI: -.56, -.07
Light in the darkness
Authenticity whilst gambling
undermines behavioral
change
Results point to the fact that
some gamblers don’t feel
authentic.
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Facilitating change with the self-concept
People who are high in self-continuity:Report Psychologically well-being (Dunkel, 2005)
A desire to achieve and maintain well-being (Chandler, Lalone,
Sokol, Hallett, & Marcia, 2003)
Have elevated levels of self-esteem (Diehl, Jacobs, & Hastings, 2006)
When change has befallen the self – anecdotal evidence from the clinical setting (Nuske & Hing, 2011)
Why is a focus on nostalgia innovative?
Therapy tends to focus on current negative states
(e.g., shame, guilt, avoidance).
Negative affect propels change
Nostalgia yields a positive emotional state
Therapy tends to look toward the future;
Nostalgia focuses on the past29
Self-
Discontinuity
Readiness to
Change
Nostalgia
Hypothesized path to change
Participants79 Disordered Gamblers (52 males)19-72 years old (M = 34.15, SD = 13.24, 4 unreported)
MeasuresGambling Symptomology - Canadian Problem Gambling Index (CPGI;
Ferris & Wynne, 2010)
Readiness to Change questionnaire (RoC; Rollnick, Heather, Gold & Hall, 1992)
Self-Discontinuity (Iyer & Jetten, 2011)
Nostalgia (Iyer & Jetten, 2011)
Study 1: Measuring self-discontuity
Kim & Wohl, in press, SPPS
Self-
Discontinuity
Readiness to
Change
Nostalgia
.68**
.67**.47*
.42
95% CI: .03, .67
Study 2: Self-discontinuity manipulated
Participants80 Disordered Gamblers (60 males)18-62 years old (M = 30.31, SD = 8.82, 1 unreported)
ProcedureManipulation: Self-discontinuity vs. Self-continuityMeasure: Nostalgia (Iyer & Jetten, 2011) Readiness to Change (Biener & Abrams,
1991)
Kim & Wohl, in press, SPPS
Gambling Can [Does Not] Change the Self
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Recent studies published in New England Journal of Medicine suggests that,
along with [despite] the potential negative consequences associated with
heavy gambling (e.g., financial, interpersonal problems), heavy gambling can
also result in losing your sense of self [does not change your sense of self].
That is, people who gamble heavily report having undergone fundamental
negative changes to their behaviors and moods and begin to dislike the
person they have become compared to the person they were before engaging
in gambling activities [people who gamble are the same person today,
compared to the person they were before engaging in gambling activities].
We would like to see how this is true for you.
4.15
3.50 3.57
1.70
2.60
1.20
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Self-Discontinuity** Nostaliga** Readiness ToChange*
Self-Discontinuity
Self-Continuity
Self-
Discontinuity
Readiness to
Change
Nostalgia
2.36**
.86**1.30*
1.25
95% CI: .58, 1.86
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How do known barriers
stack up against
nostalgia?
Participants223 Disordered Gamblers (115 males)19-72 years old (M = 34.15, SD = 13.24, 4 unreported)
MeasuresNostalgiaShame as well as guiltMotives for gambling (enhancement, social, coping)Have you tried to change? Have you sought professional treatment?
Wohl, Santesso, Salmon, & Kim , in prep
» Enhancement: p=.19,
Exp(B)=1.24
» Social: p=.21, Exp(B)=.82
» Coping: p=.31, Exp(B)=.86
» Shame: p=.64, Exp(B)=.89
» Guilt: p=.99, Exp(B)=1.03
» Nostalgia: p<.001, Exp(B)=2.48
Have you tried to change your Gambling?
Multiple logistic regression
» Enhancement: p=.78,
Exp(B)=1.08
» Social: p=.96, Exp(B)=.98
» Coping: p=.02, Exp(B)=.50
» Shame: p=.30, Exp(B)=1.61
» Guilt: p=.03, Exp(B)=.35
» Nostalgia: p<.001, Exp(B)=4.61
Have you ever sought Professional Help for Gambling?
Multiple logistic regression
» Enhancement: p=.66,
Exp(B)=1.27
» Social: p=.67, Exp(B)=1.24
» Coping: p=.51, Exp(B)=.72
» Shame: p=.93, Exp(B)=1.07
» Guilt: p=.78, Exp(B)=1.26
» Nostalgia: p=.02, Exp(B)=7.19
Have you tried to change your Gambling? Three-Month follow up
Multiple logistic regression
Facilitating gamblers to see the past ‘non-addicted self’ has a different (and better) version of the self motivates
readiness to change.
Of course, not everyone who feels nostalgic will believe they have the ability to change.
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Nostalgia is a powerful motivator
Believe that although people may
differ in basic aptitudes, interests, and
temperament, everyone can change,
grow, and improve.
Incremental Mindset
Challenges:
Obstacles:
Effort:
Failure:
Embrace them
Persist
Path to mastery
Let me learn
Incremental Mindset
Belief that traits such as intelligence,
ability, personality, and competence
are inborn and basically
unchangeable.
Entity Mindset
Challenges:
Obstacles:
Effort:
Failure:
Avoid them
Give up
Fruitless
Helpless and hopeless
Entity Mindset
Nostalgia, mindset and action
ParticipantsTime 1 (N= 347) 87 low-risk, 142 moderate-risk, 118 problem gamblers (18-72 yrs, M=35.55; Males=210)Time 2 (N=160): 45 low-risk, 61 moderate-risk, 54 problem gamblers (20-68 yrs, M=36.66; Males=89)
MeasuresTime 1: Nostalgia; MindsetTime 2: Attempted change in last three months, Avenue (professions or self-help); Manner of change
Attempted change
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Results
Entity mindset – no relationship with nostalgia
on readiness to change
Incremental mindset – Strong positive
relationship with nostalgia on readiness to
change.
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Nostalgia
Pro
ba
bili
ty o
f ch
an
ge
Entity Mindset
Incremental Mindset
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Potential for behavioral changeB
ehavio
ral cha
nge
Self-efficacy
A key MI principle is self-efficacy for change.
People need to believe they can change and
successfully reduce their gambling
behaviour. Hope and faith are important
elements of change.
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55Nostalgia
High Self-Efficacy
Low Self-Efficacy
Pro
ba
bili
ty o
f ch
an
ge
Reasons for Self-Help
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Authenticity: As a gambler or who one used to be?
Facilitating the gambler to see the past ‘non-addicted self’ has a different (and better) version of the self motivates readiness to change
The butterfly effect: Small changes can yield disproportionate changes elsewhere (Berg & Miller, 1992)
Some belief in change might be good, but a lot could be bad 57
What should I take from this?
EMOTION REGULATION
“… the processes by which individuals influence which
emotions they have, when they have them, and how they
experience and express these emotions.”
(Gross, 1998, p. 275)
Future Directions
1. Decrease (or increase) physiological arousal associated with emotion
2. Re-orient attention toward (or away) from the emotion
(Some) Tasks in Emotion Regulation(Gottman & Katz, 1990)
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Dr. Michael Wohl
613-520-2600 x 2908
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