Problem gambling is heterogeneous in nature, ranging in severity from occasional but problematic gambling episodes, to extreme, impulsive and pervasive gambling behaviour. Problem gambling may be accompanied by a sense of impaired control and can give rise to financial, interpersonal, legal and vocational costs for the sufferer, their families and society. This study investigated the relationship among metacognitions, anxiety, depression and gambling in a sample of problem gamblers. A total of 91 individuals attending gambling treatment services completed a battery of self-report instruments that consisted of the Metacognitions Questionnaire 30 (MCQ-30), the Hospital Anxiety and Depression Scale (HADS) and the South Oaks Gambling Scale (SOGS). Correlation analyses showed that anxiety, depression and metacognitions were positively and significantly correlated with both gambling consequences and behaviour. Hierarchical regression analyses indicated that two metacognitive constructs (negative beliefs about thoughts concerning uncontrollability and danger and beliefs about the need to control thoughts) predicted gambling behaviour independently of anxiety and depression. These findings are consistent with the hypothesis that metacognitions play a role in problem gambling.

OverviewThis chapter explores impulsivity and its relation to problem gambling with a particular focus on gambling-related cognitive distortions. Theory and research have suggested that cognitive distortions play a central role in the maintenance of problem gambling behaviour. Impulsivity has long been known to be key in both initiation and maintenance of the disorder. However, not much is known about the relationship between these two concepts. A recent study (discussed below) explored the link between impulsivity and cognitive distortions in a sample of treatment-seeking gamblers and suggests a strong relationship between cognitive distortions and a preference for immediate rewards. These findings are discussed in relation to existing cognitive behavioural therapy (CBT) protocols to explore how this interplay is currently being addressed by treatment.Recent interest in process-based approaches such as metacognitive therapy (MCT), acceptance and commitment therapy (ACT) and mindfulness all favour the targeting of "how" we think, as opposed to "what" we think, which is the focus of traditional CBT approaches. The latter part of the chapter will explore the possible application of a specific metacognitive framework and how this might contribute to our understanding of cognitive distortions and how these are approached in a clinical setting. Some recent experimental findings will be used to discuss such applications of the model. 252

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