One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-reward-based cognitive inflexibility. This suggests that cognitive inflexibility in GD is the result of an aberrant reward-based learning, and not based on a more general problem with cognitive flexibility. The pattern of observed problems is suggestive of a dysfunction of the orbitofrontal cortex, the ventrolateral prefrontal cortex, and the ventral regions of the striatum in gamblers. Relevance for the neurocognition of problematic gambling is discussed.

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This study tested the effectiveness of schema therapy (ST) for borderline personality disorder (BPD) and comorbid alcohol dependence (AD). Twenty patients participated in a case series study with multiple baselines. The baseline phase consisted of treatment as usual. It was followed by a case conceptualization phase, an experiential techniques phase and a behavioural change phase. Patients showed a significant decrease in BPD and AD symptoms; change was mainly accomplished in the experiential techniques phase, with medium to large effect sizes. Three months after termination of therapy, 68% of the patients had remitted from BPD, and the number of drinking days decreased clearly. This study shows that, although treatment is challenging in this group of patients, meaningful change can be obtained in patients with BPD and AD using ST.

Substance use disorders (SUDs) and borderline personality disorder (BPD) are highly comorbid. In the present study, an attempt was made to understand the differences between BPD and BPD with comorbid SUD (BPD + alcohol use disorder [AUD]), by studying impulsivity and schema modes (i.e., maladaptive moment-to-moment emotional states and coping responses). BPD patients, BPD+AUD patients, and nonpatients (NP) were compared regarding behavioral impulsivity (motor impulsivity, risk taking, delay discounting), and schema modes. The two patient groups displayed greater delay discounting than the NP group. Further, BPD and BPD+AUD groups were different from the NP group regarding all schema modes investigated. However, no differences were found on any of the dependent variables between the two patient groups. It is suggested that although BPD patients are in general more impulsive and have more maladaptive moment-to-moment emotional states and coping responses, BPD patients with and without AUD seem not to be different in this respect.