These resources can assist in making informed decisions while participating in various gambling activities. Understanding the thrill of risk-taking in gambling requires recognizing the powerful impact of dopamine release and the influence of probability and uncertainty.

By exploring these psychological factors, individuals can gain insights into the emotions and motivations that drive their engagement with gambling activities.

When it comes to gambling, emotions play a significant role in shaping the overall experience for individuals. The thrill of anticipation, the frustration of losses, and the euphoria of winning are just a few of the emotions commonly experienced by gamblers.

Let's delve into these emotional highs and lows. For many gamblers, the excitement and anticipation of playing a game can be incredibly exhilarating. The thought of a potential win, the rush of adrenaline, and the anticipation of what lies ahead create a sense of thrill that keeps people coming back for more.

This excitement is often linked to the activation of the brain's reward system, which releases dopamine, a neurotransmitter associated with pleasure and motivation. During this phase, individuals may experience a heightened sense of focus and engagement, eagerly awaiting the outcome of their bets.

The feeling of anticipation can be so powerful that it becomes a driving force behind continued gambling behavior. In the world of gambling, losses are inevitable. When faced with unfavorable outcomes, gamblers often experience frustration and disappointment.

The emotional response to losses can be influenced by various factors, such as the amount of money at stake, personal expectations, and the belief in one's own abilities. Frustration may arise from a sense of control being taken away, as luck and chance play a significant role in gambling outcomes.

The disappointment associated with losing can stem from dashed hopes and unmet expectations. These negative emotions can be particularly challenging for individuals who struggle with self-control or have difficulty accepting losses.

On the flip side, winning can lead to a euphoric state commonly known as the "gambler's high. This emotional high can be so powerful that it motivates individuals to continue gambling in pursuit of experiencing it again.

The euphoria experienced after a win is also linked to the release of dopamine in the brain. The brain's reward system reinforces the pleasurable sensation, making it enticing for gamblers to chase after that elusive high. However, it's important to note that the gambler's high can also contribute to risky behaviors and overconfidence, potentially leading to excessive gambling and financial losses.

Understanding and managing these emotional fluctuations is crucial for responsible gambling. It's important for individuals to be aware of the range of emotions they may experience while gambling and to develop strategies to cope with both the highs and lows.

Seeking support and guidance from professionals can also be beneficial, especially for those who may be at risk of developing addiction and compulsive gambling. By recognizing and acknowledging the emotional rollercoaster that comes with gambling, individuals can make informed decisions and engage in a more balanced and enjoyable gambling experience.

Remember, responsible gambling is about maintaining a healthy mindset and enjoying the activity for its entertainment value rather than seeking emotional highs or financial gains.

In the world of gambling, cognitive biases play a significant role in shaping the decisions and behaviors of gamblers. These biases can sometimes lead individuals to make irrational choices, influenced by their cognitive processes and underlying beliefs. Here, we will explore three common cognitive biases that are often observed in the psychology of gambling: the illusion of control , the gambler's fallacy , and loss aversion.

The illusion of control is a cognitive bias that leads individuals to overestimate their ability to influence the outcome of a situation that is actually determined by chance. In the context of gambling, this bias can manifest as a belief that one has some control over the outcome of a game or a belief that certain actions and behaviors can increase the chances of winning.

For example, a gambler may feel that their choice of a particular slot machine or the way they roll the dice can influence the outcome in their favor.

This bias often arises from the need for individuals to feel a sense of control in an unpredictable environment. However, it is important to recognize that most gambling outcomes are determined by random chance, and the illusion of control can lead to risky decision-making.

The gambler's fallacy is another common cognitive bias observed in gambling. It is the belief that past events in a game of chance can influence future outcomes, even when the events are independent and unrelated.

This bias is often characterized by the mistaken notion that if a particular outcome has occurred repeatedly, the opposite outcome is more likely to happen in the future.

For example, a gambler playing roulette may believe that if the ball has landed on black for several consecutive spins, red is now more likely to occur. In reality, each spin of the roulette wheel is an independent event, and the outcome of one spin has no bearing on the outcome of the next.

The gambler's fallacy can lead individuals to make irrational bets or chase losses based on faulty reasoning. Loss aversion is a cognitive bias that reflects the tendency of individuals to strongly prefer avoiding losses over acquiring equivalent gains.

In the context of gambling, this bias can lead individuals to take additional risks in an attempt to recover losses or avoid accepting losses altogether. For example, a gambler who has experienced consecutive losses may continue to bet larger amounts in the hope of recouping their losses, even if it means incurring greater financial risk.

This bias can be fueled by the emotional distress associated with losses and the desire to avoid the negative feelings that come with financial setbacks. Understanding these cognitive biases can shed light on the psychological factors that influence gambling behaviors.

By being aware of the illusion of control, the gambler's fallacy, and loss aversion, individuals can make more informed decisions while engaging in gambling activities.

If you or someone you know is struggling with addiction and compulsive gambling , seeking help and support is essential. While gambling can be an exhilarating and entertaining activity, it's important to acknowledge that there is a dark side to this pastime.

Gambling can lead to addiction and compulsive gambling , which can have severe financial and emotional consequences. However, there is help and support available for those who find themselves in the grip of gambling addiction.

For some individuals, gambling can become an addictive behavior. The thrill and excitement of winning can trigger the release of dopamine in the brain, creating a pleasurable sensation. This can lead to a cycle of seeking out more gambling experiences to replicate that initial high.

Over time, this can develop into compulsive gambling, where individuals feel unable to control their gambling habits, despite negative consequences. The financial consequences of gambling addiction can be devastating. Individuals may find themselves accumulating significant debt, draining their savings, and experiencing financial instability.

This can lead to increased stress, anxiety, and even feelings of guilt and regret. The emotional toll of gambling addiction can strain relationships, impact mental well-being, and contribute to a sense of isolation and despair.

It's important to address these consequences and seek help to minimize further damage. If you or someone you know is struggling with gambling addiction, it's crucial to seek help and support.

Various resources are available to assist individuals in overcoming their addiction and regaining control of their lives. Support groups, counseling, therapy, and treatment programs can provide the necessary guidance and tools to break free from the grip of gambling addiction.

Remember, you are not alone, and there are people and organizations ready to assist you on your journey to recovery. It's essential to reach out and take that first step towards a healthier and happier life. While gambling can be an enjoyable pastime, it's important to approach it responsibly.

Responsible gambling involves setting limits, maintaining a healthy mindset, and enjoying the activity in a responsible manner. Let's explore some key aspects of responsible gambling:. Setting limits is crucial in maintaining control over your gambling activities.

By establishing both time and monetary limits, you can ensure that gambling remains an enjoyable form of entertainment without negatively impacting other areas of your life.

Time limits help prevent excessive gambling and allow you to balance your gambling activities with other responsibilities. Set a specific amount of time you're comfortable spending on gambling and stick to it. Consider using tools such as alarms or reminders to help you keep track of time.

Monetary limits are equally important. Determine how much money you are willing to spend on gambling and never exceed that amount. Consider creating a separate gambling budget and avoid using funds allocated for essential expenses such as bills or savings. It's also wise to set a winning limit, so you know when to stop and avoid chasing losses.

By setting limits and establishing boundaries, you can enjoy gambling as a form of entertainment without it negatively impacting your financial wellbeing or daily life. Maintaining a healthy mindset is essential when engaging in any form of gambling. It's important to remember that gambling outcomes are based on chance and that winning is not guaranteed.

Here are a few tips to help you maintain a healthy mindset:. Stay informed: Educate yourself about the odds and probabilities associated with different gambling activities. e-Estesia is an app-based serious videogame designed to improve ER in patients with impulse control disorders and other disorders characterized by inhibitory control deficits.

In its current format, e-Estesia runs on password-protected Android portable devices tablets and is connected via Bluetooth to a sensor that transmits physiological data [heart rate HR and HRV] from the participant to the device. The game is based on a previous serious game, developed by our group and the PlayMancer Consortium Jiménez-Murcia et al.

PlayMancer is a more complex serious videogame that retrieves scores from multiple biofeedback sensors including galvanic skin response, oxygen saturation, HR and HRV, breathing frequency and skin temperature. This intervention has been demonstrated to improve treatment outcomes in eating and GD patients Fagundo et al.

However, PlayMancer needed patients to play the game within the premises of the hospital due to the multiple required biosensors. In contrast, e-Estesia is a much more convenient solution that facilitates treatment by a transforming the desktop computer-based experience into an app-based interface, making it fully portable and allowing treatment delivery at home, b reducing the outcome measures and the equipment needed to a single biosensor and a tablet, and c streamlining the game design and the human-media interactions to its core, most therapy-relevant components.

e-Estesia starts by asking participants about their mood. The question can be answered by selecting one of five face icons ranging from sadness to happiness graphics validated in previous studies and in different samples; Diana et al.

Next, a voice-over trains participants on how to become aware of their breathing and sitting posture. The game is set on a tropical island. The game depicts tropical vegetation, sea, horizon, sun, clouds, and rain. The game follows an A-B-A design pattern consisting of a an initial 3-min period in which the landscape is sunny, b a subsequent 4-min period in which rain clouds and eventually a storm appear, and c a final 3-min period identical to the first one.

Gamers are instructed at the beginning of the game to try and breathe calmly diaphragmatic breathing instructions. Figure 1. Screenshots from e-Estesia depicting the different phases of the Serious Game.

The initial and final periods are used as baseline to practice this breathing technique. The intermediate period is designed for the subjects to learn how to manage their breathing through a HRV biofeedback mechanism.

This mechanism gives the user information about their breathing thanks to a visual system with animations e. rainy clouds.

When participants succeed in regulating their emotions by breathing properly, the biosensor utilizes this physiological information to reinforce this behavior by dissipating the storm; if breathing does not improve, the rain becomes more intense.

This intermediate period adds stressors. During the game, simple instructions are given regarding how to modulate poor weather conditions.

The patient must be an active participant in the process as they interact with the application and consolidate this learning via breathing techniques. A pilot sample of 26 patients seeking treatment for GD was obtained for the present study.

Data from participants were collected from December to May by means of a purposive sample recruitment procedure. Consecutive patients who began cognitive-behavioral treatment for GD were offered the opportunity to participate in the study, and all participants who agreed were selected and provided that they met the inclusion and exclusion criteria.

Due to the observational nature of this pilot study, self-selection bias and lack of randomization were not deemed significant as the results at this stage were not to be compared to a control group.

In order to participate, the following exclusion criteria were considered: a the presence of a psychiatric or neurological disorder such as schizophrenia or other psychotic disorders that might impact game performance, b an intellectual disability, and c active pharmacological therapy that might interfere with game performance.

Inclusion criteria included being diagnosed with GD, which was assessed prior to the study both via screening methods SOGS, DSM-IV criteria and other relevant measures to identify psychopathological symptoms and individual structured interviews by experienced psychologists.

The sample included 21 men All participants received information regarding the aims of the research and they provided signed informed consent for participating. There was no financial or other compensation for being part of the study sample.

Participants who agreed to take part in the study were briefed on the purpose of the study and were reassured of the voluntary nature of their participation and their rights to stop at any time. After conducting the initial intervention session with the application, the usability scale described below was administered to the participants.

The System Usability Scale SUS; Brooke, was used to gauge how usable participants perceived the app to be.

This scale is context-specific and does not measure usability in isolation but as a product of the user-interface interaction and the specific goals that users expect to accomplish with its use Schmidt and De Marchi, The instrument was conceived after the international standard ISO , which identifies effectiveness, efficiency, and satisfaction as the key components of usability assessment.

Final scores for SUS range from 0 to , with higher scores indicating greater usability. Two physiological variables were measured: heart rate HR and HRV defined as the variation in the time between successive heartbeats. These measurements were recorded via a Polar H7 Bluetooth Heart Rate Sensor by Polar Electro Oy TM.

HR beats per minute scores were used. The rationale for these measures derives from previous studies pointing out that deviations higher than baseline HR scores are typically associated with emotions of anger and joy, whereas lower values of excitement i.

HRV, which usually ranges from 30 to 39, is a variation in the beat-to-beat time interval time between two successive R-waves that occurs spontaneously and naturally and that is positively associated with self-regulation, heart health, autonomous balance, and task performance.

In turn, it is negatively associated with anxiety, depression, stress, hypertension, chronic muscle pain, and nausea Porges, ; Malik, ; Sargunaraj et al.

Additional data were obtained through a semi-structured interview, which assessed sociodemographic features e. However, for the purpose of the present study, only age, gender, and gambling platform preference i. online were reported. Statistical analysis was done with Stata16 for Windows.

The number of participants who reported to prefer offline gambling was 21, whereas five preferred online gambling. Table 1 includes the frequency distribution of the items in the study. Table 2. Comparison of the SUS raw scores divided by sex, gambling preference and groups of age.

As expected, the measures varied as a function of time in the session, with increased activity during the start of the game differences are more evident for HR comparing the period of game play vs.

the period of pre-game. Particularly, women showed a decrease in the HR during the period of game play compared with the pre-game phase, while men showed an increase in the HR levels during the game playing phase.

Figure 2. Line-plot for heart rate HR and heart rate variability HRV means within the entire sample. The present study aimed to assess the usability of a new emotion-regulation training app for GD, based on previous studies carried out in eating disorders and GD Fernández-Aranda et al.

In the study participated 26 patients undergoing treatment for GD, giving high scores in effectiveness, efficiency, and satisfaction with the use of the tablet-based serious game e-Estesia according to the SUS; Brooke, This is one of the few studies conducted in order to evaluate usability of a serious game in clinical population Yáñez-Gómez et al.

The app performed comparatively well in all groups. The average score, both in men and women, and with different gambling preferences online vs.

offline was over 80 ranging from 0 to , which indicates a high levels of endorsed usability. Mean scores were somewhat lower in the younger group between 22 and 35 years.

The main reasons for using this specific type of technology are the internal characteristics of serious games, such as the intensity with which they capture the attention of the individual, the ease with which they disconnect from the outside world, their ability to immerse, the low resistance on the part of most individuals to use them and the motivation that they tend to generate in many people Eichenberg and Schott, This is an important aspect considered that one of the aims of the development of e-Estesia were to provide independence to their users, as an improvement of other similar serious games that have been used to improve emotional regulation, such as Playmancer , this serious game is useful for improving emotional regulation, but requires the support of an expert to be able to use it Fernández-Aranda et al.

Some studies have shown that the use of video games could improve motivation and adherence to treatment Kato et al. The study results showed that a high percentage of participants believed the app was coherent, consistent, not confusing This aspect is important considering that the benefits of the use of serious games in health contexts are related with their capacity to capture the attention of the user, which can help the motivation to continue using it Fagundo et al.

Also, in the context of GD patients, this could be an important auxiliary treatment strategy, if it is considered that different personality traits Tárrega et al. Finally, comfort and desire to use the app were inextricably linked. All the patients who responded that they agreed that they would like to use the application frequently also agreed that they were comfortable using it.

This is consistent with the preexisting literature that affirms that for serious game users, it is easier to engage in the therapeutic process if it is enjoyable Fleming et al. Using e-Estesia during a session with 26 GD patients revealed that women had a lower mean HR and a higher HRV during the use of the serious game compared to men.

This could indicate that for this first session, women show a greater capacity to self-regulate their psychophysiological state through biofeedback and breathing instructions Appelhans and Luecken, During the interaction phase of the serious game, this difference between men and women increased, with women showing a higher HRV.

These results should be careful lighted through the differences in emotional regulation difficulties that both genders present in GD patients. However, other aspects as the conditions of the evaluation, may influenced these results. A study comprising GD patients showed that men had more difficulties in ER compared to women specifically, men had poorer performance in the non-acceptance of emotions domain; Sancho et al.

Other studies in laboratory conditions and with healthy populations show results contrary to the study, suggesting that women could react to laboratory stressors with higher HR responses, whereas men have greater blood pressure Carrillo et al.

This application aims to improve the management of ER through a biofeedback mechanism, mediated by instructions in diaphragmatic breathing. It is possible that in the first sessions, in which patients are learning the management of their psychophysiological state and the establishment of new breathing patterns, they would not feel entirely comfortable with this intervention.

Levels of stress and anxiety might even be expected to increase during the first sessions. The majority of players, in the first sessions of the evaluation, thought that the game was hard, even on the easy mode.

Although this opinion persisted for some subjects in the later sessions as they were still trying to find a good strategy, most of them thought that the game became easier with each session, as they were able to reach higher scores and maintain the average meditation higher for longer periods of time.

Therefore, future research is needed that measures more than one e-Estesia session in contexts that differ from the laboratory.

In conclusion, the usability scores and the biofeedback information provide promising evidence of using e-Estesia to assist in the treatment of GD. This study should be interpreted in the basis on some limitations. First, the usability of the app was assessed through a scale focused on the key components of this type of systems, and, therefore, no reference benchmarks or norms are available for comparing our results.

In addition, only one scale was used to measure usability, without specific additional methods such as usability testing, cognitive walkthrough, heuristics analysis or other instruments. Second, the low sample size: statistical analysis was not adequately powered to examine associations between background variables with the usability measures.

It should be outlined that many feasibility studies are carried out within small samples, which should accurately reflect the characteristics of the larger target population of users. We tried to choose a representative group of GD patients that closely matched the distribution of age, sex, and gambling preference of the whole population candidate to use the e-Estesia.

Future studies could test additional relationships, and try to identify potential predictors of usability in the GD area such as the presence of comorbid mental health conditions, sociodemographic profile or confidence in using technology.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. SJ-M, FF-A, TM-M, RG, LM, and TS contributed to the development of the study concept and design. SJ-M, FF-A, RG, LM, AP-G, ML-M, MG-P, LM, and JM had previous experience in the design and use of SG for the treatment of impulsive spectrum disorders and their experience and advice were decisive in the design of the present device.

RG performed the statistical analysis, wrote the results and made the tables and Figures. SJ-M, TM-M, LM, TS, and HL-G aided with interpretation of data and the writing of the manuscript. TM-M, LM, AP-G, ML-M, BM-M, EV-M, MG-P, and LM collected the data.

FF-A, JM, IG, TS, MG-B, and AS revised the manuscript and provided substantial comments. SJ-M, FF-A and JM obtained funding. All authors contributed to the article and approved the submitted version. It was additionally supported by grants from the Ministerio de Economía y Competitividad PSIR , and from the Ministerio de Ciencia, Innovación y Universidades grant RTIB CIBERObn and CIBERSAM are both initiatives of ISCIII.

The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

HL-G is supported by a Generalitat de Catalunya Grant BP LM was supported by a postdoctoral Grant of the Mexican Institution Consejo Nacional de Ciencia y Tecnología-CONACYT Science and Technology National Counsel.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Abad-Tortosa, D. Sex differences in autonomic response and situational appraisal of a competitive situation in young adults.

doi: PubMed Abstract CrossRef Full Text Google Scholar. Álvarez-Moya, E. Subtyping study of a pathological gamblers sample. CrossRef Full Text Google Scholar. Comparison of personality risk factors in bulimia nervosa and pathological gambling. Psychiatry 48, — Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling.

Psychiatry Neurosci. American Psychiatric Association Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. Google Scholar. Appelhans, B. Heart rate variability as an index of regulated emotional responding. Arnow, B. The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression.

Astor, P. Integrating biosignals into information systems: a NeuroIS tool for improving emotion regulation. Barnes, S. Empirical evidence for the outcomes of therapeutic video games for adolescents with anxiety disorders: systematic review. JMIR Serious Games 6:e3.

Berking, M. Deficits in emotion-regulation skills predict alcohol use during and after cognitive-behavioral therapy for alcohol dependence. Emotion-regulation skills as a treatment target in psychotherapy.

Black, D. Personality disorders, impulsiveness, and novelty seeking in persons with DSM-IV pathological gambling and their first-degree relatives. Blaszczynski, A. A pathways model of problem and pathological gambling. Addiction 97, — Brooke, J.

Usability evaluation in industry , Bucci, S. Client and therapist attachment styles and working Alliance. Calado, F. Problem gambling worldwide: an update and systematic review of empirical research Carrillo, E. Gender differences in cardiovascular and electrodermal responses to public speaking task: the role of anxiety and mood states.

Charlier, N. Serious games for improving knowledge and self-management in young people with chronic conditions: a systematic review and meta-analysis. Clarke, D. Intrinsic and extrinsic barriers to health care: implications for problem gambling.

Coyle, D. An evaluation of a solution focused computer game in adolescent interventions. Child Psychol. Psychiatry 14, — Del Pino-Gutiérrez, A. The relevance of personality traits in impulsivity-related disorders: from substance use disorders and gambling disorder to bulimia nervosa.

Del Prete, F. The role of affect-driven impulsivity in gambling cognitions: a convenience-sample study with a Spanish version of the gambling-related cognitions scale.

De Weert-Van Oene, G. Retention in substance dependence treatment: the relevance of in-treatment factors.

Diana, C. Experience-sampling methodology with a mobile device in fibromyalgia. Ducharme, P. Videogame assisted emotional regulation training: an ACT with RAGE-control case illustration.

Eddie, D. A pilot study of brief heart rate variability biofeedback to reduce craving in young adult men receiving inpatient treatment for substance use disorders. Biofeedback 39, — Heart rate variability biofeedback: theoretical basis, delivery, and its potential for the treatment of substance use disorders.

Theory 23, — Eichenberg, C. Serious games for psychotherapy: a systematic review. Games Health J. Elmas, H. Alexithymia and pathological gambling: the mediating role of difficulties in emotion regulation. Psychiatry 28, 17— Fagundo, A. Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

Physiological and brain activity after a combined cognitive behavioral treatment plus video game therapy for emotional regulation in bulimia nervosa: a case report. Internet Res. Fernandez-Aranda, F. The use of videogames as complementary therapeutic tool for cognitive behavioral therapy in bulimia nervosa patients.

Fernández-Aranda, F. Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study. Health 21, — Fleming, T. Serious games and gamification for mental health: current status and promising directions.

Psychiatry Folino, J. Pathological gambling and criminality. Psychiatry 22, — Garcia-Palacios, A. Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study.

Pain 18, — Geddes, K. Dialectical behaviour therapy for the treatment of emotion dysregulation and trauma symptoms in self-injurious and suicidal adolescent females: a pilot programme within a community-based child and adolescent mental health service.

Psychiatry J. Granero, R. The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder. Contribution of illegal acts to pathological gambling diagnosis: DSM-5 implications. Grant, J. Commentary: illegal behavior and pathological gambling.

Psychiatry Law 35, — PubMed Abstract Google Scholar. Gratz, K. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Greenberg, L. Special topic: Emotion-focused therapy. Gross, J.

The emerging field of emotion regulation: an integrative review. Jander, A. Effects of a web-based computer-tailored game to reduce binge drinking among Dutch adolescents: a cluster randomized controlled trial.

Janiri, L. Use Misuse 42, — Jauregui, P. Metacognition in pathological gambling and its relationship with anxious and depressive symptomatology. Jerčić, P. Practicing emotion-regulation through biofeedback on the decision-making performance in the context of serious games: a systematic review.

Jiménez-Murcia, S. Playmancer project: a serious videogame as an additional therapy tool for eating and impulse control disorders.

Pathological gambling is a mental disorder characterized by an irresistible urge to engage in monetary gambling despite harmful consequences. With a Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling Duration

Equilibrio mental gamblers - In this article, we will analyze a mental attitude that distinguishes professional gamblers. This characteristic can be summarized with the Pathological gambling is a mental disorder characterized by an irresistible urge to engage in monetary gambling despite harmful consequences. With a Despite the demonstrated association between empathy and gambling at the behavioral level, limited neuroimaging research on empathy and gambling Duration

There is even evidence to suggest that some video games are capable of generating more benefits in ER than the serious game specifically designed for this purpose, because the fictional properties that can be achieved are better, as they do not have to focus on another goal beyond the fun of the user Villani et al.

Among the frequently mentioned positive outcomes of playing videogames are the development of cognitive and social abilities, the inducement of positive emotions, improvements in mood, the promotion of engagement, and the achievement of self-actualizing experiences Fernandez-Aranda et al.

The proliferation of serious games in health-related contexts has been explained as the consequence of three factors. First, serious games appeal to a wide audience that otherwise would not seek treatment; second, it is easier to engage in and enjoy the therapeutic process; and third, the immersive experiences on a sensory level at the visual, auditory level, etc.

depicted in serious games have been shown to improve effectiveness Fleming et al. Also, as self-training methods, these therapeutic aids can be easily accessible and affordable for those who face financial barriers in obtaining professional help for mental disorders Clarke, A review of 15 studies reporting uses of serious games in psychotherapy concluded that all interventions showed positive results with improvements in the outcome variable, and were particularly effective in increasing motivation, adherence to treatment and strengthening the therapeutic alliance Eichenberg and Schott, This final point is important, since the relationship between the therapeutic alliance and the response to treatment, regardless of the specific treatment modality used, has been demonstrated.

Characteristics such as sex, age, or the type of problem presented by the patient influence the therapeutic alliance, in addition to the characteristics of the therapist and the interaction with the patient themselves Martin et al.

Another study by Tárrega et al. Self-training of people experiencing GD via serious games with biofeedback sensors has been proven to reduce arousal and general impulsive behaviors while enhancing self-control Jiménez-Murcia et al.

In the specific context of the use of serious games to channel ER interventions, some experiments have shown that participants prefer these over paper-based interventions, and that they find serious games more apt to generate, first frustration and then effective ER Rodriguez et al.

The underlying mechanism of serious games for therapy is simple. Individuals become more aware of their emotions as measured by biosensors through a visual and audio representation of them on screen.

The biofeedback connects the emotional reaction to the media display, helping individuals to learn how to regulate their emotions and visually rewarding them when doing adequately Jerčić and Sundstedt, Serious games allow real situations to be recreated in virtual settings, while provoking a series of cognitive, emotional and behavioral responses in individuals.

This allows for the training of specific skills in a motivating and entertaining way that can be more difficult to achieve with traditional therapies. For example, in the concrete task of uniting stars from the constellations in Playmancer, the core objective is training in relaxation, increased self-awareness and self-regulation.

Fernández-Aranda et al. Bespoke games using biosignals to improve ER have been tested in laboratory conditions. One study reported that individuals increased their emotional awareness and improved their decision-making by refining reward processing through the biofeedback mechanism of the game Astor et al.

Heart rate variability HRV is an accessible research tool that can increase the understanding of emotion in social and psychopathological processes Porges, , , HRV analysis is emerging as an objective measure of regulated emotional responding generating emotional responses of appropriate timing and magnitude.

The measurement of HRV responds to autonomic flexibility and, therefore, an increased HRV correlates with greater emotional control Appelhans and Luecken, In an experiment using a breathing-strategy-game for ER in youths, in which a frustration-inducing phase was added, participants did not behave differently when using mobile devices as compared to using a computer, signaling the adequacy of tablets for this purpose Vara et al.

However, that experiment was carried out among high school students and caution must be exerted to generalize these conclusions into a treatment-seeking setting. Since available empirical evidence in the scientific literature has indicated that sex and age play an important moderating role in gambling Valero-Solís et al.

Here, we present a new serious videogame, e-Estesia. Thus, the aims of this study are to first present a description of the serious videogame e-Estesia and then to assess its usability in patients undergoing treatment for GD.

e-Estesia is an app-based serious videogame designed to improve ER in patients with impulse control disorders and other disorders characterized by inhibitory control deficits.

In its current format, e-Estesia runs on password-protected Android portable devices tablets and is connected via Bluetooth to a sensor that transmits physiological data [heart rate HR and HRV] from the participant to the device.

The game is based on a previous serious game, developed by our group and the PlayMancer Consortium Jiménez-Murcia et al. PlayMancer is a more complex serious videogame that retrieves scores from multiple biofeedback sensors including galvanic skin response, oxygen saturation, HR and HRV, breathing frequency and skin temperature.

This intervention has been demonstrated to improve treatment outcomes in eating and GD patients Fagundo et al. However, PlayMancer needed patients to play the game within the premises of the hospital due to the multiple required biosensors.

In contrast, e-Estesia is a much more convenient solution that facilitates treatment by a transforming the desktop computer-based experience into an app-based interface, making it fully portable and allowing treatment delivery at home, b reducing the outcome measures and the equipment needed to a single biosensor and a tablet, and c streamlining the game design and the human-media interactions to its core, most therapy-relevant components.

e-Estesia starts by asking participants about their mood. The question can be answered by selecting one of five face icons ranging from sadness to happiness graphics validated in previous studies and in different samples; Diana et al. Next, a voice-over trains participants on how to become aware of their breathing and sitting posture.

The game is set on a tropical island. The game depicts tropical vegetation, sea, horizon, sun, clouds, and rain. The game follows an A-B-A design pattern consisting of a an initial 3-min period in which the landscape is sunny, b a subsequent 4-min period in which rain clouds and eventually a storm appear, and c a final 3-min period identical to the first one.

Gamers are instructed at the beginning of the game to try and breathe calmly diaphragmatic breathing instructions. Figure 1. Screenshots from e-Estesia depicting the different phases of the Serious Game. The initial and final periods are used as baseline to practice this breathing technique.

The intermediate period is designed for the subjects to learn how to manage their breathing through a HRV biofeedback mechanism.

This mechanism gives the user information about their breathing thanks to a visual system with animations e. rainy clouds. When participants succeed in regulating their emotions by breathing properly, the biosensor utilizes this physiological information to reinforce this behavior by dissipating the storm; if breathing does not improve, the rain becomes more intense.

This intermediate period adds stressors. During the game, simple instructions are given regarding how to modulate poor weather conditions. The patient must be an active participant in the process as they interact with the application and consolidate this learning via breathing techniques.

A pilot sample of 26 patients seeking treatment for GD was obtained for the present study. Data from participants were collected from December to May by means of a purposive sample recruitment procedure.

Consecutive patients who began cognitive-behavioral treatment for GD were offered the opportunity to participate in the study, and all participants who agreed were selected and provided that they met the inclusion and exclusion criteria. Due to the observational nature of this pilot study, self-selection bias and lack of randomization were not deemed significant as the results at this stage were not to be compared to a control group.

In order to participate, the following exclusion criteria were considered: a the presence of a psychiatric or neurological disorder such as schizophrenia or other psychotic disorders that might impact game performance, b an intellectual disability, and c active pharmacological therapy that might interfere with game performance.

Inclusion criteria included being diagnosed with GD, which was assessed prior to the study both via screening methods SOGS, DSM-IV criteria and other relevant measures to identify psychopathological symptoms and individual structured interviews by experienced psychologists.

The sample included 21 men All participants received information regarding the aims of the research and they provided signed informed consent for participating.

There was no financial or other compensation for being part of the study sample. Participants who agreed to take part in the study were briefed on the purpose of the study and were reassured of the voluntary nature of their participation and their rights to stop at any time.

After conducting the initial intervention session with the application, the usability scale described below was administered to the participants. The System Usability Scale SUS; Brooke, was used to gauge how usable participants perceived the app to be.

This scale is context-specific and does not measure usability in isolation but as a product of the user-interface interaction and the specific goals that users expect to accomplish with its use Schmidt and De Marchi, The instrument was conceived after the international standard ISO , which identifies effectiveness, efficiency, and satisfaction as the key components of usability assessment.

Final scores for SUS range from 0 to , with higher scores indicating greater usability. Two physiological variables were measured: heart rate HR and HRV defined as the variation in the time between successive heartbeats. These measurements were recorded via a Polar H7 Bluetooth Heart Rate Sensor by Polar Electro Oy TM.

HR beats per minute scores were used. The rationale for these measures derives from previous studies pointing out that deviations higher than baseline HR scores are typically associated with emotions of anger and joy, whereas lower values of excitement i.

HRV, which usually ranges from 30 to 39, is a variation in the beat-to-beat time interval time between two successive R-waves that occurs spontaneously and naturally and that is positively associated with self-regulation, heart health, autonomous balance, and task performance.

In turn, it is negatively associated with anxiety, depression, stress, hypertension, chronic muscle pain, and nausea Porges, ; Malik, ; Sargunaraj et al. Additional data were obtained through a semi-structured interview, which assessed sociodemographic features e. However, for the purpose of the present study, only age, gender, and gambling platform preference i.

online were reported. Statistical analysis was done with Stata16 for Windows. The number of participants who reported to prefer offline gambling was 21, whereas five preferred online gambling. Table 1 includes the frequency distribution of the items in the study.

Table 2. Comparison of the SUS raw scores divided by sex, gambling preference and groups of age. As expected, the measures varied as a function of time in the session, with increased activity during the start of the game differences are more evident for HR comparing the period of game play vs.

the period of pre-game. Particularly, women showed a decrease in the HR during the period of game play compared with the pre-game phase, while men showed an increase in the HR levels during the game playing phase.

Figure 2. Line-plot for heart rate HR and heart rate variability HRV means within the entire sample. The present study aimed to assess the usability of a new emotion-regulation training app for GD, based on previous studies carried out in eating disorders and GD Fernández-Aranda et al.

In the study participated 26 patients undergoing treatment for GD, giving high scores in effectiveness, efficiency, and satisfaction with the use of the tablet-based serious game e-Estesia according to the SUS; Brooke, This is one of the few studies conducted in order to evaluate usability of a serious game in clinical population Yáñez-Gómez et al.

The app performed comparatively well in all groups. The average score, both in men and women, and with different gambling preferences online vs.

offline was over 80 ranging from 0 to , which indicates a high levels of endorsed usability. Mean scores were somewhat lower in the younger group between 22 and 35 years.

The main reasons for using this specific type of technology are the internal characteristics of serious games, such as the intensity with which they capture the attention of the individual, the ease with which they disconnect from the outside world, their ability to immerse, the low resistance on the part of most individuals to use them and the motivation that they tend to generate in many people Eichenberg and Schott, This is an important aspect considered that one of the aims of the development of e-Estesia were to provide independence to their users, as an improvement of other similar serious games that have been used to improve emotional regulation, such as Playmancer , this serious game is useful for improving emotional regulation, but requires the support of an expert to be able to use it Fernández-Aranda et al.

Some studies have shown that the use of video games could improve motivation and adherence to treatment Kato et al. The study results showed that a high percentage of participants believed the app was coherent, consistent, not confusing This aspect is important considering that the benefits of the use of serious games in health contexts are related with their capacity to capture the attention of the user, which can help the motivation to continue using it Fagundo et al.

Also, in the context of GD patients, this could be an important auxiliary treatment strategy, if it is considered that different personality traits Tárrega et al.

Finally, comfort and desire to use the app were inextricably linked. All the patients who responded that they agreed that they would like to use the application frequently also agreed that they were comfortable using it.

This is consistent with the preexisting literature that affirms that for serious game users, it is easier to engage in the therapeutic process if it is enjoyable Fleming et al.

Using e-Estesia during a session with 26 GD patients revealed that women had a lower mean HR and a higher HRV during the use of the serious game compared to men.

This could indicate that for this first session, women show a greater capacity to self-regulate their psychophysiological state through biofeedback and breathing instructions Appelhans and Luecken, During the interaction phase of the serious game, this difference between men and women increased, with women showing a higher HRV.

These results should be careful lighted through the differences in emotional regulation difficulties that both genders present in GD patients. However, other aspects as the conditions of the evaluation, may influenced these results. A study comprising GD patients showed that men had more difficulties in ER compared to women specifically, men had poorer performance in the non-acceptance of emotions domain; Sancho et al.

Other studies in laboratory conditions and with healthy populations show results contrary to the study, suggesting that women could react to laboratory stressors with higher HR responses, whereas men have greater blood pressure Carrillo et al.

This application aims to improve the management of ER through a biofeedback mechanism, mediated by instructions in diaphragmatic breathing. It is possible that in the first sessions, in which patients are learning the management of their psychophysiological state and the establishment of new breathing patterns, they would not feel entirely comfortable with this intervention.

Levels of stress and anxiety might even be expected to increase during the first sessions. The majority of players, in the first sessions of the evaluation, thought that the game was hard, even on the easy mode.

Although this opinion persisted for some subjects in the later sessions as they were still trying to find a good strategy, most of them thought that the game became easier with each session, as they were able to reach higher scores and maintain the average meditation higher for longer periods of time.

Therefore, future research is needed that measures more than one e-Estesia session in contexts that differ from the laboratory. In conclusion, the usability scores and the biofeedback information provide promising evidence of using e-Estesia to assist in the treatment of GD.

This study should be interpreted in the basis on some limitations. First, the usability of the app was assessed through a scale focused on the key components of this type of systems, and, therefore, no reference benchmarks or norms are available for comparing our results.

In addition, only one scale was used to measure usability, without specific additional methods such as usability testing, cognitive walkthrough, heuristics analysis or other instruments. Second, the low sample size: statistical analysis was not adequately powered to examine associations between background variables with the usability measures.

It should be outlined that many feasibility studies are carried out within small samples, which should accurately reflect the characteristics of the larger target population of users.

We tried to choose a representative group of GD patients that closely matched the distribution of age, sex, and gambling preference of the whole population candidate to use the e-Estesia.

Future studies could test additional relationships, and try to identify potential predictors of usability in the GD area such as the presence of comorbid mental health conditions, sociodemographic profile or confidence in using technology. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

SJ-M, FF-A, TM-M, RG, LM, and TS contributed to the development of the study concept and design. SJ-M, FF-A, RG, LM, AP-G, ML-M, MG-P, LM, and JM had previous experience in the design and use of SG for the treatment of impulsive spectrum disorders and their experience and advice were decisive in the design of the present device.

RG performed the statistical analysis, wrote the results and made the tables and Figures. SJ-M, TM-M, LM, TS, and HL-G aided with interpretation of data and the writing of the manuscript. TM-M, LM, AP-G, ML-M, BM-M, EV-M, MG-P, and LM collected the data. FF-A, JM, IG, TS, MG-B, and AS revised the manuscript and provided substantial comments.

SJ-M, FF-A and JM obtained funding. All authors contributed to the article and approved the submitted version. It was additionally supported by grants from the Ministerio de Economía y Competitividad PSIR , and from the Ministerio de Ciencia, Innovación y Universidades grant RTIB CIBERObn and CIBERSAM are both initiatives of ISCIII.

The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. HL-G is supported by a Generalitat de Catalunya Grant BP LM was supported by a postdoctoral Grant of the Mexican Institution Consejo Nacional de Ciencia y Tecnología-CONACYT Science and Technology National Counsel.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abad-Tortosa, D. Sex differences in autonomic response and situational appraisal of a competitive situation in young adults. doi: PubMed Abstract CrossRef Full Text Google Scholar. Álvarez-Moya, E.

Subtyping study of a pathological gamblers sample. CrossRef Full Text Google Scholar. Comparison of personality risk factors in bulimia nervosa and pathological gambling. Psychiatry 48, — Galanter M, et al. Behavioral addictive disorders. In: The American Psychiatric Publishing Textbook of Substance Abuse Treatment.

American Psychiatric Publishing. What is gambling disorder? American Psychiatric Association. Domino FJ. Overview of gambling disorder. Bodor D, et al. Treatment of gambling disorder: Review of evidence-based aspects for best practice.

Current Opinion in Psychiatry. Kraus SW, et al. Current pharmacotherapy for gambling disorder: A systematic review. Expert Opinion on Pharmacotherapy. National Council on Problem Gambling. About us. Gamblers Anonymous.

Oei TPS, et al. Effectiveness of a self help cognitive behavioural treatment program for problem gamblers: A randomized controlled trial.

Journal of Gambling Studies. Hall-Flavin DK expert opinion. Mayo Clinic. April 26, Associated Procedures. Cognitive behavioral therapy. Your gift holds great power — donate today!

Find a doctor. Explore careers. Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us. Health Information Policy. Media Requests. News Network. The uncertainty of the outcome creates a sense of anticipation and excitement, as individuals are constantly evaluating their chances of winning or losing.

The human brain is wired to seek patterns and make predictions based on past experiences. However, in gambling, the outcome is determined by chance, which introduces an element of unpredictability. This uncertainty increases the emotional intensity of the gambling experience, as individuals are constantly evaluating their odds and adjusting their strategies.

To better understand the probabilities involved in different gambling activities, individuals can refer to resources that provide insights into the odds and potential payouts. These resources can assist in making informed decisions while participating in various gambling activities.

Understanding the thrill of risk-taking in gambling requires recognizing the powerful impact of dopamine release and the influence of probability and uncertainty. By exploring these psychological factors, individuals can gain insights into the emotions and motivations that drive their engagement with gambling activities.

When it comes to gambling, emotions play a significant role in shaping the overall experience for individuals. The thrill of anticipation, the frustration of losses, and the euphoria of winning are just a few of the emotions commonly experienced by gamblers.

Let's delve into these emotional highs and lows. For many gamblers, the excitement and anticipation of playing a game can be incredibly exhilarating. The thought of a potential win, the rush of adrenaline, and the anticipation of what lies ahead create a sense of thrill that keeps people coming back for more.

This excitement is often linked to the activation of the brain's reward system, which releases dopamine, a neurotransmitter associated with pleasure and motivation. During this phase, individuals may experience a heightened sense of focus and engagement, eagerly awaiting the outcome of their bets.

The feeling of anticipation can be so powerful that it becomes a driving force behind continued gambling behavior. In the world of gambling, losses are inevitable. When faced with unfavorable outcomes, gamblers often experience frustration and disappointment. The emotional response to losses can be influenced by various factors, such as the amount of money at stake, personal expectations, and the belief in one's own abilities.

Frustration may arise from a sense of control being taken away, as luck and chance play a significant role in gambling outcomes. The disappointment associated with losing can stem from dashed hopes and unmet expectations. These negative emotions can be particularly challenging for individuals who struggle with self-control or have difficulty accepting losses.

On the flip side, winning can lead to a euphoric state commonly known as the "gambler's high. This emotional high can be so powerful that it motivates individuals to continue gambling in pursuit of experiencing it again.

The euphoria experienced after a win is also linked to the release of dopamine in the brain. The brain's reward system reinforces the pleasurable sensation, making it enticing for gamblers to chase after that elusive high. However, it's important to note that the gambler's high can also contribute to risky behaviors and overconfidence, potentially leading to excessive gambling and financial losses.

Understanding and managing these emotional fluctuations is crucial for responsible gambling. It's important for individuals to be aware of the range of emotions they may experience while gambling and to develop strategies to cope with both the highs and lows. Seeking support and guidance from professionals can also be beneficial, especially for those who may be at risk of developing addiction and compulsive gambling.

By recognizing and acknowledging the emotional rollercoaster that comes with gambling, individuals can make informed decisions and engage in a more balanced and enjoyable gambling experience. Remember, responsible gambling is about maintaining a healthy mindset and enjoying the activity for its entertainment value rather than seeking emotional highs or financial gains.

In the world of gambling, cognitive biases play a significant role in shaping the decisions and behaviors of gamblers.

These biases can sometimes lead individuals to make irrational choices, influenced by their cognitive processes and underlying beliefs. Here, we will explore three common cognitive biases that are often observed in the psychology of gambling: the illusion of control , the gambler's fallacy , and loss aversion.

The illusion of control is a cognitive bias that leads individuals to overestimate their ability to influence the outcome of a situation that is actually determined by chance. In the context of gambling, this bias can manifest as a belief that one has some control over the outcome of a game or a belief that certain actions and behaviors can increase the chances of winning.

For example, a gambler may feel that their choice of a particular slot machine or the way they roll the dice can influence the outcome in their favor. This bias often arises from the need for individuals to feel a sense of control in an unpredictable environment.

However, it is important to recognize that most gambling outcomes are determined by random chance, and the illusion of control can lead to risky decision-making.

The gambler's fallacy is another common cognitive bias observed in gambling. It is the belief that past events in a game of chance can influence future outcomes, even when the events are independent and unrelated. This bias is often characterized by the mistaken notion that if a particular outcome has occurred repeatedly, the opposite outcome is more likely to happen in the future.

For example, a gambler playing roulette may believe that if the ball has landed on black for several consecutive spins, red is now more likely to occur.

In reality, each spin of the roulette wheel is an independent event, and the outcome of one spin has no bearing on the outcome of the next.

The gambler's fallacy can lead individuals to make irrational bets or chase losses based on faulty reasoning. Loss aversion is a cognitive bias that reflects the tendency of individuals to strongly prefer avoiding losses over acquiring equivalent gains. In the context of gambling, this bias can lead individuals to take additional risks in an attempt to recover losses or avoid accepting losses altogether.

For example, a gambler who has experienced consecutive losses may continue to bet larger amounts in the hope of recouping their losses, even if it means incurring greater financial risk. This bias can be fueled by the emotional distress associated with losses and the desire to avoid the negative feelings that come with financial setbacks.

Understanding these cognitive biases can shed light on the psychological factors that influence gambling behaviors.

By being aware of the illusion of control, the gambler's fallacy, and loss aversion, individuals can make more informed decisions while engaging in gambling activities.

If you or someone you know is struggling with addiction and compulsive gambling , seeking help and support is essential. While gambling can be an exhilarating and entertaining activity, it's important to acknowledge that there is a dark side to this pastime.

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