Dr. Michael Wohl - Advances in Motivating Change Among Disordered Gamblers: Why and How Memories of the Past Self Can Facilitate Motivation to Engage in Behavioural Change

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%

66

68

70

72

74

76

78

80

82

84

86

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

[email protected]

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