Neophytou, K., Theodorou, M., Artemi, T.F., Theodorou, C., & Panayiotou, G. (2023). Gambling to escape: A systematic review of the relationship between avoidant emotion regulation/coping strategies and gambling severity. Journal of Contextual Behavioral Science, 27, 126-142. https://doi.org/10.1016/j.jcbs.2023.01.004
Several theories implicate emotion regulation difficulties in problematic gambling, which may be used to cope with distress. This systematic review summarizes the research of the last 22 years, focusing on the hypotheses that difficulties in emotion regulation are associated with problem gambling, and that avoidance-based strategies are most strongly associated with gambling severity. It expands on previous reviews on emotion dysregulation in gambling, by addressing the theoretical overlap between coping and emotion regulation, including research on the role of both emotion regulation and coping strategies. Studies conducted with adults, measuring emotion regulation and coping with standardized self-report questionnaires and with gambling severity as the outcome measure were included. Forty-two published articles and six doctoral theses fulfilled the study's inclusion criteria. A significant association between ER/coping strategies and gambling severity was found in 96% of studies. Avoidance (defined broadly, to include face-valid forms of avoidance and emotional non-acceptance, plus other strategies categorized as avoidant in the literature, including emotion-focused coping, other-blame, religion, rumination, humor and impulsivity) was most systematically related to gambling severity. Lack of emotional clarity and awareness, which may also entail unwillingness to tolerate emotions, were also related to gambling severity. Less use of approach and task-oriented strategies was associated with gambling in some studies, but results were mixed. Findings underscore that pathological gambling may be maintained as an escape from distress, in accord with recent evidence. The role of some strategies needs further study because of limited or mixed evidence. Implications for treatment, focusing on emotion regulation, acceptance and distress tolerance are discussed.
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