'I shouldn’t have taken that bet!': counterfactual thinking in gambling disorder

Abstract, Background: Counterfactual thinking is a component of human decision-making that entails “if only” thinking about unselected choice options. It is associated with strong emotional responses of regret (when the non-obtained outcome is better than the obtained) and relief (vice versa). Counterfactual thinking is implicated in cognitive distortions, which are common in gambling disorder and a target of cognitive behavioural therapy. For example, people with gambling problems may over-interpret near-wins as an outcome that could have occurred, or may persist with gambling by imagining how terrible they would feel if they stopped before a winning gamble (‘anticipatory regret’). This study compared individuals with gambling disorder and healthy controls on a behavioural economic choice task that measured counterfactual thinking.

Method: Individual with gambling disorder (n = 46, 25 male, mean age 36.2) and healthy controls (n = 25, 14 male, mean age 42.7) recruited through community advertisements and the provincial problem gambling treatment program attended a laboratory session that included a counterfactual choice task. The task entailed 80 choices between two mixed gambles; the obtained outcome (e.g. 70 point loss) and non-obtained outcome (e.g. 210 point gain) were revealed sequentially, with a 1-9 affect rating taken after each. Choices were analyzed using a computational model that derived parameters indicating sensitivity to expected value, risk variance, and anticipated regret, based on Gillan CM et al (2014 Biological Psychiatry 75: 639-646).

Results: On the affect ratings, the gambling disorder group displayed blunted emotional sensitivity to both obtained outcomes (t = -2.52, p = 0.011) and counterfactual outcomes (t = -2.647 p= 0.008). In the computational choice model, the GD group showed increased sensitivity to anticipated regret (r x Group z = 2.164, p = 0.031) in guiding their choices. This was combined with a reduced sensitivity to expected value (e x Group z = -1.970, p = 0.049) and increased preference for high risk-variance gambles (v x Group z =-4.832, p < .001).

Conclusions: Participants with gambling disorder show wide-ranging alterations in decision-making processes and emotional reactivity to choice outcomes. Enhanced sensitivity to anticipatory regret in gambling disorder may contribute to gamblers’ susceptibility to cognitive distortions, and could be fruitfully targeted in psychological treatments for gambling disorder.