Learned impotence, locus of control, cognitive bias & ego-sustainability

pokerIn the panorama of pathological addictions, gambling has overwhelmingly taken place in the last decade and today in Italy we are experiencing a real emergency in terms of the number of cases and the variety of forms of manifestation of the phenomenon. From 2007 to today the Orthos project, directed by Riccardo Zebetto, welcomed about 400 players from all over Italy, Switzerland, Croatia, France and England to short residential intensive psychotherapy treatment. The majority of them come from the Tuscany region, which with its foresight has financed the intervention for its citizens, thus limiting the damage that is produced in the social fabric to which they belong.

In the short article that follows, operating as partner and South Area Manager for the Orthos project, I would like to summarize some considerations that emerged from the clinical observation and the rich moments of exchange with colleagues and in particular with Riccardo Zerbetto, Scientific Director and creator of the project.

Corresponding to the data relating to the turnover of the various types of games, the majority of people arriving in treatment have developed dependence on slot machines, sports betting and video lottery. In decreasing percentages, those whose dependence is linked to Scratch Cards, Win for Life, Bingo, poker, casino ...

Access to the treatment can be made at the direct request of the interested party or upon sending the Drug Addiction Services (or Mental Health Centers), and requires a careful assessment of the motivation, the severity of the addiction and the general conditions of physical health. and psychic. The first assessment therefore allows the Orthos team to set up groups of 8-10 people, with an average presence of 1-2 women, in which the average levels of psychopathology do not affect the potential of group psychotherapy interventions. SOGS, BIS11, TAS20, DES-II, PAS-S, PAS-50, MMPI, are the tools that are used in the intake phase in order to complete an overall assessment of the conditions from which the treatment begins. In no case are psychiatric acute cases accepted, which must be brought to a state of compensation in other services before being inserted. However, about 35% of those who are introduced to treatment have comorbid diagnoses, the most common of which are: depression, anxiety disorders, border personality disorder, parkinson's syndrome. Previous forms of abuse and / or dependence on alcohol and / or psychotropic substances are often found. In a minor but not marginal percentage, previous or current conditions of addiction / problematic behavior were found in sexual, eating or purchasing behaviors (compulsive shopping).

This leads us directly to underline the placement of gambling disorder in the spectrum of pathological addictions, with an interpretative model that integrates the guidelines that are most often called into question in the scientific literature: drug-like addiction, control disorder. of impulses, mood spectrum disorders and the obsessive-compulsive side. Let us consider the different conceptualizations that are not mutually exclusive: for hermeneutical and pragmatic purposes it is more profitable to consider the complexity of the DGA as declinable into subtypes that are characterized from time to time by the preponderance of one of the guidelines mentioned above. A key concept to address the complexity of the DGA is undoubtedly that of "Addiction Prone Personality" (APP): a clear correlation between "Sensation Seekers - Antisocial Personality - Psychoticism" and problematic use of alcohol has been demonstrated with longitudinal studies (Barnes et al. - 2000) and new data to be collected among problem gamblers, could help us in verifying whether the personality guidelines summarized by the concept of APP are significantly predictive about the possibility of developing a gambling addiction.

A greater understanding of the dysfunctional traits significantly associated with pathological play can allow us to develop specific intervention protocols:

Alexithymia> Emotional awareness, Psychoeducation, Awareness training ...
LOC external> Re-training of attributions, Focusing on planning & responsibility ...
Impulsiveness> "Stop & Think", Emotional Awareness, Expression-Processing ...

The main lines of personality on which the concept of APP is based are Sensation / Exitement / Novelty Seeking on the one hand and Antisociality / Psychoticism on the other, aspects that are reflected respectively in the impulsiveness and in alexithymia frequently detected by the diagnostic investigations adopted by the Orthos team. In the investigations carried out, impulsiveness is correlated at trend level with alexithymia, indicating that the impulsive tract is probably connected to inadequate intrapsychic processing mechanisms and intersubjective communication of emotions, as well as their insufficient use as a guide for behavior. Furthermore, the first factor of TAS-20, (DIF - difficulty in identifying emotions and distinguishing them from somatic sensations), shows high values ​​of association with dissociative experiences measured by DES-II, confirming what has already been found in the literature compared to others forms of pathological dependence (Caretti, Craparo, Schimmenti, 2006[; Caretti et al., 2007[Iii]).

Taking charge of the problematic or frankly pathological player cannot therefore ignore the etiopathogenetic complexity and the attempt to structure reparative / cathartic experiences and paths of redefinition of the Locus of Control in terms of mastery.

The studies carried out on gamblers and attempts to classify them into typologies, (Greenson, 1947[Iv]; Moran, 1970[v]; Glatt, 1974[vi]; Custer, 1984[vii], to name a few) have highlighted a considerable complexity of the etiopathogenetic pathways and forms of manifestation of the problem. Currently there is a tendency to consider the distinction between action players and escape players to be of some use (Lesieur & Blume, 1991[viii]) as the difference in the motivations to play and the personality characteristics between these two categories suggests diversified treatment protocols. For the purposes of the topic we are presenting, however, it is important to direct our attention towards the typologies described by Moran (Ibid) in terms of "symptomatic play" and "impulsive play". For the player symptomatic, (comparable to Jellinek's alpha type alcoholic[ix]) the game is a direct expression of the psychological disorder from which it suffers (reactive forms of a neurotic nature, personality disorders, psychosis). In the players impulsive (among which we find traits of alcoholics both gamma type and Jellinek delta type; ibid) the inability to abstain from gambling and to avoid thinking about it, caused by psychological and social factors, is in many cases acted out dramatically, with phases of loss of control alternating with moments of abstinence. Both these typologies are therefore characterized by the presence of pre-existing affective / relational problems, which can be considered the substrate on which the current manifestations of impulse control have developed (DSM IV-TR[X] and ICD-10[xi]). In symptomatic players the disorder was structured starting from a premorbid emotional vulnerability, as described by Blaszczynski and Nower[xii]: in these subjects we will therefore often find anxiety, depression, comorbidity with alcohol abuse, as well as family histories characterized by problematic aspects, among which gambling or other pathological dependencies of the parents are not uncommon. Among those who are described by Moran as "impulsive player" will instead be more frequent personality disorders (in particular antisocial), borderline traits, attention deficit disorders, and in general, we will face cases in which impulsiveness gives place to a very wide range of maladaptive manifestations (substance abuse, socio-affective isolation, tendency to commit crime, sensation seeking, irritability, poor compliance with treatments, ...) which make engagement and treatment difficult. In the therapeutic-rehabilitation path of Orthos project the problematic and pathological players, belonging to both types described above, were welcomed and introduced to individual and group therapeutic meetings aimed at promoting those introspective practices and the re-examination of the path of socio-affective growth which are indispensable in order to identify the emotional, cognitive, relational and behavioral components that have determined the establishment and perpetuation of maladaptive ways of regulating one's impulses and satisfying one's needs[xiii]. In this context, what initially takes shape as a shared reconstruction of an anamnesis of emotional states and relational conditions of development, is declined step by step in the possibility of observing how what emerges from the emotional side intertwines with introjections and beliefs dysfunctional that characterize the cognitive side of the disorder. During the individual and group interventions, the coevolutionary structure of the emotional / relational and cognitive / imaginative aspects is presented in all its evidence. It thus becomes possible to underline how "shortcomings" or "invasions" that have affected one of these two main axes affect both, feeding a pathogenic spiral. Specifically, numerous cases have been found in which the distinctive signs of learned impotence are accompanied by characteristic cognitive bias such as the illusion of control, magical thinking, the player's fallacy in its various forms[xiv], the redefinition of situations in self-justifying terms (and again: clustering illusion, availability heuristic, attentional bias, illusory correlation, ludic fallacy, optimism bias, overconfidence effect, positive outcome bias, rosy retrospection, Texas sharpshooter bias ...).

Seligman [xv],[xvi] described the concept of "learned helplessness" as a complex of emotional, cognitive and motivation deficits resulting from repeated exposure to uncontrollable negative events: animal subjects subjected to this type of situations developed, in the experimental context he conceived, conditions of depression , lack of reactivity, abulia / akrasia which persisted even under changed conditions. However, this did not happen in those subjects to whom a possibility of control was guaranteed during the initial experimental phase: the explanatory inferences that derived therefore related the occurrence of negatively connoted episodes with the impossibility of acting, of carrying out actions that could influence the occurrence of events. Learned helplessness can therefore be described as a learning in which the awareness of one's own (real) helplessness is assumed as inevitable, and generalized to contexts and situations that no longer have to do with the original ones. The desired and expected objectives can no longer be related to practicable acts, efforts, and the subject falls into inaction. The concept, being borrowed from animal research, was later criticized and revisited by many, and also by Seligman himself: together with Abramson and Teasdale[xvii] he introduced changes to the initial theoretical framework that did not cover the causal attributions made by people in relation to their impotence. An internal, generalized and stable causal attribution referring to impotence, leads in fact to a more marked sense of inevitability and to a wider mistrust, whereas instead attributing one's own impotence to external factors, or internal but specific and / or variable factors can allow to escape generalization and chronicization.

In this regard: “The association between alexithymia and locus of control derives from the observation that subjects who obtain high points on the TAS-20 turn out to have an external LOC. It would seem logical: a person poorly in contact with his emotions, therefore deprived of the possibility of using them as a basis for thought and motivation, may believe that events depend on fate, or on "other powerful ones" (Solano, 2001; Carpini, 2008)

Let us now observe the relationship between illusion of control and learned impotence: the latter, which emerges from experiences in which the lack of control is central and decisive, tends to manifest itself in counterpoint with respect to the cognitive bias mentioned above: the appearance of cognitive bias specific (which are substantiated in defensive interpretations) is therefore in these cases the result of self-regulation that is activated in order to avoid the depressive experience that can derive from the loss of control in situations of stress, uncertainty, chaos, as well as supported by Fenton-O'Creevy et al.[xviii], who, studying the phenomenon in the field of business performance, have also found a drastic reduction in performance in the ability to analyze, to generate profits, as well as in risk management among those who were prone to the illusion of control. In essence, when a possibility of genuine control of one's world fails, an effective coping strategy to combat depressive experiences, uncertainty and stress can be the development of forms of magical thinking, of illusions of control which, up to a certain threshold, they have an adaptive function in that they support motivation and resilience.

In promoting actions to contrast the development and maintenance of the various forms of pathological addictionhowever, it is important to maintain a multidimensional vision and deal with the bio-psycho-social implications of the phenomenon. Maintaining a clear awareness of how these factors are inextricably embraced, even when we deal with a specific aspect of the problem, means preserving that fractality of thought that allows us to see transparently the overlap of levels ranging from the expression of biological vulnerability (original or acquired), to psychic suffering, or again, to that social "being-being" that finds its channel of expression in the person - "weak link" of the system, which becomes symptomatic as regards the crossroads of existential conditions (bio- psycho-social) unsustainable. Here it becomes important to spend a few more words on the concept of "egosustainability": With poetic license," ego "is here understood in holistic terms, as" living organism in an environmental context "and not in the classic psychoanalytic meaning which sees it as a rudimentary sketch of the primitive and narcissistic ego. We could therefore define "egostenibility" that existential condition in which, for a specific individual, the bio-psycho-social determinants present themselves as "sufficiently good" and in a state of equilibrium such as to allow a stay in the a-symptomatic world, or at least not pathological. On the contrary, the original inadequacy or damage / depletion of one or more of these aspects can lead to existential conditions that the person (organism in context) is no longer able to support: in these cases, some form (albeit morbid) equilibrium can only be regained through a regression that often accompanies frankly symptomatic manifestations, among which pathological dependence is the most common. The consumption of alcohol and tobacco as a maladaptive coping strategy (coping with stress) is widely disseminated and documented, as are unfortunately sadly known the consumption of drugs for performance purposes, also of a relational nature (doping no longer sporty, but "existential" "), Similar to some extent to the increase in sales of antidepressants and anxiolytics (+ 4,4% of drugs for the CNS between January and September 09 - OsMed Report). It is very easy for a dysfunctional coping strategy to become an addiction: when our bio-psycho-social resources are inadequate in relation to our expectations or environmental demands and we take the path of "Doping-coping " instead of maturing the necessary contact with our possibilities and our constraints, dependence is upon us, as "if it is not an answer, at least it makes us forget the question" as a German proverb says. As in any prayer (cf. Turgenev), we ask the psychoactive substance or maladaptive behavior: "do not make two plus two in my life do four", but five ... In problematic and / or pathological gambling this magical expectation seems particularly present. We must remember that, although sometimes born in the same neighborhood, with the same economic and social opportunities and perhaps even in the same family, the different people live different existential conditions. First of all, they are bearers of their own "temperamental" baggage: in fact, we know that everyone has a peculiar genetic makeup that has distinguished him since prenatal life. The scientific researches of the last years comfort us in recognizing that from the most tender childhood there are distinctive personal traits, which characterize each individual: among these characteristics we can however identify some common vulnerabilities (Hyperthymia, ADHD, ...) which will go later to be configured as risk factors for the development of a personality prone to addiction (Addiction Prone Personality). Furthermore, in the first years of life, since the prenatal period, each of us experiences the influence of unrepeatable environmental conjunctures, in which the experiences, the constellations of values ​​and the relational schemes of the family and of the other significant ones, intertwining with the basic characteristics of the person, they go to modulate / shape our personality and the modalities of our "being in the world". The fantasies, fears, convictions that are established in the years of our "training" as individuals, contribute to orienting our gaze peculiarly on the world and finally the social, cultural and economic environment in which we grow up and become adults, exercises the its inexorable influence, for better or for worse. Every action aimed at containing the development and the roots of addiction will therefore be structured with the overall nature of the person and his relationship with the environment in mind, as happens in integrated treatments.

The therapeutic-rehabilitative path proposed by Orthos is based on the integration of gestalt psychotherapy, psychoeducational interventions, coaching, elements of bioenergetics and systemic-relational therapy, meditation and counseling.

The structuring of evolutionary experiences that allow the transition from "learned helplessness" to "learned hopefullness", favoring the redefinition of a balance in terms of locus of control in the sense of "mastery" and stimulating the overcoming of the conditions of alexithymia is therefore the backbone of the Orthos intervention:

  • observation of crystallization / fixation in maladaptive contact modalities;
  • reappropriation of disturbing emotional aspects;
  • empowerment / reappropriation of the sense of self-efficacy through work approaches by objectives;
  • from external support / external influence (phantasmatic – inconsistent) to internal self-support / locus of control (realistic – substantial);
  • knowledge and reconciliation with one's "daimon";
  • reappropriation of responsibility, awareness of one's needs, dynamic pleasure / displeasure, the possibility of social play - conscious play;

are some of the intervention tools that the team of Orthos project uses in modules that we could license to define "psychological resuscitation services".

In the following months, for a year, the participants will keep in touch both with each other (with the establishment of a "chain" system for communications) and with Orthos operators in order to monitor the "assimilation" path reparative experiences lived in the intensive treatment phase. Three months, six months and a year after the end of the intensive experience, the original group will return to the health resort to share, face difficulties, "celebrate" achievements, continue to "make a soul" ...


Claudio Dalpiaz

Psychologist, psychotherapist
Resp. SOUTH Area Orthos Project
President Psy + Onlus
Psychotherapist at the Stella Polare Day Center - Rome - Rome




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