Trait and neurobiological underpinnings of negative emotion regulation in gambling disorder

Abstract

Background and aims:
Gambling disorder is characterized by poor regulation of negative emotions and impulsive behaviors. This study aimed to (1) compare gambling disorder patients (GDPs) and healthy controls (HCs) in self-report and brain activation measures of emotion regulation; and (2) establish its relationship with negative emotion-driven impulsivity.

Design:
Two cross-sectional case-control studies including GDPs and HCs.

Setting and participants:
GDPs and HCs were recruited from specialized gambling clinics in Andalusia (Spain), where they were following outpatient treatment, and from the community, respectively. Study 1 included 41 male GDPs and 45 HCs (Mage = 35.22, 33.22; SD = 11.16, 8.18; respectively). Study 2 included 17 GDPs and 21 HCs (16/20 males, Mage = 32.94, 31.00; SD = 7.77, 4.60).

Measurements:
In Study 1, we compared both groups on suppression and reappraisal emotion regulation strategies (Emotion Regulation Questionnaire [ERQ]). In Study 2, we compared GDPs with HCs on brain activation associated with downregulation of negative emotions in a Cognitive Reappraisal Task, measured with functional magnetic resonance imaging (fMRI). In both studies, we correlated the measures of emotion regulation with mood-related impulsivity indicated by negative urgency (UPPS-P scale).

Findings:
GDPs relative to HCs showed higher levels of emotional suppression [F = 4.525; p = 0.036; means difference MHCs-MGDPs = -2.433 (CI95% = -4.706, -0.159)] and higher activation of the premotor cortex and middle frontal gyrus during negative emotion regulation in the fMRI task (p ≤ 0.005, Cluster Size, CS > 50 voxels). Negative urgency positively correlated with emotional suppression [r = 0.399, (CI95% = 0.104, 0.629), one-tailed p = 0.005] and middle frontal gyrus activation during negative emotion regulation (p ≤ 0.005, CS > 50) in GDPs.

Conclusions:
Gambling disorder is associated with greater use of emotional suppression and stronger premotor cortex and middle frontal gyrus activation for regulating negative emotions, compared with healthy controls. Emotional suppression use and middle frontal gyrus activation during negative emotion regulation is linked with negative emotion-driven impulsivity in this disorder. This article is protected by copyright. All rights reserved.

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