Table 1.

Proposed Active Ingredients of Behavioral Therapies, Brain Mechanisms, and fMRI Measures in PG.

Intervention	Active Ingredient	Potential effect on neurocircuitry or brain regions	Relevant fMRI tasks	Example studies
CBT for PG	Developing skills to cope with gambling cue; altering decision-making when exposed to gambling cues	Strengthening of executive control system through enhanced prefrontal cortical function and altering control over motivation/decision-making driven by immediate/short-term rewards	Cue-exposure tasks Stroop color-word interference task (assessing cognitive control processes) Decision-making or Risk-Taking Tasks Regulation of Craving Tasks	Potenza et al 2003a; Crockford et al 2005 Potenza et al. 2003b; Proof of concept study in this article Tanabe et al 2007; Rao et al 2010 Kober et al, 2010
CBT for PG	Reducing cognitive biases relating to processing of near-misses and decisions to chase losses	Balancing activity of neural systems coding conflicting motivational states (e.g., increasing function of dorsal anterior cingulate, insula and prefrontal cortex relative to reward/motivational systems)	Near miss: Slot machine tasks that deliver occasional monetary wins, near-miss and full-miss no-win outcomes Chasing losses: Loss chasing game involving choice between gamble to recover a loss (risk of doubling loss) or quitting (sustaining a loss) Decision-making Tasks	Chase & Clark 2010; Habib & Dixon 2010 Campbell-Meiklejohn et al., 2008 Tanabe et al, 2007
CBT for PG	Developing financial management skills	Altering processing of immediate versus delayed rewards (involving ventral striatum, insula and vmPFC) and decision-making and risk-taking behaviors	Monetary incentive delay task Delay-discounting or inter-temporal choice tasks Risk-Taking Decision-making	Balodis et al., 2012 Miedl et al., 2012 Rao et al, 2010 Tanabe et al, 2007
Aversive Therapies	Changing Habitual Responses/Behaviors	Altering processing of habit-based circuitry involving lateral orbitofrontal cortical and dorsal striatal regions	Intra-dimensional/Extradimensional Set-Shifting Task	Hampshire and Owen, 2006
Imaginal Desensitization/Exposure Therapy	Controlled exposure to gambling-related cues	Strengthening of executive control system and reducing of motivational circuitry through habituation	Stroop color-word interference task (assessing cognitive control processes)	Proof of concept study in this article
Motivational Interviewing	Client change talk	Dampening of reward/motivational circuitry associated with “triggers”	Change talk and counter change talk presented along with cue-reactivity task	Feldstein Ewing et al. 2011 *
Gamblers Anonymous	Social reciprocity, peer influences on decision-making	Increasing social decision-making involving orbitofrontal and striatal circuitry	Domino Task, Peer-BART, Decision-making Tasks (e.g., Iowa Gambling Task)	Hyatt et al 2012*; Cavalca et al 2012*; Rao et al 2010; Tanabe et al 2007
Mindfulness-Based Stress Reduction and Meditation**	Increasing distress tolerance (skills to manage stress and craving) Improving and training attentional focus	Reducing stress responsivity in circuits involving amygdala, hippocampus, striatum, insula and cingulate and frontal cortical regions Optimizing function of the default mode network system	Stress-exposure/craving tasks Meditation tasks: practice Concentration, Loving-Kindness meditation in scanner	Sinha et al 2005*; Potenza et al., 2012* Brewer et al 2010*; Brewer et al., 2011*
Contingency Management**	Achieving long-term abstinence through receipt of short-term rewards	Altering processing of immediate versus delayed rewards (involving ventral striatal, insula and vmPFC), possibly through strengthening executive control system (e.g., enhanced prefrontal cortical functioning)	Monetary incentive delay task Delay-discounting or inter-temporal choice tasks	Balodis et al., 2012 Miedl et al., 2012

Notes: CBT=Cognitive Behavioral Therapy; PG=Pathological Gambling; vmPFC=ventromedial prefrontal cortex

^*Study did not examine pathological gambling, but provides an example of a relevant fMRI or cognitive task to examine the proposed active ingredient of this intervention

^**No published study to date has systematically examined the effect of this treatment for PG