Problem gambling and anxiety disorders commonly co-occur, with studies finding 60% of those with problem gambling experiencing an anxiety disorder at some point in their life and high rates of comorbidity between problem gambling and disorders like panic disorder and social phobia. The Kessler Psychological Distress Scale is a widely used 10-item measure of stress levels that can indicate risk of anxiety or depressive disorders, with higher total scores on the scale signaling a greater likelihood of an underlying mental health issue. Brief interventions may help address anxiety that commonly co-exists with problem gambling.

1. Problem Gambling
Coexisting Problems:
Identifying Anxiety
and
Brief Interventions
ABACUS Counselling, Training & Supervision Ltd

2. PG and anxiety disorders common
Kessler et al 2008 (public survey)
• Those positive for PG (sometime in life): 60%
experienced an anxiety disorder during their life
(phobia, generalized anxiety, panic, or post
traumatic stress disorder)
• 82% experienced anxiety disorder before PG
• 13% the anxiety disorder started after the PG
• 4.5% the PG and anxiety disorder started at the
same time

3. PG and anxiety disorders common
Zimmerman et al 2006 (community MH outpatients)
• Of those identified as PG (lifetime):
• 45% experienced Panic Disorder in their lifetime
• 47.5% experienced Social Phobia
• 32.5% Post traumatic Stress Disorder
• 17.5% Generalised Anxiety Disorder
• cf 62.5% Alcohol abuse/depend and 37.5% Drug
abuse/depend

4. PG and anxiety disorders common
Petry et al (2006) (review of survey sample that
excluded PTSD & OCD) in Level 3 problem
gamblers:
‘High rates of comorbidity between PG and
Panic Disorder, social and specific phobias, and
Generalised Anxiety Disorders’

5. What is ‘anxiety’?
• Common emotion that prepares for ‘fight or flight’
• But if not appropriate and is persistent, then may
be distressing and cause problems in our well-
being
• These anxiety problems have a wide range of
symptoms and these symptoms have been
categorised into 5 main categories

6. DSM-IV anxiety conditions
• Generalised Anxiety Disorder – always worried
• Panic Attacks – sudden onset uncontrolled and
without reason
• Obsessive Compulsive Disorder – compulsion to
perform rituals to prevent obsessive fear
• Phobias – unreasonable and persistent fear of
object or situation
• Post-traumatic Stress Disorder/Acute Stress
Disorder – traumatic event ‘relived’

7. One measure of stress
• Kessler Psychological Distress Scale (K10)
• Widely used
• High correlation of K10 with diagnosis of anxiety
and mood disorders in the past month
• 10 questions with client electing 1 of 5 scored
responses based upon the time client
experiences the problem
• Then scores totalled and compared with
normative ranges NB check K10 range used as
varies – overseas commonly score 1-5, in NZ
may score 0-4

8. KESSLER K10 None of the A little of Some of Most of the All of the
time (0) the time (1) the time (2) time (3) time (4)
1. In the past 4 weeks about how often did you feel
tired out for no good reason?
2. In the past 4 weeks, about how often did you feel
nervous?
3. In the past 4 weeks about how often did you feel
so nervous that nothing could calm you down?
4. In the past 4 weeks about how often did you feel
hopeless?
5. In the past 4 weeks about how often did you feel
restless or fidgety?
6. In the past 4 weeks about how often did you feel
so restless you could not sit still?
7. In the past 4 weeks about how often did you feel
depressed?
8. In the past 4 weeks about how often did you feel
that everything was an effort?
9. In the past 4 weeks about how often did you feel
so sad that nothing could cheer you up?
10. In the past 4 weeks about how often did you feel
worthless?

9. Scoring the K10
Likelihood of an anxiety or depressive disorder
(Oakley-Brown)
• 0-5 no or low probability
• 6-11 moderate probability
• 12-19 high probability
• 20-40 very high probability

10. PG and K10 stress in NZ
NZ Health Survey 2006/7 found
• 6.6% of the general population scored 12 or
more on K10
• 21% of male PGs (moderate to PG) and 23% of
female PGs scored 12 or more
• cf. Australia: 37.7% PGs have (K10 score
20-40) severe mental disorder

11. Exercise
In pairs, one completes a K10 loosely based
upon the following scenario:
A severe PG describes inability to sleep because of
gambling debts, having nightmares nightly, often
unable to stop shaking, nausea, and fear their
partner would find out about losses. History of
depression.
• What risk level for anxiety/mood disorder is their
score?
• What CEP quadrant are they best matched to?
• What is your next step?
• If sufficient time, swap over and do again