A process-based analysis of the pathways model of problem gambling through clinical case formulations

Blaszczynski and Nower conceptualized in 2002 an integrative Pathways Model leading to gambling disorder by postulating three subtypes of individuals with problem gambling characterized by common and specific characteristics (sociodemographic features, comorbidities, psychological factors). Here we propose a clinical illustration that fits each subtype. For each pathway, we (1) describe a corresponding clinical case, (2) propose a symptom-based clinical description, and (3) elaborate a process-based case formulation to explain the development and maintenance of the problematic gambling behavior. We argue that the clinical work with patients benefited from this two-level approach (symptoms vs. psychological processes) combined with a more holistic approach that takes into account intrapersonal (e.g. personality), interpersonal (e.g. family functioning), and environmental variables (e.g. life events). Crucially, our approach not only considers psychopathological dimensions (e.g. symptoms, diagnostic criteria), but it also views as central individual differences (personality traits) and cognitive and affective processes postulated to mediate relationships between biopsychosocial antecedents and psychopathological symptoms. In the current paper, we aim to demonstrate how the Pathways Model can be used as a framework to embrace a holistic perspective that promotes individualized and process-centered psychological interventions for individuals with gambling problems.