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The resulting experience is purportedly marked by 1 high attention to the activity, 2 a sense of intrinsic reward applied to the activity, and 3 decreased metacognition and awareness of task-irrelevant stimuli. Proponents of the term e.

Dixon et al. However, the applicability of flow theory to EGM immersion is still largely unknown. The former is, in my view, too 21 broad to provide much indication of what the authors believe is occurring. The latter term is not preferred here because it implies that the experience is somehow specific to slot machines.

For these reasons, I have avoided both of these terms. Chapter 4. Thus, this term has been adopted for later publications e. Chapter 3. Despite our differing terminology, authors investigating this topic are generally agreed that this state involves: 1 some alteration of normal attentional processes, 2 a subjective feeling of increased involvement in the task, and 3 a sense that one is ignoring, escaping or forgetting about stimuli and events beyond the gambling activity.

As a result, I and the gambling field generally treat these terms as interchangeable when referring to absorptive experiences in EGM gambling. Several other experiments of undergraduate students, experienced gamblers, and problem gamblers have found significant correlations between problem gambling severity and DQ score. The association they found between problem gambling severity and propensity for generalized dissociation has also been replicated Gori et al. The origins of the robust association between gambling immersion and problem gambling risk have been the subject of several investigations.

This would explain 23 why dissociative experiences among gamblers may occur outside of gambling situations as well. A number of researchers have investigated the possibility that immersion in gambling provides a cognitive escape from these negative states. This interpretation is similar to that of withdrawal-based accounts of Substance Use Disorders described in section 1.

An Australian survey of land-based i. Further investigations have since replicated the effect Dixon, Gutierrez, Larche, et al. Across a variety of instruments and scenarios, immersion in gambling appears to be positively related to problem gambling. What is immersion? What happens during immersion that makes it appealing to individuals experiencing negative cognitions or those at risk of gambling problems?

In this section, I will argue that the decision to gamble is influenced by perceptual outputs, selective attention, and the moderating effects that prior experience can have on these processes. I will review attentional experiments from the broader substance use literature, drawing parallels with gambling. I will argue that experiences of immersion while gambling may represent a special case of cue-sensitized attention.

Perceptual and attentional processes govern our interactions with the world, and are potentially important factors in the development and maintenance of gambling behaviour. Before any gambling can occur, a would-be gambler must first comprehend that there is an opportunity to gamble by for example perceiving an EGM or a display case containing scratch-off lottery tickets.

To this end, gambling providers employ a litany of attractive signals including flashing lights, bright colours, and imagery associated with common hobbies, celebrities, or desirable goods like cars, mansions, and money. These visual signals likely play an important role in potentiating engagement with gambling activities. Low-level visual properties like saturated colours and flashing lights can attract eye movements, and can in some cases be efficiently located when visually-searching complex scenes Ware, However, perceiving a gambling opportunity is only the first hurdle.

A flashing light on top of an EGM 25 may be adept at drawing eye movements, but its presence may be quickly habituated unless it signals something important or personally relevant Mather, Where basic visual features make use of stimulus-driven perceptual processes, more complex symbols and images may leverage past learning, perhaps imbuing the gambling activity with previously-learned, positive associations.

Once again, however, these specific hypotheses have not been empirically tested. The more immediate question posed by these considerations is how perceptual and attentional processes could possibly account for the extreme experiences reported by problem gamblers during EGM immersion.

At the same time, these devices do not seem to possess an inherently-overwhelming appeal; participation in casino gambling is typically much less prevalent in the general population than participation in lottery gambling Malatest, ; Office for Problem Gambling, Convenience-sampled undergraduate participants in my earlier studies sometimes remarked that EGM use was neither exciting, nor particularly positive Murch et al.

Assuming that the qualitative evidence above is supported empirically, how could exposure to the same stimulus, an EGM, come to produce such drastically different outcomes in different people? What effects does EGM use have on attentional selection for EGM-associated stimuli, and how do these effects change as use frequency escalates towards problematic levels?

Unfortunately, relatively 26 few investigations of EGM use have sought to examine attentional processes, and fewer have specifically examined the effects of EGM immersion on attention. I will recount them next. Though small, encompassing only 23 participants, this experiment has been highly influential in the field, spurring a considerable amount of follow-up research and inspiring many of the experiments described in this dissertation. They hypothesized that these effects would be more pronounced in a group of problem EGM gamblers, as compared to EGM users who gamble only occasionally.

To test these hypotheses, they affixed four small lights on the ends of arms mounted 9. Every few seconds during play, one of the four lights would illuminate, prompting a button press to acknowledge that the light had been seen. As hypothesized, participants in the problem gambling group were significantly slower to respond to the light response task while gambling on the EGM. These results are consistent with an attentional narrowing mechanism during problematic EGM use: attentional resources normally devoted to passively monitoring peripheral visual space and the passage of time may have been diverted to instead devote additional attention to the EGM.

Although their results provided support for the hypothesis that problem gambling interferes with peripheral attention, it may also be the case that the very short session and frequent interruptions prevented participants from experiencing a typical level of immersion or dissociation in play.

In these experiments, samples of experienced EGM gamblers and undergraduate students gambled on a real EGM for 30 minutes. The game was flanked by two vertical projection screens onto which I presented a constant stream of irrelevant distractor shapes white circles. The shapes appeared at the outer edges of the screens and moved at a constant rate towards the game, disappearing just before reaching the EGM. Fifteen times during the task, the distractor was replaced by a target shape red squares , prompting a button press response.

In my sample of experienced EGM gamblers, I found that the level of past-year, self-reported gambling problems significantly predicted the number of target shape responses provided while gambling. These results are consistent with those of Diskin and Hodgins , and again suggest that problem 28 gamblers may experience dissociation-like immersion in gambling, as well as deficits in gambling-irrelevant attention during EGM use.

Crucially, however, a control group in this study found that participants reported significantly higher scores on the Dissociation Questionnaire when the target-detection task was absent. Though these experiments have provided some support for the hypothesis that attention to the visual world beyond an EGM may be diminished among at-risk gamblers, they could not provide any indication of the degree of attention paid to the device itself.

This is a crucial distinction, as other scholars would propose a mechanism for EGM immersion rooted primarily in negative reinforcement Dixon et al. Discussed in depth in my introduction to chapter 4, the negative reinforcement account posits that cognitive escape from pre-existing symptoms of stress or low mood is the key driver of EGM immersion experiences.

In other words, the relief from stress or low mood provided by EGM use may be tranquilizing to the extent that gamblers are generally less vigilant towards external stimuli. A number of other attempts have been made to examine aspects of attention during gambling, and attention to gambling-related stimuli. In spite of their varying neurochemical effects, many drugs of abuse produce similar shifts in cued attention.

Users of alcohol, cannabis, nicotine, opiates, and cocaine have all shown similar attentional biases towards drug-related 29 stimuli, at the expense of processing speed for non-drug stimuli M. One study of these attentional biases in gamblers employed eye tracking, showing that problem gamblers were faster than healthy control participants to direct eye movements toward gambling-related imagery Brevers et al.

Further, the problem gambling group was significantly faster to detect changes in gambling-related images, and significantly slower to detect changes in non-gambling images. These findings support the hypothesis that gambling activities, like other addictive products, elicit biases in visual attention among those who experience harm associated with their use.

In their study, groups of EGM users, poker players, and healthy controls passively viewed gambling and non-gambling images. The greatest amount of time spent fixating on EGM images was observed among the EGM gambler group, and the greatest time spent fixating on poker imagery was observed among the poker group. The control group spent significantly less time fixating on both poker and EGM images, and all three groups spent relatively little time looking at bingo related imagery a third game, with which no group was very experienced.

Extrapolating from these findings, it seems plausible that attentional narrowing could occur among experienced EGM gamblers simply because cues of a preferred gambling form can attract increased attention. Nevertheless, my conclusions that dual-task behavioural paradigms could not provide sufficient insight into overt visual attention during EGM gambling, and that their introduction 30 may in fact significantly diminish the experience of EGM immersion, led me to explore less invasive, more direct indicators of attentional processes during gambling activities.

I pursued two general approaches that were likely to be more informative, and less disruptive than behavioural dual tasks. The first approach was explored with the hope of innovating new methods for observing granular gambling behaviours, and involved collecting a large corpus of eye tracking data while experienced EGM gamblers used a genuine EGM detailed in Chapter 4. Prior psychophysiological investigations of gambling phenomena will be discussed in the next subsection.

In this subsection, I will make the case that gambling researchers have made a number of important contributions using psychophysiological 31 measures, and that psychophysiological tools have the potential to provide further insights into EGM immersion. The hypothesis that has received the most attention with respect to physiological responses to gambling concerns the broad, somatic effects of gambling activities.

Though it seems pedestrian in a society awash in the idea that gambling is an exciting thing to do, the extent to which gambling activities increase activity within the sympathetic nervous system was and remains an empirical question. Over the past 40 years, this hypothesis has been tested repeatedly, using a number of sample populations, gambling activities and environments. Gambling research on heart rate has been supported by research examining skin conductance levels during gambling activities.

In other words, the presence or promise of reinforcement in gambling tasks has been associated with increased activation of the sympathetic nervous system. Skin conductance level has a key advantage over heart rate metrics because the electrodermal responses increases in the conductivity of skin surfaces as a result of perspiration appear to be primarily mediated by activation of the sympathetic nervous system, whereas heart rate is considerably dependent on the dual influences of both the sympathetic and parasympathetic nervous systems Cacioppo et al.

Observing changes in BPM from baseline could show significant increases as a result of either sympathetic nervous system activation, or decreases in parasympathetic tone. In an earlier study, I attempted to separate parasympathetic tone from heart rate metrics during an EGM gambling session Murch et al. I employed samples of undergraduates, who were most likely not experienced gamblers, and participants from the community who reported prior EGM use.

Interestingly, I found that, in both samples, EGM gambling was not associated with a significant increase in heart rate, but was associated with significant decreases in RSA, suggesting decreases in parasympathetic activity. These results suggested that gambling may not induce heart rate changes as a result of excitement, but rather some other factor that instead influences the parasympathetic nervous system. However, these effects have not been entirely consistent, and have most often employed heart rate measures, confounding the sympathetic and parasympathetic branches of the autonomic nervous system.

Additional measures may be useful in clearing up past controversies in the literature, and defining the phenomenon of EGM immersion and its apparent role in the development of gambling problems. In the chapters to follow, I attempt to use three distinct physiological measures to unpack the effects of EGM structural characteristics and immersion.

Neither PEP nor pupillometry have been previously examined in the context of gambling. Among the burgeoning class of addictive behaviours, EGM gambling appears particularly associated with addiction harm. However, the exact nature of this relationship is blurred by complex interactions between individual traits, specific features of gambling games, and environmental factors particular to gambling venues and jurisdictions.

Across many studies, it is clear that this altered state of attention is an important risk factor for disordered gambling. At the same time, existing work on EGM immersion measures the state using self-report measures, an unideal practice since consensus holds that immersion alters perceptual and attentional functioning, and may therefore produce biases in survey measures.

Past findings have also raised the frustrating reality that many experimental paradigms will, by attempting to measure the state, prevent immersion in gambling from occurring. Some behavioural and physiological measures may provide a less subjective, and less disruptive lens for measuring EGM immersion. Whereas somatic correlates of EGM immersion may help to characterize the phenomenon, reliable markers of the experience may be readily applied to help identify immersed individuals in future research and practice.

Chapters 2, 3 and 5 examine potential correlates of immersion and attention to EGM gambling in cardiac parasympathetic, cardiac sympathetic, and pupillary markers, respectively. Chapters 4 and 5 examine eye movements and behaviours towards the EGM itself, seeking behavioural correlates of EGM immersion.

Chapter 2 , specific regions of the EGM screen e. Chapter 4 , and specific EGM outcomes e. Chapter 5. In the concluding chapter, I remark on a number of ongoing concerns in these experiments and the broader gambling field. Drawing the collected results together, I outline the manner in which physiological and behavioural correlates of EGM immersion may reveal the potential of specific EGM devices and structural characteristics to encourage problematic gambling.

My hope is that a clarified profile of EGM immersion and its effects will lead to further research, and ultimately to empirically-supported policy proposals to modify the function of modern EGMs, reducing the rate of gambling harms disproportionately associated with these devices. In recent years, product features have received increased scrutiny, with modern Electronic Gaming Machines EGMs, including slot machines and Video Lottery Terminals bearing the brunt of this research interest.

Multi-line games allow players to place concurrent bets across multiple paylines on a single spin. As the many paylines occupy most of the EGM display and often overlap, playing the game on this setting is a perceptually-demanding experience. This study addresses game-level predictors of user experience. The immersion state is prototypically described as a feeling of amplified attention to the game at the expense of all else, and has been repeatedly related to problem gambling Cartmill et al.

We believe immersion may be related to the attentional demand of play strategies that differ in complexity. Attention was also measured using a psychophysiological proxy. Duschek and colleagues observed decreases in HRV related to sustained attention. Using a driving simulator, Tozman and colleagues linked self-reported flow experiences with moderate levels of HRV when the task was challenging. As such, immersion and HRV may correlate, and both may be affected by the differing attentional demands of different EGM bet styles.

We hypothesized that immersion during EGM play would differ with multi-line versus single-line bet strategies. To resolve this, our study added two further conditions: one where the minimum bet is placed on multiple pay-lines, and one where the same overall bet size is achieved by increasing the number of credits bet on a single pay-line, using the bet multiplier options. This approach was also adopted by Dixon et al. There, immersion in the multi-line setting more-strongly predicted problem gambling risk.

If earlier conclusions are correct, we expect that the multi-line condition will again produce higher immersion. We further hypothesized that changes in RSA across bet conditions would mirror changes in immersion across conditions. In other words, RSA should generally decrease from baseline to task, but should decrease more in blocks where multi-line strategies are employed, where we also expect immersion to be higher. We recruited 80 male undergraduate students.

This study also investigated impedance cardiography see Chapter 3. Thus, sampling was restricted to male participants 39 because impedance cardiography involves applying adhesive electrodes to shirtless participants. Inclusion criteria allowed participants: ages 19 years or older the legal age to gamble in this jurisdiction , with normal or corrected-to-normal eyesight, with no history of allergic reaction to adhesives or gels, and no current or recent use of psychotropic or cardiac medications.

Individuals who reported high risk of problem gambling on the PGSI see below were not permitted in the slot machine task. Four participants did not complete the study after providing consent; one reported high risk of problem gambling, one displayed a persistent cardiac arrhythmia, one withdrew citing concerns about adhesive electrode placement on body hair, and one session was halted due to a power outage.

The bet multiplier buttons allow the player to place 1 to 5 times the minimum bet at each line. Participants were informed that the game was real, and had not been modified. They were briefed on EGM gameplay. The slot machine session was divided into four 5-minute blocks. Each block required players to use a pre-determined betting strategy order was counterbalanced using a Latin square design. Notably, the Line-Style condition produced wins on 5 different paylines dispersed around the screen, while the Multiplier-Style condition produced wins only on the middle payline.

Since multi-line play increases the frequency of wins, 41 and since winning paylines are typically outlined on-screen when triggered by multi-line games, we reasoned that players might expend more attention on the Line-Style condition than the Multiplier-Style condition.

Additionally, players may be more vigilant towards multi-line EGMs if they engage in visual searches for matching symbols before the last reel comes to a stop. Such behaviour would also draw upon attentional resources. Following each block, participants completed a 7-item immersion questionnaire. We previously used these measures jointly Murch et al. Reliability analyses in the present study indicated that these questionnaires were well-suited to concatenation. They were provided documents describing the functioning of modern, multi-line slot machines and a list of available gambling treatment services in this jurisdiction.

Physiological data from a block was discarded if the participant ran out of credits. Three electrocardiogram ECG electrodes were affixed to the chest and lower left abdomen. Four patches were applied to the bilateral neck and ribcage for impedance cardiogram measures.

Where correlational analyses were performed with individual task bins and baseline values, all available data was used. Single missing peaks were linearly interpolated. Consecutive missing peaks triggered the exclusion of that block. RSA is defined there as the natural log of the 0. These data were resampled to Pairwise comparisons were Bonferroni corrected.

The mean ASRS score was Wins and bonus features, as well as the overall number of credits lost, varied by block. To test whether immersion was associated with reinforcement, we ran exploratory correlations of immersion scores with the number of wins and bonus features in each block. Figure 1. Lines indicate statistical significance of the pairwise comparisons. We note, however, that the restricted range of PGSI scores in our sample could have impacted these results. ASRS was median-split and tested as a between-subjects factor on the immersion model.

The interaction term was not significant F 1. In this condition, immersion increased as RSA decreased from baseline. Figure 2. Note: Bars represent one standard error for the within-subjects effects. Blocks were labelled chronologically, ignoring play condition. Secondary models tested for changes in respiration rate and heart rate. A task-related increase in respiration was observed F 1.

Heart rate also varied by block F 2. Figure 3. Our student participants, who were mostly novice gamblers, reported substantially higher immersion scores in the Large Bet condition compared to the Small Bet condition. Immersion was also higher in the Large Bet condition compared to the two intermediate conditions, indicating an additive effect of paylines 48 and bet size.

In comparing these intermediate conditions against the Small Bet condition, only the Line-Style condition showed a significant increase in immersion; changing the bet by itself in the Multiplier-Style condition did not facilitate immersion. Some of the relationship between immersion and bet style could be explained by the number of EGM bonus features, which varied in our study due to the use of authentic EGMs.

In the Large Bet condition - which produced the highest overall number of bonus features on average - a significant relationship was seen between the number of bonus features and immersion scores. Acknowledging that much EGM work relies on simulators without bonuses, these features certainly merit further research. Since no consistent relationship between immersion and RSA was observed, these relationships are not likely to confound our interpretation of the immersion data.

We further hypothesized that different bet styles would produce in-kind reductions in RSA, since multi-line and large bet strategies should impose greater attentional demands. This hypothesis was not supported. Rather, we saw significant and uniform decreases in RSA compared to baseline levels. There are a number of possible explanations for this null result.

Alternatively, outlining winning paylines with salient colours could nullify, or at least attenuate, the increased attentional demands of multi-line play by allowing wins to be pre-attentively processed regardless of the number of paylines played. Another likely factor is the relationship with respiration rate, which showed a similar response pattern to RSA. If so, why does EGM use increase respiration?

Perhaps our resting baseline led to a conscious control of breathing rate by some participants. Future studies could establish multiple baselines e. Certainly, future research on cardiac function during gambling, and particularly HRV measurement, would benefit from direct recording of respiration.

Several limitations should be acknowledged. Our student sample registered low levels of gambling involvement and PGSI scores, and thus our results do not speak to disordered gambling. Indeed, the makeup of our sample younger adults, all male does not match the demographic makeup of EGM patrons in most jurisdictions.

Stewart et al. One possible explanation for the observed decrease is that participants had slightly elevated heart rates in the unusual laboratory setting that were most pronounced during the initial baseline, and abated over time as they became familiar with their surroundings. We aimed to examine attentional differences using heart rate variability, though its close ties to respiration suggest it may not be the best tool for research on EGM users.

We note also that the cleaning of the cardiac data resulted in a smaller subsample of participants compared to the immersion analyses, reducing statistical power. A clear avenue for future research lies in applying eye tracking to monitor attentional allocation during EGM play, and relationships with immersion. The experience is typically associated with increases in positive affect Asakawa, ; Csikszentmihalyi, ; Murch et al. A negative implication is that businesses may offer products specifically designed to encourage flow, capitalizing on prolonged or more frequent participation by individuals who are seeking to escape from stress or low mood Dixon et al.

Researchers first became interested in the flow-related aspects of gambling in the s. Jacobs posited that this state of absorption could contribute to gambling addictions, and that these experiences could be addictive in-and-of-themselves Jacobs, , The susceptibility of regular gamblers to experiencing gambling flow is reliably associated with symptoms of disordered gambling; the Dissociation Questionnaire has been repeatedly correlated with measures of problem gambling Cartmill et al.

In both studies, levels of problematic gambling were associated with reduced detection of peripheral targets while gambling. Some forms of gambling may be especially good at eliciting flow. EGMs are disproportionately associated with problem gambling Binde et al. Several scholars have proposed that absorption in EGM gambling may be an effective though ultimately maladaptive coping strategy for those seeking to avoid symptoms of depression, anxiety, or stress Dixon, Gutierrez, Stange, et al.

Current research relies heavily on self-report measures of flow, which can be susceptible to disruption e. Psychophysiological methods may provide alternative markers for investigating the gambling flow phenomenon more covertly. However, little evidence exists for a link between gambling flow and physiological measures.

In two experiments, we found no significant relationships between EGM flow and respiratory sinus 54 arrhythmia, a cardiac marker of parasympathetic nervous system tone Murch et al. The present study evaluated the relationship between gambling flow and sympathetic nervous system arousal, indexed by cardiac pre-ejection period PEP. PEP is an impedance cardiography-derived metric, which approximates the interval between onset of the electrical signal that stimulates left ventricular contraction QRS complex and opening of the aortic valve commencement of blood efflux from the left ventricle into the aorta.

In human studies, PEP has been observed to decrease indicating sympathetic arousal in response to anger, disgust, and fear emotional induction, and increase in response to happiness, sadness, and amusement Kreibig, We report data from three laboratory experiments, in which self-reported flow and PEP data were collected for an EGM gambling session that lasted at least 15 minutes.

We first hypothesized that PEP would decrease relative to baseline in response to EGM gambling, indicating sympathetic nervous system arousal associated with the gambling activity. We divided 55 the gambling sessions into 5-minute blocks to test the time-course of this response, as the effects of gambling on PEP may not be uniform across a gambling session.

Study 3 has not been submitted for peer-reviewed publication Murch, Study 1 was primarily interested in examining testosterone change in relation to EGM gambling. Study 2 looked at levels of flow and heart rate variability during EGM gambling with differing bet strategies tested within-subjects.

Study 3 examined gambling immersion using a social manipulation, in which participants who provided psychophysiological data were, in some cases, tested alongside other participants seated at adjacent EGMs. Participants in Studies 2 and 3 gambled while an experimenter seated behind them monitored the physiological recording. Participants in Study 1 gambled without anyone else in the room. All participants were male undergraduate students, at least 19 years of age, who responded to an online advertisement posted by the psychology department.

Participants were 56 included only if they were not high-risk problem gamblers i. In Study 2, participants completed this questionnaire after each of four 5-minute gambling blocks. Scores for the two items were averaged, and scores were standardized within each study.

Individuals scoring greater than 7 indicating high risk problem gambling , on this measure were excluded from the gambling task, and instead proceeded straight to debriefing. The lab was then cleared of any additional participants, and participants providing physiological data were asked to remove their shirt for electrode placement. For an electrocardiogram, we then applied 3 electrodes to the upper left pectoral, upper right pectoral and lower left abdomen.

Participants then put their shirts on and provided a five-minute baseline recording in a seated position. Participants in Studies 2 and 3 were instructed to close their eyes during the baseline recording, but did not provide a saliva sample.

In each study, participants gambled on a genuine EGM for at least 15 minutes. Each EGM was a modern, multi-line device see Dixon et al. Study 2 participants completed the GEQ Flow questionnaire after each block. This introduced a break lasting approximately 1-minute between blocks. In Study 2, bet strategies were systematically manipulated, from 1 credit bet on 1 payline i. In order to address our time-course hypotheses and retain comparability to baseline recordings, PEP data were partitioned into 5-minute blocks.

As 15 minutes was the shortest session length, we extracted the first three blocks , , and minutes from each study. Physiological data were visually inspected for artifacts. Blocks were excluded in cases where either the participant had run out of credit and stopped gambling, or serious artifacts precluded an accurate extraction of PEP. PEP extraction was completed using the pre-ejection period algorithm in Acqknowledge 4.

Complete or partial PEP data was available for participants across the three studies Figure 4. Participants in study 2 gave flow ratings for each of the three blocks separately, while participants in Studies 1 and 3 gave a single flow rating for all blocks after the session was completed.

Field, Block and study number were dummy-coded. Models 1 and 2 directly address our hypotheses. Model 3 was included in order to explore the simple main 60 effects of block and study on the relationship between flow and PEP. This allowed us to investigate whether any effects observed in model 2 appeared heterogeneously across different experimental contexts.

To assess the underlying assumptions of linearity and homoscedasticity, we calculated variance inflation factors and visually inspected the distributions of fitted and residual values at the levels of the factors and random effects. We were satisfied that the models did not violate the underlying assumptions of the analyses. These data and analyses have been publicly archived1. The mean GEQ Flow score was 1.

Notably, the direction of 62 the Block 1 effect differed from those observed in Studies 1 and 2. Figure 5. Block-by-flow-by-study interactions Note: Plotted values represent interaction effect coefficients summarized in Table 1 i. For example, the mean flow rating in Study 3 was 1. A participant who gave a flow rating of 2.

A participant who gave a flow rating of 0. Block and Study factors represent dummy-codes. Values in column B are unstandardized coefficients. Values in column SE B represent the standard error for the coefficient in that row. We examined whether PEP changes were associated with EGM use, the stability of these levels over time, and their associations with self-reported flow, using multilevel regression models that accounted for the nested data structure.

We did not observe significant change in PEP from the pre-task baseline to gambling. When we examined the interaction between task block and flow on PEP during gambling, we found that self-reported flow was associated with decreases in PEP indicating increased sympathetic nervous system activity during Block 1 the first five minutes Predictor B SE B t p Main Effects: Block 1 0. Studies 1 and 2 showed results consistent with Model 2: higher self-reported flow states during gambling were associated with greater decreases in PEP during Block 1 but not Blocks 2 or 3.

In Study 3, flow was associated with increased PEP i. We have thus found tentative support for an association between subjective flow and fluctuations in sympathetic nervous system activity. Crucially, however, the direction of this effect may depend on particular aspects of the task procedure.

It is worth speculating on why the observed interactions with flow were limited to the first five minutes of gambling. These results further indicate that the initial physiological response to EGM use is an important factor in determining whether the session produces flow overall. Perhaps early experiences that produce physiological change increase the likelihood that gamblers will experience flow. In future research, it would be fruitful to take multiple flow measurements within a prolonged EGM gambling session, to characterize the subjective time-course, although such designs are challenging due to the potential for distractors to impair flow.

One possible explanation for the opposing results across the three studies is the social manipulation present in Study 3. Participants in that experiment were made aware that they may be gambling alongside other participants, and this may have impacted either their physiological 65 response or experience of flow while gambling. Alternatively, our effects could be related to participants in each study employing different betting strategies.

Study 3 employed a smaller, line strategy, and Study 2 compared several bet strategies that varied the number of lines bet, either 1, 5, or Thus, if there is a real relationship between PEP and flow during EGM use, it may depend on additional factors that we could not systematically control in this aggregated analysis. When not accounting for flow, we observed no significant change in PEP while gambling.

However, the physiology of heart rate change is complex, and affected by both branches of the autonomic nervous system Cacioppo et al. Decreases in vagal tone while gambling Murch et al. A separate possibility is that heart rate effects did 66 reflect sympathetic arousal in past experiments, but our laboratory environment or PEP measure may have lacked the sensitivity needed to detect a sympathetic response here. Our findings are preliminary and intended to stimulate further enquiry; they have several important limitations.

First, the three study protocols differed in numerous ways, and it is possible that methodological differences drove the disparate pattern of results. Second, the laboratory environment may have attenuated physiological reactivity. EGM gambling is regarded as an appetitive psychological challenge that involves intense audiovisual stimuli, motor actions and monetary outcomes, but responses to EGM use may differ based on whether the device is situated in a gambling venue, or in a laboratory environment c.

Third, participants were convenience-sampled from an undergraduate population and were not regular EGM users. This potentially diminished both physiological responses to the EGM task, and the level of flow that was reported. Fourth, participants were men, because practical application of our PEP methods precluded the recruitment of women. Fifth, the GEQ Flow scale is unidimensional, focusing on absorption states, and other measures may provide insight into different aspects of the flow state e.

Finally, the block-by-flow-by-study analytic approach was exploratory, and the available data could not clarify why opposing effects were observed between the studies. Our preliminary conclusion is that cardiac sympathetic nervous system responses early in an EGM gambling session may affect subsequent ratings of flow for that session. However, follow-up studies should be undertaken in an attempt to replicate and clarify this effect.

Although viewed as desirable in many occupational and recreational contexts Csikszentmihalyi, , immersion in gambling activities is a robust predictor of problem gambling risk Cartmill et al. In contrast, the flow account implies that these experiences emerge from skillful performance commensurate to the challenge or difficulty of the task Csikszentmihalyi, By this account, gambling success necessarily remains a valued goal, the pursuit of which generates immersion.

Mobile eye tracking technology offers a means of exploring aspects of overt visual attention during gambling. This finding complements laboratory studies in which people with gambling problems show visual biases towards gambling-related imagery Brevers et al. These characterizations lead to testable and competing predictions regarding eye movements during the immersed state. We examined whether immersed gamblers make more saccades and fewer blinks. Exploring these data further, we examined event-related fixations during different phases within each bet.

We looked for relationships between EGM outcomes and immersion. Lastly, we examined whether immersion was related to gambling-related cognitions, negative affect Dixon et al. Note: Pre-registered hypotheses were based on the results of a convenience-sampled pilot study see 4.

Ten participants were excluded from analysis: seven due to poor quality eye tracking data, one due to a video capture error that made behavioural data unavailable, and two who reported past-year EGM use on the eligibility screen but none on test day. A score of 8 or higher indicates high risk for problem gambling, and such participants were excluded from the EGM procedure. In our analyses, the PGSI was treated as a continuous measure.

One participant was missing a single item. This cell was half-mean imputed using the mean of the affected subscale. Two participants were thus excluded. Seven items e. Mean scores were calculated and reliability analyses were performed. During free spins, the game plays without user input, and winnings accrue in the Win window.

The glasses were 3-point 74 calibrated using the top left, top right, and bottom left symbols on the EGM screen Figure 6b. Participants were allowed to seat themselves at a comfortable distance from the EGM. These videos were processed using an image recognition program built in Python 2.

The output was a time series of game events for each participant. Note: A EGM and mobile eye tracking apparatus without participant. Six mutually-exclusive areas-of-interest AOIs were defined on the reference image: 1 reels, 2 credit window, 3 win window a larger window to the right of the credit window that reads zero unless a payout is being delivered , 4 menu bar which displays information about the game denomination, and bet size , 5 game border the remaining screen area not included in other AOIs , and 6 game periphery the entire area outside the game screen.

Session-wise statistics were exported from BeGaze alongside the raw reference image data. Blinks and saccades were defined automatically in BeGaze. Saccade amplitude was defined as the average distance pixels between the start and end position of all saccades. Dwell time was defined as the percentage of task time spent fixating on a given AOI. Fixations were defined 76 as the number of times visual intake was recorded in an AOI following a blink or saccade, divided by task time. Gaze data normalized by AOI size are presented in Table 4 for descriptive purposes.

Analyses were performed on the non-normalized data. The ratio of dwell time or fixations at the credit window to the reels was calculated. Descriptive data are reported with median, minimum, and maximum values where skew was present. Non-event-related hypotheses were tested using bivariate regression.

Reported confidence intervals were bootstrapped with 5, iterations A. Hayes, We analyzed data at three phases within each trial: reel spin, audiovisual feedback where reinforcement is delivered paired with some sound and animation , and spin initiation latency the delay between the feedback ending and the participant initiating the next spin, Figure 7.

Spin outcomes were categorized into wins, losses, free spin bonuses, and losses-disguised-as-wins Dixon et al. Of these, loss trials are unique in entailing a spin initiation latency phase with no preceding feedback phase since no credits are awarded. The music and spins in a free spin bonus continue without pausing for user input, so we treated them as a single feedback phase. Our use of a genuine EGM meant that we could not control how many outcomes of each type occurred, or the order in which they appeared.

In total, 20, events were recorded for each model. Note: Each trial proceeds from 1 - 3 with only one of 2A - 2D occurring. Feedback phase 2A encompasses 15 or more continuous free spins and any feedback that occurred after they were completed. There is no audiovisual feedback in phase 2D. Data inspection showed that many phases were spent fixating on only one AOI, polarizing the data i.

In a fixed-effects model, each subject is treated as their own control, and model estimates reflect increases or decreases in the likelihood that a given AOI is fixated-on during a given trial phase. With this approach, if a participant does not experience a particular outcome type e. In this way, there is no need to impute missing data or exclude participants. Separate fixed-effects logistic regressions were carried out on the reels, credit window and win window.

Odds ratios were computed. Models were assessed for multicollinearity and violations of linearity A. The duration of trial phases appeared to show evidence of linear, quadratic, and cubic trends for certain models. Non-linear trends were not included in the model as they were not expected or clearly explicable, and their inclusion could thus capitalize on error variance in the model. Standardized residuals were calculated and plotted against the predictor variables.

No relationships were apparent. Analysis scripts and all relevant data are available online3. These factors accounted for incidental variance between participants, across the span of the task, and as a result of some outcomes e. We then added the dummy-coded outcome phases.

Predictions made by these models thus reflect differences in the likelihood of fixating on a given AOI during a particular outcome phase, compared to when the reels are spinning. Lastly, for outcome phases that significantly differed from reel spins, immersion was tested as an interaction term. Bootstrapping these data produced instances of complete separation, so not all confidence intervals in Table 5 were bootstrapped. The inclusion and exclusion criteria were identical to the follow-up study, except that we did not require participants to report past-year EGM use.

Thirty-three participants were recruited, though six Procedures were otherwise identical to the main experiment. In general, pilot participants reported few problem gambling symptoms: 19 The median immersion score was 0. For the 8 Pilot participants spent Values represent the mean SD. Normalized data have been divided by the percentage of the screen occupied by the AOI. The game periphery is infinite in normalized columns because it exists off screen.

If replicated in the main experiment, these trends could impact our ability to interpret hypotheses concerning immersion and visual attention. The main experiment sought to test the reliability of these relationships, in a larger sample composed of experienced gamblers. Sample size was based on power calculations using the effect size for the correlation between immersion and the ratio of dwell time to the credit window relative to the reels AOI one-tailed. For the primary hypothesis, tests on ratios were 82 favoured to mitigate type-1 error rate.

We pre-registered the hypotheses and methods on aspredicted. Seventeen Two 3. Sixteen participants Among the 18 participants Only 0. When these values were normalized to account for the size of each AOI, a clear bias towards the credit window was observed. Figure 8. B Full-task heatmap for a participant who reported low immersion. C Full-task heatmap for a participant who reported high immersion.

Warmer colours indicate greater time spent fixating on that point. The median immersion score was 1. The median participant blinked 6. Additional results are discussed in section 4. Normalized data are provided here for descriptive purposes. The data have been divided by the percentage of the screen occupied by the AOI. X-axis represents average score on 7-item immersion questionnaire.

Each data point represents the mean of one participant. Line represents best-fit linear trend. The likelihood of fixating on the reels was lower during every outcome phase than it was during the reel spin Table 5A, Figure Note: Results are relative to the reference category, reel spins. Losses do not have audiovisual feedback.

Note: Reported confidence intervals have been bootstrapped with iterations, except where denoted by A. Non-significant interaction terms were backward-eliminated from the models in descending order of significance. Behavioural measures. This finding corroborated, and was predicated upon, the same relationship observed in the convenience-sampled pilot study.

Notably the replicated effect was somewhat smaller, though still statistically significant. We tested relationships between immersion and the ratio of fixations per minute on the credit window over the reels, and with problem gambling severity, but we did not find support for these additional hypotheses. Thus, immersed gamblers differed in the amount they looked back and forth, but this did not depend on the exact pattern in which saccades occurred.

GRCS subscales indicated higher levels of illusory and predictive control in more-immersed participants. Although immersed gamblers were less likely to fixate on the reels during some outcomes, this was not coupled with a significant increase in fixations at the credit or win windows.

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As one of the most technologically adept companies in its industry and also a serial acquirer—it has averaged one acquisition every five months in this decade—Medtronic only gets larger. Company Profiles. Your Money.

Personal Finance. Your Practice. Popular Courses. Business Company Profiles. Medtronic is a world leader in the area of implants and bone grafts. In , to minimize tax liabilities, Medtronic officially relocated its headquarters to Dublin, Ireland—a controversial corporate practice called corporate inversion. Now, with operations in countries, the medical-device company only gets larger still.

Compare Accounts. The offers that appear in this table are from partnerships from which Investopedia receives compensation. Related Articles. Company Profiles In Pain? Partner Links. Related Terms Brexit Brexit refers to the U. What Does Cambridge Analytica Mean?

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By the end of that curve, the aorta is directed downwards. The descending aorta travels down the chest and becomes the abdominal aorta when it crosses the diaphragm. The abdominal aorta comes to an end just above the groin, where it splits into two arteries, one for each leg. The aorta is important because it gives the body access to the oxygen-rich blood it needs to survive. The head including the brain , neck and arms get oxygen from arteries that come off the aortic arch.

The stomach , intestines , kidneys and other vital organs get oxygen from arteries that come off the abdominal aorta. Your aorta can be damaged by high cholesterol and high blood pressure , so anything you do to keep those risk factors under control will also help you maintain a healthy aorta. That includes eating a balanced diet , getting regular exercise and avoiding cigarettes. Call us now at or fill out our online form to get started today.

Columbia University Irving Medical Center. Aortic Center Minimally invasive, maximally effective aortic care. Call RX. All About the Aorta. Ruptured aneurysms require emergency surgery to stop the bleeding. The aorta has many layers.

Aortic dissection is a tear that develops in the inner layer of the aorta, causing blood to flow between the layers. The layers then separate, interrupting the blood flow and possibly causing the arterial wall to burst. Aortic dissection can be a life-threatening emergency, in some situations requiring emergency surgery to repair or replace the damaged segment of the aorta.

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