Identifying barriers to seeking treatment is essential for increasing problem gambler treatment initiation in the community, given that as few as 1 in 10 problem gamblers ever seek treatment. Further, many problem gamblers who take the initial step of contacting problem gambling help-lines do not subsequently go on to attend face-to-face treatment. There is limited research examining reasons for attending treatment among this population. This study addressed these gaps in the literature by examining barriers and attractions to treatment among callers to the State of Michigan Problem Gambling Help-line. In total, 143 callers (n = 86 women) completed the Barriers to Treatment for Problem Gambling (BTPG) questionnaire and responded to open-ended questions regarding barriers to and reasons for treatment initiation, as part of a telephone interview. Greater endorsement of barriers to treatment was associated with a lower likelihood of initiating treatment, especially perceived absence of problem and treatment unavailability. Correspondingly, problem gamblers who identified more reasons to attend treatment were more likely to attend, with positive treatment perceptions being the most influential. These findings can help get people into treatment by addressing barriers and fostering reasons for attending treatment, as well as reminding clinicians of the importance of identifying and addressing individual treatment barriers among patients with problem gambling.
This study tested a model of emotional processes over the course of emotion-focused therapy for trauma. The model of emotional processing (Pascual-Leone & Greenberg, 2007) proposes a sequential order of shifting from "early expressions of distress" to "primary adaptive emotion" that aid in adaptive functioning. Thirty-eight participants were taken from a randomized clinical trial to examine in-session process from video recordings of treatment. The sample had an average age (M ϭ 44.3 years) and the majority was female (55.3%) and of European descent (89.5%). The Classification of Affective Meaning States was used to examine changes in emotional processes during trauma narratives in both early and late sessions. Processes were related to treatment outcome as measured by the Impact of Event Scale and the Resolution Scale. Sessions later in treatment showed a higher frequency of primary adaptive emotions compared with early sessions (p Ͻ .001, r ϭ .76). Primary adaptive emotions were also more frequent in good-outcome cases (p ϭ .017). Using emotional processes as predictors correctly classified 67% of poor-outcome cases and 80% of good-outcome cases. Increases in primary adaptive emotions from early to late treatment sessions more than doubled the odds (2.2) of having a good treatment outcome. The order of emotion was concordant with the sequential model in early sessions and partially concordant in late sessions. Findings have implications for guiding therapeutic process in a productive manner that leads to trauma recovery. Changes in discrete emotions were related to good treatment outcome. Clinical Impact StatementQuestion: In what way do client emotions change over the course of emotion-focused therapy for trauma? Findings: Increasing adaptive emotions and minimizing expressions of distress facilitates trauma recovery. Meaning: This will help clinicians guide the therapeutic process toward positive treatment outcomes. Next Steps: It would be beneficial for future research to focus on factors that facilitate change in emotional processes over the course of treatment.
The purpose of this chapter is to identify distinct features of emotionfocused therapy specifically of use for complex trauma (EFTT), as a resource for clinicians who are already familiar with the general model of EFT (Greenberg, 2017) and those who wish to integrate aspects of EFTT into their current practice with child abuse survivors. In this chapter, we describe the nature of complex trauma-including definition, prevalence, and long-term effects. We also depict the distinct features of EFTT compared with other treatment for complex trauma and to the general model of EFT. Additionally, we present the theory, structure of therapy, intervention strategies, as well as research supporting the treatment model, and conclude with a case example to illustrate treatment principles and the process of therapy.
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