Behavioral couples therapy versus cognitive behavioral therapy for problem gambling: a randomized controlled trial

Abstract

Background and aims There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design Two parallel‐group randomized controlled study comparing two different internet‐based treatments for PG. Follow‐up measures were conducted at treatment finish, and at 3‐, 6‐ and 12‐month post‐treatment. Setting Stockholm, Sweden. Participants A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions A treatment based on BCT was compared with a CBT intervention. Both treatments were internet‐based, with 10 therapist‐guided self‐help modules accompanied by weekly telephone and e‐mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements The primary outcome measures were time‐line follow‐back for gambling (TLFB‐G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM‐IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire‐9 (PHQ‐9), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), the Relation Assessment Scale Generic (RAS‐G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO. Findings The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB‐G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002. Conclusions Differences in the efficacy of internet‐based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group.

GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions

“…Almost all participants were classified in the problem gambling category of the PGSI. This demographic and gambling profile is consistent with that reported in previous studies evaluating internet-based therapeutic interventions [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] and is very similar to gamblers using the national online gambling service [ 43 , 44 ]. These findings may indicate that young males are attracted to online modalities, in preferences to other service modalities, such as face-to-face counselling.…”

“…These findings are supported by a randomised controlled trial (RCT) in which iCBT with minimal therapist contact resulted in significant post-treatment improvements in gambling and psychological outcomes compared to a waitlist control group that were maintained up to 36 months post-treatment [ 39 ]. There is also evidence that therapist-supported iCBT is comparable to internet-based behavioural couples therapy in improving gambling and psychological outcomes over a 12 month follow-up period [ 40 , 41 ]. A recent systematic review [ 8 ] revealed that self-directed interventions with therapist contact showed a non-statistically significant advantage over those without therapist support, possibly due to the small number of studies including therapist contact.…”

Commentary on Nilsson et al. (2020): The development of effective interventions for concerned significant others affected by gambling harms

“…Low‐intensity interventions, such as that delivered in the BCT condition reported by Nilsson et al . [1], have the potential to reach CSOs who would not otherwise receive formal help. These interventions, which are scalable and can be tailored to meet individual needs and preferences, are attractive to CSOs due to their potential anonymity, discretion, and ease of access [14, 18].…”

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The lack of evidence for the efficacy of gambling interventions for concerned significant others relative to control groups raises questions about whether available interventions are meeting their needs. There is a clear necessity for additional formative research to inform the development of effective interventions for concerned significant others .

The rationale for the study conducted by Nilsson et al [1] is that involving concerned significant others [CSOs] in treatment could enhance treatment‐seeking behaviour, treatment adherence, and treatment efficacy for gamblers. This is a worthwhile aim, given the paucity of empirical research exploring this issue.…”

“…Given the primary aim of the study, the BCT program reported in Nilsson et al . [1] appropriately focussed on gambler‐focused strategies for CSOs, such as psychoeducation about problem gambling, functional analysis of gambling behaviour, and communication skills training [7]. However, it was also expected that the BCT condition would improve CSO psychopathology, relationship satisfaction, and alcohol use problems, despite the exclusion of CSO‐focused strategies in the intervention.…”