Cognitive-behavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome

Abstract

Objective:to examine short and middle-term effectiveness of a group cognitive-behavioral intervention (CBT) in pathological gambling (PG) and to analyze predictors of therapy outcome.Method:Two hundred and ninety PG patients consecutively admitted to our Unit participated in the current study. All participants were diagnosed according to DSM-IV-criteria. Manualized outpatient group CBT [16 weekly sessions] was given. Specific assessment before and after the therapy and at 1, 3 and 6 months follow-up was conducted. Logistic regression analyses and survival analysis were applied.Results:outpatient group CBT was effective with abstinence rates by the end of therapy of 76.1%, and 81.5% at 6 months follow-up. The dropout rate during treatment decreased significantly after the fifth treatment session. Psychopathological distress (p = 0.040) and obsessive-compulsive symptoms were identified as factors predicting relapses and drop-outs respectively.Conclusions:our findings suggest that group CBT is effective for treating PG individuals. Several psychopathological and personality traits were identified as outcome predictors.

Effects of Affective and Anxiety Disorders on Outcome in Problem Gamblers Attending Routine Cognitive–Behavioural Treatment in South Australia

“…There are only a few reported studies concerning the effects of co-varying problem gambling and other psychopathology on CBT outcomes. One study suggested that treatment outcomes were adversely affected by psychological distress where the outcome of interest was relapse during a 16 week treatment period (Jimenez-Murcia, et al, 2007). However, because an end-point analysis was used it was probable that additional information was lost such as that from a participant's recovery following a lapse or relapse.…”

“…However, it is unclear as to the extent of the impact due to a deficiency of evidence and extant findings being mixed. For example, in a study involving a cohort of problem gamblers who engaged in CBT, it was found that participants with higher levels of general psychological distress were more likely to relapse during treatment (Jimenez-Murcia et al, 2007). Conversely, a more recent investigation suggested that participants with a range of co-occurring conditions experienced similar improvements in outcomes during the first six sessions of CBT treatment (Soberay, Faragher, Barbash, Brookover, & Grimsley, 2013).…”

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 1: Factors that ‘Push’ Towards Relapse

“…This process suggests that relapse may be halted by interacting factors that 'pull' the problem gambler away The 'Push' model suggests many of the variables leading to relapse act through social learning processes (Skinner 1953) where particular cues become meaningful. It was surprising that the many co-morbid conditions linked to problem gambling such as alcohol use and dependence (Delfabbro 2008), diagnosable affective disorders (Scherrer et al 2007;Pietrzak et al 2007;McCormick and Taber 1988) and general level of distress and higher levels of obsessive-compulsive symptomatology (Jiménez-Murcia et al 2007) were not identified by participants as important in relapse. This could be understood, in part because financial and social problems, comorbidities, boredom, conflict, stress and illness, are all associated with negative affects, which can be relieved temporarily by triggering thoughts about winning at gambling and the associated euphoria.…”

A Preliminary, Qualitative Exploration of the Influences Associated with Drop-Out from Cognitive-Behavioural Therapy for Problem Gambling: An Australian Perspective

“…A small number of researchers have examined the factors that influence drop-out from therapy for problem gambling, each citing quite varying factors: psychological distress and obsessive-compulsive symptoms (Jimeneez-Murcia et al, 2007); absolute treatment goals, especially one of 'total abstinence' (Blaszczynski, 1998) as opposed to 'controlled gambling' (Robson, et al, 2002); and state anxiety (Echeburúa, Báez, & Fernández-Montalvo, 1996). Melville, Casey, and Kavanagh (2007) conducted a systematic review of the literature in the area.…”