Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the Treatment of Co-occurring Schizophrenia and Pathological Gambling: A Case Study

Abstract

There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a singleparticipant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at three-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.

Current psychological therapeutic approaches for gambling disorder with psychiatric comorbidities: A narrative review

“…Apart from three case reports (Borras & Huguelet, 2007;Potenza & Chambers, 2001;Shonin, VanGordon, & Griffiths, 2014), there is only one controlled trial that tested the clinical effectiveness of a cognitive-behavioral program specifically adapted for individuals with GD with chronic schizophrenia, with post-treatment and 3, 6, and 12-month follow-up assessments. Adaptation of CBT for these individuals dually diagnosed with GD and chronic schizophrenia took into account several aspects: The active role of the therapist to help patients fulfil the self-reports; the presence of a co-therapist (a family or staff member) in order to enhance motivation for treatment, to encourage patients to carry out in vivo exposure tasks and to check information provided by patients; and the implementation of the program in the stabilization phases of the schizophrenia.…”

Mindfulness as a treatment for gambling disorder: Current directions and issues

“…For instance, the case study reported by Shonin et al (2014e) also used cognitive-behavior therapy along with diary keeping, behavioral experiments, goal setting, and psycho-education. The authors also reported that the intervention employed a broad range of meditation exercises and meditation-based dialogue techniques that may exert specific training (and, therefore, time) demands on the part of the therapist.…”

“…Future research and dialogue should also focus on addressing some of the issues that currently hinder the wide-scale operationalization of mindfulness as an addiction treatment. Such issues include the need for a more established training and assessment curriculum for MBI instructors who, in some instances, may have as little as one year's mindfulness practice and teaching experience following completion of a single 8-week training course (Shonin et al 2014e;Van Gordon et al 2015). Additionally, diverse models of mindfulness are employed in different MBIs, and this is problematic when attempting to identify the precise attributes of mindfulness practice that are mechanistically active in the treatment of gambling disorder.…”

The Role of Mindfulness in Addictions: Can It Be An Effective Treatment Option?

“…10,11 The cultivation of mindfulness can create a significant change in the way individuals approach their experiences, allowing the development of greater stability, meaning, flexibility, and less reactivity. Examples of mindfulness-based interventions used in addictions include Mindfulness-Based Relapse Prevention, 12 Mindfulness-Based Stress Reduction, 13 Meditation Awareness Training, 14 MindfulnessBased Cognitive Therapy, 15 and Mindfulness-Enhanced Cognitive Behavior Therapy.…”