Developmental trajectories of gambling severity after cognitive-behavioral therapy

Abstract

Aims:To estimate trajectories of the gambling disorder (GD) severity for 12 months following a manualized cognitive-behavior-therapy (CBT) program, and to identify the main variables associated with each trajectory.Methods:Latent Class Growth Analysis examined the longitudinal changes of n = 603 treatment-seeking patients with GD.Results:Five separate empirical trajectories were identified: T1 (n = 383, 63.5%) was characterized by the most highest baseline gambling severity levels and positive progress to recovery during the follow-up period; T2 (n = 154, 25.5%) featured participants with high baseline gambling severity and good progress to recovery; T3 (n = 30, 5.0%) was made up of patients with high gambling baseline severity and slow progress to recovery; T4 (n = 13, 2.2%) and T5 (n = 23, 3.8%) contained participants with high baseline gambling severity and moderate (T4) and poor (T5) progress in GD severity during the follow-up. Psychopathological state and personality traits discriminated between trajectories. Poor compliance with the therapy guidelines and the presence of relapses also differed between the trajectories.Conclusions:Our findings show that patients seeking treatment for GD are heterogeneous and that trends in progress following treatment can be identified considering sociodemographic features, psychopathological state and personality traits. These results could be useful in developing more efficient interventions for GD patients.

Impulsivity and cognitive distortions in different clinical phenotypes of gambling disorder: Profiles and longitudinal prediction of treatment outcomes

“…Nevertheless, in contrast to what has been found in the current study, elevated punctuations on sensation seeking increased the risk of dropouts [63]. Also, severe GD patients that presented high scores in psychopathology, low persistence and low reward dependence at baseline, had poor progress in GD severity during treatment and follow-up compared to other severe patients [64]. Furthermore, beliefs of inability to stop gambling (a cognitive distortions more highly observed in online and strategic gamblers), predicted the number of relapses during treatment.…”

Does Confinement Affect Treatment Dropout Rates in Patients With Gambling Disorder? A Nine-Month Observational Study

“…This socio-demographic and clinical profile is similar to the characterization reported in previous studies of our Unit (Jiménez-Murcia et al, 2007, 2015. Regarding treatment outcome, the risk of dropout over the nine-month observational period reached similar values to those mentioned in the literature (Melville et al, 2007) and described before confinement started (Jiménez-Murcia et al, 2019). A slightly lower mean incidence of dropout was found during the lockdown in comparison with the following months although without reaching statistical significance.…”

“…The outpatient treatment program offered in the Unit was based on a standardized protocol ( Jiménez-Murcia et al, 2006 ). It has shown adequate effectiveness for GD in both short- and medium-terms, and has been widely described in previous Unit’s studies related to treatment of GD ( Jiménez-Murcia et al, 2006 , 2007 , 2019 ; Jimenez-Murcia et al, 2012 ). It comprised (a) two initial baseline assessment visits, (b) CBT group therapy phase, and (c) a post-therapy follow-up.…”

“…All the assessments apart from the Brief Telephone Survey related to COVID-19 (Behavioral Addictions Unit, Psychiatry Department, University Hospital, Barcelona, Spain, 2020) were part of the standardized assessment within the Unit’s treatment program previously described ( Jiménez-Murcia et al, 2006 ), and contemplated in other studies related to treatment of GD ( Jiménez-Murcia et al, 2006 , 2007 , 2019 ; Jimenez-Murcia et al, 2012 ).…”

“…Despite a broad dropout range (14–50%) reported by previous national and international studies ( Melville et al, 2007 ; Smith et al, 2010 ; Jimenez-Murcia et al, 2012 ), an average of around 26% has been agreed ( Melville et al, 2007 ). Prior to confinement, a recent national study ( Jiménez-Murcia et al, 2019 ) reported dropout rates of 32.4% among patients with GD regarding clinical trajectories based on GD severity among patients following a 12months manualized CBT program. Features such as patients’ medical or family issues, length of therapy, personality traits (e.g., perseverance, reward sensitivity, sensation-seeking), younger age, lower educational level, and neurocognitive variables, among others, have been studied as potential predictors of treatment dropout ( Melville et al, 2007 ; Álvarez-Moya et al, 2011 ; Jiménez-Murcia et al, 2015 ; Mallorquí-Bagué et al, 2018 , 2019 ; Mestre-Bach et al, 2019 ).…”