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

Abstract

Aims This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive-behavioural therapy (CBT). Methods A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using Victorian Gambling Screen (VGS) 'harm to self' sub-scale with validated cut score 21+ (score range: 0 -60) indicative of problem gambling behaviour. Secondary outcome measure was work and social adjustment scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale (K10). We used propensity score adjusted random-effects models to estimate treatment outcomes for subpopulations of individuals from baseline to 12 month follow-up. Results Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1(SD=13.6) years and 211 (56%) were males. At baseline, 353 (92.9%) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46%) had a very high probability of a 12-month affective or anxiety disorder, 103 (27%) in the high range and 102 (27%) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p < 0.001). Conclusions Individuals with covarying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia gain similar significant reductions in gambling behaviours from routine cognitivebehavioural therapy in the mid-term.

Cognitive versus exposure therapy for problem gambling: Randomised controlled trial

“…In a previous study involving a large cohort of treatment-seekers who attended SGTS, similar prevalence rates were found for 12-month affective disorder and anxiety disorder based on Australian normative data (Slade, Grove, & Burgess, 2011;Smith, Harvey, Humeniuk, Battersby, & Pols, 2014). Based on the potential for high prevalence rates of co-occurring conditions in the present study, the specificity of CT alone or ET alone may have been too prescriptive for some participants alongside other mental symptoms.…”

The role of homework in exposure-based CBT outcome for problem gambling

“…The data also suggests that taking psychotropic medication did not impose on the current participants' engagement with psychotherapy. Given reported high rates of co-morbid mental health issues among problem gamblers (Lorains, Cowlishaw & Thomas, 2011) this is encouraging, and further supported by a recent study by Smith, Harvey, Humeniuk, Battersby and Pols (2014) that found individuals with comorbid anxiety and affective disorders enjoyed similar reductions in gambling behaviours from routine CBT. The finding that older participants had lower expectations about treatment outcome and engaged in less homework is of interest.…”

Effective Treatment and Support for Problem Gambling

“…16 Overall, the evidence would suggest that a treatment strategy combining CBT with helplines, motivational interventions, and remote treatment options, has the potential to reduce barriers, enhance treatment uptake and completion, and address problematic gambling thoughts and behaviours for many problem gamblers. However, while CBT and the other strategies mentioned do have the potential to effectively treat patients with co-occurring disorders; [32][33][34] patients with more complex diagnoses and needs may require additional forms of treatment. The literature sourced suggests that some patients may benefit from problem gambling treatment that specifically addresses sources of anxiety and depression, 52,90,91,97 and patients with particularly complex needs may benefit from residential treatment options.…”

“…32 › Evidence suggests that CBT may be equally effective for problem gamblers with and without co-occurring mood and anxiety disorders. 33,34 › A cross-sectional study of 53 treatment-seeking problem gamblers (based on DSM-IV criteria) tested the relationship between number of comorbid disorders and treatment outcomes. It found that higher numbers of co-occurring disorders were associated with high problem gambling scores (assessed using NODS-SA).…”