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BMC Psychiatry

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01-12-2021 | Psychotherapy | Research article

Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials

Authors: Eliana O. Ribeiro, Nuno H. Afonso, Pedro Morgado

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

The main focus of the non-pharmacological treatment of Gambling Disorder (GD) is the behaviour, cognition and motivation of the patient, addressing the psychological determinants of gambling. Although there is not a gold standard non-pharmacological treatment yet, many studies already had promising results, and the outcomes were even better when pharmacotherapies were combined with psychotherapies. This review intended to synthesise the efficacy of various available non-pharmacological therapies for GD evaluated in randomized controlled trials.

Methods

A systematic search was conducted in PubMed and in Cochrane Library for randomized controlled trials. Studies were included if participants had GD as their primary diagnosis and excluded if patients had other comorbidities.

Results

From 320 records identified, 22 studies were included in the critical appraisal. They included a total of 1694 patients, with a mean age of 42.94 years, and a 62.31% of males. Seven trials revealed the efficacy of cognitive behaviour therapy in improving significantly the outcomes. Three studies assessing cognitive therapy showed significant improvements in gambling symptoms, while one study showed improvements in gambling behaviour using exposure therapy. Combined or separate motivational interviewing and imaginal desensitization had significant results in 4 trials. Four other studies also showed efficacy for: couples therapy, node-link mapping therapy, 12-step facilitated and personalized feedback intervention. Physical exercise had promising results but did not reach significance.

Conclusion

The literature included in this review showed the heterogeneity of available psychotherapies. The majority of studies supported the efficacy of the tested therapies, while some of them, due to limitations such as small sample sizes or inadequate control groups, failed to reach significance.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: American Psychiatric Association; 2013.

Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, Yip SW. Gambling disorder. Nat Rev Dis Primers. 2019;5:51. https://doi.org/10.1038/s41572-019-0099-7.CrossRefPubMed

Shaffer HJ, Korn DA. Gambling and related mental disorders: a public health analysis. Annu Rev Public Health. 2002;23:171–212.CrossRefPubMed

Kraus SW, Etuk R, Potenza MN. Current pharmacotherapy for gambling disorder: a systematic review. Expert Opin Pharmacother. 2020;21(3):287–96. https://doi.org/10.1080/14656566.2019.1702969.CrossRefPubMed

Cowlishaw S, Merkouris S, Dowling N, Anderson C, Jackson A, Thomas S. Psychological therapies for pathological and problem gambling. Cochrane Database Syst Rev. 2012. https://doi.org/10.1002/14651858.CD008937.pub2.

Echeburúa E, Báez C, Fernández-Montalvo J. Comparative effectiveness of three therapeutic modalities in the psychological treatment of pathological gambling: long term outcome. Behav Cogn Psychother. 1996;24:51–72. https://doi.org/10.1017/S1352465800016830.CrossRef

Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1(1):91–111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833.CrossRefPubMed

Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527–37. https://doi.org/10.1037/a0016830.CrossRefPubMedPubMedCentral

Fong TW. Types of psychotherapy for pathological gamblers. Psychiatry (Edgmont). 2005;2(5):32–9.

10.

Gooding P, Tarrier N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: hedging our bets? Behav Res Ther. 2009;47(7):592–607. https://doi.org/10.1016/j.brat.2009.04.002.CrossRefPubMed

11.

Petry NM, Ginley MK, Rash CJ. A systematic review of treatments for problem gambling. Psychol Addict Behav. 2017;31(8):951–61. https://doi.org/10.1037/adb0000290.CrossRefPubMedPubMedCentral

12.

Critical Appraisal Skills Programme. CASP randomised controlled trials checklist. 2018. https://casp-uk.net/casp-tools-checklists/. Accessed 17 Mar 2020.

13.

Leyfer OT, Ruberg JL, Woodruff-Borden J. Examination of the utility of the Beck anxiety inventory and its factors as a screener for anxiety disorders. J Anxiety Disord. 2006;20(4):444–58. https://doi.org/10.1016/j.janxdis.2005.05.004.CrossRefPubMed

14.

Melville CL, Davis CS, Matzenbacher DL, Clayborne J. Node-link-mapping-enhanced group treatment for pathological gambling. Addict Behav. 2004;29(1):73–87. https://doi.org/10.1016/s0306-4603(03)00091-1.CrossRefPubMed

15.

Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–97. https://doi.org/10.1207/s15327752jpa6703_13.CrossRefPubMed

16.

Dowling N, Smith D, Thomas T. A comparison of individual and group cognitive-behavioural treatment for female pathological gambling. Behav Res Ther. 2007;45(9):2192–202. https://doi.org/10.1016/j.brat.2006.11.003.CrossRefPubMed

17.

Derogatis LR, Melisaratos N. The brief symptom inventory: an introductory report. Psychol Med. 1983;13(3):595–605. https://doi.org/10.1017/s0033291700048017.CrossRefPubMed

18.

Lee B, Awosoga O. Congruence couple therapy for pathological gambling: a pilot randomized controlled trial. J Gambl Stud. 2014;31(3):1047–68. https://doi.org/10.1007/s10899-014-9464-3.CrossRef

19.

Svetieva E, Walker M. Inconsistency between concept and measurement: the Canadian Problem Gambling Index (CPGI). J Gambling Issues. 2008;22:157. https://doi.org/10.4309/jgi.2008.22.2.CrossRef

20.

Bouchard S, Robillard G, Giroux I, Jacques C, Loranger C, St-Pierre M, Chrétien M, Goulet A. Front Psych. 2017:8. https://doi.org/10.3389/fpsyt.2017.00027.

21.

Cunningham JA, Hodgins DC, Toneatto T, Rai A, Cordingley J. Pilot study of a personalized feedback intervention for problem gamblers. Behav Ther. 2009;40(3):219–24. https://doi.org/10.1016/j.beth.2008.06.005.CrossRefPubMed

22.

Potard C. Self-esteem inventory (Coopersmith). Encyc Pers Individ Diff. 2017:1–3. https://doi.org/10.1007/978-3-319-28099-8_81-1.

23.

Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38(1):15. https://doi.org/10.2307/350547.CrossRef

24.

Parkitny L, McAuley J. The depression anxiety stress scale (DASS). J Physiother. 2010;56(3):204. https://doi.org/10.1016/s1836-9553(10)70030-8.CrossRefPubMed

25.

Casey L, Oei T, Raylu N, Horrigan K, Day J, Ireland M, Clough B. Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: a randomised controlled trial. J Gambl Stud. 2017;33(3):993–1010. https://doi.org/10.1007/s10899-016-9666-y.CrossRefPubMed

26.

Fortune EE, Goodie AS. Comparing the utility of a modified Diagnostic Interview for Gambling Severity (DIGS) with the south oaks gambling screen (SOGS) as a research screen in college students. J Gambl Stud. 2010;26(4):639–44. https://doi.org/10.1007/s10899-010-9189-x.CrossRefPubMedPubMedCentral

27.

de Castro V, Fuentes D, Tavares H. The gambling follow-up scale: development and reliability testing of a scale for pathological gamblers under treatment. Can J Psychiatry. 2005;50(2):81–6. https://doi.org/10.1177/070674370505000202.CrossRefPubMed

28.

Penna AC, Kim HS, Cabrita de Brito AM, Tavares H. The impact of an exercise program as a treatment for gambling disorder: a randomized controlled trial. Ment Health Phys Act. 2018;15:53–62. https://doi.org/10.1016/j.mhpa.2018.07.003.CrossRef

29.

Myrseth H, Litlerè I, Støylen I, Pallesen S. A controlled study of the effect of cognitive–behavioural group therapy for pathological gamblers. Nord J Psychiatry. 2009;63(1):22–31. https://doi.org/10.1080/08039480802055139.CrossRefPubMed

30.

Lévesque D, Sévigny S, Giroux I, Jacques C. Gambling-Related Cognition Scale (GRCS): are skills-based games at a disadvantage? Psychol Addict Behav. 2017;31(6):647–54. https://doi.org/10.1037/adb0000297.CrossRefPubMed

31.

Myrseth H, Molde H, Støylen I, Johnsen B, Holsten F, Pallesen S. A pilot study of CBT versus escitalopram combined with CBT in the treatment of pathological gamblers. Int Gambl Stud. 2011;11(1):121–41. https://doi.org/10.1080/14459795.2011.559647.CrossRef

32.

Smith DP, Pols RG, Battersby MW, Harvey PW. The gambling urge scale: reliability and validity in a clinical population. Addict Res Theory. 2012;21(2):113–22. https://doi.org/10.3109/16066359.2012.696293.CrossRef

33.

Williams JBW, Kobak KA. Development and reliability of a structured interview guide for the Montgomery-Åsberg depression rating scale (SIGMA). Br J Psychiatry. 2008;192(1):52–8. https://doi.org/10.1192/bjp.bp.106.032532.CrossRefPubMed

34.

Hobden B, Schwandt ML, Carey M, Lee MR, Farokhnia M, Bouhlal S, et al. The validity of the Montgomery-Asberg depression rating scale in an inpatient sample with alcohol dependence. Alcohol Clin Exp Res. 2017;41(6):1220–7. https://doi.org/10.1111/acer.13400.CrossRefPubMedPubMedCentral

35.

Nilsson A, Magnusson K, Carlbring P, Andersson G, Hellner C. Behavioral couples therapy versus cognitive behavioral therapy for problem gambling: a randomized controlled trial. Addiction. 2019. https://doi.org/10.1111/add.14900.

36.

Carlbring P, Jonsson J, Josephson H, Forsberg L. Motivational interviewing versus cognitive behavioral group therapy in the treatment of problem and pathological gambling: a randomized controlled trial. Cogn Behav Ther. 2009;39(2):92–103. https://doi.org/10.1080/16506070903190245.CrossRefPubMedCentral

37.

Carlbring P, Smit F. Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. J Consult Clin Psychol. 2008;76(6):1090–4. https://doi.org/10.1037/a0013603.CrossRefPubMed

38.

Grant J, Donahue C, Odlaug B, Kim S. A 6-month follow-up of imaginal desensitization plus motivational interviewing in the treatment of pathological gambling. Ann Clin Psychiatry. 2011;23(1):3–10. https://doi.org/10.1192/bjp.bp.108.062414.CrossRefPubMedPubMedCentral

39.

Grant J, Donahue C, Odlaug B, Kim S, Miller M, Petry N. Imaginal desensitisation plus motivational interviewing for pathological gambling: randomised controlled trial. Br J Psychiatry. 2009;195(3):266–7. https://doi.org/10.1192/bjp.bp.108.062414.CrossRefPubMedPubMedCentral

40.

Lesieur H, Blume S. The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers. Am J Psychiatry. 1987;144(9):1184–8. https://doi.org/10.1176/ajp.144.9.1184.CrossRefPubMed

41.

Petry N, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, Molina C, Steinberg K. Cognitive-behavioral therapy for pathological gamblers. J Consult Clin Psychol. 2006:555–67. https://doi.org/10.1111/j.1360-0443.2007.01907.x.

42.

Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck anxiety inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res. 2011;63(S11):S467–72. https://doi.org/10.1002/acr.20561.CrossRef

43.

He Y, Hardy NR, Zinbarg RE, Goldsmith JZ, Kramer A, Williams AL, Pinsof WM. The Systemic Therapy Inventory of Change (STIC) initial scales: are they sensitive to change? Psychol Assess. 2019;31(9):1107–17. https://doi.org/10.1037/pas0000729.CrossRefPubMed

44.

Goldsmith J, Fisher L. Systemic therapy inventory of change. Encyc Couple Fam Ther. 2017:1–6. https://doi.org/10.1007/978-3-319-15877-8_404-1.

45.

Zinbarg RE, Pinsof W, Quirk K, Kendall A, Goldsmith J, Hardy N, et al. Testing the convergent and discriminant validity of the systemic therapy inventory of change initial scales. Psychother Res. 2017;28(5):734–49. https://doi.org/10.1080/10503307.2017.1325022.CrossRefPubMed

46.

Tolchard B, Delfabbro P. The Victorian gambling screen: validity and reliability in an adolescent population. Int J Ment Heal Addict. 2013;11(5):514–25. https://doi.org/10.1007/s11469-013-9441-6.CrossRef

47.

Smith D, Battersby M, Harvey P, Pols R, Ladouceur R. Cognitive versus exposure therapy for problem gambling: randomised controlled trial. Behav Res Ther. 2015;69:100–10. https://doi.org/10.1016/j.brat.2015.04.008.CrossRefPubMed

48.

Marceaux J, Melville C. Twelve-step facilitated versus mapping-enhanced cognitive-behavioral therapy for pathological gambling: a controlled study. J Gambl Stud. 2010;27(1):171–90. https://doi.org/10.1007/s10899-010-9196-y.CrossRef

49.

Ladouceur R, Sylvain C, Boutin C, Lachance S, Doucet C, Leblond J. Group therapy for pathological gamblers: a cognitive approach. Behav Res Ther. 2003;41(5):587–96. https://doi.org/10.1016/s0005-7967(02)00036-0.CrossRefPubMed

50.

Ladouceur R, Sylvain C, Boutin C, Lachance S, Doucet C, Leblond J, Jacques C. Cognitive treatment of pathological gambling. J Nerv Ment Dis. 2001;189:774–80. https://doi.org/10.1097/00005053-200111000-00007.CrossRefPubMed

51.

Sylvian C, Ladouceur R, Boisvert J-M. Cognitive and behavioral treatment of pathological gambling: a controlled study. J Consult Clin Psychol. 1997;65:727–32. https://doi.org/10.1037//0022-006x.65.5.727.CrossRef

52.

Mcconaghy N, Blaszczynski A, Frankova A. Comparison of Imaginal desensitisation with other behavioural treatments of pathological gambling a two- to nine-year follow-up. Br J Psychiatry. 1991;159(3):390–3. https://doi.org/10.1192/bjp.159.3.390.CrossRefPubMed

53.

Newbern D, Donald F, Czuchry DM, Simpson D. Node-Link Mapping in Individual Counseling: Treatment Impact on Clients with ADHD-Related Behaviors. J Psychoactive Drugs. 2005;37(1):93-103. https://doi.org/10.1080/02791072.2005.10399752.

Title: Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials
Authors: Eliana O. Ribeiro
Nuno H. Afonso
Pedro Morgado
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Psychotherapy
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03097-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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