Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial

Another prominent pattern was that all participants reported that available resources (i.e., access to money) were a critical antecedent condition. For example, participant 3 described a monthly pattern where he gambled using all his salary as soon as the amount was transferred to his bank account. From there on, he lived without money for a couple of weeks feeling pretty good at not gambling and often thinking that he did not want to gamble again. However, as soon as the new salary was transferred to his bank account, he started to gamble online again until the salary was spent, often gambling the whole night long. Fourth, participants in both treatments rated treatment credibility and therapist alliance equally high.

Visualization techniques to support sobriety

Gam-Anon is an organization that offers support tailored to friends and family members affected by a loved one’s gambling problem. It provides a platform for individuals to share experiences, fears, and successes, fostering mutual support and healing. This community-centric approach helps loved ones understand the nature of gambling addiction and how to cope with its impact on their lives.

Without treatment, the cycle of addiction can escalate, leading to devastating outcomes. Unlike casual gambling, addiction involves losing control over the behavior. Those affected might continue gambling to chase losses, seek a rush of excitement, or escape emotional distress. Recognizing the seriousness of this disorder is the first step toward effective treatment.

Effect sizes were calculated by dividing the estimated effect by the observed standard deviation at baseline (61). Pearson’s correlations of observed values between baseline and post-treatment, and post-treatment to 6-month follow-up were used to calculate confidence intervals for within-group effect sizes. The National Gambling Support Network helps people struggling with gambling, and people who are worried about someone else’s gambling. With Talkspace, you can connect with a licensed therapist who specializes in CBT techniques, addictive behaviors, and trauma-informed care. Culture also influences both the types of gambling that are socially acceptable as well as the likelihood that a person will seek help for their problem gambling (Raylu & Oei, 2004).

Individuals with this condition often find themselves unable to resist the temptation to gamble, leading to riskier bets, gambling with more money, and gambling more frequently. The optimal duration of residential treatment can vary depending on the severity of the addiction and individual progress. However, most programs recommend a stay of 30 to 90 days, with longer stays often resulting in more successful long-term recovery outcomes.

These questions are recommended by the Swedish National Board of Health and Welfare. Weekly hours of gaming will be monitored during the treatment and control period, using the Gaming Disorder Timeline Follow-Back (GD-TLFB). The mean change from the start of treatment to end of treatment will constitute the outcome for GD-TLFB. Gaming time is not directly connected to GD 29, but spending excessive amounts of time gaming has been identified as a risk factor for GD 30.

Emotional events were coded irrespective of their descriptive value into one theme (i.e., emotion), as the distinction between positive and negative emotional valence was far from clear cut. Thus, emotional antecedents could be described in positive terms, as when participants expressed that they often gambled after “feeling good” or “satisfied in life”. Indeed, all participants expressed that they could experience a positive emotional state of anticipation, excitement or exhilaration prior to gambling. Some, but not all, participants described negatively valued emotional antecedents.

The NEQ short form consists of 20 yes/no questions, where participants are asked if a certain type of negative effect has occurred during treatment. If a yes answer is given, participants are asked to rate how negatively this affected them on a scale of 0–4, where 0 means “not at all” and 4 “extremely negative.” The total score ranges between 0 and 80. While holistic therapies are not standalone treatments, they are valuable additions to other evidence-based interventions, providing individuals with diverse tools for managing addiction. Beyond conventional treatments, holistic therapies are https://gameaviatorofficial.com/ increasingly incorporated into comprehensive treatment programs for gambling addiction. These therapies address the mind-body connection, emphasizing relaxation, stress management, and emotional resilience.

This is not surprising as spending time thinking and talking about gambling problems might remind participants of problems caused by gambling behavior. The treatment of gambling addiction requires a comprehensive approach that addresses the psychological, social, and behavioral components of the disorder. From Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI) to family counseling and pharmacotherapy, a variety of evidence-based interventions provide effective tools for recovery. Structured programs like inpatient and outpatient rehabilitation and support groups like Gamblers Anonymous (GA) offer continuous support, reinforcing the skills needed to prevent relapse. Psychosocial interventions alone may not be sufficient for individuals with severe gambling addiction or co-occurring mental health disorders. In such cases, combining psychosocial approaches with other therapies, such as cognitive-behavioral therapy (CBT) or medication, may be necessary to achieve comprehensive recovery.

For general characteristics of all 34 studies initially identified, see Supplementary Material 1 Table S2. A 5-point difference on the IGDS9-SF scale corresponds to changes in frequency of at least two symptoms of GD. It is also equivalent to the minimal clinically important difference defined as half the standard deviation of the change scores40. Due to the lack of clinical evidence using this particular questionnaire, we have also made parallel calculations of sample size using data about time spent gaming. The sample size (128 individuals) would allow for detection of about an eight hour decrease in time spent gaming per week, i.e. a full workday. Based on clinical judgment and data from our pilot study, we have therefore made the decision that this sample size would allow for detection of clinically meaningful changes.

• Many previously studied treatments are also resource-intensive, making it difficult to implement in routine care.
• Data for depression and anxiety will be collected at every time point for assessment (see Table 2, timeline), and data will be aggregated as the mean change from baseline to follow-up.
• A majority of the participants described specific preceding behaviors that either would increase or decrease the likelihood of gambling.

Trial status

Gambling-related physiological arousal and subjective excitement is consistent with the theoretical Pathways Model 18, and has been examined in several experimental studies e.g., 50–52). For example, Rockloff and Greer 53 concluded that high arousal can increase subsequent gambling behavior among at-risk players, as long as the arousal is not perceived as a negative emotion. Thus, future etiological and treatment models may consider affective antecedents regardless of valence. A majority of the participants described specific preceding behaviors that either would increase or decrease the likelihood of gambling.

Estimated mean differences post-treatment and at 6-month follow-up between the ICBTa and the IMIb treatment in the full analysis sample. To see whether there were any statistical differences in perceived working alliance (WAI), treatment credibility (TCS), and patient-rated impact of adverse events (NEQ) between the treatment groups in the FAS and ITT sample, ANOVA was used. The Revised short version of the Working Alliance Inventory (WAI-SR) (56) is a revised 12-item version of the original Working Alliance Inventory (57) which is designed to measure the alliance between patient and therapist during treatment. The Treatment Credibility Scale is an adapted version of the Credibility Scale (58). It contains five items measuring perceived credibility and expectancy of the current treatment.

Frequencies of endorsed constructs and phrases were summarized for all participants, as well as for each clinically assessed Pathways subtype 18. Results were reported in alignment with the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist 47. Six individuals from a treatment study, diagnosed with gambling disorder and with diverse symptom profiles of psychiatric comorbidity, were recruited. Participants were interviewed using an in-depth semi-structured functional interview and completed self-report measures assessing gambling behavior.

Another strength was that gambling symptoms were measured at the first visit, which made it possible to discover that change started well before treatment start. Finally, the study was conducted in the clinic and thus explored the effect of treatment in a real clinical sample. No difference was found between treatments, or over time during treatment, in the total sample for the secondary outcomes from the gambling diary (G-TLFB) of amount of money bet per week and time spent gambling per week. This lack of change over time might be due to low values already at baseline, paired with a large variability in scores. As abstinence from gambling gives scores of zero, while a setback for a few participants might give large scores at certain time points, there is an innate variability in this type of measurement.

Family Therapy: Involving Loved Ones in the Recovery Process

A further limitation was that no toxicological screening was carried out, and no specific exclusion criteria were set regarding co-morbid alcohol or substance use disorder. The reason for not excluding these participants was to ensure that the sample would be as close to a true clinical population as possible. However, due to the high co-morbidity of GD with alcohol and substance use disorder, this might potentially have affected the participant’s ability to interact with the treatment. Another limitation was that symptoms of both GD and co-morbid disorders were only assessed using self-report questionnaires and were not corroborated with diagnostic interviews. Finally, the fact that a large number of potential participants declined may have led to self-selection, which can potentially have caused bias.

This therapeutic approach aims to reduce chaos and conflict within families, creating a more supportive environment for recovery. JWE and TM were responsible for managing and coordinating the research activity and each step of planning and execution. JWE and AF designed and conducted the literature search and study selection.