GGTU Cognitive behavioural therapy CBT for problem gambling

At the intermediate stages of therapy, the goal is to develop a plan to prevent potential relapses (Fong & Rosenthal, 2009; Raylu & Oei, 2010). Clinical experience indicates that both identifying a client’s reasons for gambling, along with recognizing the role of gambling in coping with their challenges or life circumstances, are key when using CBT to treat problem gambling. In CBT, the clinician works with the client to identify, question and change thoughts, attitudes and beliefs that may be at the root of their emotional and behavioural difficulties (Rector, 2010). The client learns to better manage problems by identifying and correcting cognitive distortions and by seeing thoughts as ideas and beliefs rather than as facts (Rector, 2010).

Another systematic review and meta-analysis found that CBT is highly effective in reducing problem gambling for all types of gambling up to 24 months after people complete therapy (Gooding & Tarrier, 2010). 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.

If a participant needs extra support or care after the CBT treatment it will be provided at the clinic or the participant will be referred to the appropriate treatment provider. During the telephone follow-up (3 months after end of treatment) it will be possible to identify patients that may have a relapse in GD and provide further care. After the active treatment period, the participants will be free to seek any form of care they need.

Gambling is often described as an escape from negative emotions and aversive experiences 3, 18. Some participants described that positive emotions preceded their gambling, and others that negative emotions did so. Conversely, some participants expressed that positive emotions decreased the possibility for them to gamble, and others that negative ones did so.

However, in the RCT the control group will receive questionnaires including questions about time spent gaming. This kind of self-monitoring might lead to some additional changes in behavior that would occur while waiting for treatment. Data from our pilot study showed low levels of quality of life among patients with GD 24. In order to determine the treatment’s effect on quality of life, the Brunnsviken Brief Quality of Life Scale (BBQ) 35 will be used. This questionnaire will be included in the data collection at time points 0, 3 and 4. Mean change from baseline to follow up will be used as outcomes for the BBQ.

The sponsor and funder had no influence on the study design, writing or decision to submit the report. Results were only presented for models with adequate degrees of freedom after accounting for small sample size adjustments to the robust variance estimates. Study flowchart for identification of studies to be included in this review. So if gambling’s wrecking your life (or someone you care about), recovery isn’t just hopium—it’s legit. The future’s about spotting at-risk folks early—like college kids or people with other addictions—and giving them tools before gambling becomes a problem.

Recruitment will start in August 2025, thus randomizing the first participant in September 2025. All participants will be covered by a patient insurance and will be able to seek compensation if they have suffered harm from treatment. Each participant’s family and/or close friends will be offered 3–4 sessions together with the participant and a social worker, in parallel with the CBT treatment. The purpose is to set common goals, provide information on how the family can support the participant through the treatment, and give advice on how to communicate within the family. For GD, no evidence-based CBT program for adolescents and adults exists in Sweden. Therefore, we aim to evaluate a CBT-manual based on standardized modules which can be flexibly combined depending on individual needs.

Several limitations should be borne in mind when interpreting the results of the present meta-analysis. First, the procedures for testing publication bias in the present meta-analysis do not necessarily represent direct evidence of publication bias. However, the results related to publication bias suggest that it is highly likely that the magnitude of the effect of CBTs on gambling disorder severity and gambling behavior is overestimated. Future researchers are strongly encouraged to pre-register their randomized controlled trials in trial registries, as pre-registration will facilitate later investigations of publication bias. Recommendations from the Banff, Alberta Consensus guided the selection of several outcomes (26), and multiple outcomes were extracted to evaluate the efficacy at posttreatment and at the longest available follow-up.

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. All but one participant expressed that negative emotions triggered their gambling, for example feeling “bored”, ”anxious”, “worried”, “stressed”, “sad”, or ”restless”.

Composition of the coordinating center and trial steering committee 5d

After the waitlist period, the participants in this group will be offered the same treatment as the intervention group. Participants in the waitlist control group will, after the control period, be offered the same treatment as participants in the intervention group. Finally, participants were asked to report other behaviors that they had engaged in, that resembled the experience of gambling. Four participants described various behaviors and activities, i.e., computer games, other games, sex, deliberate self-harm, and work tasks. However, we decided that these behaviors were too disparate to constitute a functional theme and they were therefore excluded from the thematic analysis.

Others reported pre-gambling rumination, for example thinking that they ought not be gambling, or being displeased with relationships or other areas in their life. Overall, however, few participants expressed that specific gambling-related thoughts triggered their gambling, and when they did, it was often in conjunction with a positive emotional experience. Only two participants described thinking of gambling losses as a trigger for gambling. Emotional events were also reported as antecedents that could decrease the likelihood of gambling. Half of the participants described positive emotions, such as “feeling good”, “happy” or “life going in the right direction”.

They experienced no negative symptoms, such as anxiety, depression or concentration problems. It should be noted that both participants were assessed as impulsive gamblers according to the Pathways Model 18, which may indicate a unique feature of this theme. 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. 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.

By gambling, participants avoided symptoms of anxiety, for example post-mortem ruminations on social situations, or post-traumatic memories. Interestingly, anxiety was also described as a part of the gambling activity in itself. A majority of the participants described specific preceding behaviors that either would increase or decrease the likelihood of gambling.

• In a recent meta-analysis that included 38 studies, it was concluded that CBT seems to have a good effect, but the reliability of the results may have been biased due to the inclusion of small studies with low scientific quality 26.
• The client and clinician have already identified problem areas and treatment goals, and have a good therapeutic alliance and trust.
• Overall, participants described that they experienced a range of emotional states while they gambled; these we categorized as positive (Emotional positive).
• We plan to conduct interim analyses when approximately 50% of the planned total sample has finished the trial period 60.
• The participants will be followed up by telephone three months after the end of treatment.
• Based on the total score the level of severity is classified as none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19) or severe (20–27).

Table 2.

To encourage the participants to complete the follow-ups, they will be rewarded with a gift card after the post-treatment assessment (T4). If the participant discontinues participation before end of study for any reason, they will be contacted by telephone. Standardized questions will be asked in order to complete questionnaires equivalent to those in T3 (see Table 2) as well as the reasons for discontinuation (optional). 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.

The client and clinician have already identified problem areas and treatment goals, and have a good therapeutic alliance and trust. Note the clinician’s use of CBT to prevent relapses by identifying triggers and the function of multiplayer entertainment platform gambling in the client’s life. The next step is to work with your client to identify and implement strategies to manage gambling urges.

The last question measures time spent sitting during a day (seven response alternatives ranging from “almost all day” to “never”) 51. These questions are recommended by the Swedish National Board of Health and Welfare. To complement the diagnostic criteria in the DSM-5, a shorter questionnaire based on ICD-11, the Gaming Disorder Test (GDT), is included in the test battery, 31, 32. The mean change from baseline to end of treatment will constitute the outcome for GDT, that will be distributed at all time points for data collection (see Table 2, Timeline). This is a single-center study including participants from all geographical areas of Sweden. The trial will be performed at the Clinic for Gambling Disorder and Screen Health, Sahlgrenska University Hospital, Gothenburg, Sweden, and the treatment sessions will be held on site at the clinic or digitally via computer or smartphone.

These qualitative and clinical based assessment procedures are, however, rarely published as formal systematic studies. The current paper is thus an important exception in the clinical treatment literature. Participants from a CBT study were purposely selected by a clinical psychologist.

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