Cognitive Versus Exposure Therapy for Problem Gambling: Randomised Controlled Trial.

 New Study (1)Abstract


Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial.


To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service.


Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up.


Of eighty-seven participants who were randomised and started intervention (CT = 44; ET = 43), 51 (59%) completed intervention (CT = 30; ET = 21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference -0.18, 95% CI: -4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI: -4.46-7.39).


Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out.

Smith, D. P., Battersby, M.W., Harvey, P.W., Pols, R.G., & Ladouceur, R. (2015). Cognitive versus exposure therapy for problem gambling: Randomised controlled trial. Behavior Research and Therapy, 69, 100-110. doi: 10.1016/j.brat.2015.04.008

CBT is Effective for Pathological Gambling

OBJECTIVE: Clinicians lack adequate data on the effectiveness of treatment for pathological gambling in low- and middle-income countries.

METHODS: We evaluated a manualized treatment program that included components of cognitive-behavioral therapy, motivational interviewing, and imaginal exposure in a sample of 128 participants diagnosed with pathological gambling. Our team recruited participants via the helpline of the National Responsible Gambling Program (NRGP) of South Africa between May 2011 and February 2012. Eligible participants, who met the DSM-IV-TR criteria for pathological gambling as assessed by the Structured Clinical Interview for Pathological Gambling (SCI-PG), were referred to practitioners who had been trained in the intervention technique. We then compared pre- and post-treatment scores obtained on the Yale-Brown Obsessive-Compulsive Scale Adapted for Pathological Gambling (PG-YBOCS), the primary outcome measure, and the Sheehan Disability Scale (SDS), the secondary outcome measure.

RESULTS: Scores obtained on the PG-YBOCS and the SDS both decreased significantly from the first to the final session (t[127] = 23.74, P < .001, r = .9; t[127] = 19.23, P < .001, r = .86, respectively).

CONCLUSIONS: The urges and disability symptoms related to pathological gambling were significantly reduced among participants completing treatment. These preliminary results hold promise for individuals with pathological gambling in South Africa and other low- and middle-income countries.

Pasche, S. C., Stein, D. J., Sinclair, H., Sinclair, H., Collins, P., Pretorius, A., & Grant, J. E. (January 01, 2013). The effectiveness of a cognitive-behavioral intervention for pathological gambling: A country-wide study. Annals of Clinical Psychiatry, 25, 4, 250-256.

Research Results: CBT plus Medication is Effective for Gambling

An initial randomized, controlled trial shows that Cognitive Behavior Therapy (CBT) plus Selective Serotonin Reuptake Inhibitor (SSRI) can improve pathological gambling. For this study, 34 patients were randomly assigned to either medication alone, CBT plus medication, or CBT plus placebo for 16 weeks. Patients who received CBT plus medication improved the fastest. Further study is needed to assess long-term outcomes and other variables. Results were presented at the November, 2006 Canadian Psychiatric Association’s annual meeting.