Group Cognitive Behavioural Therapy for Gambling Disorder: A Case Series

Introduction: Treatments for gambling addiction are under-evidenced as there is limited high-quality research available. Some of the problematic issues within the treatment literature include: a lack of inclusion of individuals with gambling problems with complex co-morbidities; an emphasis on a statistical reduction in outcome measures, rather than identifying whether treatment results in abstinence and/or satisfaction from service users; a limited consideration of the mechanisms of change in therapy and; limited long-term data. This study aims to address these problems by evaluating a group cognitive behavioural therapy (CBT) intervention provided by the Northern Gambling Treatment Service in the UK, through use of single-case experimental method. Aims: The research aimed to answer the questions: What does recovery look like for individuals with gambling problems? How effective is a group CBT programme in reducing problem gambling? What aspects of the programme are helpful or unhelpful for recovery and why is this? Methods: Eight participants participated in a single case experimental design (SCED) which incorporated a baseline, treatment and follow-up phases. Standardised outcome measures assessed the impact of the intervention on gambling severity, wellbeing, gambling-related cognitions, self-efficacy and stigma. Regular 'target' measures assessed the impact on participants' goals for treatment, their gambling behaviour and urges. In order to identify key processes in the intervention, participants completed a group session rating scale during the group and a Change Interview at the end. Results: Most participants demonstrated significant improvements in gambling severity, wellbeing and gambling-related cognitions. There was evidence of reduced gambling behaviour and urges following treatment. There was no evidence that the treatment improved perceived or experienced stigma. All participants' goals were to become abstinent. There were unexpected high levels of abstinence at baseline and the improvements in gambling severity and wellbeing occurred before starting the CBT group. Conclusions: Treatment as a whole appears to be effective, particularly in regards to gambling severity and wellbeing, and there is evidently an important early impact before treatment. CBT appeared to be effective in improving gambling-related cognitions, increasing confidence in maintaining abstinence and reducing gambling behaviour and urges. Replication of the SCED methodology for this population with longer baseline and follow-up phases is recommended to help clarify and increase generalisability of these findings.