Comment: The quality of evidence is downgraded by study limitations (inappropriate allocation concealment and selective reporting)
Cognitive behavior therapy is suggested for treatment of people suffering from pathological or problem gambling
A Cochrane review [Abstract] 1 14 randomized trials (with 1245 participants) comparing psychological therapies to either waiting list (9 studies), referral to Gamblers Anonymous (GA, 2 studies), or assessment only (3 studies). Eleven of the 14 studies assessed cognitive behavior therapy (CBT), half of them where on group therapies. Four studies assessed integrative therapy consisting of motivational enhancement therapy (MET) and condensed CBT. Self help programs and remotely delivered interventions were excluded, as well as studies comparing different psychological therapies. Primary outcomes were gambling symptom severity, financial loss from gambling and frequency of gambling. All trials contained adults (mean age 44 years).
Gambling symptom severity, frequency of gambling and financial losses due to gambling were significantly lower in CBT group than in controls in short follow up (0 to3 months), based on 7 studies. There was only one study (147 participants) that reported these outcomes at long follow up (9 to 12 months) and it did not identify significant difference between the groups. MET reduced significantly financial losses in short term (based on three studies) and frequency of gambling at one year (based on one study); no other significant differences were noticed
| Outcome | Number of participants (trials) | Control: waiting list, GA, assessment only/normalized control score* | Intervention:Cognitive behavioral therapy (CBT)/ % of normalized control score(range) | Effect size (95 % CI) |
|---|---|---|---|---|
| Gambling symptom severity at 0-3 months post treatment | 402(7) | 100 | 32 (7 to 64) | SMD -1.82(-2.61 to -1.02) |
| Financial loss from gambling at 0-3 months | 505(7) | 100 | 31 (12 to 53) | SMD -0.52( -0.71 to -0.33) |
| Frequency of gambling at 0-3 months | 505(7) | 100 | 44 (10 to 69) | SMD - 0.78 (-1.11 to -0.45) |
| Depression symptoms at 0-3 months | 276(4) | 100 | 61 (35 to 67) | SMD -0.66 (-0.93 to -0.39) |
| * Calculated as a n-weighted mean of [mean score (intervention group)/mean score (control group) ×100] | ||||
A meta-review 2 studied pharmacological and psychosocial treatment of adults with gambling disorder. 26 studies were included. There was promising results of opioid antagonists and mood stabilizers; lithium was effective in subjects with comorbid bipolar disorders. Cognitive behavioral therapy (CBT) was the most commonly used psychological intervention and reduced global severity, gambling frequency, and financial loss. Motivational interviewing (MI) seemed to improve several gambling domains, alone or in combination with CBT. Self-help interventions showed some efficacy in promoting treatment-seeking, and in combination with other treatments.
Clinical commentsNoteDate of latest search: 9.11.2011 References
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