What treatment goals are important to individuals harmed by gambling and to what extent are these met through a cognitive behavioural therapy programme? A single-case series

Abstract

There is a growing evidence base for the treatment of gambling harms indicating that cognitive behavioural therapy (CBT) is an effective treatment. However, limitations in research methodology raise questions about the effective mechanisms of change. Existing research has been inconsistent in the measurement of change, and it is not clear whether markers of recovery identified by researchers represent the treatment goals that are most important to those recovering from gambling harm. This study aimed to clarify these areas using a single-case experimental design for treatment seekers accessing a CBT intervention. Recovery trajectories were observed for eight participants attending a group CBT programme, identifying changes in measures of wellbeing and gambling severity through baseline, treatment and follow-up phases. Each participant’s recovery journey was illustrated through weekly measures of perceived closeness to achieving their self-identified treatment goal as well as daily reports of urge severity and presence of gambling behaviour. Findings indicated that all participants viewed abstinence from gambling as their treatment goal. Unexpectedly, half of the sample had already achieved abstinence prior to attending the CBT programme, suggesting that additional factors, including initial contacts with the service contributed to reductions in gambling. This finding also indicated that for individuals recovering from gambling harm, achieving abstinence is not the end of their recovery. Most participants demonstrated improvements in wellbeing and gambling-related cognitions that could be attributed to the CBT programme, with those gambling at baseline showing improvements in gambling urges and behaviour following treatment. The study highlights the need for service-user perspectives in measurements of recovery. Implications for clinical practice and future research are discussed.

Key learning aims