383: Psychological therapies effective for pathological and problem gambling

March 30, 2013

PEARLS 383, February 2013, written by Brian R McAvoy

Clinical question
How effective are psychological therapies (cognitive behavioural therapy [CBT], motivational interviewing [MI], integrative therapies, and Twelve-step Facilitated Group Therapy) for pathological and problem gambling?

Bottom Line
Data from nine studies indicated benefits of CBT in the period immediately following treatment. However, there were few studies across longer periods of time (e.g. 12 months) after treatment, and little was known about whether effects of CBT were lasting. Data from three studies of MI therapy suggested some benefits in terms of reduced gambling behaviour, but not necessarily other symptoms of pathological and problem gambling. There were also few studies that provided evidence on integrative therapies (two studies) and other psychological therapies (one study), and there was insufficient data to evaluate the efficacy of these therapies.

A substantial amount of the evidence came from studies that suffered from multiple limitations, and these may have led to overestimations of treatment efficacy. There was variability in the nature of the interventions classified as CBT, and the effects of individual and group CBT were also combined. The data on MI therapy came from few studies and conclusions require further research.

The prevalence of pathological and problem gambling has been found to vary internationally, with studies suggesting anywhere between 0.2% (in Norway) and 5.3% (in Hong Kong) of individuals affected.1 The term 'pathological gambling' is derived from psychiatric diagnostic systems, such as the Diagnostic and Statistical Manual of Mental Disorders. Problem gambling is also sometimes used to describe a subclinical level of the psychiatric disorder or alternatively, a broader category of severe gambling based on a continuum model of gambling-related harm.

Cochrane Systematic Review
Cowlishaw S et al. Psychological therapies for pathological and problem gambling. Cochrane Reviews, 2012, Issue 11. Art. No.: CD008937.DOI: 10.1002/14651858. CD008937.pub2. This review contains 14 studies involving 1,245 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.