Effectiveness of Therapy Treatment
- Conditions
- GamblingPathological Gambling
- Interventions
- Behavioral: 12-week wait listBehavioral: Cognitive Motivational Behavior TherapyBehavioral: Treatment as Usual
- Registration Number
- NCT01596478
- Lead Sponsor
- Problem Gambling Institute of Ontario
- Brief Summary
The efficacy of psychosocial treatments for PG, including cognitive-behaviour therapy (CBT) and motivational interviewing (MI) approaches, has been supported in a handful of clinical trials. Indeed, there is more evidence supporting these two approaches than for any other psychosocial treatment for problem gambling. However, while efficacy studies have been conducted, few studies have examined the effectiveness of behavioural treatment in community-based gambling treatment settings. That is to say, the investigators have a good idea of what works in a laboratory setting (i.e., university research settings), but the investigators have no research assessing the transfer of evidence-based treatments for problem gambling to community care. Efficacy studies provide substantially less information about the actual utility of treatments than do effectiveness trials because the way in which treatment is actually provided in the field (with flexibility in terms of time-frame and technique and the tendency to address co-occurring problems) is different from the much more single-focused (on gambling) way it is conducted in laboratory settings. The proposed study is designed to address this significant gap in the research literature. The investigators propose to conduct a treatment effectiveness trial examining a combined cognitive motivational behavior therapy (CMBT) delivered by community-based problem gambling treatment providers, compared with treatment as usual (TAU).
- Detailed Description
Pilot Study: Eligible participants will undergo a full consent process and a brief interview to assess demographics. Participants' counselors will be asked to audio-record up to 3 therapy sessions which will subsequently be rated for adherence to CMBT procedures.
Main Study: Eligible participants will undergo a full consent process followed by an in-depth interview, with a research assistant. Following an intake assessment, participants will be randomly assigned to one of the three intervention groups. Randomization also will be balanced based on gender to ensure an equitable distribution of men and women in each condition. The research assistant will give the treatment referrals and will introduce the participant to his/her therapist as appropriate.
Treatment will be provided by clinicians at the Windsor Regional Problem Gambling Services.
* Treatment as usual (TAU) - Therapists will be instructed to conduct therapy as they normally would with PGs entering treatment.
* Cognitive motivational behaviour therapy (CMBT) Therapy will consist of 12 60-minute individual counselling sessions. The cognitive-behavioural portion of the intervention is targeted at addressing gambling-related cognitive distortions (e.g., the idea that the gambler can control random events). Motivational interviewing techniques are included to address participant ambivalence about his/her gambling.
Approximately 8 therapists will provide treatment (4 CMBT and 4 TAU, randomly assigned using flip of a coin.) The therapists enrolled in CMBT will be trained for the study. TAU therapists will be offered training in CMBT once study recruitment goals have been met (thus, eventually all therapists will receive training in CMBT). Prior to providing treatment, therapists selected to administer CMBT will receive intensive training in administration of this approach. The therapists will be selected from the professional staff of the Windsor Regional Hospital's Problem Gambling Services.
-Waitlist control condition (WLC) - WLC participants will wait 12-weeks to begin treatment.
At that point, participants will be randomly assigned to receive TAU or CMBT and will proceed through the same study phase (i.e., treatment and follow-up).
Participants will undergo assessments at intake, post-treatment, 6- and 12-months.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 150
- Main Study: Participants must score at least a 5 on the NODS, and have gambled in the previous two months. Participants must speak English and be able to provide informed consent.
- Pilot Phase: Participants must be patients of the Problem Gambling Services at Windsor Regional Hospital.
- Main Study: Acute psychosis, mania or suicidality for which the participant needs immediate treatment, and current enrollment in formal problem gambling treatment (other than the current admission).
- Participants with a co-occurring psychiatric or substance use condition will receive referrals to appropriate ancillary services.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 12-week wait list 12-week wait list Participant will start treatment 12 weeks from day of consent. Cognitive Motivational Behavior Therapy Cognitive Motivational Behavior Therapy An approach that addresses motivation to change gambling and behavioral patterns related to gambling. Treatment As Usual Treatment as Usual The standard treatment usually provided at the clinic.
- Primary Outcome Measures
Name Time Method Changes in pathological gambling severity through treatment changes in gambling severity from baseline at post-treatment Changes in problem gambling severity through follow-up Changes in gambling severity from post-treatment through 6-month and 12-month follow-up periods
- Secondary Outcome Measures
Name Time Method Examine putative mechanisms of action of "cognitive motivational behavior therapy" relative to "treatment as usual". Baseline, and changes in gambling mechanisms of action from baseline at post-treatment, 6 and 12 months after beginning treatment Assess treatment motivation, coping style, cognitive distortions, psychiatric severity and gambling self-efficacy before and after treatment.
Trial Locations
- Locations (1)
Windsor Regional Hospital Problem Gambling Services
🇨🇦Windsor, Ontario, Canada