Table 3.
Summary table of non-pharmacological treatments for gambling disorder and brief results of the included studies
| Article | Therapy (ies) | Control | Outcome (Primary measures) | Results |
|---|---|---|---|---|
| Nilsson et al. 2019 [35] | 10 sessions of BCT | 10 sessions of CBT | NODS; TLFB-G | BCT group had statistically significant improvements on every outcome; there was not, however, a significant difference between BCT and CBT. |
| Penna et al. 2018 [28] | 16 sessions of an Exercise program | Stretching session | GFS-SR; psychiatric comorbidities | Both groups had statistically significant improvements on both outcomes. The exercise group had significantly greater improvements on psychiatric comorbidities compared to control, but no significantly differences on GFS-SR scale. |
| Casey et al. 2017 [25] | 6 sessions of I-CBT | I-MFS and waitlist | G-SAS; SOGS; GRCS; GUS; DASS; gambling amount; gambling frequencya | Compared to the waitlist, the I-CBT group had significant reductions on every outcome, at follow-up. Compared to the I-MFS group, I-CBT showed significant reductions in gambling urges (GUS), gambling related cognitions (GRCS) and in depression, anxiety and stress (DASS). |
| Bouchard et al. 2017 [20] | 4 VR sessions in CBT | 4 imagination control stimuli sessions in CBT | CPGI; DIG; GRCS | The VR + CBT group had significant reductions on every outcome, at post treatment. However, there was no significant differences compared to the control group. |
| Smith et al. 2015 [47] | Twelve 1 h sessions of ET | Twelve 1 h sessions of CT | VGS | ET group significantly improved on VGS score, at post-treatment and at follow-up. However, there was not a significant difference between the treatment and the control groups. |
| Lee et al. 2014 [18] | 12 weekly sessions of CCT | Brief check-in phone calls | G-SAS; BSI; DAS; STIC | CCT group significantly improved on gambling symptoms (G-SAS) and mental distress (BSI), compared with control group, at post-treatment and follow-up. Compared with control, the CCT group significantly improved on systemic functioning (STIC) at post treatment, but did not show significant differences at follow-up. There was no difference between groups on DAS. |
| Grant et al. 2011 [38] | 6 h sessions over 8 weeks of ID+MI | Gamblers Anonymous | PG-YBOCS | ID+MI group significantly improved on PG-YBOCS score, compared to the GA group, at post-treatment. This significant improvement was maintained at the follow-up. |
| Myrseth et al. 2011 [31] | Eight weekly 50 min sessions for 8 weeks CBT | Escitalopram | G-SAS; PGVAC | At post-treatment (8 weeks) and at 6 months follow-up, both groups showed improvements on every outcome. However, there was no significantly difference between groups. |
| Marceaux et al. 2010 [48] | Two weekly sessions over 8 weeks of CBT-mapping or TSF | Waitlist | DSM-IV criteria; self-efficacy; frequency of gamblinga; desire to gamble | At post treatment and 6 months follow up, both treatment groups significantly improved on every outcome, except for desire to gamble. However, there was no significant differences between both treatment groups. |
| Grant et al. 2009 [39] | Six 1 h session for 8 weeks of ID+MI | Gamblers Anonymous | PG-YBOCS; G-SAS | ID+MI group significantly improved on every outcome, after the 8 weeks treatment, compared to the GA group. |
| Myrseth et al. 2009 [29] | 6 sessions of 2 h CBT in group | Waitlist | Money spent per week; GINC and DSM-IV | CBT group had a significant decrease in DSM-IV criteria, compared to control; however, the improvements on money spent per week and GINC were non significant, compared to control. The CBT group significantly improved on every outcome, at 3-months follow-up. |
| Carlbring et al. 2009 [36] | four 50 min sessions of MI or eight 3 h sessions of CBT | Waitlist | NODS | Both CBT and MI groups significantly improved on NODS, compared to the control group, at post-treatment and at 12 months follow-up. There were no significant differences between the two active treatments at any time. |
| Cunningham et al. 2009 [21] | E-mailed PFI | Waitlist | CPGI; Money spent per 3 months; largest money gamble in a day in the past 3 months | PFI group significantly reduced the total amount of money spent, at follow up, compared with control; there were also improvements on the maximum amount of money spent on one occasion and gambling severity (CPGI) at follow-up, but with no significant difference compared with control. |
| Carlbring et al. 2008 [37] | 8-Week I-CBT | Waitlist | NODS; anxiety; depression; quality of life | I-CBT group significantly improved on every outcome, compared with control; the improvements were maintained significant at 6-, 18- and 36-month follow-up. |
| Dowling et al. 2007 [16] | Twelve 2 h sessions of group CBT or twelve 1.5 h sessions of individual CBT | Waitlist | Gambling frequencya and duration; money inserted; expenditure; BDI-II scores; STAI scores; CSEI scores | The individual group, compared to control, significantly improved on every outcome. The group format treatment, compared to control, significantly improved on every outcome, except for STAI state anxiety scores and CSEI scores. Compared to each other, the two intervention groups showed no significant differences at post-treatment; However, after the 6 month follow-up period, 92% of the individual treatment group participants no longer had criteria for pathological gambling, compared with only 60% of the group treatment group participants. |
| Petry et al. 2006 [41] | 8 Weeks of a CBT workbook or eight 1 h sessions of CBT | Gamblers Anonymous | SOGS; days spent gambling; money spent gambling; abstinence | At post-treatment and 12-month follow-up, the individual CBT group significantly improved on gambling severity (SOGS) and on money spent gambling, compared to the control and to the CBT workbook group. CBT group had significantly greater abstinence rates at post-treatment, compared with the other groups. The outcome days spent gambling did not register any differences between groups. |
| Melville et al. 2004 [14] | 2 weekly 90 min node-link-mapping-enhanced CBT group for 8 weeks | Waitlist | DSM-IV; self-ratings of control of gambling; refrain from gambling; desire to gamble; BDI; BAI | The mapping group significantly improved on every outcome at post-treatment, compared to control. Regarding depression (BDI) and anxiety (BAI), the mapping group had significant reductions compared to the control group, but only the depression improvements were maintained at 6-month follow-up. |
| Ladouceur et al. 2003 [49] | 120 min weekly sessions of CT in group for 10 weeks | Waitlist | DSM-IV; perceived self-efficacy; gamblers’ perception of control; desire to gamble and frequency of gamblinga | CT group, at post-treatment and compared to control, significantly improved on every outcome, except for frequency of gambling and desire to gamble. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. |
| Ladouceur et al. 2001 [50] | Weekly 60 min individual CT session for 20 weeks | Waitlist | SOGS; DSM-IV; gamblers’ perception of control; frequency of gamblinga; perceived self-efficacy; and desire to gamble | CT group significantly improved on every outcome measure, compared with control group; analysis of data from 6 and 12-month follow-up revealed maintenance of therapeutic gains. |
| Sylvain et al. 1997 [51] | 1 or 2 weekly 60-90 min CBT sessions to a maximum of 30 h of treatment | Waitlist | SOGS; perception of control; frequency of gamblinga; perceived self-efficacy; desire to gamble; DSM-III-R | CBT group significantly improved, compared with control group, on every outcome measure, except for hours spent gambling; analysis of data from 6 and 12-month follow-up revealed maintenance of therapeutic gains. |
| Echeburua et al. 1996 [6] | 6 h of CT or 6.5 h of ET or 12.5 h of CT + ET | Waitlist | < 3 episodes of gambling during follow up | ET group and CT group significantly improved on every outcome, compared to the combined treatment and to control, at 6 months follow-up. At 12 months follow up, the ET group already had a significant difference compared to CT. |
| McConaghy et al. 1991 [52] | Five 20 min sessions of ID | Aversive therapy, imaginal relaxation, exposure therapy | Cessation or controlled gambling symptoms | At follow-up, 79% of the patients who received ID therapy showed significant improvements on cessation/controlled gambling symptoms, compared with only 53% of the patients of the control group. |
BCT Behavioural couples therapy, CBT Cognitive-behavioural therapy, I-CBT Internet-based cognitive-behavioural therapy, VR Virtual Reality, CT Cognitive therapy, ET Exposure therapy, CCT Congruence couples therapy, ID Imaginal desensitization, MET Motivational Enhancement Therapy, TSF Twelve-step facilitated, PFI Personalized feedback intervention, I-MFS Internet-based monitoring, feedback and support, NODS National Opinion Research Center DSM Screen for Gambling Problems, TLFB-G The gambling timeline followback, GFS-SR Gambling Follow-up Scale self-report version, G-SAS The gambling symptom assessment scale, SOGS South Oaks Gambling Screen, GUS Gambling Urge Scale, DASS Depression Anxiety Stress Scale, CPGI The Canadian Problem Gambling Index, DIG Diagnostic Interview for Gambling, GRCS Gambling Related Cognitions Scale, VGS Victorian Gambling Screen, BSI Brief Symptom Inventory, DAS Dyadic Adjustment Scale, STIC Systemic Therapy Inventory of Change, PG-YBOCS Pathological Gambling – Yale Brown Obsessive-Compulsive Scale, PGVAC Pathological Gambling Visual Analogue Craving Scale, DSM Diagnostic and Statistical Manual of Mental Disorders, GINC Gamblers Inventory of Negative Consequences, BDI Beck Depression Inventory, STAI State-Trait Anxiety Inventory, CSEI Coopersmith Self-Esteem Inventory, BAI Beck Anxiety Inventory
a a) number of gambling sessions, b) number of hours spent gambling and c) total amount of money they had spent on gambling during the previous week