Does Money Control Enhance the Effectiveness of CBT for Gambling Disorder?

Abstract

Several therapy modalities have been developed for gambling disorder (GD), and the cognitive behavioral therapy (CBT) is one of the most promising approaches. The objective of this study was to explore the impact of patients’ adherence to guidelines concerning money control on the effectiveness and outcomes of a CBT program. Sample included n = 998 gambling disorder (GD) patients aged between 18 and 80 years old, who were consecutively attended in a Spanish reference-university-based hospital specialized in gambling treatment. The CBT program consisted of 16 weekly group sessions (each lasting about 90 min) aimed to achieve definitive abstinence from all types of gambling. Money control was integrated during the complete treatment. Different assessments were made: at baseline, during the CBT program, and at the end of the intervention. The risk of dropout during therapy was lower in patients who reported money control (19.1% versus 76.4%, p = 0.001), and differences were also found in the Kaplan-Meier cumulative survival functions of dropout (χ2 = 118.9, p < 0.001). No differences were found for the risk of relapse (defined in this study as the occurrence of gambling episodes during the intervention) (26.4% versus 28.0%, p = 0.775) or in the cumulative survival function of relapse (χ2 = 0.16, p = 0.689). At the end of the intervention, patients with money control had lower levels of gambling severity and comorbid psychopathology. The benefits of money control as a stimulus control during the CBT highlight the need to design intervention programs with reliable adherence strategies addressed to achieve complete abstinence from the gambling activities. Personalized interventions for GD should identify patients with higher needs of stimulus control training.