Abstract
BackgroundThe main focus of the non-pharmacological treatment of Gambling Disorder (GD) is the behaviour, cognition and motivation of the patient, addressing the psychological determinants of gambling. Although there is not a gold standard non-pharmacological treatment yet, many studies already had promising results, and the outcomes were even better when pharmacotherapies were combined with psychotherapies. This review intended to synthesise the efficacy of various available non-pharmacological therapies for GD evaluated in randomized controlled trials.MethodsA systematic search was conducted in PubMed and in Cochrane Library for randomized controlled trials. Studies were included if participants had GD as their primary diagnosis and excluded if patients had other comorbidities.ResultsFrom 320 records identified, 22 studies were included in the critical appraisal. They included a total of 1694 patients, with a mean age of 42.94 years, and a 62.31% of males. Seven trials revealed the efficacy of cognitive behaviour therapy in improving significantly the outcomes. Three studies assessing cognitive therapy showed significant improvements in gambling symptoms, while one study showed improvements in gambling behaviour using exposure therapy. Combined or separate motivational interviewing and imaginal desensitization had significant results in 4 trials. Four other studies also showed efficacy for: couples therapy, node-link mapping therapy, 12-step facilitated and personalized feedback intervention. Physical exercise had promising results but did not reach significance.ConclusionThe literature included in this review showed the heterogeneity of available psychotherapies. The majority of studies supported the efficacy of the tested therapies, while some of them, due to limitations such as small sample sizes or inadequate control groups, failed to reach significance.
Highlights
The main focus of the non-pharmacological treatment of Gambling Disorder (GD) is the behaviour, cognition and motivation of the patient, addressing the psychological determinants of gambling
The results showed that the virtual reality group had significant reductions on gambling severity (CPGI score), diagnostic criteria (DIG score) and dysfunctional gambling beliefs (GRCS score) at 2-week follow-up, without statistically significant differences compared to controls
The internetbased approach is an innovative format of Cognitive-behavioural therapies (CBT) as it can be offered as a way of enabling gamblers to overcome many of the barriers that prevent them from accessing traditional forms of treatment, as it is more versatile and convenient to the patient than the classical therapy [25]
Summary
The main focus of the non-pharmacological treatment of Gambling Disorder (GD) is the behaviour, cognition and motivation of the patient, addressing the psychological determinants of gambling. There is not a gold standard non-pharmacological treatment yet, many studies already had promising results, and the outcomes were even better when pharmacotherapies were combined with psychotherapies. In the DSM-5, GD is classified as an addictive disorder rather than as an impulse control disorder (in DSMIV) [2]. Any pharmacological treatment has yet to be approved for GD, many studies have already had promising results regarding its efficacy, both in pharmacological-only schemes and in combination with psychotherapies [4]. Topiramate combined with behavioural therapy could be used to treat patients without comorbidities, while Escitalopram may be effective for the treatment of patients with cooccurring affective disorders [2]
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