A Proof of Concept for Using Brief Dialectical Behavior Therapy as a Treatment for Problem Gambling

Abstract

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress, mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single DBT process skill, and the benefits of using group-based approaches.

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

“…These interventions may include dialectical behavior therapy, other mindfulness-based approaches, schema-focused therapy, mentalization-based treatment, interpersonal therapy, and contingency management (Blaszczynski and Nower 2002;Christensen et al 2013;Dowling et al 2014;Gibbon et al 2010;Stoffers et al 2012). Many of these interventions address the psychological problems associated with comorbid problem gambling and personality disorders in this study, such as impulsivity, distress intolerance, PTSD symptoms, psychological distress, and impairment in functioning.…”

“…Many of these interventions address the psychological problems associated with comorbid problem gambling and personality disorders in this study, such as impulsivity, distress intolerance, PTSD symptoms, psychological distress, and impairment in functioning. Indeed, there is preliminary evidence that mindfulness-based approaches such as modified dialectical behaviour therapy, mindfulness-based cognitive therapy, and meditation awareness training are effective in improving gambling behaviour, psychological distress, mindfulness, distress tolerance, anger, and substance use in problem gamblers (Christensen et al 2013;de Lisle et al 2011de Lisle et al , 2012de Lisle et al , 2014Korman et al 2008;Shonin et al 2014;Toneatto et al 2007). The efficacy of interventions specifically designed for problem gamblers with comorbid personality disorders clearly represents an area of future research.…”

Mindfulness and problem gambling treatment

“…They found that the integrated treatment model reduced substance use, but no measure of specific mindfulness skills were reported. Recently, Christensen et al (2013) reported an evaluation of the use of a modified DBT approach with treatment-resistant problem gamblers. They found that mindfulness improved significantly from pre-test to post-test.…”

“…According to Shonin et al (2013b) andde Lisle et al (2012), little research has been conducted on the use of mindfulness for problem gambling treatment. As noted above, there have been two case studies published about mindfulness (see, de Lisle et al, 2011) and two research studies that evaluated DBT (Korman et al, 2008;Christensen et al, 2013). The study by Christensen et al (2013) reported that the intervention resulted in significant improvements in the participants' level of dispositional mindfulness.…”

“…As noted above, there have been two case studies published about mindfulness (see, de Lisle et al, 2011) and two research studies that evaluated DBT (Korman et al, 2008;Christensen et al, 2013). The study by Christensen et al (2013) reported that the intervention resulted in significant improvements in the participants' level of dispositional mindfulness. In general, there has been relatively little published research on the use of mindfulness for problem gamblers.…”