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Cognitive-Behavioural Therapy (CBT)

Cognitive behavioural therapy (CBT) is a best practice in problem gambling treatment.1,2,3 CBT can teach people to identify, question, and change their thoughts and behaviours related to gambling, and respond to problem behaviours in a more productive way.4

Gambling, Gaming & Technology Use
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Cognitive Behavioural Therapy (CBT)

People who have gambling problems often have cognitive distortions (faulty thinking), impulsiveness, and poor decision-making, and reducing these cognitive distortions is an effective way to reduce gambling and stay in recovery.5,6

Research has shown that CBT reduces gambling by helping the person identify the thoughts, attitudes, and beliefs that lead to gambling.1,2,3 The person can then develop strategies to help them change their thought processes and decision-making.7,8

A CBT approach also addresses faulty thinking (also called cognitive distortions)—about the problem behaviour—to help maintain the changes.7,8

This webpage looks at the evidence about CBT and problem gambling and offers practical advice on how to use CBT to help clients gamble less. The content is based on a review of the evidence and was reviewed by an expert in the field of problem gambling.

About CBT

CBT is an intensive, short-term form of structured psychotherapy that takes a problem-oriented and goal-focused approach.1,2,3 It focuses on the relationship between a client’s thoughts, feelings, and behaviours, and teaches clients proven strategies and skills to identify and change problematic thoughts and behavioural patterns.4

When used to treat problem gambling, CBT includes the following elements: 7,8

  • assessment
  • treatment planning, including establishing a therapeutic alliance and collaborative values-based goal setting
  • cognitive and behavioural interventions and
  • planning to prevent relapses.

In CBT, the clinician works with the client to identify, question, and change thoughts, attitudes, and beliefs that may be at the root of their emotional and behavioural difficulties.4 The client learns to better manage problems by identifying and correcting cognitive distortions and by seeing thoughts as ideas rather than as facts.4

Cognitive distortions are thoughts and beliefs that are not based in fact. For instance, a client may believe that wearing a lucky hat would increase the odds of winning at slots. Logically, wearing the hat does not influence the outcome of the client’s play, but believing that it does could cause the person to gamble beyond their intended limit.5

Other examples of cognitive distortion in problem gambling include believing that skills or knowledge can influence the likelihood of winning at cards or sports betting, that playing longer will allow them to recoup losses, and that a certain outcome, such as a roll of the dice, is due to happen.7

For an overview of CBT approaches to problem gambling, watch this video.

What does the evidence say?

A Cochrane systematic review found that CBT reduced the amount of money lost and the severity of gambling.9 Another systematic review and meta-analysis found that CBT was highly effective in reducing problem gambling for all types of gambling up to 24 months after people completed therapy.10

Research also showed that CBT is effective for problem gambling in diverse populations, offering equal chances of recovery regardless of the person’s age, gender, ethnicity, or psychiatric comorbidity.6,11

CBT is effective not only in an in-person, one-on-one format, but also when delivered in group settings or through self-directed online programs with minimal therapist support.12,13,14 A systematic review of Internet-based CBT also found that this format was as effective as in-person CBT.15

Putting the evidence into practice

When treating clients with problem gambling, one main goal of CBT is to help them become aware of their cognitive distortions related to winning and losing.1,2,3,7,8

You can help your client bring their cognitive distortions to light by helping them trace the development of their gambling problem and analyze their gambling-related decisions and motivations, as well as their adoptions of rituals, techniques, or strategies that they believe will increase their likelihood of winning.7,8

Once the client is aware of their own cognitive distortions, you can then help your client modify them by highlighting the discrepancies between their beliefs and reality.1,2,3,7,8 The objective here is to refute the cognitive distortions by helping them see that there is no connection between gambling beliefs and gambling outcomes.5,6

The next step is to work with your client to identify and implement strategies to deal with gambling urges and, at the intermediate stages of therapy, develop a plan to prevent potential relapses.7,8 Clinical experience indicates that identifying a client’s reasons for gambling, and the role of gambling in coping with their challenges or life circumstances, is key to performing CBT for problem gambling. The Inventory of Gambling Situations (IGS) is an evidence-based tool that you can use to help your client identify the situations that lead them to gamble and create an effective plan for relapse prevention.16

As you and your client discuss their feelings towards gambling and their treatment goals, keep in mind that cultural beliefs and values may shape their ideas about gambling and their help-seeking behaviours.17,18 For example, people from cultures that favour gambling, such as some Asian cultures with a strong belief in luck, are more likely to gamble and to develop problems with gambling than are people from other cultures.18

Culture also influences the types of gambling that are socially acceptable and the likelihood that a person will seek help for their problem gambling.18 For some immigrants, stresses related to acculturation can increase the likelihood of developing problem gambling.18

This clinical simulation video show what CBT may look like when working with a client who has problem gambling. This video represents the fourth session between the therapist and client. The client and clinician have already identified problem areas and treatment goals, and have a good therapeutic alliance and trust. Note the clinician’s use of CBT to prevent relapses by identifying triggers and the function of gambling in the client’s life.

If you are interested in CBT training, CAMH offers a cognitive-behavioural therapy certificate program.

Handouts for Clients

CBT Overview - This two-page handout provides a brief description of CBT for problem gambling.
Aussi disponsible en franҫais.

Understanding Your Gambling - This worksheet helps clients identify the situations in which they gamble and their thoughts and feelings about gambling.

Changing Your Thinking - This worksheet helps clients identify their irrational thoughts about gambling and create rational statements to replace them.

Dealing with Urges - This worksheet helps clients identify coping strategies for resisting the urge to gamble.

Slipping and Relapses - This worksheet helps clients identify and plan for situations in which they are at risk of gambling.

References

This information is intended to help clinicians in their use of evidence-informed practice (EIP) when screening, assessing, and treating clients with behavioural addiction(s). Evidence-informed practice, sometimes called evidence-based practice, is a client-centred approach to clinical decision making. It’s a way to solve problems by integrating the best available research evidence with the clinician’s experience, the client’s preferences and values, and the organizational and cultural context.1,2,3,4