This section provides a general overview of Mindfulness-Based Relapse Prevention for Problem Gambling as well as an overview of the evidence regarding the use of mindfulness for problem gambling. Learn more about applying mindfulness in your practice in the
Putting it into Practice section.
The concept of mindfulness as it is known today originated from Buddhist contemplative practices that date back over 2,500 years. The practice was born from a quest to achieve enlightenment and end suffering. In recent years, mindfulness has increasingly been integrated into a variety of physical and mental health care programs. For example, it has been used to help clients deal with chronic pain and cope with cancer. It has also been used to help clients with mental health problems, including depression and substance use problems. Several studies report positive effects of mindfulness meditation. Morone et al. (2008) reported that meditation helped their clients relieve pain as well as improve their attention, sleep and sense of well-being. Similarly, Shonin et al. (2013a) reported that participants with issues of stress and low mood experienced an improvement in psychological well-being because of receiving meditation awareness training. Based on its effectiveness with other conditions, Toneatto et al. (2007) speculated on the role mindfulness could play in problem gambling recovery.
What is mindfulness?
Mindfulness is essentially an awareness and acceptance of your own moment-to-moment experience, including thoughts, emotions and body sensations. It is non-judgmental awareness, but it also involves a sense of detachment from thoughts, emotions and body sensations. That is, you are aware of the content of your thoughts but are not consumed by them or feel that you must act upon them—you can let them slide in and out of awareness. It is well known that you cannot will yourself to stop thinking about something. In fact, the opposite happens—trying not to think about something makes it more difficult to unhook the thought. Rather than trying to suppress unwanted thoughts, being mindful brings awareness to those thoughts and lets them be. This process is one of the key principles taught in a mindfulness class.
Introduction of mindfulness to Western approaches
In 1979, Jon Kabat-Zinn pioneered the implementation of mindfulness in Western medicine through the development of his Mindfulness-Based Stress Reduction (MBSR) program. His focus was to treat patients at the University of Massachusetts Memorial Medical Center who suffered from chronic pain and a variety of other medical issues, including HIV and heart disease.
The focus of his mindfulness-based approach, also called acceptance-based approach, is on a person’s relationship to thoughts and emotions. The aim is for clients to become aware of and accept, without judgment, their present-moment experience and to learn to see thoughts and emotions as passing mental events. It is important to understand that the goal of the contemplative practice is not to change experiences or thoughts but simply to “pay attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4).
The beginnings of mindfulness and relapse prevention
One of the first researchers to recognize the potential for mindfulness in the addiction field was Alan Marlatt. Marlatt recognized that the greatest challenge of substance abuse was not quitting but maintaining the changes. Marlatt was a pioneer in the area of relapse prevention. He realized that meditation could act as a coping strategy for people who were at risk for relapse. As such, practicing meditation could be used as a relapse prevention strategy, providing benefits such as reduced stress and improved life balance. According to Marlatt (1985):
[O]ne of the most significant effects of regular meditation practice is the development of mindfulness—the capacity to observe the ongoing process of experience without at the same time becoming ‘attached’ or identifying with the content of each thought, feeling, or image. Mindfulness is a particularly effective cognitive skill for the practice of relapse prevention. If clients can acquire this ability through the regular practice of meditation, they may be able to ‘detach’ themselves from the lure of urges, cravings, or cognitive rationalizations that may otherwise lead to a lapse. (p. 319)
How it works
Rather than trying to suppress the unwanted thoughts, the client is encouraged to cultivate an attitude of curiosity, openness, friendliness, non-judgmental awareness and acceptance of the present-moment experience. It is well known that trying
not to think about something will often fail. Instead, mindfulness teachings encourage clients to allow these thoughts to come into awareness and, rather than getting caught up in them, bring a gentle, non-judgmental awareness to them and let them be. These attitudes are emphasized through teaching and learning about such themes as beginner’s mind, non-judging, acceptance, letting go, trust, patience, non-striving, gratitude and generosity.
A variety of applications of mindfulness
Since the initial work of Kabat-Zinn and Marlatt, mindfulness-based approaches have been integrated into a variety of other therapies/programs, including Dialectical Behaviour Therapy (DBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Relapse Prevention (MBRP). A core element of a number of these programs (e.g., MBSR, MBCT and MBRP) is that they all follow an eight-week group protocol that uses similar mindfulness meditation practices, such as the body scan, mindful eating, sitting meditation (i.e., mindfulness of the breath, body, sounds, thoughts and emotions), mindful walking and yoga.
Effectiveness of a mindfulness-based relapse prevention approach
Mindfulness has been increasingly implemented into addiction programs, including those for problem gambling. The Problem Gambling and Technology Use Treatment Service at the Centre for Addiction and Mental Health (CAMH) introduced mindfulness groups as a regular part of its treatment program in 2010.
The Mindfulness-Based Relapse Prevention for Problem Gambling program at CAMH is for clients attending problem gambling treatment in the action or maintenance stages of change. Their gambling behaviour would need to be stabilized, meaning that the client has goals of abstinence or controlled gambling.
The development of this program was based on the structure and format of MBSR, MBCT and MBRP but has been tailored for people experiencing problems with gambling.
Here are some comments from participants in past groups:
"Now I can recognize what [is] happening internally and separate myself from what I'm thinking."
"I have become more aware of the present moment. I have become more mindful and conscious about the present moment, learning to take things one step at a time."
"My brain is very busy but in this course, I learned how to stay on NOW, in this moment."
"Much better listener and not affected by small things. Conflicts are less severe when you don't react right away."
"Mindfulness/awareness of warning signs and triggers is my main tool to not returning to coping via gambling."
"Learn how to calm down by using the three minute breathing meditation."
"Stop and think before I do any harm or damage to myself."
"I learned to discipline myself better."
"To be able to control going into auto pilot."
"Learned how I sometimes get rid of bad thinking and be relaxed."
"Mental and physical health has improved greatly."
"Feel more positive."
"Always brightened my mood."
"Learned about taking your time on something without stressing yourself."
"I have more patience and am aware of my heartbeat."
"Learn how to calm down—less anxiety."
The aim of a mindfulness approach is for clients to become aware of and accept, without judgment, their present-moment experience and to learn to see thoughts and emotions as passing mental events.
How a mindfulness-based approach can be useful in problem gambling treatment
Cultivating awareness of cognitive distortions and stepping out of automatic pilot
Cognitive factors, such as erroneous beliefs about random chance, play a role in a person’s difficulty with controlling the impulse to engage in repeated, persistent gambling. For example, many problem gambling behaviours (e.g., chasing losses, incremental betting) are linked to erroneous beliefs about the concept of randomness. Yet even if people are taught about the concept of the independence of random events, the act of gambling itself can overpower what they have learned. Furthermore, people with gambling problems often report going into a trance-like state while gambling. Some even report being completely dissociated from their physical body—a passive observer—while their body gambles away their money.
These reports suggest that problem gambling often involves automatic thoughts that take place outside of awareness and that people with gambling problems might benefit from greater awareness of their present-moment experience. This may help them avoid slipping into automatic pilot and being overwhelmed by their thoughts. Many attempts have been made to help people with gambling problems by teaching them a greater understanding of probability, but the key problem remaining is that when they gamble, they operate on automatic pilot. According to Toneatto et al. (2007):
[D]istinguishing mental events from the responses to them provides a choice to the gambler regarding how best to respond, rather than react, to gambling related cognition. It is argued that improving gambler’s mindfulness can help them overcome the erroneous beliefs and automatic behaviours associated with problem gambling. Learning to relate differently to gambling cognitions may be as important as, if not more important than, challenging the specific content of the thoughts. (p. 94)
Therefore, the mindful approach to erroneous cognitions brings awareness to those thoughts and, in particular, the
automatic nature of those thoughts. By bringing awareness to their thoughts, clients can recognize that these are just thoughts and not act on them. As noted, people with gambling problems often do know that these thoughts are inaccurate but, in the excitement of gambling, simply go into automatic pilot. Mindfulness may be a means of breaking out of that cycle by helping the client avoid automatic pilot.
Seeing thoughts and emotions as passing mental events
If people learn how to cultivate non-judgmental awareness of their thoughts and emotions by practicing mindfulness, the urges and cravings that often drive them to gamble or relapse may be overcome.
One technique of mindfulness is an "urge surfing" analogy to help clients cope with the intensity of their cravings. Riding the wave of craving (i.e., the urge to gamble) is like riding on a surfboard without being submerged by the intensity of the wave. Clients accept the idea that the urge will happen, but through this meditation exercise, they become aware of their urges and therefore are not ruled by them.
The key learning here is recognizing the impermanence of all experiences and understanding that urges are passing mental events that do not have to be acted upon or fought. One simply accepts the urges as thoughts, feelings and body sensations—nothing more—and lets them slide in and out of awareness.
The nine attitudes of mindfulness in Jon Kabat-Zinn’s Full Catastrophe Living
The following attitudes that help deepen mindfulness can be useful in many areas of someone’s life, including having to cope with addictive behaviours like problem gambling. These attitudes can provide a different perspective, which can help with stress management, emotion regulation and impulse control. These attitudes are all interrelated and overlap with each other.
Beginner’s mind: Seeing something as if you are seeing it for the first time. Bringing an attitude of "not knowing" to every situation, for only then can you truly "bear witness." Zen Master Shunryu Suzuki once said, "In the beginner’s mind there are many possibilities, but in the expert’s there are few" (Suzuki, 1970, p. 21). This could be similar to the way babies see the world—with wonder and curiosity and without any language.
Non-judging: Not trying to get rid of judgment but instead becoming aware of your judging nature. Seeing things as they are, while being aware of any judgment, allows you to see things clearly and stops you from being compelled to act while on automatic pilot.
Acceptance: Accepting the way things are and not the way you want them to be. Resisting the way things are is not accepting but rather creates suffering. Accepting does not mean you have to like or condone what is. Acceptance is the first step toward change.
- The Serenity Prayer can help here: "Grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference."
Letting go: Allowing things to be as they are when you catch yourself grasping or clinging to something (e.g., an idea)—letting go or letting be is the opposite of clinging and grasping. Not getting too caught up in having things another way from what they already are. This can be the doorway to freedom. Every time we take a breath in, we have to let it go.
Trust: Trusting in the wisdom of the body and life. Many vital bodily functions happen on their own, without the need for us to do anything. For instance, plants grow, and our bodies can breathe on their own. Trust in the flow of life.
Patience: Being here and now and not always trying to get to the next moment. We are always rushing to get to the next thing that we never appreciate the present. Patience can protect us from getting angry and help us keep calm under pressure.
Non-striving: Cultivating being and non-doing. Not having to get anywhere or change anything. Letting things be as they are and going with the flow of life. Cultivating the
being mind as opposed to the
Gratitude: Being grateful for what you have and not focusing on what you do not have. This can protect you from constantly complaining and finding the negatives in things.
Generosity: Serving others without expecting anything in return. Cultivating an attitude of giving rather than clinging. The greatest gift that you can give anyone is your non-judgmental presence.
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