Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T05:25:51.080Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 April 2013

Darren R. Christensen ,
Nicki A. Dowling ,
Alun C. Jackson ,
Meredith Brown ,
James Russo ,
Kate L. Francis  and
Azusa Umemoto
Darren R. Christensen*
Affiliation:
Problem Gambling Research and Treatment Centre, University of Melbourne, Melbourne, Victoria, Australia
Nicki A. Dowling
Affiliation:
Problem Gambling Research and Treatment Centre, University of Melbourne, Melbourne, Victoria, Australia
Alun C. Jackson
Affiliation:
Problem Gambling Research and Treatment Centre, University of Melbourne, Melbourne, Victoria, Australia
Meredith Brown
Affiliation:
School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
James Russo
Affiliation:
Gamblers Help North Western, Melbourne, Victoria, Australia
Kate L. Francis
Affiliation:
Problem Gambling Research and Treatment Centre, University of Melbourne, Melbourne, Victoria, Australia
Azusa Umemoto
Affiliation:
Problem Gambling Research and Treatment Centre, University of Melbourne, Melbourne, Victoria, Australia
*
Address for correspondence: Darren Christensen, Problem Gambling Research and Treatment Centre, University of Melbourne, 100 Leicester Street, Melbourne VIC 3010, Australia. Email: [email protected]
Get access

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.

Keywords

problem gamblingdialectical behavior therapyborderline personality disordertreatment
Type
Standard Papers
Information
Behaviour Change , Volume 30 , Issue 2 , June 2013 , pp. 117 - 137
Copyright
Copyright © The Authors 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (APA). (2000). Diagnostic and statistical manual for mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
Axelrod, S.R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behaviour therapy. The American Journal of Drug and Alcohol Abuse, 37, 37–42.Google Scholar
Bagby, M., Bachon, D.D., Bulmash, E., & Quilty, L.C. (2008). Personality disorders and pathological gambling: A review and re-examination of prevalence rates. Journal of Personality Disorders, 22, 191–207.Google Scholar
Berk, M.S., Jeglic, E., Brown, G.K., Henriques, G.R., & Beck, A.T. (2007). Characteristics of recent suicide attempters with and without borderline personality. Archives of Suicide Research, 11, 91–104.CrossRefGoogle ScholarPubMed
Binks, C., Fenton, M., McCarthy, L., Lee, T., Adams, C.E., & Duggan, C. (2006). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, John Wiley & Sons.Google Scholar
Black, D.W., Blum, N., Pfohl, B., & Hale, N. (2004). Suicidal behaviour in borderline personality disorder: Prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders, 18, 226–239.CrossRefGoogle ScholarPubMed
Bohus, M., Haaf, B., Stiglmayr, C., Pohl, U., Bohme, R., & Linehan, M. (2000). Evaluation of inpatient dialectical-behavioral therapy for borderline personaility disorder: A prospective study. Behaviour Research and Therapy, 38, 875–887.Google Scholar
Bouchard, S., Sabourin, S., Lussier, Y., & Villeneuve, E. (2009). Relationship quality and stability in couples when one partner suffers from borderline personality disorder. Journal of Marital and Family Therapy, 35, 446–455.CrossRefGoogle ScholarPubMed
Bray, S., Barrowclough, C., & Lobban, F. (2007). The social problem-solving abilities of people with borderline personality disorder. Behaviour Research and Therapy, 45, 1419–1417.Google Scholar
Bush, K., Kivlahan, D.R., McDonell, M.B., Fihn, S.D., & Bradley, K.A. (1998). The AUDIT alcohol consumption questions (AUDIT-C). Archives of Internal Medicine, 158, 1789–1795.CrossRefGoogle ScholarPubMed
Carter, G.L., Willcox, C.H., Lewin, T.J., Conrad, A.M., & Bendit, N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Australian New Zealand Journal of Psychiatry, 44, 162–173.Google Scholar
Cohen, J. (1988). Statistical power for the behavioural sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
Crockford, D.N., & el-Guebaly, N. (1998). Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry, 43, 43–50.Google Scholar
Crowell, S.E., Beauchaine, T.P, & Linehan, M.M. (2009). A biosocial development model of borderline personality: Elaborating and extending Linehan's theory. Psychological Bulletin, 135, 495–510.Google Scholar
de Lisle, S., Dowling, N.A., & Allen, S. (2011). Mindfulness-based cognitive therapy for problem gambling. Clinical Case Studies, 10, 210–228.Google Scholar
Delfabbro, P., Lahn, J., & Grabosky, P. (2006). Psychosocial correlates of problem gambling in Australian students. Australian and New Zealand Journal of Psychiatry, 40, 587–595.CrossRefGoogle ScholarPubMed
Dowling, N., Smith, D., & Thomas, T. (2007). A comparison of individual and group cognitive-behavioural treatment for female pathological gambling. Behaviour Research and Therapy, 45, 2192–2202.CrossRefGoogle ScholarPubMed
Echeburua, E., & Fernandez-Montalvo, J. (2008). Are there more personality disorders in treatment-seeking pathological gamblers than in other kinds of patients? A comparative study between the IPDE and MCMI. International Journal of Clinical and Health Psychology, 8, 53–64.Google Scholar
Evans, K., Tyer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., . . . Thompson, S. (1999). Manual-assisted cognitive-behaviour therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 22, 19–25.Google Scholar
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.P. (2007). Mindfulness and emotion regulation: The development and initial valudation of the Cognitive and Affective Mindfulness Scale — Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29, 177–190.Google Scholar
Fernandez-Montalvo, J., & Echeburua, E. (2004). Pathological gambling and personality disorders: An exploratory study with the IPDE. Journal of Personality Disorders, 18, 500–505.CrossRefGoogle ScholarPubMed
Ferris, J., & Wynne, H.J. (2001). The Canadian Problem Gambling Index. Ottawa: Canadian Centre on Substance Abuse.Google Scholar
Grant, J.E., & Kim, S.W. (2005). Quality of life in kleptomania and pathological gambling. Comprehensive Psychiatry, 46, 34–37.Google Scholar
Gratz, K.L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.Google Scholar
Hills, A. (2005). Foolproof guide to statistics using SPSS (2nd ed.). Sydney, Australia: Pearson Education Australia.Google Scholar
Holtgraves, T. (2009). Evaluating the Problem Gambling Severity Index. Journal of Gambling Studies, 25, 105–120.Google Scholar
Huang, K., Szabó, M., & Han, J. (2009). The relationship of low distress tolerance to excessive worrying and cognitive avoidance. Behaviour Change, 26, 223–234.Google Scholar
Jacob, G.A., Guenzler, C., Zimmermann, S., Scheel, C.N., Rüsch, N., . . . Lieb, K. (2008). Time course of anger and other emotions in women with borderline personality disorder: A preliminary study. Journal of Behavior Therapy and Experimental Psychiatry, 39, 391–402.Google Scholar
Jacobson, N.S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
Kaare, P., Mottus, R., & Konstabel, K. (2009). Pathological gambling in Estonia: Relationships with personality, self-esteem, emotional states and cognitive ability. Journal of Gambling Studies, 25, 377–390.Google Scholar
Kessler, R.C., Andrews, G., Colpe, L.J., Hiripi, E., Mroczek, D.K., Normand, S.L.T., Walters, E.E., & Zaslavsky, A.M. (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.Google Scholar
Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E., . . . Zaslavsky, A.M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184–189.CrossRefGoogle ScholarPubMed
Kim, S.W., Grant, J.E., Eckert, E.D., Faris, P.L., & Hartman, B.K. (2006). Pathological gambling and mood disorders: Clinical associations and treatment implications. Journal of Affective Disorders, 92, 109–116.CrossRefGoogle ScholarPubMed
Koons, C.R., Robins, C.J., Tweed, J.L., Lynch, T.R., Gonzelez, A.M., Morse, J.Q., . . . Bastian, L.A. (2001). Efficacy of dialectical behaviour therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.Google Scholar
Korman, L., Collins, J., Littman-Sharp, N., McMain, S., & Skinner, W. (2005). Concurrent gambling, substance use and anger: Development of a brief integrated treatment (Final report). Guelph, ON: Ontario Problem Gambling Research Centre.Google Scholar
Korman, L., Collins, J., Dutton, D., Dhayananthan, B., Littman-Sharp, N., & Skinner, W. (2008). Problem gambling and intimate partner violence. Journal of Gambling Studies, 24, 13–23.CrossRefGoogle ScholarPubMed
Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., Doucet, C., Leblond, J., & Christian, J. (2001). Cognitive treatment of pathological gambling. Journal of Nervous and Mental Disease, 189, 774–780.Google Scholar
Ladouceur, R.R., Sylvain, C.C., Boutin, C.C., Lachance, S.S., Doucet, C.C. & Leblond, J.J. (2003). Group therapy for pathological gamblers: A cognitive approach. Behaviour Research and Therapy, 41, 587–596.Google Scholar
Larsen, D.L., Attkisson, C.C., Hargreaves, W.A., & Nguyen, T.D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197–207.Google Scholar
Linehan, M.M. (1987). Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality Disorders, 1, 328–333.Google Scholar
Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford Press.Google Scholar
Linehan, M.M., Armstrong, H.E., Suarez, A., Allmon, D., & Heard, H.L. (1991). Cognitive-behavioral treatment of chronically suicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.Google Scholar
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., & Heard, H.L., . . . Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.CrossRefGoogle ScholarPubMed
Lopez Viets, V.C., & Miller, W.R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review, 17, 689–702.Google Scholar
Lorains, F.K., Cowlishaw, S., & Thomas, S. (2011). Prevalence of co-morbid disorders in problem and pathological gambling. Addiction, 106, 490–498Google Scholar
MacCallum, F., & Blaszczynski, A. (2003). Pathological gambling and suicidality: An analysis of severity and lethality. Suicide and Life Threatening Behavior, 33, 88–98.Google Scholar
MacKay, M., Wood, J.C., & Brantley, J. (2007). Dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation, & distress tolerance. Oakland, CA: New Harbinger Publications.Google Scholar
McMain, S.F., Links, P.S., Gnam, W.H., Guimond, T., Cardish, R.J., Korman, L., & Streiner, D.L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166, 1365–1374Google Scholar
McMillen, J., Marshall, D., Wenzel, M., & Ahmed, A. (2004). Validation of the Victorian gambling screen. Melbourne, Australia: Gambling Research Panel.Google Scholar
Miller, A.L., Wyman, S.E., Huppert, J.D., Glassman, S.L., & Rathus, J.H. (2000). Analysis of behavioral skills utilized by suicidal adolescents receiving dialectical behavior therapy. Cognitive and Behavioral Practice, 7, 183–187.Google Scholar
Morey, L.D. (1991). Personality Assessment Inventory. Lutz, FL: Psychological Assessment Resources.Google Scholar
Neal, P., Delfabbro, P., & O'Neil, M. (2005). Problem gambling and harm: A national definition. Adelaide, Australia: South Australia Centre for Economic Studies.Google Scholar
Nower, L., & Blaszczynski, A. (2006). Impulsivity and pathological gambling: A descriptive model. International Gambling Studies, 6, 61–75.Google Scholar
Osman, A., Bagge, C., Gutierrez, P., Konick, L., Kopper, B., & Barrios, F. (2001). The Suicidal Behaviours Questionnaire — Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454.Google Scholar
Petry, N.M. (2005). Pathological gambling: Etiology, comorbidity, and treatment. Washington, DC: American Psychological Association.Google Scholar
Petry, N.M. (2007). Gambling and substance use disorders: Current status and future directions. The American Journal on Addictions, 16, 1–9.CrossRefGoogle ScholarPubMed
Querney, D. (2006). STEPS: A modified DBT group for preventing relapse among problem gamblers and substance abusers. Retrieved December 14, 2011, from http://www.responsiblegambling.org/articles/deirdre_querney_discovery_2006.pdfGoogle Scholar
Rathus, J.H., & Miller, A.L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32, 146–157.Google Scholar
Saunders, J.B., Aasland, O.G., Babor, T.F., De La Guente, J.R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88, 791–804.Google Scholar
Simons, J., & Gaher, R. (2005). The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83–102.CrossRefGoogle Scholar
Stanley, B., & Wilson, S.T. (2006). Heightened subjective experience of depression in borderline personality disorder. Journal of Personality Disorders, 20, 307–318.Google Scholar
Ste-Marie, C., Gupta, R., & Derevensky, J. (2006). Anxiety and social stress related to adolescent gambling behavior and substance use. Journal of Child and Adolescent Substance Abuse, 15, 55–74.Google Scholar
Stepp, S.D., Epler, A.J., Jahng, S., & Trull, T.J. (2008). The effect of dialectical behaviour therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22, 549–563.Google Scholar
Toneatto, T., Vettese, L., & Nguyen, L. (2007). The role of mindfulness in the cognitive-behavioural treatment of problem gambling. Journal of Gambling Issues, 19, 91–100.Google Scholar
Trull, T., Sher, K.J., Minks-Brown, C., Durbin, J., & Burr, R. (2000). Borderline personality disorder and substance use disorders: A review and integration. Clinical Psychology Review, 20, 235–253.CrossRefGoogle ScholarPubMed
Wanner, B., Ladouceur, R., Auclair, A.V., & Vitaro, F. (2006). Flow and dissociation: Examination of mean levels, cross links and links to emotional well being across sports and recreational and pathological gambling. Journal of Gambling Studies, 22, 289–304.Google Scholar
Weinstock, J., Whelan, J.P., Meyers, A.W., & McCausland, C. (2007). The performance of two pathological gambling screens in college students. Assessment, 14, 399–407.CrossRefGoogle ScholarPubMed