Are the Effects of Cognitive-Behavioral Techniques for Gambling-Related Harms Overestimated? A Meta-Analysis

Session Title

Session 2-3-C: Problem Gambling Treatment Considerations

Presenters

Rory A. Pfund, University of MemphisFollow
David P. Forman, University of New MexicoFollow
Shelby A. King, East Tennessee State UniversityFollow
Meredith K. Ginley, East Tennessee State UniversityFollow
Samuel C. Peter, Durham VA Medical CenterFollow
Nicholas W. McAfee, University of Mississippi Medical CenterFollow
James P. Whelan, University of MemphisFollow

Presentation Type

Paper Presentation

Location

Park MGM, Las Vegas, NV

Start Date

24-5-2023 1:30 PM

End Date

24-5-2023 3:00 PM

Disciplines

Clinical Psychology

Abstract

Comprehensive reviews have touted cognitive-behavioral (CB) techniques as the treatment elements with the most robust empirical support for treating gambling-related harms. However, these meta-analyses contain methodological weaknesses that limit understanding of how strongly CB techniques affect gambling disorder symptom severity and dimensions of gambling behavior. Specifically, prior meta-analyses have not thoroughly conducted publication bias analyses or examined the impact of heterogeneity in effect sizes estimates from individual studies on overall weighted effect sizes yielded from meta-analysis.

Following best practice guidelines, we identified 29 studies representing 3,991 participants. CB techniques significantly reduced gambling disorder symptom severity (g = -1.14), gambling frequency (g = -0.54), and gambling intensity (g = -0.32) at posttreatment relative to control. However, publication bias analyses indicated that studies with low sample sizes skew these estimates of treatment effects; only a few studies with large sample sizes exist across the literature. Furthermore, high heterogeneity was concerning in that the effect sizes in future studies were estimated to range from large reductions to deterioration (g = -2.58 to g = 1.42). Clearly, large, carefully designed, and funded treatment outcome studies are necessary to confidently understand how best help individuals with gambling-related harms.

CB techniques are a promising treatment for gambling-related harms, but the effects of techniques are probably overestimated. Furthermore, techniques may not be reliably efficacious for all individuals seeking treatment for gambling-related harms. More randomized controlled trials are needed to yield precise estimates of the effect of treatment.

Keywords

treatment gambling disorder problem gambling outcome cognitive-behavioral CBT

Author Bios

Rory A. Pfund, PhD is a Research Assistant Professor of Psychology and the Clinic and Research Director of The Institute of Gambling Education and Research at the University of Memphis. Dr. Pfund’s research focuses on understanding the effects of psychological treatments for gambling disorder. He is currently the co-investigator on a grant from the Tennessee Department of Mental Health and Substance Abuse Services to develop a web-based portal to facilitate the initiation of gambling disorder treatment.

David P. Forman, MS, MSW is doctoral candidate in the Department of Psychology at the University of New Mexico and a predoctoral fellow at the Center on Alcohol, Substance Abuse, & Addictions. His research focuses on the process and dissemination of motivational interventions to improve outcomes in alcohol, substance use, and other behavioral domains.

Shelby A. King, MS is a clinical psychology doctoral student at East Tennessee State University in the Prevention Education and Treatment of Addiction Learning Lab. Her research focuses on studying transdiagnostic risk factors underlying addiction and other risky health behaviors. Additionally, she is interested in intervention and treatment research and identifying mechanisms that improve clinical outcomes for individuals with addictions.

Meredith K. Ginley, PhD is an Assistant Professor in the Department of Psychology at East Tennessee State University and a co-investigator at The Institute for Gambling Education and Research. Her research focuses on efforts to improve outcomes and retention in treatment for substance use disorders and behavioral addictions.

Samuel C. Peter, PhD is a Clinical Staff Psychologist working at the Durham VA Health Care System in Durham, NC. He graduated with his doctoral degree from the University of Memphis in 2021. His research has primarily focused on how to best engage and retain individuals experiencing trauma- and addictions-related concerns in helping services. He is an alumni of The Institute of Gambling Education and Research.

Nicholas W. McAfee, PhD is an Assistant Professor in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center and serves as the Director of the UMMC Student Counseling and Wellness Center. His research is primarily focused on interventions for addictions, including problem gambling, and training healthcare providers in evidenced-based practices to assess and treat addictive behaviors.

James P. Whelan, PhD is a University of Memphis Professor of Psychology and Director of The Institute for Gambling Education and Research. He leads the Institute’s initiative to develop a research center response for all living in the U.S. state of Tennessee – a project funded by Tennessee’s Department of Mental Health and Substance Abuse Services. His research spans prevention, assessment, and treatment of gambling disorder.

Funding Sources

This project was funded by the Tennessee Department of Mental Health and Substance Abuse Services. The funding source had no involvement in any aspects of the research, including the decision to submit the abstract.

Competing Interests

None