Cognitive behavioral therapy (CBT) considers how a person’s thought patterns affect behavior and choices. By learning to recognize and address faulty ways of thinking, behavioral health clients can change their behaviors, potentially improving their symptoms and quality of life.
CBT, which can occur as individual or group sessions, encourages clients to talk about their thoughts and feelings, difficulties, desires, and goals. Clients learn new ways of self-talk, interpreting a situation, and responding to challenges. They can learn to recognize inaccurate or unhealthy thought patterns and adopt more productive patterns.
A person with problem gambling (also known as excessive gambling, gambling addiction, compulsive gambling, or a gambling disorder) feels compelled to gamble despite negative consequences. He or she may want to stop gambling, but feels that they cannot. This condition has been listed as an impulse-control disorder in the DSM-5.
Clinicians and their clients have successfully used CBT to address problem gambling. Let’s take a look at how this might work.
How is CBT used for problem gambling?
CBT follows some general principles, but the specific process may look different for each therapist and client. Overall, clinicians should use CBT to coach their clients to identify the thoughts and attitudes that may prompt them to gamble.
For example, a behavioral health client may believe that lucky objects or specific circumstances may make them more likely to win at gambling. Alternatively, a client may engage in logical fallacies, such as sunk cost fallacy or the gambler’s fallacy. A client also may identify other feelings or circumstances that increase their desire to gamble.
Once these triggers have been identified, the clinician and client can work together to develop individualized strategies to change these thought processes. Eventually, this can improve the client’s decision-making and behavior.
How can CBT be individualized for gambling addiction?
An article published in BMC Psychiatry in 2022 recommends some specific gambling-related behaviors that CBT can target. The authors noted that there are several pathways to problem gambling, including conditioned, emotional, and impulsive. Understanding which of these pathways apply to individual clients can help clinicians better tailor their CBT approach.
Some specific areas to target include:
- Antecedents, or events that occur before gambling behavior occurs, such as receiving a salary deposit or being alone
- Feelings that trigger gambling, such as feeling exhilarated, bored, or anxious
- Substance use before gambling
- Physiological responses to gambling, such as an endorphin rush
- Emotional states when gambling, such as avoiding negative feelings like anxiety or boredom, or feeling in control or focused
After identifying potential triggers for gambling, and the experiences that reinforce it, clinicians and clients can work on strategies to change thoughts and behaviors. Possibilities include:
- Learning mindfulness to reduce gambling
- Identifying and avoiding gambling triggers, such as specific locations or individuals
- Tracking days spent gambling and not gambling, and rewarding non-gambling behavior
- Practicing alternatives to gambling, such as calling a friend when feeling alone
- Considering future events that may make it difficult to avoid gambling and how to prevent relapse
Like any other behavioral health treatment, CBT for problem gambling should be customized to each individual client. Staying up-to-date on recent research and best practices can help clinicians determine the best route for each client.
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