Abstract
A multi-site pilot randomized controlled trial of Congruence Couple Therapy (CCT) for problem gambling was conducted in Ontario and Alberta, Canada from 2009 to 2011. The purpose was to assess the feasibility of a full trial and to identify methodological modifications to enhance future trials. The sample (N = 30; 15 couples) consisted of 66 % male gamblers and 34 % female. Mean age of sample was 49.1 years. Baseline mean DSM-IV gambling score was 8.7/10. Retention of the treatment couples was 89 % at 2-month follow-up. Retention of control couples was 78 %. A randomized controlled design compared the status of couples in treatment condition to control condition. Treatment couples received 12-week CCT while control couples received three brief check-ins over 12 weeks. No significant difference was found between treatment and control group at baseline on all measures. At (1) week 12 post-treatment, and (2) week 20 follow-up, significant treatment effects were found for gambling symptoms (p = 0.008; p = 0.041), mental distress (p = 0.001; p = 0.035), and family systems function (p = 0.023; p = 0.054) between treatment and control group. Within group changes for treatment couples over time were significant for mental distress (p = 0.000), dyadic adjustment (p = 0.002), and family systems function (p = 0.000). On similar measures, control group showed non-significant improvement. Future methodological changes, advantages and disadvantages of multi-site partnerships with community treatment agencies are discussed. Of interest is that control participants showed unintended improvement. CCT as a treatment was favourably accepted by counselors, problem gamblers and their spouses. Positive outcome trends ranging from small to large effect size on key measures indicate that a full-scaled trial will require approximately 140 couples and is an investment worth pursuing.
Similar content being viewed by others
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Arlington, VA: American Psychiatric Association.
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., et al. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect, 27, 169–190.
Bertrand, K., Dufour, M., Wright, J., & Lasnier, B. (2008). Adapted couple therapy for pathological gamblers: A promising avenue. Journal of Gambling Studies, 24, 393–409.
Bradbury, T. N. (1994). Unintended effects of marital research on marital relationships. Journal of Family Psychology, 8, 187–201.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Cunha, D., & Relvas, A. P. (2013). Pathological gambling and couple: Towards an integrative systemic model. Journal of Gambling Studies, 1–16. doi:10.1007/s10899-013-9366-9. Retrieved on November 21, 2013 http://download.springer.com/static/pdf/67/art%253A10.1007%252Fs10899-013-9366-9.pdf?auth66=1385254001_b8dcdc93f0604ebcada1962dce7f2c23&ext=.pdf.
Derogatis, L. R. (1993). Brief Symptom Inventory (BSI) administration, scoring and procedures manual (3rd ed.). Minneapolis, MN: National Computer Systems.
Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index final report. Submitted to the Canadian Centre on Substance Abuse, Ottawa Ontario: CCSA.
Ford, J. D., Racusin, R., Ellis, C. G., Daviss, W. B., Reiser, J., Fleischer, A., et al. (2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Child Maltreatment, 5, 205–218.
Friedman, L. (2013). Commentary: Why we should report results from clinical trial pilot studies. Trials, 14, 14. doi:10.1186/1745-6215-14-14.
Grant-Kalischuk, R., Nowatzki, N., Cardwell, K., Klein, K., & Solowoniuk, J. (2006). Problem gambling and its impact on families: A literature review. International Gambling Studies, 6(1), 31–60.
Hodgins, D. C., Stea, J. N., & Grant, J. E. (2011). Gambling disorders. The Lancet, 378(9806), 1874–1884.
Jacobs, D. F. (2002). Jacobs neglect, abandonment, and abuse protocol (J-NAAP, 2002). Redlands, CA: Loma Linda University Medical Centre. Retrieved from http://www.wrh.on.ca/webbuild/site/wrh-internet-upload/file_collection/J-NAAP-1version3.pdf.
Kim, S. W., Grant, J. E., Adson, D. E., & Shin, Y. C. (2001). Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49, 914–921.
Kourgiantakis, T., Saint-Jacques, M. C., & Tremblay, J. (2013). Problem gambling and families: A systematic review. Journal of Social Work Practice in the Addictions, 13(4), 353–372.
Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: Recommendations for good practice. Journal of Evaluation in Clinical Practice, 10, 307–312.
Lee, B. K. (2002). Well-being by choice, not by chance: An integrative, system-based couple treatment model for problem gambling. Final Report: Prepared for the Ontario Gambling Research Centre. Guelph, Ontario: OPGRC.
Lee, B. K. (2009). Congruence Couple Therapy for pathological gambling. International Journal of Mental Health and Addiction, 7, 45–67.
Lee, B. K. (2012a). Towards a relational framework for pathological gambling (Part I): Five Circuits. Journal of Family Therapy,. doi:10.1111/j.1467-6427.2012.00588.x.
Lee, B. K. (2012b). Towards a relational framework for pathological gambling (Part II): Congruence. Journal of Family Therapy,. doi:10.1111/j.1467-6427.2012.00591.x.
Lee, B. K., Rovers, M., & MacLean, L. (2006). Development and application of a Congruence Model of Couple Therapy: Evaluation of a counselors’ training module. Final Report: Prepared for the Ontario Gambling Research Centre. Guelph, Ontario: OPGRC.
Lee, B. K., Rovers, M., & MacLean, L. (2008). Training problem gambling counselors in Congruence Couple Therapy: Evaluation of training outcomes. International Gambling Studies, 8, 95–112.
Lee, B. K., & Rovers, M. (2008). “Bringing torn lives together again”: Effects of the first Congruence Couple Therapy training application to clients in pathological gambling. International Gambling Studies, 8(1), 113–129.
McComb, J. L., Lee, B. K., & Sprenkle, D. H. (2009). Conceptualizing and treating problem gambling as a family issue. Journal of Marital and Family Therapy, 35(4), 415–431.
Oken, B. S. (2008). Placebo effects: Clinical aspects and neurobiology. Brain, 131(11), 2812–2823.
Pinsof, W., Lebow, J., Zinbarg, R., Knobloch-Fedders, L., Friedman, G., Mann, B., et al. (2005). STIC ® Initial (Systemic Therapy Inventory of Change) and STIC ® Intersession (Systemic Therapy Inventory of Change). Evanston, IL: The Family Institute at Northwestern University.
Pinsof, W., Zinbarg, R. E., & Knobloch-Fedders, L. (2008). Factorial and construct validity of the revised short form integrative psychotherapy alliance scales for family, couple, and individual therapy. Family Process, 47, 281–301.
Richardson, J. T. (2011). Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review, 6(2), 135–147.
Shaffer, H. J., & Costikyan, N. (2002). Treatment for substance use disorders: Exploring the relationship between treatment training and treatment outcomes. Boston, MA: Robert Wood Johnson & Join Together.
Sherin, K. M., Sinacore, J. M., Li, X. Q., Zitter, R. E., & Shakil, A. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine, 30(7), 508–512.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.
Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L., et al. (2010). A tutorial on pilot studies: The what, why and how. BMC Medical Research Methodology, 10(1), 1.
Van Teijlingen, E. R., & Hundley, V. (2001). The importance of pilot studies. Social Research Update, 35, 1–4.
Walker, M., Toneatto, T., Potenza, M. N., Petry, N., Ladouceur, R., Hodgins, D. C., et al. (2006). A framework for reporting outcomes in problem gambling treatment research: The Banff, Alberta consensus. Addiction, 101, 504–511.
Acknowledgments
This research was funded by an Ontario Problem Gambling Research Centre Level II Research Award (2009). The authors gratefully acknowledge contributions of the research couples, counsellors and their agencies who made this study possible. Dr. Peter Seraganian, research consultant, is acknowledged for his judicious advice in early stages of this project. We extend our thanks to Dr. Meryl Ko, who gave valuable input on the statistical analysis, and to Dr. Darren Christensen, who provided thoughtful comments on an earlier draft of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, B.K., Awosoga, O. Congruence Couple Therapy for Pathological Gambling: A Pilot Randomized Controlled Trial. J Gambl Stud 31, 1047–1068 (2015). https://doi.org/10.1007/s10899-014-9464-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10899-014-9464-3