Journal of Gambling Studies

, Volume 31, Issue 3, pp 1047–1068 | Cite as

Congruence Couple Therapy for Pathological Gambling: A Pilot Randomized Controlled Trial

  • Bonnie K. Lee
  • Olu Awosoga
Original Paper


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.


Randomized controlled trial Congruence Couple Therapy Couple therapy Problem gambling Pathological gambling Gambling disorder Spouses 



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.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Arlington, VA: American Psychiatric Association.Google Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. Bradbury, T. N. (1994). Unintended effects of marital research on marital relationships. Journal of Family Psychology, 8, 187–201.CrossRefGoogle Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  6. 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
  7. Derogatis, L. R. (1993). Brief Symptom Inventory (BSI) administration, scoring and procedures manual (3rd ed.). Minneapolis, MN: National Computer Systems.Google Scholar
  8. Ferris, J., & Wynne, H. (2001). The Canadian problem gambling index final report. Submitted to the Canadian Centre on Substance Abuse, Ottawa Ontario: CCSA.Google Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. Friedman, L. (2013). Commentary: Why we should report results from clinical trial pilot studies. Trials, 14, 14. doi: 10.1186/1745-6215-14-14.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. Hodgins, D. C., Stea, J. N., & Grant, J. E. (2011). Gambling disorders. The Lancet, 378(9806), 1874–1884.CrossRefGoogle Scholar
  13. Jacobs, D. F. (2002). Jacobs neglect, abandonment, and abuse protocol (J-NAAP, 2002). Redlands, CA: Loma Linda University Medical Centre. Retrieved from
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.Google Scholar
  18. Lee, B. K. (2009). Congruence Couple Therapy for pathological gambling. International Journal of Mental Health and Addiction, 7, 45–67.CrossRefGoogle Scholar
  19. 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.Google Scholar
  20. 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.Google Scholar
  21. 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.Google Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. Oken, B. S. (2008). Placebo effects: Clinical aspects and neurobiology. Brain, 131(11), 2812–2823.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 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.Google Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.Google Scholar
  30. 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.PubMedGoogle Scholar
  31. 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.Google Scholar
  32. 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.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Van Teijlingen, E. R., & Hundley, V. (2001). The importance of pilot studies. Social Research Update, 35, 1–4.Google Scholar
  34. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Faculty of Health SciencesUniversity of LethbridgeLethbridgeCanada

Personalised recommendations