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Dropout or Early Treatment Response Among Gamblers with Depressive Symptoms

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Many individuals who start psychotherapy for gambling disorder leave treatment within the first five sessions. Researchers have viewed early dropouts as treatment failures, but some may be early responders. This study examined dropout and early treatment response among those with probable depression in the first six therapy sessions of a gambling problem treatment program. The percentage of individuals who dropped out of treatment was 37%. Dropout was highest after the intake session and decreased at each subsequent session. We identified a group of early treatment responders who showed reduced depressive symptoms and improvement on gambling-related variables. This group made up about 12% of the total sample and about half of those traditionally viewed as in-treatment dropouts. Demographic and gambling history/behavior variables were not associated with early treatment response. Baseline depression severity, number of sessions attended, change scores for gambling’s interference with normal activities, and overall life satisfaction, as well as meeting one’s intake gambling-related treatment goal, were associated with early treatment response. Study findings suggest that some may be early treatment responders, even those who leave psychotherapy after the first few sessions.

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  • Abend, R., Dan, O., Maoz, K., Raz, S., & Bar-Haim, Y. (2014). Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. Journal of Behavior Therapy Adn Experimental Psychiatry, 45, 447–453.

    Article  Google Scholar 

  • Alvarez-Moya, E. M., Ochoa, C., Jimenez-Murcia, S., Aymami, M. N., Gomez-Pena, M., Fernandez-Aranda, F., … Menchon, J. M. (2011). Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathological gambling. Journal of Psychiatry and Neuroscience, 36(3), 165–175.

  • Aragay, N., Jimenez-Murcia, S., Granero, R., Fernandez-Aranda, F., Ramos-Grille, I., Cardona, S., … Valles, V. (2015). Pathological gambling: Understanding relapses and dropouts. Comprehensive Psychiatry, 57, 58–64.

  • Beard, C., Hsu, K. J., Rifkin, L. S., Busch, A. B., & Bjorgvinsson, T. (2016). Validation of the PHQ-9 in a psychiatric sample. Journal of Affective Disorders, 193, 267–273.

    Article  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory - II. Psychological Corporation.

    Google Scholar 

  • Dowling, N. (2009). Client characteristics associated with treatment attrition and outcome in female pathological gambling. Addiction Research and Theory, 17(2), 205–219.

    Article  Google Scholar 

  • Echeburua, E., Baez, C., & Fernandez-Montalvo, J. (1996). Comparative effectiveness of three therapeutic modalities in the psychological treatment of pathological gambling: Long-term outcome. Behavioural and Cognitive Psychotherapy, 24(1), 51–72.

    Article  Google Scholar 

  • Echeburua, E., Fernandez-Montalvo, J., & Baez, C. (2001). Predictors of therapeutic failure in slot-machine pathological gamblers following behavioural treatment. Behavioural and Cognitive Psychotherapy, 29(3), 379–383.

    Article  Google Scholar 

  • Frosini, D., Pesaresi, I., Cosottini, M., Belmonte, G., Rossi, C., Dell’Osso, L., … Ceravolo, R. (2010). Parkinson’s disease adn pathological gambling: Results from a functional MRI study. Movement Disorders, 25(14), 2449–2453.

  • Haas, E., Hill, R. D., Lambert, M. J., & Morrell, B. (2002). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology, 58(9), 1157–1172.

    Article  Google Scholar 

  • Hodgins, D. C., & Makarchuk, K. (2003). Trusting problem gamblers: Reliability and validity of self-reported gambling behavior. Psychology of Addictive Behaviors, 17(3), 244–248.

    Article  Google Scholar 

  • Hodgins, D. C., Currie, S. R., & el-Guebaly, N. . (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69(1), 50–57.

    Article  CAS  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(1), 12–19.

    Article  CAS  Google Scholar 

  • Jimenez-Murcia, S., Alvarez-Moya, E. M., Granero, R., Aymami, M. N., Gomez-Pena, M., Jaurrieta, N., … Vallejo, J. (2007). Cognitive-behavioral group treatment for pathological gambling: Analysis of effectiveness and predictors of therapy outcome. Psychotherapy Research, 17(5), 544–552.

  • 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.

    Article  Google Scholar 

  • Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515.

    Article  Google Scholar 

  • Kroenke, K., Spitzer, R., & Williams, J. W. (2001). The PHQ-9: Validity of a brief depression measure. Journal of General Internal Medicine, 16, 606–613.

    Article  CAS  Google Scholar 

  • Ladouceur, R., Sylvain, C., Boutin, C. L., Doucet, C., Leblond, J., & Christian, J. (2001). Cognitive treatment of pathological gambling. The Journal of Nervous and Mental Disease, 189(11), 774–780.

    Article  CAS  Google Scholar 

  • Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., & Doucet, C. L. (2003). Group therapy for pathological gamblers: A cognitive approach. Behaviour Research and Therapy, 41(5), 587–596.

    Article  CAS  Google Scholar 

  • Leblond, J., Ladouceur, R., & Blaszczynski, A. (2010). Which pathological gamblers will complete treatment? British Journal of Clinical Psychology, 42(2), 205–209.

    Article  Google Scholar 

  • Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction, 106(3), 490–498.

    Article  Google Scholar 

  • Lowe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical Care, 42, 1194–1201.

    Article  Google Scholar 

  • Mallorqui-Bague, N., Mestre-Bach, G., Lozano-Madrid, M., Fernandez-Aranda, F., Granero, R., Alcaraz, C. V., … Jiménez-Murcia, S. (2018). Trait impulsivity and cognitive domains involving impulsivity and compulsivity as predictors of gambling disorder treatment response. Addictive Behaviors, 87, 169–176.

  • McCallum, F., Blaszczynski, A., Ladouceur, R., & Nower, L. (2007). Functional and dsyfunctional impulsivity in pathological gambling. Personality and Individual Differences, 43, 1829–1838.

    Article  Google Scholar 

  • McMillan, D., Gilbody, S., & Richards, D. (2010). Defining successful treatment outcome in depression using the PHQ-9: A comparison on methods. Journal of Affective Disorders, 127, 122–129.

    Article  Google Scholar 

  • Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007). Psychological treatment dropout among pathological gamblers. Clinical Psychology Review, 27, 944–958.

    Article  Google Scholar 

  • Milton, S., Crino, R., Hunt, C., & Prosser, E. (2002). The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling. Journal of Gambling Studies, 18(2), 207–229.

    Article  Google Scholar 

  • Moghaddam, J. F., Campos, M. D., Reid, R. C., & Fong, T. W. (2015). A longitudinal examination of depression among gambling inpatients. Journal of Gambling Studies, 31, 1245–1255.

    Article  Google Scholar 

  • Pelletier, O., Ladouceur, R., & Rheaume, J. (2008). Personality disorders and pathological gambling: Comorbidity and treatment dropout predictors. International Gambling Studies, 8(3), 299–313.

    Article  Google Scholar 

  • Petry, N. M., Ammerman, Y., Bohl, J., Doersch, A., Gay, H., Kadden, R., … Stienberg, K. (2006). Cognitive-behavioral therapy for pathological gamblers. Journal of Consulting and Clinical Psychology, 74(3), 555–567.

  • Pfund, R. A., Peter, S. C., Whelan, J. P., & Meyers, A. W. (2018). When does premature treatment termination occur? Examining session-by-session dropout among cleints with gambling disorder. Journal of Gambling Studies, 34, 617–630.

    Article  Google Scholar 

  • Robson, E., Edwards, J., Smith, G., & Colman, I. (2002). Gambling decisions: An early intervention program for problem gamblers. Journal of Gambling Studies, 18(3), 235–255.

    Article  Google Scholar 

  • Ronzitti, S., Soldini, E., Smith, N., Clerici, M., & Bowden-Jones, H. (2017). Gambling disorder: Exploring pre-treatment and in-treatment dropout predictors. A UK study. Journal of Gambling Studies, 33, 1277–1292.

    Article  Google Scholar 

  • Smith, D., Harvey, P., Battersby, M., Pols, R., Oakes, J., & Baigent, M. (2010). Treatment outcomes and predictors of drop out for problem gamblers in South Australia: A cohort study. Australian & New Zealand Journal of Psychiatry, 44(10), 911–920.

    Article  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Kroenke, K., & Colleagues, & . . (2014). Test reviews: Patient health questionnaire-9 (PHQ-9). Rehabilitation Counseling Bulletin, 57(4), 246–248.

    Article  Google Scholar 

  • Sylvan, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65(5), 727–732.

    Article  Google Scholar 

  • Wulfert, E., Blanchard, E. B., Freidenberg, B. M., & Martell, R. S. (2006). Retaining pathological gamblers in cognitive behavior therapy through motivational enhancement: A pilot study. Behavior Modification, 30(3), 315–340.

    Article  Google Scholar 

  • Zack, M., & Poulus, C. (2007). A D2 antagonist enhances the rewarding and priming effects of a gambling episode in pathological gamblers. Neuropsychopharmacology, 32, 1678–1686.

    Article  CAS  Google Scholar 

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Correspondence to Michael D. Campos.

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Ethics Approval

Collection of data used in this study was approved by the University of California at Los Angeles Institutional Review Board (UCLA IRB #: 11-000764) under the title “Assessing the Quality and Effectiveness of the California Problem Gambling Treatment System”. Data collection was performed in accordance with the ethical standards of the UCLA IRB and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Data for this study came from the California Gambling Education and Treatment Services (CalGETS) program. All CalGETS patients had the option to allow their data to be used for research and quality assurance purposes. Treatment providers obtained voluntary informed consent at CalGETS intake, and the decision to allow use of data had no bearing on service eligibility.

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Campos, M.D., Williams, R.C., Joshi, V. et al. Dropout or Early Treatment Response Among Gamblers with Depressive Symptoms. Int J Ment Health Addiction 21, 165–179 (2023).

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