Introduction
An estimated 2.3% of the global population suffers from problem gambling. This destructive habit not only impacts the gamblers themselves but also their concerned significant others (CSOs), causing financial strain, strained relationships, and even mental health issues. It is crucial to find effective treatments for problem gambling to address the consequences that range from depression to intimate partner violence.
A number of systematic reviews have highlighted cognitive behavioral therapy (CBT) as the most commonly recommended approach for problem gambling. However, these reviews emphasize the need for better-designed trials and variations in the content and delivery methods of CBT protocols. While most therapies are conducted individually, there are group-based and internet-delivered options available as well.
Despite the efficacy of problem gambling (PG) interventions, poor adherence and reluctance to seek treatment are significant barriers, with only 5-12% of problem gamblers seeking help. Barriers to treatment participation include lack of access, shame, stigma, desire for self-treatment, and denial of the problem. Involving CSOs in treatment could enhance gamblers’ treatment-seeking behavior, adherence to treatment, and the effectiveness of the treatment. However, there is also a risk that CSOs unintentionally worsen the situation by enabling the gambler or hiding the problem from others.
Some studies have explored involving CSOs in the treatment of problem gambling or interventions aimed at CSOs. Community Reinforcement and Family Training (CRAFT) has been effective for other addictions but has not been proven as efficient for problem gambling. Couple therapy specifically for problem gambling may show promise, but more research is needed to draw definitive conclusions. Coping skills training for CSOs has shown positive results in terms of reducing anxiety and depression.
Behavioral couples therapy (BCT) has yielded positive results in the treatment of other addictions. BCT combines interventions for addiction and relationship functioning and is based on similar behavioral principles as CBT. A meta-analysis has shown superior outcomes for BCT compared to individual treatments in terms of relapse prevention and overall treatment effectiveness.
This paper describes a randomized controlled study of BCT for problem gamblers and their CSOs delivered via the internet. This study is the first of its kind involving more than one person in treatment for problem gambling. Internet-delivered interventions have the advantage of accessibility and privacy, which helps overcome some of the barriers to treatment. Involving a CSO in treatment may also help buffer some of the attrition associated with problem gambling interventions.
The aims of this study were to compare the treatment response of problem gamblers in two internet-based CBT (ICBT) conditions: BCT involving both the gambler and a CSO, and CBT involving only the gambler. The study also aimed to compare the treatment effects on the participating CSOs in terms of mental health and relationship satisfaction.
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