Mindfulness_Based_Cognitive_Therapy_for_Gambling_Problems

Innovative Applications of Practice 6855 Mindfulness Based Cognitive Therapy for Gambling Problems Word count 1517 Suzanne Fitzgerald u 3007514 Mindfulness Based Cognitive Therapy for Gambling Problems Gambling problems can and have affected many people. Not only problem gamblers lose money, they also suffer significant emotional and health issues. There does not appear to be one therapy option with empirical evidence to support its use. Mindfulness based cognitive therapy (MBCT) modified from Segal, Williams and Teasdale (2002) for problem gamblers provides a comprehensive new framework for treatment that encompasses behaviour therapy and cognitive therapy (CBT) with mindfulness based interventions (de Lisle, Dowling & Allen 2011). In Australia, and world-wide, the availability and gambling opportunities for gambling participation have substantiality increased (ABS 2004-05). Figures from the Australian Bureau of Statistics estimate the total income for hospitality clubs with gambling facilities to be $7,103 m; with gambling income accounting for 60.6% of the total income and the majority of this money (98.1%) coming from poker/gaming machines (ABS 2004-05). A study by the British Gambling Prevalence Survey found 0.5% of the adult population in their study had gambling problems within the previous 12 months (Warle, Sproston, Orford, Erens, Griffiths & Constantine 2007). Problem gambling is associated with many detrimental effects including significant financial consequences, social impairment, psychological impact and significant health problems (Shaffer & Korn, 2002). There are many different therapy approaches available for treating gambling problems. These therapies include Gamblers Anonymous, Inpatient rehabilitation programs, behavioural interventions, cognitive therapy and antidepressant medication (Blaszxynski & Nower 1999). Blaszxyski and Nower (1999) contend that until recently there appears little recognition, apart from gender and age, in determining whether intergroup differences exist for problem gamblers. It could therefore be possible to have a complex interaction of genetic, biological, psychological and environmental factors all or partly contributing to the problem (Blaszxyski & Nower 1999). Dowling, Jackson and Thomas (2009) contend that improvements in gambling problems have been limited, with overall success rates for psychological treatment estimated at 70% at six months follow up, 50% at the one year follow up, and as low as 30% at the two year follow up (Walker, 1992). Behavioural treatment for problem gambling in its earliest form is said to have originated using classical conditioning where the client learns by experiencing unpleasant stimulation, usually electric shock treatment, to reduce the arousal and excitement associated with gambling (Walker, 1992). One innovation for the treatment of problem gambling is mindfulness-based cognitive therapy (MBCT). This treatment has been developed by Segal, Williams and Teasdale (2002). According to de Lise, Dowling and Allen (2011), behaviour therapy is described as the first wave and cognitive therapy the second wave, with MCBT being the third wave which expands on cognitive behavioural therapy (CBT) by applying eastern approaches to the mind and body in a CBT framework. Mindfulness is described as observing the body and mind and intentionally letting experiences unfold while living in the present moment to moment and accepting experiences as they are (de lisle et al 2011). Toneatto, Vettese and Nguyen (2007) describe the role of mindfulness in cognitive behavioural treatment as the way of assisting clients to examine how they relate to their thoughts. Learning mindfulness strategies help clients to observe their thoughts and process them without judgement or restriction. Through accepting thoughts, images and memories, the client can eliminate negative thoughts and feelings (Toneatto, Wettese & Nguyen 2007). De Lisle et al. (2011) adapted a treatment program using MBCT therapy for a female with gambling problems. She was assessed using the Diagnostic and Statistical manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). She met 5 out of the 10 criteria for this diagnosis. The subsequent interview revealed evidence of anxiety and past depressive episodes. This was confirmed using the Beck Anxiety Inventory BAI (Beck & Steer 1990) and Beck Depression Inventory-11 BDI-11(Beck , Steer,& Brown 1996) which indicated severe anxiety and moderate depression respectively. A report of her history was then obtained which revealed her problem gambling started five years ago when she underwent a course in CBT therapy (de Lisle et al. 2011). De Lisle et al. (2011) obtained all approval for this research and used previous diagnostic measures at assessment, with self-report measures at pre-intervention, post-intervention, four week follow up and ten week follow up. The client also committed to undertake 40 minutes of mindfulness practice daily (de Lisle et al. 2011). The 21 item BAI (Beck & Steer, 1990) inventory was used to assess behavioural, emotional and physiological symptoms in anxiety, and the BDI-ll (Beck, Steer, & Brown 1996) inventory was used to identify the severity of depression. Mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). Baer and Krietemeyer (2006) developed this questionnaire to measure five factors that represent the elements of mindfulness. The first element measured observing, noticing, and attending. The second measured labelling with words and acting with awareness. The third seeks to measure the level of non-judging of inner experiences and non-reactivity to inner experiences (de Lise et al. 2011). Using the treatment protocol developed for MBCT by Segal et al. (2002) an intervention plan was developed. The therapist conducting the program was an accredited MBCT facilitator. To obtain the baselines of daily gambling frequencies, expenditure and duration, a gambling diary 5 weeks prior to the intervention was provided, along with the requirement that a daily mindfulness diary be completed. The client then attended eight weekly MBCT sessions; each session consisted of two hour durations with a four week and ten week follow up session conducted to consolidate learning and to discuss any practical issues that related to her mindfulness practice (de Lise et al. 2011). The treatment program for session one consisted of teaching mindfulness techniques, psychoeducation concepts whereby conscious attention and present moment thoughts, feelings, and sensations are brought into awareness but not acted on. The client then learned the body scan technique which will help the client gain awareness of physical sensations (de Lise et al. 2011). Session two concentrated on barriers that affect the mindfulness practice (de Lise et al. 2011). Session three explored a range of mindfulness techniques which included mediation, three minutes breathing space and walking (de Lise et al. 2011). Session four encouraged the client to be in the present moment and to observe thoughts, feelings, and sensations without acting on them (de Lise et al. 2011). Session five focused on accepting gambling related triggers (de Lise et al. 2011). In session six the client explored gambling related thoughts and feelings (de Lise et al. 2011). Session seven included the used of traditional CBT related techniques (de Lise et al. 2011). Session eight linked the learning with the client’s future, also the program was summarised with relapse action plans in place (de Lise et al. 2011). The BAI scores for the client, which indicated severe anxiety at the pre-intervention assessment, were reduced to mild anxiety at the post-intervention assessment. These scores remained constant at the follow up assessments at four weeks and ten weeks (de Lise et al. 2011). Scores for the BDI-II which indicated moderate depression at the pre-intervention assessment were reduced to minimal depression at the post-intervention assessment. The four week follow up revealed a further decrease in this level of depression which was maintained at the 10 week assessment (de Lise et al. 2011). Mindfulness sores using the FFMQ at the post-intervention assessment indicated a moderate decrease in observing at the four week follow up with no change in the subsequent ten week follow up period (de Lise et al. 2011). Acting with awareness showed no change at the post-intervention assessment and the four week follow up but there was a moderate reduction in the ten week follow up period (de Lise et al. 2011). The client was responsible for completing a daily diary in which the frequency and duration of mindfulness practices were recorded but despite the therapists encouragement the diary was at times uncompleted and led the therapist to conclude the regular 40 minutes of meditation had at times not happened (de Lise et al. 2011). This model of MBCT for gambling problems appears to incorporate many ideas from the cognitive behavioural approach as well as using other theoretical frameworks, thereby making this model a new innovation for the treatment of program gambling. In particular it provides for the treatment needs of clients who are suffering depression or anxiety because of their association with gambling (de Lise et al. 2011) For MBCT to be effective it is essential the instructor has considerable experience using this technique. As the literature regarding success rates using MBCT is limited it is unsure if any cultural limitations will apply. Another difficulty, as displayed by our example, would be the difficulty encouraging clients to practice mindfulness therapy as homework (de Lise et al. 2011). MBCT will require significantly more research to be conducted in the future. MBCT is currently being used to reduce anxiety and depression, but could be used as a treatment option for a wider range of disorders including alcoholism. 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