CBT for gambling

Domain II · Behavioural & cognitive · Petry, Ladouceur, Fong · 1997 · Quebec

What it is

CBT for gambling is not one branded therapy. It is a family of closely related, manualised, short-term outpatient protocols for problem gambling and gambling disorder. They can be delivered individually, in groups or as guided self-help and online programmes. The protocols share two ideas about how…

Format

• Engagement, assessment and motivation (sessions 1–2). Goals: build the alliance, assess gambling, debts, suicidality and supports, give personalised feedback, and agree a goal (abstinence or controlled gambling) and a rationale.
• In Petry, session 1 is psychoeducation and identifying the client's triggers.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Goals vague enough that any amount of gambling seems to meet them.
• Silent dropout; arrange a proactive call after any missed check-in.
• The client defending their thoughts; return to 4.17-style curiosity.
• Avoidance of problems that the client keeps re-labelling as "no time".
• Revise the formulation as monitoring and functional analysis add information.

Problems the guide addresses

• Ambivalence and the stuck client
• Resistance in session (minimising, denying, blaming, arguing, sidetracking)
• Overwhelm: debt crisis, shame, distress during exposure
• Non-adherence: homework not done, logs blank
• Missed sessions and dropout
• Lapses and relapse during treatment
• Suicide risk
• Ruptures
• Modality-specific difficulties

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.