Can a single session be enough to significantly improve the problems of pathological gambling? And can it be just as effective as longer treatments?
Asked Tony Toneatto, of the Department of Psychiatry at the University of Toronto (Canada), who conducted research approved by the Research Ethics Board of the Center for Addiction and Mental Health, and which was then published in 2016 in Addictive behaviors, with the title Single session interventions for problem gambling may be as effective as longer treatments: Results of a randomized control trial.
Here is a summary of the study and its results.
Research
Toneatto starts from previous empirical studies that have shown that the most effective treatments for pathological gambling problems (GAP) tend to be multimodal, that is, to combine 3 types of interventions:
- Cognitive
- Behavioral
- Motivational
In the present study, the basic hypothesis on the treatment of pathological gambling is to demonstrate that interventions based on a single session are just as effective as these three therapies with longer duration.
The study was carried out on a sample of 99 gamblers (74% men, average age 47.5 years) divided into four groups, each of which underwent a different type of treatment:
- Six sessions of Cognitive Therapy (n = 25)
- Six Behavioral Therapy sessions (n ​​= 24)
- Six sessions of Motivational Therapy (n = 22)
- Interventions of a single session through minimal interventions (especially with psychoeducation and delivery of an information booklet) (n = 28)
In all four cases, the sample was followed up after 12 months after the end of treatment.
The sample
Participants were recruited in the Toronto area through ads placed in local newspapers, looking for people with pathological gambling problems interested in the treatment.
Initially they were selected by telephone to determine if they had the necessary requirements. Participants initially experienced between 6 and 7 symptoms reported in the DSM-IV criteria for pathological gambling, with over 80% of the sample fully reflecting the diagnostic criteria and 20% finding a subclinical condition.
The exclusion criteria included any psychiatric or psychosocial problems (eg suicide attempts, psychosis).
The most common pathological gambling problems included:
- slot machine (50.5% of the sample)
- casino card games (35.1%)
- racing track bets (34.4%)
- lotteries (32.3%)
Results
Although it is intuitive to think that with a long-term treatment, better results can be obtained in treating patients with gambling problems, the analysis of this study has instead shown that this hypothesis has not been supported.
In fact, it was observed that the effectiveness of the treatment was the same for each of the four groups. This means that the participants in the one-session therapy group perceived the treatment as effective and useful as the individuals who had received one of the longer treatments.
Through the ANOVA for repeated measures (ANOVA), a significant reduction in the frequency and number of plays (average effect size) was highlighted in all 4 groups, as well as in the average expenditure used in gambling, which passed into average from $ 334 to $ 117 (small effect size), as well as a symptomatic reduction: if at the beginning the criteria for diagnosing pathological gambling were found in 80% of the sample (average of 6-7 symptoms) , subsequently they were found only in 43% (average 3-4 symptoms).
To report some percentages, here is the average reduction in days spent playing for each therapy (initial value -> all follow-up value):
- Cognitive therapy: 47.2% -> 25.3%
- Behavioral therapy: 46.2 -> 19.8%
- Motivational therapy: 38.8% -> 23.3%
- Single session (minimal intervention): 36.7% -> 23.5%
 And here is the average reduction in symptoms (initial value -> value at all follow-up):
- Cognitive therapy: 6.3 -> 3.7
- Behavioral therapy: 7.1 -> 3.6
- Motivational therapy: 6.6 -> 4.3
- Single session (minimal intervention): 6.0 -> 2.9
 And finally, the reduction in the number of pathological players according to the DSM criteria (initial value -> all follow-up value):
- Cognitive therapy: 80.0% -> 42.1%
- Behavioral therapy: 83.3% -> 41.2%
- Motivational therapy: 90.9% -> 53.3%
- Single session (minimal intervention): 71.4% -> 39.1%
Follow up
Of the 99 participants, 79 (80%) were available for follow up.
After 12 months, the treatment group with a single session improved in the same way as the others, also in these 3 areas:
- confidence in controlling the game
- manage the craving for the game
- desire to play in the equivalent grade follow-up of the three longest treatments.
Basically, the participants who received the single-session intervention behaved (obtained the same results) as those who completed the six sessions of cognitive, behavioral and motivational treatment.
Limits
Some improvements can be implemented in subsequent research, including:
- use objective measures of adherence faithful to the treatment method used
- distribute an equal number of subjects for each sample
- add a control group without treatment
 Conclusions
The null hypothesis concerned a relative superiority of the three treatments of six sessions each over the single session treatment, both at the end of the treatments themselves and at the 12-month follow-up, assuming that a therapy of more sessions is more effective than one from a single session.
This hypothesis was rejected.
In all four groups, the effect sizes showed a “medium” capacity for change in reducing the frequency of gambling and the number of symptoms related to the GAP, and “medium-small” in the decrease in spending on gambling.
Even the study of the satisfaction of the participants did not show any differences: in those who received only one session, the same degree of satisfaction was found as in those who received more sessions.
This means that even with reduced interventions it is possible to obtain significant results. In this particular case, however, the single session was carried out above all in terms of psychoeducation: the author then emphasizes how it can be easily integrated into other therapies, such as those examined.
Ultimately, therefore, having more sessions does not necessarily lead to higher efficacy rates or to a higher satisfaction with the treatment by the person.
Veronica Torricelli & Flavio CannistrĂ
Psychologists, Psychotherapists
Team & Founder of the Italian Center
for Single Session Therapy
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Bibliography
Toneatto, T. (2015) Single-session interventions for problem gambling may be as effective as longer treatments. Addictive Behaviors, 52, 58–65.