Contingency Management + Cognitive Behavioural Therapy for Gambling Addiction

Overseen By Chad Witcher, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Lethbridge

Disqualifiers: Unmanaged psychiatric, neurological disorders

Stay on Your Current Meds You can continue your current medications while participating

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 39

Duration: 12 weeks

54 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to determine if combining contingency management—a system where participants earn rewards for attending therapy and avoiding gambling—with cognitive behavioral therapy (CBT) helps individuals with gambling issues remain engaged in counseling. The study focuses on those in rural or remote areas who might find it difficult to access regular in-person therapy. Participants diagnosed with a gambling disorder, who have gambled in the last month, and live in a rural or remote area are well-suited for this trial. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could enhance access to effective treatments for gambling disorders.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have a medically unmanaged psychiatric or neurological disorder, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Cognitive Behavioral Therapy (CBT) is well-received by people with gambling problems. Studies have found that CBT can significantly improve gambling habits and reduce the disorder's severity. Participants generally improve over time, indicating that this therapy is safe and effective for many.

For Contingency Management (CM), research suggests it is a promising and safe addition to treatments for gambling problems. CM involves earning rewards for reaching certain goals, such as attending therapy sessions or reducing gambling. Studies confirm that CM does not increase gambling and can actually help reduce it. Both treatments appear to be safe options, with no major negative effects reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the combination of Contingency Management (CM) and Cognitive Behavioural Therapy (CBT) for gambling addiction because it offers a unique approach not typically seen in standard treatments like traditional CBT or medication. Contingency Management introduces an innovative element where participants earn rewards for attending sessions and staying away from gambling, which can motivate and reinforce positive behavior changes. By blending this reward-based system with the proven effectiveness of CBT, this approach not only targets the psychological aspects of gambling addiction but also adds an extra layer of motivation, potentially enhancing treatment outcomes.

What evidence suggests that this trial's treatments could be effective for gambling addiction?

Research has shown that Cognitive Behavioral Therapy (CBT), one of the treatments in this trial, effectively treats gambling problems. One study found that CBT significantly reduces the severity of gambling issues and the frequency of gambling. Another study demonstrated that CBT improves life quality and reduces stress, anxiety, and depression in individuals with gambling problems.

Contingency Management (CM) is another treatment option in this trial and offers a promising approach for harmful gambling. Studies confirm that CM can reduce gambling by using rewards to encourage positive behaviors, such as attending therapy sessions and avoiding gambling. Clinical trials have shown that CM supports recovery by helping individuals stop gambling. ^{1 2 6 7 8}

Who Is on the Research Team?

Darren R Christensen, PhD

Principal Investigator

University of Lethbridge

Are You a Good Fit for This Trial?

This trial is for English-speaking individuals living in rural or remote areas who have been diagnosed with a gambling disorder and have gambled within the last month. They must be able to give written consent. People with unmanaged psychiatric or neurological conditions, other than gambling disorder, cannot participate.

Inclusion Criteria

Capable of providing written consent

Live in a rural or remote location

Gambled within the last month

Exclusion Criteria

Medically unmanaged psychiatric or neurological disorder(s) except for disordered gambling

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual)

Pre-treatment Assessment

Participants complete baseline assessments including demographic information

1 week

1 visit (virtual)

Treatment

Participants receive Cognitive Behavioural Therapy (CBT) or CBT with Contingency Management (CM) for 12 weeks

12 weeks

36 visits (virtual, 3 times a week)

Post-treatment Assessment

Participants complete post-treatment assessments to evaluate clinical, psychological, and behavioural outcomes

1 week

1 visit (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Behavioural Therapy
• Contingency Management

Trial Overview The study tests if adding Contingency Management to regular Cognitive Behavioural Therapy (CBT) helps improve attendance and retention in counselling sessions for disordered gamblers using video-conferencing tools designed for those living far from treatment centers.

How Is the Trial Designed?

Group I: Contingency Management Experimental Treatment 1 Intervention

This is a treatment where participants earn points for treatment attendance and for providing evidence of gambling abstinence. These points are added to study accounts that can be redeemed for goods and services available at a variety of on-line businesses (e.g., Amazon, Walmart, etc.). Submission of evidence of gambling behaviour or non-attendance at an on-line counselling session re-sets subsequent points to the starting level. The CM procedure is implemented as part of the CBT counselling session.

Group II: Cognitive Behavioural Therapy Active Control 1 Intervention

CBT is currently considered "best practice" for the treatment of problem gambling, as noted in the National Health and Medical Research Council (Australia) endorsed Clinical Guidelines for problem and pathological gambling treatment (Problem Gambling Research and Treatment Centre, 2011). CBT is typically a semi-structured approach for delivering cognitive behavioural therapy addressing the participant's experiences, thoughts, and emotions relating to their gambling and substance use. Techniques include psychoeducation, behavioural interventions, and cognitive strategies. Participants are expected to attend on-line counselling sessions three times a week for approximately 12 weeks. All participants will receive individual counselling from an experienced counsellor/therapist.

Cognitive Behavioural Therapy is already approved in United States, Canada, European Union for the following indications:

Approved in United States as Cognitive Behavioral Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Approved in Canada as Cognitive Behavioural Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Approved in European Union as Cognitive Behavioural Therapy for:

• Anxiety disorders
• Substance use disorders
• Depression
• Post-traumatic stress disorder (PTSD)
• Eating disorders

Who Is Running the Clinical Trial?

University of Lethbridge

Lead Sponsor

Trials

10

Recruited

760+

Rural Development Network

Collaborator

Trials

1

Recruited

50+

Alberta Rural Development Network

Collaborator

Trials

1

Recruited

50+

Published Research Related to This Trial

A systematic review of 12 randomized controlled trials involving 1654 adults found that adding cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET) to contingency management (CM) did not improve rates of abstinence from substance use at the end of treatment or during follow-up.

The analysis showed no significant benefits in secondary outcomes, such as self-reported days of substance use, indicating that CM alone is as effective as when combined with these psychotherapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. Sheridan Rains, L., Steare, T., Mason, O., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10524575/

Effect of Cognitive-Behavioral Techniques for Problem ... In conclusion, CBTs show promise for reducing gambling disorder severity and gambling behavior. However, the effect of CBTs on these outcomes is overestimated, ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S0883941722001625

Efficacy of cognitive-behavioral therapy in improving the ... Cognitive-behavioural therapy can improve the quality of life of people with pathological gambling, reduce stress, anxiety, depression. •. Cognitive behavioural ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11059187/

Cognitive-behavioral treatment for gambling harm A robust variance estimation meta-analysis indicated that CBT significantly reduced gambling disorder severity (g = −0.91), gambling frequency (g = −0.52), and ...

4. onlinescientificresearch.com onlinescientificresearch.com/journals/jpmrs/articles/efficacy-of-cognitive-behaviour-therapy-in-gambling-disorder-a-case-study.html

Efficacy of Cognitive Behaviour Therapy in Gambling ... A meta-analytical study conducted by Gooding & Tarrier found that cognitive behavior therapy is an effective intervention in persons with gambling disorder [3].

5. jmir.org jmir.org/2024/1/e54754/

Introducing and Evaluating the Effectiveness of Online ... This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD)

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4458066/

Gambling Disorder and Other Behavioral Addictions Meta-analyses of psychotherapeutic and behavioral treatment approaches for disordered gambling suggest that they can result in significant improvements.

7. link.springer.com link.springer.com/article/10.1007/s10899-023-10224-z

A Randomized Controlled Trial for Gambling Disorder and ... On most measures, including primary outcomes, participants improved significantly over time with no difference between treatment conditions.

8. clinicaltrials.gov clinicaltrials.gov/study/NCT06989125

Internet-based Versus Synchronous Cognitive Behavioural ... The aim of this two-armed, randomized controlled trial is to determine if internet-based cognitive behavioural therapy (CBT) is as effective ...