**6. Treating gambling disorder**

In an explorative study carried out by Fernandez-Montalvo and Echeburua [17], the following personality profile of the compulsive gamblers is depicted: they are impulsive, present the slight symptoms of depression and anxiety, and have the tendency to consume alcohol in an abusive manner and to experience difficulty adjusting to daily life; a percentage of 16% fulfills the criteria for a diagnosis of the borderline personality disorder, followed by antisocial

In terms of diagnosing gambling disorder, there are multiple instruments utilized, such as South Oaks Gambling Screen (SOGS); Massachusetts Gambling Screen (MAGS); Gamblers Anonymous 20 Questionnaire; The Problem Gambling Severity Index-PGSI; The Inventory of Gambling Situations (IGS); The Gambling Related Cognition Scale; The Composite

*South Oaks Gambling Screen* (SOGS) was developed by Lesieur and Blume [18], and it contains 20 items which correlate with the criteria of the diagnostic for the pathological gambling from DSM-IV; the advantage of SOGS is the ease with which it is administered and the way of scoring, as well as the fact that proved useful with diagnosing the pathological gambling for both

Massachusetts Gambling Screen (MAGS) [19] is an easily administrable and markable questionnaire that can be used for both teenagers and adults, and it utilizes the criteria of DSM IV for the diagnosis of the pathological gambling; a score of minimum 5 permits the adjustment

*Gamblers Anonymous 20 Questionnaire* [20] is a more extensive questionnaire with 20 questions, which the gamblers can self-manage in order to establish whether they possess an addiction

*The Problem Gambling Severity Index* (PGSI) [21] represents an instrument which comprises a number of nine items with whose help any person can self-evaluate the severity of their

*The Inventory of Gambling Situations* (IGS) [22] represents an identifying instrument identify for the situations, where a person presents a risk of compulsive gambling and comprises a number of 63 items, which represent just as many possible situations in which someone could

*The Gambling Related Cognition Scale* [7] is a questionnaire with 23 items, which help the participant to self-evaluate their irrational beliefs related to games of chance, and the items are divided in five subsections: interpretative biases referring to the capacity of controlling the game; the illusion of control; the prediction of control; nonrealistic expectations tied to gam-

International Diagnostic Interview (CIDI); and The Structured Clinical Interview.

behavior, narcissism, and paranoia.

164 Cognitive Behavioral Therapy and Clinical Applications

**5. Screening**

teenagers and adults.

problem or not.

pathological gambling.

gamble excessively.

in the pathological game of chance.

bling; and the inability to stop gambling.

Gambling disorder is best described as being a syndrome, and from this perspective, the most efficient treatment reflects a multimodal approach, which bases itself upon a personalized and complex treatment plan. Multidimensional treatments thus include different combinations of therapeutic, financial, and educational counseling, as well as self-help, psychotherapy, and psychopharmacology in the case of intervention.

There is a wide range of treatment programs for compulsive gambling, based on the specific professional expertise of the therapist and the existing therapeutic resources. Primary medical care programs tend to offer more screening, short-term pharmacological treatment, and guidance for follow-up counseling.

The problems faced by specialists when starting treatment with compulsive gamblers mainly relate to the fact that they deny that they have an addiction problem, they are not informed on the fact that there are qualified professionals in this field, they are fearful of the fact that they could be stigmatized, often they do not want to give up gambling, their partner does now want to get involved, and their family is not supportive.

The treatment for the gambling disorder shares many similarities with the treatment for drug addiction, and it involves the development and techniques and measures to cope with the phenomenology of craving that characterizes any addiction and has a neurophysiological substrate. In drug and alcohol addiction and even in gambling disorder, we find the following aspects [23]:


Until the present day, there have been relatively few studies on checking the efficiency of the different forms of treatment for gambling disorder [24–26, 6–7, 27].

**Pharmacological treatment** has some promising results in ameliorating some comorbidities, such as impulsivity and mood disorders, but the results of the efficiency studies for this type of treatment are limited due to the fact that there were smaller lots of people used, high dropout rates recorded, and big variations in terms of the placebo effect [28–30].

**Cognitive-behavioral therapy** is currently considered the most efficient method of treatment for gambling disorder; this type of therapy postulates the fact that the irrational thoughts tied to the ability of a person to control the game and predict the win represent the main factors

Cognitive-Behavioral Therapy for Gambling Addiction http://dx.doi.org/10.5772/intechopen.72671 167

The literature on the topics includes more models of cognitive-behavioral therapy for the gambling disorder [6, 10, 15, 36, 46–49]; self-help books can determine the improvement of the compulsive behavior according to the studies conducted by Apodaca and Miller [50] and

Petry and his associates [51] conducted a comparative study on a lot of 231 compulsive gamblers which they split into three groups: the first group was treated using the Gamblers Anonymous method, the second group using GA combined with the help of the cognitivebehavioral therapy guiding exercises, and the third group participated at the GA groups plus eight individual sessions of CBT. They found improvements in 59% of the participants that benefited from CBT, 39.2% of the participants who completed the exercises from the CBT

Ladouceur and others [52] proposed a model of therapy for treating the gambling disorder

• Modifying the irrational beliefs of the gambler with how the activities in gambling are car-

Petry [36] proposes a protocol of cognitive-behavioral therapy group therapy which lasts eight sessions, with a weekly frequency; the session's homework within which the protocol

• General information, presenting the reward system for game abstinence and identifying

which determine the development and the maintenance of this pathology [39–45].

books, and 34% of the participants who only took part in the GA groups.

which comprises the following five steps:

• Informing in terms of the general aspects of the game;

• Learning some relapse prevention techniques.

• The functional analysis of the gambling behavior;

• Planning for emergencies and preventing relapse.

• The increasing frequency of pleasant activities;

• The development of new coping abilities and problem-solving;

those factors those factors that contribute to the urge to play;

• Training for assertiveness and the ability to refuse the game;

Hodgins et al. [32].

ried out;

is the following:

• Acquiring social abilities;

• The auto-management plan;

• Coping with the urge to gamble;

• Changing irrational thoughts;

**Psychological treatment** for gambling disorder includes numerous approaches, such as psychodynamic therapy and analytic therapy [31], multimodal therapy, the Gamblers Anonymous group [20], the motivational interview [32], online counseling [33], behavioral therapy [34], and cognitive-behavioral therapy [6, 15, 23, 24, 35–37].

Chambles and Ollendick [38] have analyzed the efficiency of various approaches to treat gambling disorder; based on the scientifically validated evidence and the research that has been carried out, following classification has been established:


Gooding and Tarrier [26] have studied the efficiency of the cognitive-behavioral therapy by examining 25 studies carried out by several experts in the field in USA, Canada, Spain, and Australia, targeting the reduction of gambling disorder; based on their meta-review, the mentioned authors presented the following conclusions:


Given that most of the studies carried out so far have investigated the efficiency of the treatment of compulsive gambling only in relation to the specific type of therapy that was used in the treatment process, one must also acknowledge that there are a number of nonspecific factors which can contribute to the success of the treatment: extra-therapeutic attributes which the subject presents at the moment of treatment (level of education and family support); the therapist's qualities (empathy, warmth, understanding, and acceptance of the subject); and the subject's expectations, his/her hopes in terms of the results of the treatment [39].

**Cognitive-behavioral therapy** is currently considered the most efficient method of treatment for gambling disorder; this type of therapy postulates the fact that the irrational thoughts tied to the ability of a person to control the game and predict the win represent the main factors which determine the development and the maintenance of this pathology [39–45].

The literature on the topics includes more models of cognitive-behavioral therapy for the gambling disorder [6, 10, 15, 36, 46–49]; self-help books can determine the improvement of the compulsive behavior according to the studies conducted by Apodaca and Miller [50] and Hodgins et al. [32].

Petry and his associates [51] conducted a comparative study on a lot of 231 compulsive gamblers which they split into three groups: the first group was treated using the Gamblers Anonymous method, the second group using GA combined with the help of the cognitivebehavioral therapy guiding exercises, and the third group participated at the GA groups plus eight individual sessions of CBT. They found improvements in 59% of the participants that benefited from CBT, 39.2% of the participants who completed the exercises from the CBT books, and 34% of the participants who only took part in the GA groups.

Ladouceur and others [52] proposed a model of therapy for treating the gambling disorder which comprises the following five steps:


of treatment are limited due to the fact that there were smaller lots of people used, high drop-

**Psychological treatment** for gambling disorder includes numerous approaches, such as psychodynamic therapy and analytic therapy [31], multimodal therapy, the Gamblers Anonymous group [20], the motivational interview [32], online counseling [33], behavioral

Chambles and Ollendick [38] have analyzed the efficiency of various approaches to treat gambling disorder; based on the scientifically validated evidence and the research that has been

• Cognitive-behavioral therapy together with behavioral therapy represents the most effi-

• Psychodynamic therapy, aversive therapy, auto exclusion, and the Gamblers Anonymous

Gooding and Tarrier [26] have studied the efficiency of the cognitive-behavioral therapy by examining 25 studies carried out by several experts in the field in USA, Canada, Spain, and Australia, targeting the reduction of gambling disorder; based on their meta-review, the men-

• There is conclusive evidence according to which cognitive-behavioral therapy creates visible improvements in the gambler's behavior, and these are maintained at the follow-up

• The improvements were maintained after 6 months and 12 months of finishing treatment, but these results will be interpreted with caution, due to the reduced number of participants at the long-term re-evaluation meetings and the small number of studies carried out

• Both group therapy and individual therapy are efficient in the follow-up evaluation which takes place 3 months after finishing treatment, but at the 6 month evaluation, the effects of

• Authors mention the fact that it is possible that cognitive-behavioral therapy has no direct effect on game behavior; however, its effect relates to reducing symptoms of depression and anxiety, which will then influence in their turn the improvement of game behavior.

Given that most of the studies carried out so far have investigated the efficiency of the treatment of compulsive gambling only in relation to the specific type of therapy that was used in the treatment process, one must also acknowledge that there are a number of nonspecific factors which can contribute to the success of the treatment: extra-therapeutic attributes which the subject presents at the moment of treatment (level of education and family support); the therapist's qualities (empathy, warmth, understanding, and acceptance of the subject); and the subject's

expectations, his/her hopes in terms of the results of the treatment [39].

out rates recorded, and big variations in terms of the placebo effect [28–30].

therapy [34], and cognitive-behavioral therapy [6, 15, 23, 24, 35–37].

• Relapse prevention techniques have shown moderate efficiency;

groups present a reduced efficiency in treating this pathology.

carried out, following classification has been established:

cient forms of scientifically validated treatment;

166 Cognitive Behavioral Therapy and Clinical Applications

tioned authors presented the following conclusions:

evaluation conducted 3 months posttreatment;

the groups therapy are better maintained;

in this way;

• Learning some relapse prevention techniques.

Petry [36] proposes a protocol of cognitive-behavioral therapy group therapy which lasts eight sessions, with a weekly frequency; the session's homework within which the protocol is the following:


Ledgerwood and Petry [53] proposed a model where the main components refer to the restructuring of the gambler's medium in a way that it is less conductive to pathological gambling; the patients are initially taught to identify their irrational thoughts connected to the game of chance, about the game of chance, to understand the connection between these thoughts and their pathological game behavior, and to identify new coping methods.

research has been done and there is a lack of professionals trained in offering psychological

Cognitive-Behavioral Therapy for Gambling Addiction http://dx.doi.org/10.5772/intechopen.72671 169

We have introduced a model of cognitive-behavioral therapy for gambling addiction in Romania, based mainly on cognitive restructuring techniques, with the following fundamen-

• Reducing the consequences of gambling disorders which interfere in the everyday func-

• Managing the negative emotionality associated with this disorder (depression, anxiety,

• Satisfying the need for entertainment and developing new and pleasant recreational and social activities, which do not pose the risk of having a destructive impact on the lives of

The model includes several stages, namely assessment and formulation, psycho-education and introduction to the ABCDE model, cognitive restructuring, problem-solving training,

During the clinical assessment stage, we look at client engagement in the therapeutic process by increasing his motivation to change his gambling behavior and we clarify the following

• The degree to which the subjects have reached out for psychological support and the ef-

• Whether they have reached out for treatment out of their personal initiative or at the their

We will adopt an attitude of acceptance toward the subjects and their gambling experience, using techniques such as active listening, reflection, nonverbal communication (maintaining visual contact, open body posture, nonevaluative facial expression, consistency of tone etc.),

*John is 32 years old, he is married and has been gambling electronic roulette and poker machines since he was 18; his parents are divorced and his father told John that he had been an unwanted child, whose birth had been a mistake and with whom he wishes to have no relation whatsoever. John faced economic* 

*hardships his entire childhood and he remembers being the poorest child at his school.*

• In case they have not reached out for psychological support, the reasons why not.

• Avoiding or reducing the risk of developing a gambling addiction behavior;

and psychiatric services in this field.

assertiveness skills training, and relapse prevention.

• Etiological and maintenance factors;

ficiency of the support they have received;

• The origin of the client's pathological gambling problems;

• How they heard about our specialized psychological services;

and verbal communication (the meaning of what is said).

tal objectives:

stress);

aspects [47]:

friends' bidding;

Case example:

the subjects.

tioning of gamblers;

Raylu and Oei [6] proposed a model of cognitive-behavioral therapy that contains four steps:


Blaszczynsky [10] introduced a complete self-help program for compulsive gamblers which comprises the following steps:


Wulfert, Blanchard, and Martell [54] used for the treatment for gambling disorder an alternative of cognitive-behavioral therapy which comprises techniques of the motivational interview, cognitivebehavioral therapy, and techniques for relapse prevention, while Miller and Rollnick [55] proposed a model of raising motivation where the key concepts are the following: raising the motivation of the client is essential in observing the product of change; motivation is a dynamic feature; and motivation is influenced by external factors, including the behavior and attitude of the counselor.

The advantages of cognitive-behavioral therapy refers to the fact that it is a well-structured type of therapy, it is carried out on a limited period of time, it requires limited costs compared to the other types of therapy, and it produces long-term benefits and supposedly the fall off the risk of relapse [6, 15, 36, 43]. Success rates of this type of therapy for gambling disorder within the studies that have been carried out so far have ranged from 36% [25] to 42% [56]; to 72% [57]; to 77% [40]; to 49% [36]; and 74% [43].

The treatment of gambling disorder poses many problems, first of all, because pathological gambling has been only recently recognized as a disorder in its own right, not enough research has been done and there is a lack of professionals trained in offering psychological and psychiatric services in this field.

We have introduced a model of cognitive-behavioral therapy for gambling addiction in Romania, based mainly on cognitive restructuring techniques, with the following fundamental objectives:


The model includes several stages, namely assessment and formulation, psycho-education and introduction to the ABCDE model, cognitive restructuring, problem-solving training, assertiveness skills training, and relapse prevention.

During the clinical assessment stage, we look at client engagement in the therapeutic process by increasing his motivation to change his gambling behavior and we clarify the following aspects [47]:


We will adopt an attitude of acceptance toward the subjects and their gambling experience, using techniques such as active listening, reflection, nonverbal communication (maintaining visual contact, open body posture, nonevaluative facial expression, consistency of tone etc.), and verbal communication (the meaning of what is said).

#### Case example:

Ledgerwood and Petry [53] proposed a model where the main components refer to the restructuring of the gambler's medium in a way that it is less conductive to pathological gambling; the patients are initially taught to identify their irrational thoughts connected to the game of chance, about the game of chance, to understand the connection between these thoughts and

Raylu and Oei [6] proposed a model of cognitive-behavioral therapy that contains four steps:

• Evaluating the problems and needs with which the client is confronted, his/her education and motives with the purpose of changing dysfunctional behaviors, while using motiva-

• Familiarizing the gambler with the fundamental strategies of the cognitive-behavioral therapy used with the purpose of stabilizing his/her compulsive gambling behavior and

• Learning some coping methods in terms of maintenance the positive changes in game

• Learning of maintenance strategies of the therapeutic wins obtained and preventing relapse.

Blaszczynsky [10] introduced a complete self-help program for compulsive gamblers which

Wulfert, Blanchard, and Martell [54] used for the treatment for gambling disorder an alternative of cognitive-behavioral therapy which comprises techniques of the motivational interview, cognitivebehavioral therapy, and techniques for relapse prevention, while Miller and Rollnick [55] proposed a model of raising motivation where the key concepts are the following: raising the motivation of the client is essential in observing the product of change; motivation is a dynamic feature; and motivation is influenced by external factors, including the behavior and attitude of the counselor. The advantages of cognitive-behavioral therapy refers to the fact that it is a well-structured type of therapy, it is carried out on a limited period of time, it requires limited costs compared to the other types of therapy, and it produces long-term benefits and supposedly the fall off the risk of relapse [6, 15, 36, 43]. Success rates of this type of therapy for gambling disorder within the studies that have been carried out so far have ranged from 36% [25] to 42% [56]; to

The treatment of gambling disorder poses many problems, first of all, because pathological gambling has been only recently recognized as a disorder in its own right, not enough

their pathological game behavior, and to identify new coping methods.

• Controlling the impulse to gamble by following relaxation techniques;

• Identifying irrational thoughts and replacing them with other rationalities;

minimizing the negative effects in case of a relapse;

tional interview techniques;

168 Cognitive Behavioral Therapy and Clinical Applications

comprises the following steps:

• Monitoring gambling behavior;

• Preventing relapse;

• Increasing the motivation to stop the game;

• Learning new ways of getting family support.

72% [57]; to 77% [40]; to 49% [36]; and 74% [43].

behavior;

*John is 32 years old, he is married and has been gambling electronic roulette and poker machines since he was 18; his parents are divorced and his father told John that he had been an unwanted child, whose birth had been a mistake and with whom he wishes to have no relation whatsoever. John faced economic hardships his entire childhood and he remembers being the poorest child at his school.*

*When he got married, he vowed that his family would never suffer from poverty, but the company he started is not doing well and he believes that only his gambling activities will help them escape poverty.*

A study carried out in Romania from 2010 to 2012, involving 119 compulsive gamblers with an average age of 29.86 years, identified the following irrational cognitions about gambling, cognitions that play a central role in the development and maintenance of the gambling behavior [43].

Cognitive-Behavioral Therapy for Gambling Addiction http://dx.doi.org/10.5772/intechopen.72671 171

The participants had a 70.58% co-occurring addiction, alongside gambling disorders, as follows: 50% of the participants engage in excessive alcohol consumption; 41.20% are heavy

*Given that, whenever he goes to a casino, John is certain he will win a substantial sum of money that will get him out of poverty, I asked him where exactly such a huge win could come from, seeing how the casino where he gambles is basically just a small hall, in which approximately 10 gamblers try their* 

*"That's easy. If there are ten gamblers who hope to win, just like I do, I will outsmart them all and I'll get their money. Then I'll be able to have a flourishing financial situation that will enable me not to be poor again, my wife will love me again, just like she did when we first met. Also, when I gamble, life seems more beautiful and I only gamble when I feel I'm lucky and I'm on the verge of winning. When I* 

During the cognitive restructuring phase, we focus on changing gambling behaviors by correcting irrational beliefs, cognitions and dysfunctional attitudes about gambling, as seen in

Therefore, we will help the subject dispute each irrational belief we identify using the follow-

Case example:

Case example:

**Table 1** [58].

ing type of questions [60]:

*luck.*

*Gambling makes me happy.*

*When I am gambling, life seems better.*

*If I win once, I am bound to win again.*

*When I am gambling, the future looks brighter.*

*To a certain extent, I can predict my next win.*

*Gambling makes me feel less agitated or stressed out.*

*The memory of winning makes me want to gamble again.*

smokers; 16.8% engage in occasional drug use [43].

*lose, I get really mad, I yell at everybody, I turn into a monster."*

• What effect does this belief have on me? Does it help me or not?

• What evidence is there that this belief is actually true?

• Is my belief logical and does it reflect reality?

*My skillfulness and abilities make me continue to gamble.*

*Losing makes me gain experience so I can become a better gambler.*

*Because he is not able to support his wife financially, he experiences profound sadness, disappointment and discouragement.*

*"She thinks I'm so stupid, I can't do anything right, I'm embrassed to see myself through her eyes. I think she's very disappointed in me and maybe she is already thinking of ending our marriage; if she leaves me, what reason do I have for living? The thought of suicide has crossed my mind, but then I started thinking: am I really such a coward? My family needs me, but they need me to be a strong and normal person, not the kind of person I am right now. I usually play the victim: I think of myself as lazy, I have time management issues, I fall into a trance for long periods of time, I have negative thoughts".*

*For John, gambling is an escape. At the casino, he puts all his problems behind him and cuts himself off from the world.*

In the case formulation, we will focus on the experiences, cognitions, emotions, and behavior of each client; the case formulation will help the client understand the factors that led to the development and maintenance of their compulsive gambling [58].

In the following stage, we will teach the client the ABCDE model designed by Albert Ellis [59] and we will familiarize him with the basic principles of cognitive-behavioral therapy [1]:


The goal of cognitive restructuring is to interrupt the vicious cycle of compulsive gambling and to help the subject have control over his behavior. The main irrational cognitions that pertain to gambling disorder can be classified in three groups [6]:


A study carried out in Romania from 2010 to 2012, involving 119 compulsive gamblers with an average age of 29.86 years, identified the following irrational cognitions about gambling, cognitions that play a central role in the development and maintenance of the gambling behavior [43].

The participants had a 70.58% co-occurring addiction, alongside gambling disorders, as follows: 50% of the participants engage in excessive alcohol consumption; 41.20% are heavy smokers; 16.8% engage in occasional drug use [43].

Case example:

*When he got married, he vowed that his family would never suffer from poverty, but the company he started is not doing well and he believes that only his gambling activities will help them escape poverty. Because he is not able to support his wife financially, he experiences profound sadness, disappointment* 

*"She thinks I'm so stupid, I can't do anything right, I'm embrassed to see myself through her eyes. I think she's very disappointed in me and maybe she is already thinking of ending our marriage; if she leaves me, what reason do I have for living? The thought of suicide has crossed my mind, but then I started thinking: am I really such a coward? My family needs me, but they need me to be a strong and normal person, not the kind of person I am right now. I usually play the victim: I think of myself as lazy, I have time management issues, I fall into a trance for long periods of time, I have negative thoughts". For John, gambling is an escape. At the casino, he puts all his problems behind him and cuts himself off* 

In the case formulation, we will focus on the experiences, cognitions, emotions, and behavior of each client; the case formulation will help the client understand the factors that led to the

In the following stage, we will teach the client the ABCDE model designed by Albert Ellis [59] and we will familiarize him with the basic principles of cognitive-behavioral therapy [1]:

• Psychological issues represent learned maladaptive responses, supported by irrational

• Dysfunctional cognitions can be identified and replaced, which takes effort and persever-

The goal of cognitive restructuring is to interrupt the vicious cycle of compulsive gambling and to help the subject have control over his behavior. The main irrational cognitions that

• Illusion of control of gambling, which can take three forms: active illusionary control (the belief that he can directly control his gambling outcomes); passive illusionary control (the belief that he may indirectly have control in determining whether he wins or loses only when he feels lucky), or magnifying his own gambling skills and minimizing other gam-

• Predictive control, which involves the belief that the gambler has the skill of making ac-

• Interpretive biases, which involve reframing gambling outcomes in such a way that encourages continued gambling despite of heavy losses: gambler's fallacy, chasing, selective

development and maintenance of their compulsive gambling [58].

• Dysfunctional thinking results from genetic and environmental factors;

pertain to gambling disorder can be classified in three groups [6]:

memory, reframed losses internal or external attributions.

• Modifying irrational beliefs is the best way to reduce maladaptive behaviors;

*and discouragement.*

170 Cognitive Behavioral Therapy and Clinical Applications

*from the world.*

cognitions;

blers' skills;

curate predictions;

ance on the part of the subject.

*Given that, whenever he goes to a casino, John is certain he will win a substantial sum of money that will get him out of poverty, I asked him where exactly such a huge win could come from, seeing how the casino where he gambles is basically just a small hall, in which approximately 10 gamblers try their luck.*

*"That's easy. If there are ten gamblers who hope to win, just like I do, I will outsmart them all and I'll get their money. Then I'll be able to have a flourishing financial situation that will enable me not to be poor again, my wife will love me again, just like she did when we first met. Also, when I gamble, life seems more beautiful and I only gamble when I feel I'm lucky and I'm on the verge of winning. When I lose, I get really mad, I yell at everybody, I turn into a monster."*

During the cognitive restructuring phase, we focus on changing gambling behaviors by correcting irrational beliefs, cognitions and dysfunctional attitudes about gambling, as seen in **Table 1** [58].

Therefore, we will help the subject dispute each irrational belief we identify using the following type of questions [60]:


Following the disputation process, we will help the subject replace his irrational beliefs with a different set of beliefs, which will be rational and will reflect reality, such as [47]:

Preventing relapses is a psychoeducational approach targeting behavioral change, through which the gambler learns to identify and overcome risk situations that could make him return

Cognitive-Behavioral Therapy for Gambling Addiction http://dx.doi.org/10.5772/intechopen.72671 173

Creating a decisional balance sheet for when he feels the urge to gamble again will help the subject to make the right decision about gambling. The decisional balance sheet is a technique which consists in creating a list of pros and cons of a certain behavior, as they appear to the subject at that particular moment in time. With the help of this balance sheet, the subject will weigh the long-term and short-term advantages and disadvantages of his gambling behavior, and based on the weight he gives to each advantage and disadvantage, he will make the decision to either cease or to continue to gamble, taking on the full responsibility for the conse-

*John's decisional balance sheet includes the possibility of winning a lot of money, satisfying a momentary urge and forgetting about his troubles at home among the advantages of continuing to gamble. Among the disadvantages he includes losing large sums of money, addiction, wasting his time, neglecting his responsibilities, negative emotional states, heavy smoking while gambling, a permanent state* 

Depending on each gambler's specific circumstances, we will continue the process of cognitive restructuring with the goal of treating any potential depression and anxiety disorders, given that the negative emotionality underlying depression and anxiety play an important role in triggering as well as maintaining the gambling addiction [61–64]. The key irrational

• Unconscious associations between the activating event (A) and the consequences (C).

During the process of cognitive restructuring, these cognitions will be replaced by rational

• Nondogmatic preferences: I may want something, but I do not have to absolutely have it;

cognitions that generate negative emotional states are the following:

• Absolutist demands: the absolute "must";

• Catastrophizing: it is terrible/horrible;

• Intolerance to frustration: I cannot stand;

• Evaluation as unpleasantness: it is unpleasant;

• Tolerance to frustration: I do not like it, but I can put up with it;

• Avoiding global evaluation: I am human and I can make mistakes sometimes.

• Global evaluation: I am terrible; the others are terrible;

to his old compulsive gambling behavior [39].

quences of his actions.

Case example:

*of restlessness.*

alternatives:


The following is an example of an irrational belief: "on a certain extent, I can predict my next win". As a result of the disputation process, the compulsive gambler's irrational beliefs will be replaced by rational beliefs, which will reflect reality and will help him manage his gambling behaviors.

After the cognitive restructuring process, we will suggest to the gambler that he creates a list of alternative activities to replace his gambling behavior and as well as a schedule of daily activities which should leave him no spare time to gamble or identify the triggers for his gambling behavior. Studies have shown that involving compulsive gamblers in a large number of activities to fill up their spare time significantly reduces the risk of a relapse.

Identifying irrational beliefs ↓ Testing the validity of irrational beliefs ↓ Replacing irrational beliefs with rational thoughts ↓ Positive influence on emotions ↓ Behavioral modification

**Table 1.** The cognitive restructuring process.

Preventing relapses is a psychoeducational approach targeting behavioral change, through which the gambler learns to identify and overcome risk situations that could make him return to his old compulsive gambling behavior [39].

Creating a decisional balance sheet for when he feels the urge to gamble again will help the subject to make the right decision about gambling. The decisional balance sheet is a technique which consists in creating a list of pros and cons of a certain behavior, as they appear to the subject at that particular moment in time. With the help of this balance sheet, the subject will weigh the long-term and short-term advantages and disadvantages of his gambling behavior, and based on the weight he gives to each advantage and disadvantage, he will make the decision to either cease or to continue to gamble, taking on the full responsibility for the consequences of his actions.
