Psychiatry and Clinical Psychopharmacology

Psychosocial and other nonbiological therapies and interventions Medical and cognitive behavioral therapy in a patient with pathological gambling

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S235-S236
Read: 493 Published: 17 March 2021

Pathological Gambling (PG) is a condition associated with continuous, persistent and inappropriate gambling behavior despite the significant losses it engenders in the individual’s life. Psychological disorders that accompany PG can affect the outcome of treatment. It has been reported that high levels of depressive symptoms can increase the probability of developing a gambling behavior. In this case report, we discuss the medical and Cognitive Behavioral Therapy (CBT) treatment of a PG case with comorbid depression, and describe the effects and outcome of this treatment. SD is a 32-year-old male, university graduate. He is married and has one child. He was admitted to our clinic following suicide attempt, and described complaints of continuous and uncontrolled betting on football games over the internet, hopelessness. During the first meeting, the patient was diagnosed with “pathological gambling” and “major depressive disorder” according to DSM-IV-TR. The patient’s Beck Depression Inventory (BDI) score was 31 and Gambling Symptom Assessment Scale (GSAS) score was 45 during first evaluation. The patient had previously attempted to stop gambling, but he was only able to stop for 10 days at most. For these reasons, the patient was started on duloxetine 60 mg, and CBT was planned first for the patient’s thoughts of suicide, and then for gambling behavior. During the first three sessions, the patient’s thoughts of suicide and depressive symptoms were considered in detail. In these antecedent sessions, an effectiveness table was provided for “behavioral activation,” and the thoughts of suicide were addressed by using execution metaphor. Efforts were made to “develop alternative and realistic thoughts” in order to correct the existing cognitive errors of the patient. During the 4-5th sessions, it was ensured that the patient monitored his own gambling behavior on daily basis, and the short- and long-term advantages and disadvantages associated with playing or stopping gambling were considered in order to increase his motivation. During the 6-7th sessions, a personalized model was developed in accordance with the model previously proposed by Ladouceur and Lachance (2007) regarding gambling behavior. During the 8-9th sessions, cognitive restructuring was performed for the patient’s cognitive distortions. It was observed that the patient did not gamble during the 12-week treatment period, that his BDI score decreased to 10, and that his GSAS score decreased to 4. This report discussed the treatment of a case with pathological gambling. Although there is no commonly accepted treatment approach for PG, therapies and medical treatments represent the most preferred methods. However, as studies in the literature describe mixed results regarding the effectiveness of antidepressant medication in the treatment of pathological gambling, and as the use of treatments involving cognitive behavioral approaches along with medical treatment have yielded promising results in recent years, we wanted to report for this case the favorable results obtained by using CBT in addition to medical treatment, as well as the methods associated with the treatment approach we employed. However, to be able to identify effective treatment approaches for PG, it is necessary to conduct further studies on this disease with larger numbers of cases.
 

EISSN 2475-0581