Control Problem Gambling with CBT and Mindfulness


By John M. de Castro, Ph.D.


“Whether you bet on sports, scratch cards, roulette, poker, or slots—in a casino, at the track, or online—problem gambling can strain relationships, interfere with work, and lead to financial catastrophe. You may even do things you never thought you would, like stealing money to gamble or pay debts.”


People love to gamble! They wager on everything from sports, to politics, to personal achievements, to even random outcomes, like slot machines of lotteries. It can be great fun, adding zest to otherwise mundane days or routine athletic competitions. It can be part of personal bonding with friends as in an ongoing poker game. A good bet can even be used to motivate someone to stop smoking, lose weight, or support a charity. In fact, over 80% of all Americans wager on at least a yearly basis and 15% gamble every week. In and of itself there is nothing wrong with gambling.


But, for 3% to 5% of people who gamble, it becomes a major problem. There are about 6 million Americans who are problem gamblers. They gamble money they can ill afford to lose and it becomes an obsession and an addiction. When this happens, it can wreak havoc with a person’s life, ruining careers, relationships, families, credit, and even physical and mental health. Indeed, on average about half of people with gambling addictions commit crimes to support their addiction and the majority of people in prison have a gambling problem.


There are a wide variety of treatments for problem gambling including psychotherapies, 12-step programs, medication, support groups, etc. Cognitive Behavioral Therapy (CBT) has been particularly effective. Recently, mindfulness has been added to produce Mindfulness Based Cognitive Therapy (MBCT). This has been found to be effective in treating a range of addictions.  Cognitive Behavioral Therapy attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. These skills are particularly pertinent to problem gambling as there’s no physical basis like in other addictions. Rather, it is entirely driven by inappropriate thought processes and emotions.


In today’s Research News article “Treating Problem Gambling Samples with Cognitive Behavioural Therapy and Mindfulness-Based Interventions: A Clinical Trial.” See:

or see below

McIntosh and colleagues randomly assigned problem gamblers to receive a 4-week program of either treatment as usual (TAU) which provided an individualized Cognitive Behavioral Therapy (CBT), CBT using a standardized manual for gambling addiction, or Mindfulness Based Cognitive Therapy (MBCT). All groups, in addition, received an education package on problem gambling.


They found that all three treatments produced large and clinically significant improvements in problem gambling that persisted at 3 and 6 months after the end of treatment. They all improved patient quality of life and mindfulness, particularly the acting with awareness facet of mindfulness. They also found that the mindfulness group (MBCT) had additional improvements in rumination and thought suppression. Hence, Cognitive Behavioral Therapy, whether individualized, standardized, or included mindfulness were successful in treating problem gambling. But, mindfulness training in addition to CBT had the added benefits of decreasing rumination and thought suppression, which are thought to add to the patient’s psychological distress.


These are exciting results. More than half of the problem gamblers no longer met the clinical standard as problem gamblers 6 months after treatment. They support the growing research evidence of the efficacy of CBT for problem gambling. They also suggest that adding mindfulness training to the package produces additional benefits that can help the gambler stop repetitively thinking about gambling (rumination) and to stop trying to suppress this thinking, rather bringing it to consciousness where it can be addressed. These two extra benefits may be helpful for preventing relapse.


So, control problem gambling with CBT and mindfulness.


“mindfulness focuses on the present and acceptance of oneself. Such an approach allows the practitioner to identify and deal with the gambling urge when it comes. Mindfulness also enables the practitioner to appreciate each moment, leaving less opportunity to think about or desire hitting the casino or racetrack.”


CMCS – Center for Mindfulness and Contemplative Studies


Study Summary

McIntosh CC, Crino RD, O’Neill K. Treating Problem Gambling Samples with Cognitive Behavioural Therapy and Mindfulness-Based Interventions: A Clinical Trial. J Gambl Stud. 2016 Apr 4. [Epub ahead of print], PMID: 27040973



The problem gambling (PG) intervention literature is characterised by a variety of psychological treatments and approaches, with varying levels of evidence (PGRTC in Guideline for screening, assessment and treatment in problem and pathological gambling. Monash University, Melbourne, 2011). A recent PG systematic review (Maynard et al. in Res Soc Work Pract, 2015. doi:10.1177/1049731515606977) and the success of mindfulness-based interventions to effectively treat disorders commonly comorbid with PG suggested mindfulness-based interventions may be effective for treating PG. The current study tested the effectiveness of three interventions to treat PGs: 1. case formulation driven Cognitive Behaviour Therapy (CBT); 2. manualised CBT; and 3. mindfulness-based treatment. All three interventions tested returned large effect size improvements in PG behaviour after seven sessions (Cohen’s d range 1.46–2.01), at post-treatment and at 3 and 6-month follow-up. All of the interventions were rated as acceptable by participants at post-treatment. This study suggests that the mindfulness-based and TAU interventions used in the current study appear to be effective at reducing PG behavior and associated distress and they also appear to generalise to improvements in other measures such as quality of life-mental functioning and certain mindfulness facets more effectively than the manualised form of CBT utilised used here. Secondly, a brief mindfulness intervention delivered after psycho-education and a brief CBT intervention may be a useful supplement to traditional CBT treatments by addressing transdiagnostic processes such as rumination and thought suppression. Thirdly, CBT interventions continue to report effectiveness in reducing PG behaviour and associated distress consistent with the prevailing literature and clinical direction.