The importance of a therapeutic contract in a CBT gambling disorder treatment
Background: Gambling disorder and its treatment is still poorly studied in Portugal. Therapeutic Contract (T.C.) is a set of guidelines (i.e. controlling money access, self-exclusion, significant other participation in some sessions, commitment to 15 psychotherapy sessions…) to help patients and families to obtain satisfactory treatment results.
Method: 71 participants were voluntarily recruited by the IAJ and fulfill an evaluation protocol before the CBT/CT intervention (moment 1) and for at least 6 months (or 15 sessions) after the intervention (moment 2).
Measures: The evaluation protocol included a 1- Therapeutic Goals Contract (Hubert, 2010); 2- SOGS (Lesieur & Blume, 1987); 3- self-devised questionnaire based on patient's perceptions : “Impact of treatment or relapse in gambling behavior” (Hubert, 2015).
Results: Results showed statistically significant differences between abstinent and relapsed groups concerning treatment success. Abstinent group had higher figures concerning: good relationship with psychologist (p=0.003), coping with feelings/ thoughts/behaviors (p= 0.008), attending self-help group of gamblers anonymous (p= 0.08), doing requested therapeutic exercises/tasks (p=0.05) and having a job (p= 0.05).
In the relapsed group, patients showed that their relapse was mainly related to: having access to money, doing less psychotherapy sessions, difficulties in coping with feelings/thoughts/behaviors (anxiety and stress problems, return of obsession, self-criticism and shame), marketing and gambling accessibility/diversity, prize amount and fast delivery of money in gambling.
Conclusions: The patients showed good adherence and acceptance of TGC guidelines and the total gambling abstinence concept. These “external TGC guidelines” may become the structure to better prepare and involve patients in effective treatment changes, and it’s characterized by being “easily” followed in patients daily lives, by being adaptable, negotiable, and by having a direct impact on patients and their significant others in the process. Informing patients about beliefs, causes and consequences of relapse, may be useful for relapse prevention. Identifying what went wrong with TGC guidelines, allows the introduction of new therapeutic strategies to work together with motivational interview techniques.