Psychological therapies for pathological and problem gambling

摘要: Background Various psychological therapies for pathological and problem gambling have been evaluated in randomised trials. A synthesis of best-quality evidence is required. Objectives The objective was to synthesise from trials (cognitive-behaviour therapy (CBT), motivational interviewing therapy, integrative other therapy), order indicate the efficacy durability effects, relative control conditions. Search methods We conducted a search Cochrane Depression, Anxiety Neurosis Review Group's Specialised Register (CCDANCTR), which includes relevant controlled following bibliographic databases: CENTRAL (The Central Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) PsycINFO (1967 -). also carried out complementary searches MEDLINE, EMBASE, PsycINFO, LILACS studies published between January 1980 October 2011. examined WHO International Clinical Trials Registry Platform ClinicalTrials.gov manual selected journals reference lists included studies. Selection criteria Included were clinical using random allocation groups, considering or gamblers, evaluating gambling. Control conditions 'no treatment' controls, referral Gamblers Anonymous non-specific treatment component controls. Data collection analysis systematically extracted data on characteristics results Primary outcomes measures symptom severity, financial loss frequency Secondary occurrence diagnoses depression anxiety symptoms. Treatment effects defined by comparisons at post-treatment assessments (conducted 0 3 months completion treatment) follow-up 9 12 treatment), respectively, standardised mean difference (SMD) risk ratio (RR). synthesised through random-effects meta-analysis. Main Fourteen (n = 1245) met inclusion criteria. Eleven compared CBT with showed beneficial that ranged medium (when gambling: SMD -0.52; 95% confidence interval (CI) -0.71 -0.33, n 505) very large (for severity: -1.82; CI -2.61 -1.02, 402). Only one study 147) groups produced smaller not significant. Four identified mainly considered samples demonstrating less severe (relative gamblers). suggested reduced (SMD -0.41; -0.75 -0.07, 244), although effect approached zero when severity -0.03; -0.55 0.50, 163). Studies found significant terms -0.53; -1.04 -0.02, 62), Two overall low no post-treatment. Comparisons differences outcomes. One 18) another (i.e.Twelve-Step Facilitated Group Therapy) most supporting these various classes quality. Authors' conclusions This review supports reducing behaviour symptoms immediately therapy. However, therapeutic gain unknown. There preliminary some benefits behaviour, necessarily findings are based few additional research needed inform conclusions. suggestive possible benefit therapies, there too insufficient evaluate therapies. majority this varied bias, much comes multiple limitations. current may thus reflect overestimates efficacy.