by Roger Horbay
Several studies have examined the effectiveness of various behavioural techniques used to change problem gambling behaviour. Blaszczynski, McConaghy, and Frankova (1991) used one of four techniques to treat 120 gamblers: imaginal desensitization, aversion therapy (no longer used with people affected by problem gambling), imaginal relaxation and in vivo exposure. The results were promising. In an average six-month follow-up of 63 clients, 18 reported abstinence, 25 reported controlled gambling and 20 reported uncontrolled gambling. Of those who were treated with imaginal desensitization, 78% stopped gambling or became controlled gamblers compared with 53.4% of these treated with alternative methods. Although only behavioural treatments have been tested enough to be judged as “effective” — because they lend themselves more readily to scientific study (Lopez & Miller, 1997) — skill-based interventions should not cause the counsellor to neglect the client’s personal matters. For example, a client may require help for marital difficulties or any other life stressor such as unresolved grief over the death of a loved one. Some clients express a desire to understand how their problem gambling developed. Exploring the issues that concern the client maintains matching and may be a significant source of motivation.
Cue Response Techniques
Cue response techniques — imaginal desensitization and imaginal relaxation — are based on the premise that exposure to cues or triggers evoke conditioned responses such as cravings or arousal. These are extinguished when behaviour is prevented. McConaghy, Armstrong, Blaszczynski, and Allcock (1988) compared the effectiveness of two cue response techniques: imaginal desensitization (ID) and imaginal relaxation (IR). Both treatments were found to reduce anxiety. Gamblers who reported decreased anxiety showed a decrease in their gambling behaviours. IR involves learning and rehearsing muscle relaxation techniques in response to anxiety. ID incorporates IR into a framework of coping with increasingly anxiety-evoking gambling situations.
Imaginal Desensitization
Imaginal desensitization (ID) is a relaxation-based and guided imagery technique based on the premise that systematic desensitization allows individuals to control their impulses. The client describes four or five situations in which he or she typically gambles or thinks about gambling. These situations are ranked according to the degree to which each evokes gambling urges and anxiety and the difficulty the client has in leaving the situation. id treatment then begins, with the therapist teaching the client five-minute relaxation techniques in which the client practises tensing and relaxing muscle groups. When relaxation becomes sufficiently automatic, the client is guided through the gambling situations, moving from situations of lesser to greater anxiety. New situations are introduced when the client indicates that he or she has visualized the situation and dealt with it in a relaxed manner. The scenarios are usually recorded on tape so that the client can practise them throughout the week.
Muscle Relaxation Techniques
Muscle relaxation techniques are particularly important in the early stages of treating problem gambling. They (see above example) are intended to counter-condition evoked anxiety, urges and/or cravings that arise from cues in the environment (such as seeing a lottery advertisement on a billboard) and from internal cues (such as feelings of loneliness that have often been dealt with by escaping into the excitement and social surroundings of the casino) and are inherently self-empowering. When coupled with other therapeutic strategies (from any therapeutic approach), a client can quickly increase his or her motivation and confidence to curtail or stop gambling. Muscle relaxation techniques are used throughout the recovery process. See Section 3.9, “Teaching Clients Skills for Change and Relapse Prevention” for further applications.
References
Blaszczynski,McConaghy & Frankova. (1998). Lopez, V. (Ed.). Treating Addictive Behaviours (2nd ed.) New York, ny: Plenum Press.
Lopez, V.C. & Miller,W.R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review, 17 (7): 689-702.
McConaghy, Armstrong, Blaszczynski & Allcock. (1988). Behavioural completion versus stimulus control in compulsive gambling: implications for behavioral assessment. Behaviour Modification, 12, 371-384.