A Randomized Controlled Trial for Gambling Disorder and PTSD: Seeking Safety and CBT

Lisa M Najavits; David M Ledgerwood; Tracie O Afifi

doi:10.1007/s10899-023-10224-z

A Randomized Controlled Trial for Gambling Disorder and PTSD: Seeking Safety and CBT

J Gambl Stud. 2023 Dec;39(4):1865-1884. doi: 10.1007/s10899-023-10224-z. Epub 2023 Jun 12.

Authors

Lisa M Najavits^{1

2}, David M Ledgerwood^{3

4}, Tracie O Afifi⁵

Affiliations

¹ Treatment Innovations, Newton Centre, MA, USA. director@treatment-innovations.org.
² Department of Psychiatry, UMass Chan Medical School, Worcester, MA, USA. director@treatment-innovations.org.
³ Department of Psychology, University of Windsor, Windsor, ON, Canada.
⁴ Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
⁵ Department of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Canada.

Abstract

Studies show a compelling association between gambling disorder and posttraumatic stress disorder. However, there have been no randomized controlled trials for this co-morbidity. The aim of the current study was to compare two evidence-based models, one that addresses both disorders and another that addresses gambling alone. Sixty-five men and women with gambling disorder and posttraumatic stress disorder were randomized to one of two treatment conditions delivered via telehealth, Seeking Safety (integrated treatment for gambling and posttraumatic stress disorder) or Cognitive-Behavioral Therapy for Pathological Gambling (for gambling alone), in a randomized controlled non-inferiority trial. Primary outcomes were net gambling losses and number of sessions gambling. Secondary outcomes were posttraumatic stress disorder symptoms, coping skills, general psychiatric symptoms, global functioning, and gambling cognitions. Assessment occurred at baseline, 6-weeks, 3 months (end of treatment) and 1-year. On most measures, including primary outcomes, participants improved significantly over time with no difference between treatment conditions. Seeking Safety patients had significantly higher session attendance. Effect sizes were large for gambling, posttraumatic stress disorder and coping. All other measures except one showed medium effect sizes. Therapeutic alliance, treatment satisfaction, and the telehealth format were all rated positively. This was the first randomized trial of Seeking Safety in a gambling disorder population. Seeking Safety showed comparable efficacy to an established gambling disorder intervention; and significantly higher Seeking Safety attendance indicates especially strong engagement. Our finding of overall comparable results between the two treatments is consistent with the comorbidity treatment literature.Trial registration: ClinicalTrials.gov NCT02800096; Registration date: June 14, 2016.

Keywords: Cognitive behavioral therapy; Gambling disorder; Posttraumatic stress disorder; Randomzied controlled trial; Seeking Safety; Trauma.

Publication types

Randomized Controlled Trial

MeSH terms

Adaptation, Psychological
Cognition
Cognitive Behavioral Therapy* / methods
Female
Gambling* / psychology
Humans
Male
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / psychology
Stress Disorders, Post-Traumatic* / therapy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02800096

Grants and funding

LG-15-13/Manitoba Gambling Research Program