A FEW SESSIONS OF MOTIVATIONAL INTERVIEWING COULD THAT REALLY BE AN EFFECTIVE TREATMENT FOR PATHOLOGICAL GAMBLING?

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1 A FEW SESSIONS OF MOTIVATIONAL INTERVIEWING COULD THAT REALLY BE AN EFFECTIVE TREATMENT FOR PATHOLOGICAL GAMBLING? Lars Forsberg, Ph.D., supervisor in CBT Karolinska Institutet, Department of Clinical Neuroscience, Section of Dependency Research, Stockholm, Sweden.

2 We don t know but There are some support for this belief

4 Hodgins, Currie & el-guebaly, 2001 Clients with gambling problems randomised to 1) 1-month Waiting-list control 2) Self-help manual 3) Motivational Interviewing (20-45 minutes telephone session) + Self-help manual Clients with a telephone MI session had better outcome at 3 and 6 month follow ups. At the 12 month follow up only MI-clients with less severe problems had better outcome.

5 Takushi et al., 2004 Motivational Interviewing and short Cognitive Behavior Therapy have a preventive effect on university students with gambling problems.

6 Similarities in diagnostic criteria for pathological gambling and substance dependence Pathological gambling as indicated by 5 or more of 10 criteria. Dependence of alcohol, cannabis, cocain or heroin is at hand if manifested by 3 or more of 7 criteria in the last 12-month period.

7 Similarities in etiology according to learning psychology Negative emotions of depressiveness, stress, anger or arousal may disappear. Positive emotions of joy, energy, social closeness and generousness may develop. The short time frame between behavior and the positive effects is powerful learning force. Intermittently negative or positive reinforced Classical conditioning

8 Similarities in etiology and diagnosis might also warrant similarities in treatment MI has been found effective with alcohol problems (31 studies) and with drug problems (14 studies) (Hettema,J. Steele,J. Miller,W.; in press) 4 sessions of MI is as effective as 12 sessions of CBT or a 12 step program

9 (Babor,T. Del Boca,F. 2003)

11 Treatment effectiveness and costs 2-months Waiting-list control 8 sessions of CBT in a group format 4 sessions of Motivational Interviewing Follow ups at 6 and 12 month Per Carlbring, Jakob Jonsson, Lars Forsberg

12 Manual for Motivational Interviewing for Pathological Gambling Lars Forsberg & Kerstin Forsberg Karolinska institutet & The Stockholm Dependency Centre November 2004

13 Four MI-sessions Timing of the four sessions Session 1 & Week

14 Session I Focus on building rapport and on factors, pros and cons attending treatment for gambling problems. Understand the client s frame of reference. Investigate factors, pros and cons for gambling. Offer questionaires and the card value sort. Elaborate on the ambivalance (ambi=dubbel; valence=valid)

15 Instruments Questionnaire of consequences of gambling Motivation to change with RTCQ Questionnaires of thoughts about gambling The Card value sort

16 Session II Repetition and completing the session I and coninuing the session I issues. Discussion of test results. Elaborate on details in pro and con gambling. Reduce resistance to change Reinforce commitment to change.

17 Session III & IV Summarize the clients reasons for change, develop self-efficacy to change. Investigate ambivalance to change, reinforce progress and commitment to change. Reduce resistance to change. If the client is ready to change, develop a change plan in six steps.

18 Treatment Integrity of MI Motivational Interviewing Treatment Integrity Manual (MITI), version 2.0 Theresa Moyers, Tim Martin & William R. Miller, University of New Mexico, USA. translation to Swedish, Lars Forsberg & Timothy Van Loo A coding lab. at Karolinska Institutet with 8 coders

19 Knowledge to win Will a few sessions of MI be beneficial? Our Swedish study will give a small piece of answer to that question. Need of treatment studies teaching how to be helpful for clients. A long voyage with exiting knowledge to learn.

Treatment Indications for Problem Gambling. Mood Modification. Coping 7/25/2012. NCPG Annual Conference July 14, 2012 Louis Weigele, LISW S, NCGC II

Treatment Indications for Problem Gambling NCPG Annual Conference July 14, 2012 Louis Weigele, LISW S, NCGC II Mood Modification Wood and Griffiths (2007) Qualitative study Lack of theoretical foundation