Cognitive versus exposure therapy for problem gambling: randomised controlled trial

Background: Problem gambling-specific cognitive therapy (CT) and behavioural (exposure-based) therapy (ET) are two core cognitive-behavioural techniques to treating the disorder, but no studies have directly compared them using a randomised trial. Aims: To evaluate differential efficacy of CT and ET for adult problem gamblers at a South Australian gambling therapy service. Methods: Two-group randomised, parallel design. Primary outcome was rated by participants using the Victorian Gambling Screen (VGS) at baseline, treatment-end, 1, 3, and 6 month follow-up. Findings: Of eighty-seven participants who were randomised and started intervention (CT=44; ET=43), 51 (59%) completed intervention (CT=30; ET=21). Both groups experienced comparable reductions (improvement) in VGS scores at 12 weeks (mean difference-0.18, 95% CI:-4.48-4.11) and 6 month follow-up (mean difference 1.47, 95% CI:-4.46-7.39). Conclusions: Cognitive and exposure therapies are both viable and effective treatments for problem gambling. Large-scale trials are needed to compare them individually and combined to enhance retention rates and reduce drop-out.