Extinction of gambling cue-reactivity: A pilot study in a problem gambling treatment setting

Clinical interventions which focus on extinction learning have been shown to reduce craving and relapse in substance related and behavioural addictions. This paper reports a small pilot study with 20 problem gamblers referred for treatment by a local court diversion program. We investigated the use of portable heart rate monitors to measure the effectiveness of Cue Exposure Therapy (CET) in extinguishing gambling cue-reactivity. Cue-reactivity procedures consisted of a relaxation period followed by in-vivo exposure with response prevention in a gambling environment. Cue exposure therapy was manualised. Dependent measures comprised both self-report (gambling urge and problem gambling questionnaire) and physiologic measures (heart rate). Significant increases in heart rate were observed during in-vivo pre-CET but not post-CET (p < 0.001). Following CET, significant reductions across all dependent variables were observed (p ≤ 0.001) with within-group effect sizes ranging between r = -.55 and -.61. Overall, the results of this small pilot study support the feasibility and acceptability of the use of portable heart rate monitors to observe the extinction of gambling cue-reactivity. Portable heart rate monitors may provide a novel and useful tool for therapists and their problem gambling patients to monitor gambling cue-reactivity during treatment. Further research is needed to evaluate whether extinction of cue-reactivity can reduce problem gambling relapse