2006, Tolchard, Barry, Thomas, Lyndall, Battersby, Malcolm

There is a paucity of treatment-outcome research for problem or pathological gambling. Single-session exposure therapy has been used successfully with a broad range of psychological disorders such as panic disorder and the phobias. This article will describe the use of single-session graded exposure to treat problem gambling with an Electronic Gaming Machine (EGM) gambler. Pretreatment to 6-month follow-up repeated measures showed a significant reduction in client-rated gambling severity, that is, showed a significant reduction in client-rated gambling severity (Gambling Severity Checklist [GSCL]), the Symptom Checklist-90-Revised (SCL-90-R) and the Beck Depression Inventory (BDI). This case demonstrates a novel intervention which is brief, convenient and accessible to the client, and which resulted in gains maintained over the medium-term. This promising single case indicates the need for further research to determine whether positive benefits are realised in larger randomised control designs.

2013, Tolchard, Barry, Battersby, Malcolm

Cognitive-Behaviour Therapy (CBT) is considered the number one non-pharmacological treatment for a number of mental and psychological disorders (Tolin, 2010; Stuhlmiller & Tolchard, 2009). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent (Walker, 2005). This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.

2009, Tolchard, Barry

The Problem with the Problem: Definition - • U.S. driven medical model • Addiction or Compulsion • DSM - failure to differentiate regular and problem gamblers • Pathology or Harm • Local context Victorian Gambling Screen (VGS) - • Developed using a definition of problem gambling based on harm: "'Problem' gambling refers to the situation when a person's gambling activity gives rise to harm to the individual player, and/or his or her family, and may extend into the community" [DIPG Report, p.106]

2013, Tolchard, Barry, Delfabbro, Paul

Although many attempts have been made to assess problem or pathological gambling in adolescents, concerns have been raised about whether existing measures are ideally suited for this purpose. Such measures are heavily influenced by traditional addiction models common to the study of substance use. In contrast, more recent public health approaches to gambling place a greater emphasis on the role of behavior and its harmful consequences and this is implicit in many currently accepted definitions of problem gambling. This paper reports on the use of one such measure (Victorian Gambling Screen -VGS), with 926 grade 7-12 adolescents surveyed in the Australian Capital Territory. The VGS was shown to correlate well with the gold standard Diagnostic & Statistical Manual-IV-Juvenile Screen (DSM-IV-J) for problem gamblers producing similar prevalence estimates. The measure also has sound internal reliability and concurrent validity. The findings suggest that harm-based measures such as the VGS are credible with adolescent populations in Australia and that various forms of harm observed in adult populations can also be observed in adolescent problem gamblers.

2012, Tolchard, Barry

CBT is recognised at the most successful non-pharmacological treatment for problem gamblers. However, debate surrounds the true efficacy of the approach especially in light of the inconsistency in which CBT is applied and reported. All too often research purporting to offer CBT frequently use a mixed models or integrative approaches. This leads to it being unclear which components are responsible for the therapeutic change. This paper will examine the evidence supporting Cognitive-Behavior Therapy (CBT) with problem gamblers. The core components of CBT, as used with problem gamblers, will be further highlighted and a comparison across published studies made. Data will be presented from the authors' own practice and compared against published data where CBT is the main treatment approach. A Cognitive-Behavioral model of problem gambling will be formulated. This model will be used to inform a unified CBT approach that will assist therapists when choosing to treat gamblers using CBT. It will be argued that this approach will offer a common person-centred formulation driven model of treatment that sticks to the fundamental principles of CBT.

2011, Tolchard, Barry

Cognitive-Behaviour Therapy (CBT) is increasingly being considered the psychological treatment of choice for problem gamblers. A number of reviews have reported overall positive outcomes in both randomized controlled and naturalistic trials. There is also dissenting evidence that CBT may, in fact, be no better than other talking therapies or indeed no treatment. Such evidence is driven by research using limited methodologies. However, such criticism cannot be ignored. This paper will present an overview of the multitude of CBT approaches being offered around the world. Common elements of all approaches will be examined and the possibility of a unified model suggested. This standardization of CBT for problem gambling may provide a more consistent approach internationally and thus give greater weight to the overall efficacy of CBT.

2010, Tolchard, Barry, Battersby, Malcolm

There is a need to establish reliability and the various forms of validity in all measures in order to feel confident in the use of such tools across a wide diversity of settings. The aim of this study is to describe the reliability and validity of the Victorian Gambling Screen (VGS) and in particular one of the sub-scales (Harm to Self - HS) in a specialist problem gambling treatment service in Adelaide, Australia. Sixty-seven consecutive gamblers were assessed using a previously validated clinical interview and the VGS (Ben-Tovim et al., The Victorian Gambling Screen: project report. Victorian Research Panel, Melbourne, 2001). The internal consistency of the combined VGS scales had a Cronbach's alpha of .85 with the HS scale .89. There was satisfactory evidence of convergent validity which included moderate correlations with another measure of gambling—the South Oaks Gambling Screen. There were also moderate correlations with other measures of psychopathology. Finally, how the VGS may best be used in clinical settings is discussed.

2007, Tolchard, Barry, Thomas, Lyndall, Battersby, Malcolm

General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.

2008, Battersby, Malcolm, Oakes, Jane, Tolchard, Barry, Forbes, Angus, Pols, Rene

The cognitive behavioral therapy (CBT) approach used within the unit for the treatment of problem gambling is based on the same principles used to treat clients with anxiety disorders and depression. This approach is based on the work of Isaac Marks (Marks, 1986) and was introduced by Battersby (Tolchard and Battersby, 2000) to South Australia in 1996. The service is part of the Break Even network funded by the South Australian government Department of Families and Communities and is integrated with the Mental Health Sciences postgraduate courses in cognitive-behavioral therapy for health professionals at Flinders University, Adelaide, Australia. This chapter provides an outline of the theoretical framework, assessment process, specific treatment methods, and measurement of treatment outcomes of the Flinders Therapy Service for Problem Gamblers. A case example and outcome data are provided to demonstrate the treatment model and its effectiveness. An overview of treatment Outcomes for problem gambling assessing different modalities is discussed.

2010, Tolchard, Barry

Gambling before CBT: • Freud - gamblers were trying to punish themselves for their unresolved oedipal urges and that this meant they were deliberately trying to lose • Bergler - "...the gambler is not a weak person who wants to gain money [easily] ...but a neurotic with an unconscious wish to lose" Cognitive-Behavioural Theories (CBT) of gambling: • A number CBT models have been described - e.g., Petry, 2005; Sylvain, et al., 1997; Toneatto, 2002 - no single unified approach has been tested and the efficacy of CT continues to be debated • Sharpe and Tarrier (1993)--CBT model - incorporating relaxation, exposure and cognitive restructuring - while cited frequently - reservations must exist lack of empiricism - generalisation to all gambling problems is limited