Introducing the New England 4G framework of guided self-health for people in rural areas with physical and psychological conditions
The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.
Cognitive-Behavior Therapy for problem gamblers: Examining the key components to success
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.
Treatment Completion in a Cognitive Behaviour Therapy Service for Problem Gamblers: Clinical Outcome Study
Increased access to gambling is proving to be a great burden on the individuals who partake, their families and society in general. Despite growing evidence for the use of Cognitive-Behaviour Therapy (CBT) with problem gamblers, important questions remain unanswered regarding those individuals who do not respond to CBT. This paper compares gamblers who are considered 1) treatment completers, 2) drop-out following an initial assessment and, 3) drop-out after commencing treatment from a specialized CBT service. The results indicate a number of differences between the groups in regard to gambling severity and behaviour, demographic profile and variations in overall psychopathology.
Cognitive Behaviour Therapy for Problem Gamblers: A Clinical Outcomes Evaluation
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.
What Influences the Types of Help that Problem Gamblers Choose? A Preliminary Grounded Theory Model
Research has not fully explored factors that influence types of help used from the suite of available options once problem gamblers reach an action stage of change. This study aimed to explore critical factors influencing choice of help (or interventions) once people have decided to address their gambling problem. Particular emphasis was on counselling and self-exclusion, given their demonstrable effectiveness for most users. Interviews were conducted with 103 problem gamblers taking action to address their gambling problem. Inductive analysis revealed nine critical influences on type(s) of help chosen, presented as a grounded theory model. Independent variables were goals of taking up the intervention, problem gambling severity, and level of independence/pride. Six mediating variables helped to explain relationships between the independent variables and choice of intervention. Understanding key influences on choice of gambling help can illuminate how to encourage further uptake and better align interventions with gamblers' preferences, to reduce barriers to help-seeking.
A Process Evaluation of a Self-Exclusion Program: A Qualitative Investigation from the Perspective of Excluders and Non-Excluders
This paper draws on a process evaluation of Queensland' self-exclusion program to examine how people use the program, motivations for self-excluding, barriers to use, experiences and perceptions of program elements, and potential improvements. Detailed, reflective, first-person accounts were gathered through interviews with 103 problem gamblers, including excluders and non-excluders. Identified strengths include the program's widespread availability. Many self-excluders reported positive experiences with responsive, knowledgeable, respectful venue staff. Major weaknesses include low publicity, limited privacy and confidentiality, the need to exclude individually from venues, and deficiencies in venue monitoring for breaches, which hinder the program's capacity to meet harm minimisation objectives. While the program reaches some problem gamblers, others are delayed or deterred from self-excluding by low awareness, shame and embarrassment, difficulties of excluding from multiple venues, and low confidence in venue staff to maintain confidentiality and provide effective monitoring. Potential improvements include wider publicity, off-site multi-venue exclusion, and technology-assisted monitoring.