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-behavioral therapy (CBT) is the most effective nonpharmacological treatment for almost all mental disorders, especially anxiety and depression. The treatment is time limited, encourages self-help skills, is problem focused, is inductive, and requires that individuals develop and practice skills in their own environment through homework. However, most of those with mental health issues are unable to seek help because of factors related to treatment availability, accessibility, and cost. CBT is well suited to computerization and is easy to teach to nurses. In this article we describe outcome studies of computer-assisted CBT (cCBT), outline the current technologies available, discuss concerns and resistance associated with computerized therapy, and consider the role of nurses in using cCBT.

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.

Introduction: This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective: To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods: Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results: Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion: Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.

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.

Mary is a 20-year-old college student who presented to the university counseling service with fear of driving on busy freeways, especially at night. The problem emerged 12 months ago after she was involved in a five-car accident while returning late from college. Another driver who swerved from the outside lane into her lane caused the accident. She was sideswiped by the car, and the resulting accident involved three other cars. No one was killed. However, one other driver had serious injuries. Mary had to be cut from her car, which took over 5 hours. Throughout the incident, Mary remembers thinking she was going to die. Before this, Mary had not experienced any significant anxiety and had been able to drive in any conditions. Since the accident, Mary has stopped driving; has become anxious, leading to avoidance of many situations; experiences poor sleep due to nightmares; is easily startled; and feels depressed. Mary's college work and social life are severely affected, and she is in danger of failing. She has been to her family practitioner, who has prescribed 50 mg of sertraline daily. Mary often forgets to take her medicine and believes it does not really help. The counseling service referred Mary to the community psychiatric/mental health nurse, who helps Mary recognize that her fear of driving is a symptom of post-traumatic stress disorder. The nurse has suggested several approaches to Mary's problems. First, they work to improve sleep problems using a standard sleep hygiene approach. Second, she tackles her nondriving-related avoidances, such as agreeing to meet friends and go shopping. Finally, the nurse helped Mary to see the benefits and disadvantages of her medication. This discussion led to Mary's agreeing to take her medication regularly to see if it would help. After 2 months of weekly sessions, Mary began to show some general improvement. However, her fear of driving remained and she continued to struggle at college. One week, Mary told the nurse about a TV program showing a virtual reality (VR) driving simulator treatment for people who have been in car accidents. The nurse stated she knew of this and would find out if it were available. The nurse was able to arrange a VR demonstration in the next session. After seeing how the simulator could help, Mary agreed to use it. Both the nurse and Mary were fitted with VR glasses, and different driving experiences were introduced. At first, Mary practiced quiet daytime driving and progressed to busy freeway night driving. Mary's anxiety about driving reduced quickly over 3 weeks. However, she still had not returned to driving. The nurse suggested that Mary repeat the VR exercises but in her own car. This involved graded live exposure. At first, Mary drove with friends and family in quiet times, moving to driving with others at night and then finally on her own at night. After 6 weeks, she had completely returned to driving, her college and social life was back to normal, and she experienced no anxiety.