Mindfulness-Based Approaches to the Treatment of Pathological Gambling: A Systematic Review and Meta-Analysis
Various intervention methods have been employed to intervene with problematic and pathological gamblers. Mindfulness-based interventions have received significant attention as a promising intervention across a range of addictive behaviors; however, it is unclear whether mindfulness based interventions have been tested to treat gambling addiction and, if so, whether they are effective. The purpose of this systematic review is to examine the extent to which mindfulness based interventions have been used to treat gambling disorders and to assess the effects of mindfulness-based interventions on gambling outcomes. The specific questions guiding this review are: 1) Are mindfulness-based approaches being used in the treatment of pathological gambling? 2) What are the effects of mindfulness-based approaches on gambling outcomes? 3) Are mindfulness-based approaches more effective than others on gambling outcomes?
Method:
The present study used systematic review methods to examine the corpus of mindfulness based intervention studies assessing gambling outcomes with problematic or pathological gamblers. For the purposes of this review, mindfulness-based interventions include methods for teaching mindfulness awareness where participants are encouraged to focus their attention either on covert activity (e.g., thoughts, feelings, urges) or overt activity (e.g., lights, sounds, smells). Mindfulness interventions include present moment work, meditation, relaxation skills training, breathing techniques, awareness of moment and can be delivered in vivo, via formal meditation practices or informal mindfulness exercises. A comprehensive search strategy, comprised of searching 15 electronic databases and research registers, reference lists, and a comprehensive gray literature search was undertaken to find studies conducted between 1980 and January 2014.
Descriptive analysis was conducted to examine and describe characteristics and outcomes of all included studies. Standardized mean difference effect sizes, adjusted for small sample size, were calculated. Meta-analysis, assuming random effects models using inverse variance weights, was used to quantitatively synthesize results across the included randomized and quasi-experimental studies.
Results:
The search yielded 12 studies for inclusion in this review; 4 single subject studies, 2 single group pre-post test studies, 2 quasi-experimental studies and 4 randomized controlled trials. The types of mindfulness-based interventions included in this review were Acceptance & Commitment Therapy (n=3), Mindfulness-based CBT (n=2), Dialectical Behavior Therapy (n=1) and other interventions incorporating mindfulness techniques (n=6). The meta-analytic findings demonstrated an overall small but positive effect on gambling outcomes (g=0.26); however, a test of homogeneity results revealed that the variability of effect sizes was greater than what would be expected from sampling error alone.
Implications:
Findings suggest that mindfulness based interventions are a promising approach to treating gambling disorders; however, the research in this area is in its early stages and additional research with rigorous comparison group designs, larger samples, and replication studies are needed. Comparison of results to reviews of other types of gambling interventions and implications for practice and research will be discussed.