(PS3-70) Does Cognitive Behavioral Treatment Affect Development and Maintenance Factors of Gambling Harm? An Exploratory Meta-analysis

Gambling cognitions, coping strategies, and self-efficacy are associated with the development and maintenance of gambling harm. Individuals who struggle with gambling experience harms such as financial consequences, social conflict, and psychological distress. For individuals seeking treatment for these harms, cognitive-behavioral treatment (CBT) has been established as an efficacious intervention that has been believed to change gambling cognitions, coping strategies, and self-efficacy. Through a systematic review and meta-analysis, the present study examined the degree to which CBT affected these three development and maintenance factors. Studies were identified for analysis through a database of randomized controlled trials on CBT for gambling harm (https://www.metapsy.org/database/gambling). Studies were included if they 1) were published randomized controlled trials of CBT for gambling harm; 2) included minimal or no treatment conditions; and 3) reported the effects of CBT on gambling cognitions, coping strategies, and self-efficacy. Eleven studies representing 876 participants were identified. Hedge’s g effect sizes were calculated to understand the effect of CBT relative to control conditions at posttreatment. CBT significantly affected all targeted development and maintenance factors at posttreatment. Specifically, CBT significantly decreased gambling cognitions (g = -0.50, 95% CI [-0.90, -0.10]), increased coping strategies (g = 0.27, 95% CI [0.02, 0.51]), and increased self-efficacy (g = 1.27, 95% CI [0.77, 1.77]). The effect of CBT on self-efficacy was the most robust, as no single study influenced the significance or magnitude of the effect size. However, the 95% prediction interval [-0.48, 3.02] indicated that the effect of CBT on self-efficacy was unreliable. The effects of CBT on gambling cognitions and coping strategies were both unstable, as removing individual studies from the calculation of the pooled Hedges’s g effect size nullified the significance of the effect size and reduced its magnitude. These results show preliminary evidence for the efficacy of CBT on three development and maintenance factors, thereby advancing research on mechanisms of change for gambling harm. Specifically, the selected development and maintenance factors were based on rich theoretical and empirical research, and all studies included in the meta-analysis provided posttreatment assessments of the factors with random assignment to conditions. Strengthening support for these three development and maintenance factors as mechanisms of change will require randomized controlled trials with longitudinal designs that temporally sequence changes in the proximal factors and examine each factor’s relation to changes in the distal outcomes of gambling harm.