Submitted by Edo Shonin, William Van Gordon, and Mark D.

Gri ths, UK

Mindfulness and Meditation for the Treatment of Problem Gambling

Second-wave cognitive behavioral therapies (CBTs) have consistently been regarded as the intervention of choice for the treatment of problem gambling. Cognitive-behavioral approaches share a common mechanism of therapizing via the restructuring of maladaptive core beliefs. In e ect, patients are empowered to control and modify faulty cognitions and to self-intervene at the level of individual thoughts and feelings. Whilst CBT has cautiously been advocated for the treatment of problem gambling, CBT does not appear to be an e ective or accessible treatment for all problem gamblers. Furthermore, relapse rates for problem gamblers can be as high as 75% and there is a scarcity of high quality CBT trials reporting long-term follow-up data. Throughout the last decade, the practice of mindfulness inherited from Buddhist tradition - has been integrated into a number of third-wave cognitive behavioral approaches. Third wave approaches are increasingly being employed for the treatment of a wide range of psychological disorders that often share comorbidity with problem gambling such as depression, anxiety, bipolar disorder, and schizophrenia, as well as addiction disorders in and of themselves (such as substance abuse). Rather than a deliberate attempt to control and modify distressing thoughts and emotions (i.e., as happens in traditional second wave CBT approaches), third wave approaches operate via a mechanism of transformative present-moment awareness. Indeed, mindfulness is described in the psychological literature as purposeful, moment-to-moment, non-judgmental awareness. Mindfulness as a problem gambling intervention As part of the wider increase in research assessing the psychotherapeutic utility of mindfulness therapies, in the last ve years there has also been growing interest and scienti c investigation into the potential applications of mindfulness for the treatment of problem gambling. Research has shown that higher levels of mindfulness are associated with reductions in severity of (i) gambling involvement, (ii) overcon dence and risk willingness, (iii) reward and sensation seeking, and (iv) thought suppression. Furthermore, clinical case studies demonstrate that problem gambling participants who receive mindfulness training show reductions in gambling urges, gambling frequency, and gambling expenditure as well as improvements in depression and anxiety along with greater awareness and regulation of gambling-related feelings and thoughts.

Mechanisms of action for mindfulness Proposed mechanisms for the e ects of mindfulness on problem gambling and addictive behavior centre upon the acceptance, non-reactive awareness, and un ltered present-moment-experiencing of mental urges (sometimes referred to as urge sur ng). Participants of mindfulness interventions are commonly taught to focus their attention on the natural ow of their in-breath and out-breath as a means of calming the mind and anchoring their concentration in the present moment. The breath is therefore used to surf cravings for euphoric states that are a means of escaping from the present moment. Increased breathing awareness has been shown to increase prefrontal functioning and vagal nerve output which in turn helps to reduce heart rate. A further proposed mechanism for the bene cial e ects of mindfulness for problem gamblers is that of spiritual development. Indeed, Buddhist philosophy is constructed on the view that all forms of addictive behavior are maladaptive spiritual coping strategies. Spirituality has been shown to increase subjective wellbeing and attainment of abstinence in those with a diagnosis of pathological gambling. Mindfulness may also help to reduce relapse and temper withdrawal symptoms via a form of substitution e ect. Substitution techniques are already used in problem gambling interventions (an example is the use of recreational and social task-engagement to help moderate the risk of relapse). Bliss is frequently referred to in the meditation literature as an outcome of certain concentrative forms of meditation. It is feasible that bliss substitution could be used to maximise the maintenance of bene cial outcomes in problem gamblers who undergo treatment using mindfulness techniques. Integration and roll-out issues Factors that may impede the successful integration of mindfulness interventions as treatments for problem gambling relate to the transcultural di culties of assimilating Eastern techniques into Western culture. One such issue is the relative reluctance of Westerners to participate in introspective or contemplative practice. However, working in its favor is the fact that mindfulness interventions are predominantly delivered in secularized format. Furthermore, qualitative studies suggest that mindfulness techniques represent acceptable interventions for service users. There are also integration issues that relate to the inadequate provision of both problem gambling interventions and mindfulness therapies by service providers. For example, in the United Kingdom only 3% of the 327 Primary Care Trusts, Story continued on page 18...

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Foundation Trusts, and Mental Health Trusts actually provide a service (specialist or otherwise) for treating people with gambling problems. Likewise, only 20% of general practitioners report being able to access mindfulness-based interventions for their patients. Other integration issues relate to (i) the competence of clinicians and instructors of mindfulness who may lack the experience and training required to teach the subtler aspects of mindfulness practice, and (ii) whether existent mindfulness interventions impart an authentic (i.e., traditionally grounded) transmission of mindfulness and

meditation practices. A study (currently in the planning phase) being conducted by some of the members of the International Gaming Research Unit at Nottingham Trent University (UK) will seek to address these limitations by assessing eight week intervention known as Meditation Awareness Training that follows a more traditional approach to mindfulness mindfulness approaches as problem gambling treatments are promising, clinical evaluation is still at an early stage and further research is required.

May-June CEU Trainings

Counseling the Pathological Gambler Date: May 1, 2013 May 31, 2013 Location: Web-based, On Demand Description: The online clinical training, Counseling the Pathological Gambler, is interactive, audio-based, with downloadable training manuals. This online training ranges from 4 hours to 60 hours and is designed for mental health care providers, drug and alcohol counselors, and all addiction practitioners who wish to add a gambling addiction specialization to their practice or organization, become certi ed or require CEs. The NCPG Education Committee has approved this course for 4 to 60 gambling speci c continuing education units. Contact: Elizabeth George, 1.888.989.9234 Advanced Disordered Gambling Treatment: Gambling Ethics and Case Conceptualization Date: May 30, 2013 - May 31, 2013 Location: Cleveland, OH Description: In this two day training participants will gain further knowledge and experience in treating disordered gamblers. This training will provide the required 3 hours of ethics needed for the Ohio gambling credential. Participants will take hands on approach in case conceptualization. Clinicians will discuss best practices in treating gambling related issues. The NCPG Education Committee has approved this course for 12 gambling speci c continuing education units. Contact: Jennifer Clegg, 216.923.4021 Midwest Conference on Problem Gambling and Substance Abuse Date: June 26-28, 2013 Location: Hilton Kansas City Airport, Kansas City, Missouri Description: To increase awareness, education and understanding of problem gambling and substance abuse by providing keynote presentations and breakout sessions presented by quali ed individuals in the elds of problem gambling and substance abuse. The NCPG Education Committee has approved this course for 17.75 gambling speci c continuing education units. Contact: Holly Koofer-Thompson, 573.526.7467 E ective Strategies for Treating those with the Illness of Pathological Gambling Date: May 31, 2013 -June 1, 2013 Location: La Quinta, CA Description: To increase participants' awareness, knowledge and skills related to e ective substance use or abuse prevention, treatment and recovery, program administration and system development. The NCPG Education Committee has approved this course for 13.5 gambling speci c continuing education units. Contact: Dee McGraw, 616.581.4855

www.ncpgambling.org/conference

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