ABSTRACT
OBJECTIVES: The present study analyzes the association between the motivation to change and the cognitive-behavioral group intervention, in terms of dropouts and relapses, in a sample of male pathological gamblers. The specific objectives were as follows: (a) to estimate the predictive value of baseline University of Rhode Island Change Assessment scale (URICA) scores (i.e., at the start of the study) as regards the risk of relapse and dropout during treatment and (b) to assess the incremental predictive ability of URICA scores, as regards the mean change produced in the clinical status of patients between the start and finish of treatment. METHOD: The relationship between the URICA and the response to treatment was analyzed by means of a pre-post design applied to a sample of 191 patients who were consecutively receiving cognitive-behavioral group therapy. The statistical analysis included logistic regression models and hierarchical multiple linear regression models. RESULTS: The discriminative ability of the models including the four URICA scores regarding the likelihood of relapse and dropout was acceptable (area under the receiver operating haracteristic curve: .73 and .71, respectively). No significant predictive ability was found as regards the differences between baseline and posttreatment scores (changes in R(2) below 5% in the multiple regression models). CONCLUSIONS: The availability of useful measures of motivation to change would enable treatment outcomes to be optimized through the application of specific therapeutic interventions.
Subject(s)
Cognitive Behavioral Therapy , Gambling/therapy , Motivation , Adult , Gambling/psychology , Humans , Male , Patient Compliance/psychology , Patient Dropouts/psychology , Personality , Personality Inventory , Psychiatric Status Rating Scales , Psychological Tests , RecurrenceABSTRACT
El presente estudio se ha dirigido a analizar la eficacia y la eficiencia de dos programas de tratamiento grupa cognitivo-conductual, así como a determinar los factores predictores de respuesta al tratamiento, en una muestra de jugadores patológicos. Para ello, se incluyeron 194 sujetos que acudieron al Hospital Universitario de Bellvitge (HUB) solicitando tratamiento por su problema. Los resultados evidenciaron que el tratamiento cognitivo-conductual grupal mostraba ser eficaz en la mayoría de pacientes, siendo la tasa de abandonos para la muestra total del 33,0% y la de recaídas del 24,5%. Se observaron, asimismo, cambios significativos entre el pre y el post-test en las medidas de psicopatología y gravedad de la conducta de juego. Se evidenció que el riesgo de abandono y recaída decrecía significativamente tras la quinta sesión de terapia. Finalmente, se identificaron como factores de pobre respuesta al tratamiento la gravedad del problema de juego, la elevada impulsividad y búsqueda de sensaciones, así como la gravedad de la psicopatología asociada. Sin embargo, la persistencia como rasgo de temperamento pareció actuar como factor protector de recaída
The present study aimed to analyze the efficacy and efficiency of two cognitive-behavioral group treatment programs, as well as to determine which factors predict response to treatment, in a sample of pathological gamblers. We included 194 subjects seeking treatment for pathological gambling at Bellvitge University Hospital. The results indicated that our cognitive-behavioral group treatment was efficacious in most patients. The dropout rate for the total sample was 33,0% and the relapse rate was 24,5%. In addition, we observed statistically significant pretreatment- post- treatment changes in some measures of psychopathological state and severity of gambling behavior. The risk of dropouts and relapses decreased significantly after the fifth session of therapy. Finally, severity of gambling behavior, high impulsivity, high novelty seeking, and severity of the psychopathological state were identified as factors predicting poor response to treatment. However, persistence seemed to act as a temperamental protective factor for relapse