This article describes treatment of a female problem gambler using mindfulness-based cognitive therapy (MBCT). The treatment protocol was adapted for problem gamblers from the manualized MBCT intervention developed by Segal, Williams, and Teasdale. Gambling behavior and mindfulness practice were monitored using daily diary entries maintained by the participant. The Beck Anxiety Inventory, Beck Depression Inventory—II, and the Five Facet Mindfulness Questionnaire were administered at pretreatment, posttreatment, 4-week follow-up, and 10-week follow-up phases. The Client Satisfaction Questionnaire was also used to assess acceptability of the intervention. The participant abstained from gambling, and anxiety and depression scores significantly reduced to subclinical levels over the assessment period. Exploration of mindfulness facets revealed that MBCT for problem gambling (MBCT-PG) may be useful in promoting acceptance of distressing thoughts and emotions. However, the participant did not maintain an intensive mindfulness-meditation practice over the follow-up phase of the intervention. The clinical implications of this case study are discussed.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Arlington, VA: Author.
2.
Baer, R.A. ( 2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice , 10, 125-143.
3.
Baer, R.A., Fischer, S., & Huss, D.B. ( 2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive Behavior Therapy, 23, 281-300.
4.
Baer, R.A., & Krietemeyer, J. (2006). Overview of mindfulness and acceptance-based treatment approaches. In R. Baer (Ed.), Mindfulness-based treatment approaches: A clinician’s guide to evidence base and applications (pp. 3-27). London, England: Academic Press.
5.
Baer, R.A., Smith, G.T., Hopkins, J., Krietemeyer, J., & Toney, L. ( 2006). Using self-report methods to explore facets of mindfulness . Assessment, 13, 27-45.
6.
Baer, R.A., Smith, G.T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., . . . Williams, J.M.G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples . Assessment, 15, 329-342.
Beck, A.T., & Steer, R.A. ( 1991). Relationship between the Beck Anxiety Inventory and the Hamilton Anxiety Rating Scale with anxious outpatients. Journal of Anxiety Disorders, 5, 213-223.
9.
Beck, A.T., Steer, R.A., & Brown, G.K. ( 1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
10.
Bishop, S.R. ( 2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71-84.
11.
Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., . . . Devins, G. ( 2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230-241.
12.
Bowen, S., Witkiewitz, K., Dillworth, T.M., & Marlatt, G.A. ( 2007). The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addictive Behaviors , 32, 2324-2328.
13.
Boyer, M., & Dickerson, M. ( 2003). Attentional bias and addictive behaviour: Automaticity in a gambling-specific modified Stroop task. Addiction, 98, 61-70.
14.
Carlbring, P., & Smit, F. ( 2008). Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. Journal of Consulting and Clinical Psychology, 76, 1090-1094.
15.
Carmody, J., & Baer, R.A. ( 2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23-33.
16.
Carmody, J., Baer, R.A., Lykins, E.L.B., & Olendzki, N. ( 2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 65, 613-626.
17.
Coelho, H.F., Canter, P.H., & Ernst, E. ( 2007). Mindfulness-based cognitive therapy: Evaluating current evidence and informing future research. Journal of Consulting and Clinical Psychology, 75, 1000-1005.
18.
Cumming, G., & Finch, S. ( 2005). Inference by eye: Confidence intervals, and how to read pictures of data. American Psychologist, 60, 170-180.
19.
Di Dio, K., & Ong, B. ( 1997). The conceptual link between avoidant coping style, stress and problem gambling. In G. Coman, B. Evans, & R. Wooton (Eds.), Proceedings of the 8th National Association for Gambling Studies Conference: Responsible gambling: A future winner (pp. 91-100). Adelaide , Australia: National Association for Gambling Studies .
20.
Dowling, N., Smith, D., & Thomas, T. ( 2006). Treatment of female pathological gambling: Efficacy of a cognitive-behavioural approach. Journal of Gambling Studies , 22, 355-372.
21.
Dowling, N., Smith, D., & Thomas, T. ( 2007). A comparison of individual and group cognitive behavioral treatment for female pathological gambling. Behaviour Research and Therapy, 45, 2192-2202.
22.
Dowling, N., Smith, D., & Thomas, T. ( 2009). A preliminary investigation of abstinence and controlled gambling as self-selected goals of treatment for female pathological gambling . Journal of Gambling Studies, 25, 201-214.
23.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. ( 2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35-43.
24.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2004). Mindfulness and acceptance: Expanding the cognitive tradition. New York, NY: Guilford .
25.
Hayes, S.C., Strosahl, K., & Wilson, K.G. ( 1999). Acceptance and commitment therapy. New York, NY: Guilford.
26.
Hodgins, D.C., Currie, S., el-Guebaly, N., & Peden, N. ( 2004). Brief motivational treatment for problem gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18, 293-296.
27.
Hoppes, K. ( 2006). The application of mindfulness-based cognitive interventions in the treatment of co-occurring addictive and mood disorders. CNS Spectrums, 11, 829-851.
28.
Kabat-Zinn, J. ( 2005). Full catastrophe living-Using the wisdom of your body and mind to face stress, pain, and illness (3rd ed.). New York, NY: Bantam Dell.
29.
Kessler, R.C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N.A., Winters, K.C., & Shaffer, H.J. ( 2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine: A Journal for Research in Psychiatry and the Allied Sciences, 38, 1351-1360.
30.
Kuyken, W., Byford, S., Taylor, R.S., Watkins, E., Holden, E., White, K., . . . Teasdale, J.D. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 966-978.
31.
Ladouceur, R., Lachance, S., & Fournier, P. M. (2009). Is control a viable goal in the treatment of pathological gambling? Behaviour Research and Therapy, 47, 189-197.
32.
Lakey, C.E., Campbell, W.K., Brown, K.W., & Goodie, A.S. ( 2007). Dispositional mindfulness as a predictor of the severity of gambling outcomes. Personality and Individual Differences , 43, 1698-1710.
33.
Larsen, D., Attkisson, C., Hargreaves, W., & Nguyen, J. ( 1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197-207.
34.
Lau, M.A., & Yu, A.R. ( 2009). New developments in research on mindfulness-based treatments: Introduction to the special issue. Journal of Cognitive Psychotherapy , 23, 179-184.
35.
Leyfer, O., Ruberg, J., & Woodruff-Borden, J. (2006). Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders . Journal of Anxiety Disorders, 20, 444-458.
36.
Linehan, M.M. ( 1993a). Cognitive-behavioural treatment of borderline personality disorder. New York, NY: Guilford .
37.
Linehan, M.M. ( 1993b). Skill training manual for treating borderline personality disorder. New York, NY: Guilford .
38.
Logan, G.D. ( 2004). Attention, automaticity, and executive control. In A. F. Healy (Ed.), Experimental cognitive psychology and its applications: Festschrift in honor of Lyle Bourne, Walter Kintsch, and Thomas Landauer (pp. 129-139). Washington, DC: American Psychological Association Press.
Ma, S.H., & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology , 72, 31-40.
41.
Mace, C. ( 2007). Mindfulness in psychotherapy: An introduction. Advances in Psychiatric Treatment, 13, 147-154.
42.
May, R.K., Whelan, J.P., Steenbergh, T.A., & Meyers, A.W. ( 2003). The gambling self-efficacy questionnaire: An initial psychometric evaluation. Journal of Gambling Studies, 19, 339-357.
43.
McCusker, C.G., & Gettings, B. ( 1997). Automaticity of cognitive biases in addictive behaviours: Further evidence with gamblers. British Journal of Clinical Psychology, 36, 543-554.
44.
Melbourne Academic Mindfulness Interest Group. ( 2006). Mindfulness-based psychotherapies: A review of conceptual foundations, empirical evidence and practical considerations. Australian and New Zealand Journal of Psychiatry, 40, 285-294.
45.
National Research Council. (1999). Pathological gambling: A critical review. Washington, DC : National Academy Press.
46.
Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B., & Molde, H. ( 2005). Outcome of psychological treatments of pathological gambling: A review and meta-analysis. Addiction, 100, 1412-1422.
47.
Petry, N.M., Ammerman, Y., Bohl, J., Doersch, A., Gay, H., Kadden, R., . . . Steinberg, K. ( 2006). Cognitive-behavioral therapy for pathological gamblers . Journal of Consulting and Clinical Psychology, 74, 555-567.
48.
Petry, N.M., Stinson, F.S., & Grant, B.F. ( 2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 564-574.
49.
Petry, N.M., Weinstock, J., Ledgerwood, D.M., & Morasco, B. ( 2008). A randomized trial of brief interventions for problem and pathological gamblers. Journal of Consulting and Clinical Psychology, 76, 318-328.
50.
Ree, M.J., & Craigie, M.A. ( 2007). Outcomes following mindfulness-based cognitive therapy in a heterogeneous sample of adult outpatients. Behaviour Change, 24(2), 70-86.
51.
Sauer, S.E., & Baer, R. ( 2009). Responding to negative internal experience: Relationships between acceptance and change-based approaches and psychological adjustment . Journal of Psychopathology and Behavioral Assessment, 31, 378-386.
52.
Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford.
53.
Semple, R.J., Lee, J., Rosa, D., & Miller, L.F. ( 2010). A randomized trial of mindfulness-based cognitive therapy for children: Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family Studies, 19, 218-229.
54.
Shapiro, S.L., Carlson, L.E., Astin, J.A., & Freedman, B. ( 2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373-386.
55.
Smith, A. ( 2006). "Like waking up from a dream": Mindfulness training for older people with anxiety and depression. In R. Baer (Ed.), Mindfulness-based treatment approaches: A clinician’s guide to evidence base and applications (pp. 191-215). London, England: Academic Press.
56.
Smith, A., Graham, L., & Senthinathan, S. (2007). Mindfulness-based cognitive therapy for recurring depression in older people: A qualitative study. Aging & Mental Health, 11, 346-357.
57.
Tavares, H., Martins, S.S., Zilberman, M.L., & el-Guebaly, N. (2002). Gamblers seeking treatment: Why haven’t they come earlier? Addictive Disorders & Their Treatment, 1, 65-69.
58.
Teasdale, J.D. ( 1997). The transformation of meaning: The interacting cognitive subsystems approach. In M. Power & C. R. Brewin (Eds.), The transformation of meaning in psychological therapies (pp. 141-156). Chichester , UK: Wiley.
59.
Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M., & Lau, M. ( 2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.
60.
Toneatto, T., Vettese, L., & Nguyen, L. ( 2007). The role of mindfulness in the cognitive-behavioural treatment of problem gambling. Journal of Gambling Issues , 19, 91-100.
61.
Volberg, R.A. ( 2002). The epidemiology of pathological gambling. Psychiatric Annals, 32, 171-178.
62.
Walker, M., Anjoul, F., Milton, S., & Shannon, K. ( 2006). A structured clinical interview for pathological gambling . Gambling Research, 18, 39-56.
63.
Walker, M., Toneatto, T., Potenza, M.N., Petry, N., Ladouceur, R., Hodgins, D.C., . . . Blaszczynski, A. (2006). A framework for reporting outcomes in problem gambling treatment research: The Banff, Alberta Consensus . Addiction, 101, 504-511.
64.
Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M., Constantine, R., & Pigott, S. ( 2007). The British Gambling Prevalence Survey 2007. London, England: The Stationery Office.
65.
Wells, A. ( 2002). GAD, metacognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9, 95-100.
66.
Westphal, J.R. ( 2008). How well are we helping problem gamblers? An update to the evidence base supporting problem gambling treatment. International Journal of Mental Health and Addiction, 6, 249-264.
67.
Whelan, J.P., Steenbergh, T.A., & Meyers, A.W. ( 2007). Problem and pathological gambling. Cambridge, MA: Hogrefe.
68.
Williams, J.M.G., & Swales, M. ( 2004). The use of mindfulness-based approaches for suicidal patients. Archives of Suicide Research, 8, 315-329.
69.
Williams, J.M.G., Teasdale, J.D., Segal, Z.V., & Soulsby, J. ( 2000). Mindfulness-based cognitive therapy reduces overgeneral autobiographical memory in formerly depressed patients. Journal of Abnormal Psychology, 109, 150-155.
