Make clear the significance of your lens focus in relation to the broader context/issue.

Rates of gambling addictions have fluctuated over the years, but once the Supreme Court allowed for legal sports betting in 2018, there was a significant rise in addictions. It became easier and simpler for people to access gambling platforms at any given moment. This became a concern for young adults and teens, who are especially susceptible to compulsive and addictive behaviors. As of recently in the US, around 2 million adults struggle with severe gambling addiction, and another 4-6 million who are classified as "problem gamblers". However, around 4-8% of teenagers have been noted to have gambling problems according to the California Council on Problem Gambling. As rates of PG spike, the need for support systems and treatment options are as important as ever. However these addictions harm much more than just a single person. Issues of compulsive gambling damage family relationships. As stated by Catherine Tulloch of Central Queensland University, households with problem gamblers have increased rates of drug use, violence, and higher psychological distress. Addressing these damaged relationships is a crucial part of supporting PG and diminishing compulsive gambling behaviors. Cognitive Behavioral Therapy (CBT) has proven to be very effective in decreasing such behaviors. As Olaf Molander PhD of the Centre for Psychiatry Research in Stakhold states in his study, less than 20% of the time, participants reported gambling during the CBT treatments. On the other hand, over 86% of reports stated they were using the taught techniques to cease compulsive thoughts and behaviors. But what is the best method of CBT to approaching both PG and their close relationships?

Researcher & Institution Information: Steliana Rizeanu- PhD in Psychology, professor at Hyperion University, Bucharest in the Psychology department.  She has around 116 publications as well as 354 citations.   

*Research Question/Purpose: Studying the effects of cognitive behavioral therapy on Gambling Addiction. Furthermore, explaining the psychological characteristics of gambling addicts and their compulsive behaviors. Then, the author takes a look at the methods that will best support the addict and cease the destructive behaviors. 

*How they answer their research question: Study conducted with 231 gamblers, whom were split into three groups. One being treated through Gamblers Anonymous methods, the second using GA groups with the addition of cognitive behavioral therapy exercises. Lastly, the third group was treated with the GA groups and eight individual sessions of cognitive behavioral therapy. 

*Results/Conclusion: improvements in 59% of participants that went through cognitive behavioral therapy (Group 3), 39.2% of participants who went through the CBT exercises (Group 2). And 34% improvements in those who only participated in the gamblers anonymous groups (Group 1). 

*Limitations: Results of the CBT and GA groups depend on person to person, therefore results may not be completely dependent on the usage of cognitive behavioral therapies

QUOTE:“They found improvements in 59% of the participants that benefited from CBT, 39.2% of the participants who completed the exercises from the CBT books, and 34% of the participants who only took part in the GA groups” (Rizeanu 2018). 

• This quote is significant because it provides statistical results from the experiments, proving that cognitive behavioral therapy showed the most improvement in gambling addicts at 59%. Therefore, CBT is an effective way in treating gambling addicts and stopping compulsive/ destructive behaviors. 

*Research Question/Purpose: Identify the consequences and effects linked to family related gambling problems. 

*How they answer their research question: Analyzing data from the National Health Survey. 

*Results/Conclusion: Participants reported 14 stressors in family relationships as a result of gambling problems. Families with FGP (family gambling problems) were about eight times more likely to be addicted to drugs or alcohol. Additionally, they had a higher chance of being associated with abuse and violence. Higher psychological distress, and lower self-assessed mental health. 

*Limitations: People may not respond honestly about the amount of harm they may be facing due to social stigmas or expectations. Those with gambling addictions, or addictions in general often do not respond honestly about their behaviors. It must also be addressed that those with addictions are not always self aware, and lack understanding about the problem at hand.

QUOTE:“Interviewees  in  these  households reported  three  times  the  number  of  other  stressors  than  those  without  a  FGP.  In  addition, they  were  around  eight  times  more  likely  to  be  experiencing  other  addictions  (drug  and alcohol related problems) and stressors associated with socially deviant behaviours (trouble with police, abuse or violent crime, and witness to violence). Once age, gender, socioeconomic  disadvantage,  and  other  stressors  were  controlled  for,  FGPs  significantly  predicted lower self-assessed health and higher psychological distress” (Tulloch 2020).

• This quote is significant because it provides further evidence as to how gambling problems can bring burden into family relationships. Similar to the chart, this quote provides specific areas in which families facing gambling issues may face compared to families that don’t report having gambling issues. 

*Research Question/Purpose: Studying the effectiveness of group cognitive behavioral therapy (GCBT) on Nigerian students with gambling addictions.

 *How they answer their research question: Randomised participants as well as a control group. 40 undergrads, aged 18-30, classified as “pathological gamblers’ participated in this study. Intervention lasted 8 weeks.

*Results/Conclusion: GCBT proved to be very efficient in decreasing symptoms of compulsive gambling behaviors. 

Limitations: Clinical and psychological characteristics of the participants were not considered. Therefore, external factors could have influenced the success of the study. A specific disorder was not targeted. Additionally, the follow up occurred only one month after the treatment. Therefore long term effects are unclear.

QUOTE:“The  result showed that there is significant effect of group cognitive behavioural therapy on PG of students  in  Anambra  State,  Nigeria,  when  measured  with  South  Oaks  Gambling  Screen  and Gambling  Symptom  Assessment  Scale.  It  was  also  found  that  the  effectiveness  of  group cognitive behavioural therapy on college pathological gamblers was sustained at follow-up assessment. This aligns with Kim (2008) who indicated that the reality group therapy programme effectively reduced addiction level of substance addicted University students.” (Ede 2020)

• This quote is significant because it shows the results of the study. Stating that group cognitive behavioral therapy was effective in helping problem gamblers. Furthermore, according to the follow up assessment conducted in the study, GCBT had a positive impact. Reducing levels of addiction. Therefore, GCBT is effective and helpful to problem gamblers. 

*Researcher & Institution Information: Olof Molander, PhD- researcher at Centre for Psychiatry Research in Stockholm, Registered clinical psychologist

*Research Question/Purpose: to evaluate the effectiveness of a new internet based cognitive behavioral therapy(iCBT)  in treating gambling addiction. 

*How they answer their research question: evaluating results of iCBT and face to face CBT in patients after 2 years of routine treatment. 

*Results/Conclusion: iCBT was rated high for satisfaction. Patients who went through iCBT had similar and comparable results to those of face to face therapy. 

*Limitations: Study was performed in Sweden, therefore it may not be generalizable to patients in other countries. May not be generalizable to those without adequate internet access.

QUOTE:“However, the average occurrence of any gambling during the treatment window was low, reported on only 19.4% of assessments, consistent with high rates (86.4%) of used stimuli control techniques (eg, the Spelpaus.se self-exclusion registry) during treatment” (Molader 2024).

*This quote is significant because it provides evidence from the research that iCBT is effective in treating gambling addictions. Patients reported a total of less than 20% of gambling occurrences during the treatment. Furthermore, 86% of patients regularly followed the techniques taught by the iCBT program. Therefore, iCBT is overall beneficial to the PG, teaching them to be consistent with healthy coping habits, and reducing compulsive behaviors. 

*Research Question/Purpose:  The effects and efficiency of online interventions in treating problem gambling. Furthermore, to find out how other addictions such as alcohol and drugs affect the intervention. 

*How they answer their research question: analyzing the effectiveness of a cognitive behavioral therapy program created to help problem gambling. Follow up analysis was done as well. Part of the program were self reports. Taking a look at other factors that may influence or worsen the problem gambling. This includes alcohol/drugs, depression, financial situation, and other demographic variables. 

*Results/Conclusion: Lower psychological health indicates higher NODS score, or higher levels of reported problem gambling. The NODS scores decreased overall after the treatment. However, the scores did not stay low for long in individuals who believed their financial situation was uncontrollable.  

*Limitations: Patients dropped out for a number of reasons. Some thought the desired effects of the treatment were not obtained. This may be due to incorrect assumptions and bias. Furthermore, participants who reported symptoms of depression were highly likely to drop out of the study. There was also a lack of control group in the study, therefore the findings of the study have no data to be compared to.

QUOTE:“The treatment was effective on average, with NODS scores [95% CI] dropping from 5.85 [5.83–5.87, baseline] to 1.73 [1.61–1.85, post-treatment], 1.92 [1.72-2.12, 6-month follow-up], and 2.09 [1.8-2.38, 12 month follow-up.”(Palomaki 2022).

• This quote is significant because it provides statistical results from the study, exemplifying how rates of problem gambling were significantly reduced after the treatment. The results continued to stay generally consistent, with some slight variation. We can observe the test results with rates of problem gambling significantly dropping after the treatment. Therefore, we can conclude from this evidence that the online interventions were effective in treating gambling addictions. 

*Research Question/Purpose: How cognitive behavioral therapy can reduce gambling behavior and other symptoms of pathological gambling. 

*How they answer their research question: They reviewed and synthesized a number of clinical trials to analyze the effectiveness of CBT.  

*Results/Conclusion: Two studies confirmed and supported the claim that CBT does improve the lives of gambling addicts. The therapy was more productive when it was supported by other Anonymous support groups. 

*Limitations: Rather than studies conducted, this article surrounds analyzing many other cases and articles

QUOTE:“Cognitive behavioral interventions were more effective when it was supported by a manual or when were combined with Mindfulness or Player Anonymous sessions. Having better long-term results in these cases.” (Ahijado 2023)

• This quote is significant because it shows that CBT is more effective when paired with different support groups. Although CBT is beneficial, it can be enforced and enhanced through other resources as well. 

*Research Question/Purpose: Studying the effectiveness of how concerned significant others of gambling addicts can motivate the addict to quit self- destructive habits and addictions. Specifically through an internet-based intervention.

 *How they answer their research question: a total of 100 “concerned significant others” of gambling addicts were randomly split into two groups. The internet- based cognitive behavioral therapy for the CSO or a control group, who received the same treatment but at a later time. Also known as the wait-list control group. The internet based treatment consisted of nine modules to complete, along with a therapist who was available to contact via calling or email. Results were measured after 12 months of the treatment. 

*Results/Conclusion: The intervention improved the mental health/ well being of the significant other. However the results found that helping/ affecting the gambler through a concerned significant other is difficult. 

*Limitations: Many of the participants chose to drop out of the experiment, making it harder to create conclusions. The population of participants decreased, and this may have limited the generalizability of the results, and harmed the authority of the results. Furthermore, the gender distribution was imbalanced as most CSOs were female and the addicts were male. Therefore, further proving that this experiment may not be generalizable or apply to all.

QUOTE:“CSOs are often financially affected because they pay for problem gamblers’ subsistence, repay debts caused by gambling, become victims of fraud or theft committed by the gambler, or simply pay for a disproportional part of the expenses they share with the gambler (...)Further, problem gambling is associated with elevated levels of domestic violence compared to the general population (Dowling et al., 2016). In addition, CSOs experience more psychological distress than the general population, which manifests itself in higher levels of depression, anxiety, drinking, panic attacks, excessive eating, and smoking (Dickson-Swift et al., 2005; Patford, 2009; Svensson et al., 2013), and they report feeling isolated and lacking support ” (Magnusson 2019)

• This quote is significant because It shows how the friends, family members, relatives, and colleagues of those struggling with gambling addictions face a number of consequences as a result of the addict. It provides reasons as to why a CSO (concerned significant other) may be in need of additional support, or cognitive behavioral therapy, as provided in the experiment. 

(social, cultural)

By taking a look at the effects and burdens of CSO, we can understand the importance of finding a strong support system for such relationships. Online cognitive behavioral therapy was used to aid in the support of PG who had worried or struggling significant others. The results showed that this online treatment is effective in BOTH supporting the SO and the pathological gambler. (Rates of reported gambling were reduced, and CSO's felt satisfied and would recommend the treatment) Therefore, CBT can be used in this way in order to repair relationships broken as a result of gambling addictions. 

These sources support my main question as it researches and compares the most effective ways to use CBT. Between one on one CBT, as well as a control group with only the Gamblers Anonymous groups. There was also a third group who went through both CBT and group exercises. Therefore, testing different types of CBT will help draw a conclusion to the best and most effective form in supporting PG, thus guiding the answer to my main question.

*Research Question/Purpose: treatment for pathological gamblers. The article reviews cognitive behavioral models to find new perspectives and findings specific to gambling treatment. 

*How they answer their research question: Analyzing major healthcare databases such as Medline and PsycINFO.

*Results/Conclusion: clinicians must consider techniques to target specific cognitive habits regarding problem gamblers. The study also concluded that a mix of new techniques may be the best strategy to treating gambling addictions. 

*Limitations: More cultures and demographics may need to be studied inorder to come to a more generalizable conclusion. Furthermore, this article reviews and analyzes original CBT studies on treatment of problem gamblers.

QUOTE:“The blending of these new techniques into a multimodal treat-ment of addiction potentially balances the rational and exter-nal orientation of the cognitive-behavioural approach with interpersonal and introspective components of the more tradi-tional approach to addiction treatment” (Tavares 2003)

• This quote is significant because it tells the reader what solution is the most effective based on analyzing multiple different studies. Therefore, leading us to believe that a mixture of new CBT techniques will best accommodate and support the problem gambler. 

This connects to my main question as the study explores the effectiveness of a specific type of cognitive behavioral therapy. Taking a look at how online CBT supports gamblers can guide a solution to find the best way to utilize CBT to repair relationships.

We can observe through these sources that CBT is effective in supporting the addict and their concerned significant others. However, we must also consider the usage of community and group exercises in treating gambling addictions, not just individual programs. In the next thematic cluster, we will discuss the effectiveness of approaching PG with a sense of community.

2.  Circle back to how the three themes connect with each other AND how these themes shed light on your lens-focused question.

3.  Based on these implications, suggest how to proceed with investigating different solutions.

Both adults and adolescents alike continue to fall victim to pathological gambling disorders, as a result the easy access to gambling and the recent trends on social media. Gambling addictions attract a list of damaging factors, harming family members and significant others. In order to provide adequate support to such situations it is essential to consider both the addict, and their surroundings. Furthermore, finding innovative ways to approach gambling addictions though different group methods can build a stronger support system for the PG, which may give a stronger motive to quit gambling. Additionally, considering the accessibility of treatment and CBT is to be considered. Therefore, online CBT may benefit many, motivating both SO and the addicts to seek help.