While the pharmacological treatment addresses the dysregulation in neurotransmitter systems, non-pharmacological treatments have a different approach, with a main focus on the behaviour, cognition and motivation of the patients, addressing the psychological determinants of gambling. Also, Topiramate combined with behavioural therapy could be used to treat patients without comorbidities, while Escitalopram may be effective for the treatment of patients with co-occurring affective disorders. When combined, better rates of patient retention were found, in comparison to pharmacotherapy-only treatments. Although any pharmacological treatment has yet to be approved for GD, many studies have already had promising results regarding its efficacy, both in pharmacological-only schemes and in combination with psychotherapies. In fact, GD is now the first and only formal behavioural addiction in the DSM-5. In contrast, patients with GD find their gambling pleasant and only when they stop gambling or suffer losses, they begin to feel distress, as it happens in substance use disorders. As Shaffer and Korn observed, patients with disorders such as kleptomania or pyromania (impulse control disorders) feel overwhelmed by their impulses to act and then, feel a sense of relief after having acted. Thus, in the DSM-5, GD is now classified as an addictive disorder rather than as an impulse control disorder (in DSM-IV). The symptoms associated with this disorder are very similar to those seen in addictive disorders. Gambling disorder (GD) is the term used to define a persistent and recurrent pattern of gambling that is associated with substantial distress or impairment, according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5). The majority of studies supported the efficacy of the tested therapies, while some of them, due to limitations such as small sample sizes or inadequate control groups, failed to reach significance. The literature included in this review showed the heterogeneity of available psychotherapies. Physical exercise had promising results but did not reach significance. Four other studies also showed efficacy for: couples therapy, node-link mapping therapy, 12-step facilitated and personalized feedback intervention. Combined or separate motivational interviewing and imaginal desensitization had significant results in 4 trials. Three studies assessing cognitive therapy showed significant improvements in gambling symptoms, while one study showed improvements in gambling behaviour using exposure therapy. Seven trials revealed the efficacy of cognitive behaviour therapy in improving significantly the outcomes. They included a total of 1694 patients, with a mean age of 42.94 years, and a 62.31% of males. Resultsįrom 320 records identified, 22 studies were included in the critical appraisal. Studies were included if participants had GD as their primary diagnosis and excluded if patients had other comorbidities. MethodsĪ systematic search was conducted in PubMed and in Cochrane Library for randomized controlled trials. This review intended to synthesise the efficacy of various available non-pharmacological therapies for GD evaluated in randomized controlled trials. Although there is not a gold standard non-pharmacological treatment yet, many studies already had promising results, and the outcomes were even better when pharmacotherapies were combined with psychotherapies. The main focus of the non-pharmacological treatment of Gambling Disorder (GD) is the behaviour, cognition and motivation of the patient, addressing the psychological determinants of gambling.
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