Behavioral couples therapy versus cognitive behavioral therapy for problem gambling: a randomized controlled trial
Open accessAbstract
Abstract Background and aims There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO. Design Two parallel‐group randomized controlled study comparing two different internet‐based treatments for PG. Follow‐up measures were conducted at treatment finish, and at 3‐, 6‐ and 12‐month post‐treatment. Setting Stockholm, Sweden. Participants A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women. Interventions A treatment based on BCT was compared with a CBT intervention. Both treatments were internet‐based, with 10 therapist‐guided self‐help modules accompanied by weekly telephone and e‐mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition. Measurements The primary outcome measures were time‐line follow‐back for gambling (TLFB‐G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM‐IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire‐9 (PHQ‐9), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), the Relation Assessment Scale Generic (RAS‐G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO. Findings The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB‐G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002. Conclusions Differences in the efficacy of internet‐based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group.
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Involving significant others in the treatment enhances adherence.
“as well as the relevance of involving significant others in the treatment to enhance adherence (Nilsson et al., 2019).”
From Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial (2021) · cites this paper as Nilsson et al., 2019
The Discussion says the trial only partially supports improved adherence with a concerned significant other: gamblers in couples therapy completed slightly more modules, but those in individual CBT returned more follow-up measures. The Conclusions say adherence might increase, so the claim states a tentative, mixed finding too definitively. (LLM, conf=0.88)
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Problem Gambling - Barriers to Help-seeking Behaviours (Final Report)
Bellringer, M., Pulford, J., Abbott, M., DeSouza, R., & Clarke, D. E. (2008) · Tuwhera (Auckland University of Technology) · Cited by 18 · see citing works
Nilsson, A., Magnusson, K., Carlbring, P., Andersson, G., & Gumpert, C. H. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011974 · Cited by 10 · see citing works
Flagged first, then by citations
1 of the 79 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [76]Nilsson A., Magnusson K., Carlbring P., Andersson G., Gumpert C. H. Effects of added involvement from concerned significant others in internet‐delivered CBT treatments for problem gambling: study protocol for a randomised controlled trial. BMJ Open 2016; 6: e011974. PMC5051398 27670519
Cited by
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Ribeiro, E. O., Afonso, N., & Morgado, P. F. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03097-2 · Cited by 52 · see citing works
“Echeburua’s et al. [6] controlled trial randomized Dowling et al., 2007 [16] Australia 6 months 56 43.58 years 100% females Diagnostic according DSM-IV criteria ━ Petry et al., 2006 [41] United States 12 months 231 44.87 years 54.98% males 84.42% caucasians Diagnostic according DSM-IV criteria, gambled in the past 2 m…”
BackgroundMethodResultInfluentialSagoe, D., Griffiths, M. D., Erevik, E. K., Høyland, T., Leino, T. M., Lande, I. A., Sigurdsson, M. E., & Pallesen, S. (2021) · Journal of Behavioral Addictions · doi:10.1556/2006.2021.00062 · Cited by 51 · see citing works
Gambling-Related Harms for Affected Others: A Finnish Population-Based Survey
Castrén, S., Lind, K., Hagfors, H., & Salonen, A. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189564 · Cited by 43 · see citing works
Harm as reported by affected others: A population-based cross-sectional Finnish Gambling 2019 study
Lind, K., Castrén, S., Hagfors, H., & Salonen, A. H. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107263 · Cited by 39 · see citing works
Treatment of gambling disorder: review of evidence-based aspects for best practice
Bodor, D., Ricijaš, N., & Filipčić, I. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000728 · Cited by 27 · see citing works
GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions
Dowling, N. A., Merkouris, S., Rodda, S. N., Smith, D., Aarsman, S. R., Lavis, T., Lubman, D. I., Austin, D., Cunningham, J. A., Battersby, M., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10112224 · Cited by 33 · see citing works
“There is also evidence that therapist-supported iCBT is comparable to internet-based behavioural couples therapy in improving gambling and psychological outcomes over a 12 month follow-up period [40,41].”
BackgroundTreatment for the concerned significant others of gamblers: A systematic review
Edgren, R., Pörtfors, P., Raisamo, S., & Castrén, S. (2022) · Journal of Behavioral Addictions · doi:10.1556/2006.2021.00088 · Cited by 22 · see citing works
“…letters: a Magnusson et al. (2015); b Copello et al. (2010); c Standard treatment, refers to intervention utilized in Kourgiantakis (2017); d Nilsson et al. (2016); e Tremblay et al. (2015); f www.gamblinghelponline.org.au; For elaboration to the intervention content checklist see online…”
BackgroundDowling, N. A., Hawker, C. O., Merkouris, S., Rodda, S. N., & Hodgins, D. C. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102542 · Cited by 17 · see citing works
Internet Interventions in Clinical Psychology
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Treatment for the concerned significant others of gamblers : A systematic review
Edgren, R., Pörtfors, P., Raisamo, S. U., & Castrén, S. (2022) · Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) · doi:10.48350/168493 · Cited by 14 · see citing works
Dowling, N. A., Hawker, C. O., Merkouris, S., Rodda, S. N., & Hodgins, D. C. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102543 · Cited by 13 · see citing works
Nilsson, A., Simonsson, O., & Hellner, C. (2021) · Current Psychology · doi:10.1007/s12144-021-02368-1 · Cited by 12 · see citing works
“Of 136 included individuals with gambling problems in the RCT, 46 participants, or 33.8%, completed less than half of the treatment.”
BackgroundResultInfluentialHigueruela-Ahijado, M., López‐Espuela, F., Caro‐Alonso, P. A., Novo, A., & Rodríguez‐Martin, B. (2022) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2022.12.014 · Cited by 13 · see citing works
Lee, B. K., Dei, S. M. O., Brown, M. M. R., Awosoga, O., Shi, Y., & Greenshaw, A. J. (2022) · Family Process · doi:10.1111/famp.12813 · Cited by 10 · see citing works
Diaz-Sanahuja, L., Campos, D., Mira, A., Castilla, D., García-Palacios, A., & Bretón-López, J. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100466 · Cited by 10 · see citing works
Stenbro, A. W., Moldt, S., Eriksen, J. W., & Frostholm, L. (2023) · Journal of Gambling Studies · doi:10.1007/s10899-023-10199-x · Cited by 8 · see citing works
Vassallo, M., DeGiovanni, K., & Montgomery, P. (2023) · Journal of Gambling Studies · doi:10.1007/s10899-023-10220-3 · Cited by 9 · see citing works
“In Nilsson et al. (2020), 136 problem gamblers and their affected others, including partners, parents and other individuals, were randomised in the same manner as the pilot study.”
InfluentialDowling, N. A. (2020) · Addiction · doi:10.1111/add.15026 · Cited by 8 · see citing works
Wall, H., Magnusson, K., Hellner, C., Andersson, G., Jayaram‐Lindström, N., & Rosendahl, I. K. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01257-7 · Cited by 7 · see citing works
Côté, M., Dufour, M., & Tremblay, J. (2022) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12596 · Cited by 6 · see citing works
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Case study of A Pilot Online Treatment Service for Problem Gambling
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Hagen, A. E. F., Nogueira‐Arjona, R., Sherry, S., Rodriguez, L. M., Yakovenko, I., & Stewart, S. H. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1018098 · Cited by 3 · see citing works
“Clinicians may also wish to target both negative affect and coping gambling motives in both individual treatment with a partnered gambler and in couples-based treatments for gamblers experiencing romantic conflict (Nilsson et al., 2019).”
Rakitzi, S. (2023) · Springer eBooks · doi:10.1007/978-3-031-27837-2_2 · Cited by 2 · see citing works
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Molander, O., Johnsson, A., Bjureberg, J., Jayaram‐Lindström, N., Dowling, N. A., & Ljótsson, B. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2639523 · Cited by 2 · see citing works
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Early Disengagement from Gambling Treatment: Insights from Clients and Practitioners
Hawker, C. O., Dowling, N. A., Thomas, A. R., & Merkouris, S. (2026) · Journal of Gambling Studies · doi:10.1007/s10899-026-10484-5 · Cited by 1 · see citing works
“…(Hawker et al. 2025a , b, c ), many interventions incorporate engagement-enhancing components, including motivational enhancements, involvement of significant others, and concurrent pharmacotherapy (Jiménez-Murcia et al. 2017; Kraus et al. 2020; Nilsson et al. 2020; Pfund et al. 2020a , b ).”
Cognitive-Behavioral Therapy for Gambling Disorder: Current Status and Future Directions
Pfund, R. A., Rodda, S. N., & Weinstock, J. (2026) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2026.05.006
Eficácia de intervenções biopsicossociais no transtorno do jogo
Leite, E. M. (2026) · Revista Brasileira de Terapia Comportamental e Cognitiva · doi:10.31505/rbtcc.v28i1.2199
- Authors
- Nilsson, A., Magnusson, K., Carlbring, P., Andersson, G., & Hellner, C.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Linköping University (SE)
- Corresponding author
- Nilsson, Anders
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2020-01-08
- Volume
- 115
- Issue
- 7
- Pages
- 1330-1342
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC7317433
- OpenAlex
- W2991348149
- Cited by
- 34
- References
- 79
- Citations by year
- 2026: 4 · 2025: 4 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 1 · 2019: 1
- FWCI
- 5.55
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Addiction (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- problem gambling, behavioral couples therapy, cognitive behavioral therapy, online therapy, concerned significant others, gambling addiction, medication adherence, anxiety, alcohol consumption, relationship quality, treatment discontinuation, gambling consequences, treatment efficacy comparison, PHQ-9, generalized anxiety disorder
- MeSH terms
- Treatment Adherence and Compliance, Internet-Based Intervention, Adult, Female, Gambling, Humans, Male, Sweden, Cognitive Behavioral Therapy, Treatment Outcome, Couples Therapy
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