Pathological gambling: Implications for therapeutic recreation practice

Therapeutic Recreation Journal, Fourth Quarter 1999 by Carruthers, Cynthia

Cognitive therapy has another important function in the treatment of clients who gamble pathologically (Walters, 1994b). As was mentioned previously, these individuals often have beliefs that affect directly the maintenance of gambling behaviors, such as illusions of control, biased evaluations of their own skill or knowledge, misperceptions of randomness, rationalizations, and justifications (Walters. 1994a). In many treatment facilities, all members of the treatment team, including TR specialists, are expected to assist the recovering pathological gambler in identifying, confronting, and changing the irrational thoughts that will undermine recovery. Cognitive therapy is a primary emphasis in most relapse prevention programs (Rugle, 1993).

Although changing one's thoughts is a very helpful practice in the management of stress and "high risk" situations, there are times when it is best to take constructive action to minimize or eliminate the stressor. It is important that the pathological gambler learn to assess a stressful situation to determine if there is any constructive action that he or she can take to alleviate the stressful situation. If there is any constructive action that can be taken, it should be taken. It is characteristic of pathological gamblers to use the coping strategies of escape/avoidance or distancing, rather than the more effective strategies of accepting responsibility and problem solving (McCormick, 1994). Active strategies for problem solving and responding to high risk situations should be learned in treatment. TR specialists can facilitate this active coping style by having clients identify the stressors that may threaten their recovery, their degree of confidence in their ability to manage the stressors, and coping strategies that will increase their confidence in high risk situations (Carruthers, 1995).

Clients in treatment for pathological gambling can also acquire skills in monitoring and reducing physiological arousal (hyperarousal). Relaxation techniques, such as progressive relaxation, meditation, imagery, and exercise can be helpful in the regulation of the stress response (McCormick. 1994; Walters, 1994b). These interventions are included in many TR programs. Research suggests that they make a positive contribution in the treatment of people with addictions when used in conjunction with other interventions (Stockwell, 1995).

A key problem in stress management for pathological gamblers is impulse control and, therefore, it should be emphasized in any program implemented by a TR specialist. As mentioned previously, pathological gamblers often ]cap from cue to response without consideration of the potential risks involved. The positive short term consequences of their behaviors (the thrill of placing the bet) often exceed the less immediate and generally more negative long term consequences of betting. Impulse control interventions provided by TR specialists should focus on slowing down the decision making process. Systematic problem solving should be emphasized. According to McCormick (1995), pathological gamblers may need to be taught how to break presenting problems into parts, fully explore each of the options, weigh the pros and cons of each option, choose a solution, try it, and evaluate it. Helping pathological gamblers to separate their thoughts, feelings, and actions will minimize typical short cut thinking. and will assist them in regulating their own impulses (Castellani & Rugle, 1995).