Little is known about the change processes in gambling disorder-specific cognitive therapy (CT) and exposure therapy (ET). These therapies are underpinned by the cognitive approach (i.e., restructuring gambling cognitions) and the psychobiological approach (i.e., elimination of gambling urges) to treating problem gambling. Here, piecewise-linear modelling is used in a secondary analysis of randomised trial data for a CT group (n = 44) versus an ET group (n = 43) with the aim to open a discourse on how individuals respond to CT and ET relative to theory. Measures were administered between therapy sessions (average = 6.2 per individual) across 18 weeks for gambling urge (GUS) and gambling cognitions (GRCS). Results indicated the ET group had a stronger reduction in GUS (p < .01) in the first 4 weeks of treatment. Between 4–12 weeks, improvement in GUS (p < .01) and GRCS (p = .02) was more rapid in the CT group. Both groups experienced comparable improvements from 12–18 weeks. These findings have implications for further treatment development, including a combined cognitive and exposure approach that is flexibly adapted to the patient. A larger trial is needed to formally establish change processes and identify differences in problem gambler subgroups. This would provide therapists capacity to offer each patient a clear direction and an expedited pathway to their preferred outcome.

中文翻译：

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探索电子游戏机问题赌徒认知和暴露疗法不同治疗阶段的变化过程模式

关于赌博障碍特异性认知疗法（CT）和暴露疗法（ET）的变化过程知之甚少。这些疗法的基础是认知方法（即重组赌博认知）和心理生物学方法（即消除赌博冲动）来治疗问题赌博。在这里，分段线性建模用于对 CT 组的随机试验数据进行二次分析（n= 44) 与 ET 组 (n= 43) 旨在就个人如何相对于理论对 CT 和 ET 做出反应展开讨论。在为期 18 周的赌博冲动 (GUS) 和赌博认知 (GRCS) 的治疗期间（平均每人 6.2 次）进行了测量。结果表明，ET 组的 GUS 降低幅度更大（p< .01) 在治疗的前 4 周。在 4-12 周之间，GUS 改善（p< .01) 和 GRCS (p= .02) 在 CT 组中更快。两组在 12 至 18 周期间都经历了相当的改善。这些发现对进一步的治疗发展具有重要意义，包括灵活适应患者的认知和暴露相结合的方法。需要进行更大规模的试验来正式建立变革过程并确定问题赌徒亚群的差异。这将使治疗师有能力为每位患者提供明确的方向和快速的途径，以达到他们的首选结果。