e noted that chronic gamblers have told researchers that they gamble for the thrill, not the money (New York Times October, 1989).Behavioral psychotherapy is an educational model of therapy; it is self-directed with the therapist acting as educator, adviser and coach. Outpatient management begins with two assessment sessions to set up the treatment, each taking one hour, with once a week therapist sessions of approximately half and hour. The main focus of therapy is homework between sessions, monitored on homework sheets by the client. Progress is monitored on homework sheets by the client. Progress is monitored every four weeks and if progress is not maintained, then therapy is discontinued. If outpatient therapy is unsuccessful, clients are offered an inpatient program.In our own work with pathological gamblers, we have recognized similarities with anxiety disorders. The uncontrollable urge to gamble described by patients is similar to the compulsion felt by patients with obsessive-compulsive disorder. That a behavioral technique such as imaginal (systematic) desensitization was effective for anxiety disorders and pathological gambling, suggests that some aspect of the therapeutic response is common to both disorders.There is growing evidence for using exposure in the treatment of pathological gamblers. In exposure, clients are asked to grade their gambling triggers from very difficult to relatively easy. They are then asked to enter the easiest of the situations and remain there until the urge to gamble habituates. This is repeated daily until they are able to move onto the next stage. While their in this situation, they are asked to resist the urge to gamble. Therefore the four principles of exposure are used with gamblers (graded, prolonged, repeated, and the person focuses on the task). Graded exposure differs from imaginal (systematic) desensitization in that the pairing of relaxation is not present. In treatment of...
