Psicoterapia psicodinâmica e o tratamento do jogo patológico / Psychodynamic psychotherapy and the treatment of pathological gambling

OBJETIVO: A busca por tratamentos com base empírica para o jogo patológico está em sua infância, havendo relativamente poucos ensaios clínicos e uma ausência de estudos naturalísticos. A adesão dos jogadores ao tratamento tem sido um problema, sendo que o tratamento cognitivo-comportamental e os estudos farmacoterápicos relatam índices particularmente altos de abandono. As abordagens psicodinâmicas, com sua ênfase na relação terapêutica e no significado dos comportamentos autodestrutivos e aparentemente irracionais, e nos obstáculos à capacidade de se perdoar, poderiam melhorar o desfecho. MÉTODO: Após uma descrição da psicoterapia psicodinâmica, foi feita uma revisão da literatura que investigou a eficácia de tratamentos psicoterápicos de curto e longo prazo para uma série de transtornos. Com relação ao jogo patológico, foi feito um resumo da literatura psicanalítica inicial (1914-1970) e a seguir foi revisada a literatura mais recente sobre a utilização da psicoterapia psicodinâmica no jogo patológico. RESULTADOS: A pesquisa da literatura recente sobre psicoterapia psicodinâmica não revelou nenhum estudo controlado aleatorizado sobre a eficácia ou efetividade desse tratamento. No entanto, há oito estudos com desfechos positivos descritos como ecléticos multimodais; a metade destes parece utilizar abordagens psicodinâmicas. São descritos dois programas entre os que obtiveram maior êxito. CONCLUSÕES: Uma observação sobre os desfechos mais gerais da psicoterapia psicodinâmica na literatura demonstra eficácia suficiente para uma variedade de transtornos que justificam um ensaio clínico sobre o jogo patológico. A psicoterapia psicodinâmica de curto prazo, com seu foco em questões nucleares, pode ser particularmente aplicável à necessidade dos jogadores patológicos de evitar ou escapar de efeitos e problemas intoleráveis. Terapias de mais longo prazo podem ser necessárias para modificar um padrão evitativo de comportamento e defesas psicodinâmicas.

OBJECTIVE: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. METHOD: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. RESULTS: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. CONCLUSIONS: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.

[Psychodynamic psychotherapy and the treatment of pathological gambling]. / Psicoterapia psicodinâmica e o tratamento do jogo patológico.

OBJECTIVE: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. METHOD: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. RESULTS: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. CONCLUSIONS: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.

A comparison of craving and emotional states between pathological gamblers and alcoholics.

Fifty pathological gamblers and 42 alcohol dependent subjects were compared regarding craving, emotional states and social functioning. Subjects self-rated their cravings using the Weiss Craving Scale (WCS) and the Pennsylvania Craving Scale (PCS). Subjects answered a semi-structured interview, the Positive and Negative Affect Scale Extended Form (PANAS-X), and the Social Adjustment Scale (SAS-SR). Gamblers had higher scores on craving measures. Regression models showed that craving for gambling and alcohol have a significant correlation with emotional states. Craving for gambling was inversely correlated with positive affect and craving for alcohol was directly correlated with negative affect. Gambling craving was more dependent upon external factors and related to an unpleasant dearousing state, while alcohol craving was associated with an unpleasant arousing state. These findings point to the key role of emotional deregulation on gambling and alcohol cravings following early abstinence.