Cognitive-Behavioral Techniques Are Important Tools for Gambling Disorder Treatment: Insights for Therapists

Gambling problems, often referred to as gambling addiction, can lead to substantial distress, including difficulties at work or school as well as financial, interpersonal, and psychological harms. The DSM-5 classifies gambling disorder as an addictive disorder. Even gambling that does not meet diagnostic criteria for gambling disorder can still cause harm and may also warrant treatment. Recently, it was estimated that 9% of adults engage in risky gambling, and approximately 1% engage in problematic gambling (Tran et al., 2024). As gambling opportunities proliferate, some worry that gambling problems may increase in prevalence as well.

Even though problem gambling is not uncommon and can cause considerable harm, many mental health professionals lack training in gambling disorder treatment.

However, effective treatment of problem gambling is possible. Treatment that uses cognitive-behavioral techniques (CBT) has been found to be effective. The Gambling Clinic® has extensive experience using CBTs to treat problem gambling. This brief shares some strategies that we use that are well researched and effective.

Researchers affiliated with The Gambling Clinic have conducted several meta-analyses that suggest cognitive-behavioral techniques (CBT) are effective when used in treatment for problem gambling. One meta-analysis found that, relative to control conditions, cognitive-behavioral techniques led to reductions in gambling disorder severity and gambling behavior at post-treatment (Pfund et al., 2023a). Another meta-analysis reported that adults participating in CBT had fewer gambling-related mistaken beliefs, greater self-confidence to control gambling, and better coping strategies than those in control conditions (Free et al., 2024). A third meta-analysis found benefits even beyond gambling-focused outcomes, including decreased symptoms of anxiety and depression and enhanced general quality of life (Pfund et al., 2023b). Given the evidence for the benefits of CBT for gambling disorder, the American Psychological Association’s Society of Clinical Psychology classified CBT as an empirically supported treatment. 

Motivational enhancement involves understanding clients in a way that helps resolve their ambivalence and strengthen their commitment to change their gambling. The therapist aims to understand why each specific client wants to change, highlighting both the benefits a client sees for changing and the ways gambling has hurt them. When clients share things they like about gambling or desires to continue to gamble, therapists don’t shy away. Instead, they seek to understand the client while supporting an exploration the full range of outcomes gambling may produce for them. The therapist isn’t imposing the desire to change on the client but rather recognizing and talking about the change that client wants. Past research has found motivationally-enhanced CBT improves session attendance and increases motivation to change (Wulfert et al., 2025).

At The Gambling Clinic, we build motivational enhancement into therapy sessions, written communication with clients, and other interactions. We draw on Miller and Rollnick’s classic book Motivational Interviewing: Helping People Change (Fourth Edition), which therapists may find to be a useful resource in their own practice.

Setting goals is a cognitive-behavioral technique that is commonly used for problem gambling. The Gambling Clinic is gambling-neutral, meaning that clients make the decision about what change means for them, be it total abstinence or a form of moderated gambling. That is, in collaboration with their therapist, they decide whether to set a goal of abstaining from gambling completely or setting limits on how much money they will risk, how frequently they will gamble, and/or how long they will spend gambling. For instance, a client might set a goal of limiting their gambling to 1% of their income or to no more than four days per month.

People are often more motivated to work toward goals they have set for themselves than goals others have set for them. Further, when the client and therapist set specific, measurable goals—that is, those that precisely identify maximum spending, frequency, and/or duration for gambling within a given timeframe (i.e., per week or month)—they can evaluate the success of the strategies the client is using to eliminate or reduce their gambling and achieve those goals.

CBT for problem gambling may involve psychoeducation on topics such as the odds and risks associated with specific forms of gambling, information about problem gambling treatment, or information about the nature of probability. Education on these topics can offer clients insights into their experiences and history with gambling as well as ways they can make changes in their lives.

Building on this psychoeducation, therapists may work with their clients on cognitive restructuring (Ladouceur & Lachance, 2007). This work begins with identifying mistaken thoughts related to gambling. For instance, the client and therapist could explore common inaccurate beliefs about gambling, many of which relate to beliefs about the control over random events or the belief that continuing to gamble will lead to monetary gain (Goodie & Fortune, 2013).

Once potentially inaccurate thoughts have been identified, the client and therapist can examine the validity of the thoughts and generate thoughts that are more accurate. This process may involve psychoeducation, behavioral experiments (e.g., rolling a die in session to illustrate the independence of random events), or the client’s elaboration of their thoughts about gambling.

CBT for problem gambling may also involve stimulus control. Therapists can work with clients to identify ways they can modify their environments to reduce exposure to triggers that may evoke the urge to gamble. This may involve self-excluding from betting apps and/or casinos; blocking gambling ads and content from email, social media, and the web; or changing access to monetary resources, such as by leaving credit cards at home while gambling, setting limits on the amount of money they can deposit into a gambling app, or even temporarily relinquishing control of finances to a trusted person. By controlling stimuli that could evoke the urge to gamble, clients can make it easier to maintain adherence to their abstinence or moderation goals.

Behavioral substitution is a technique used to help clients replace gambling with a values-based alternative behavior. It is understood that all behaviors—even potentially harmful behaviors like gambling—serve a function in context. When a client aims to eliminate or reduce their gambling, it is vital to develop substitute behaviors that fill the void left by the elimination of gambling from their repertoire. Clients are also encouraged to fill their lives with opportunities to engage in activities that are pleasurable, health promoting, or bring a sense of meaning or fulfillment to their lives.

To identify appropriate behavioral substitutes for gambling, it may be helpful for the client to understand the function that gambling serves for them so that they can generate alternative ways to serve that function. For instance, a client who gambles for social connection would need to find another way to spend time with friends.

In generating ideas for substitute behaviors, it can be useful for the client to recall activities they engaged in during periods in their life when they were not gambling. Homework assignments can also prompt clients to generate options beyond gambling that they might enjoy.

Once the client has ideas for potential substitute behaviors, the client and therapist can work together to develop specific plans for the client to incorporate these activities into their lives.

As the client nears the conclusion of treatment, developing plans for relapse prevention is valuable. Having a plan for “coping ahead” as we call it at The Gambling Clinic can enable clients to navigate high-risk situations while adhering to their goals. When the client has identified high-risk situations, they can create a plan for avoiding or adjusting the risky environment or for managing it in a way that is in keeping with their abstinence or moderation goals.

The process of planning for maintenance post-treatment may also include mindfulness-based strategies for craving management such as urge surfing (Bowen et al., 2021) and psychoeducation about the abstinence violation effect to support clients in viewing any future lapses as learning experiences, rather than personal failures.

Therapists may encounter clients experiencing gambling addiction or gambling disorder. CBT can benefit people experiencing gambling-related harm by reducing gambling behavior, reducing gambling-related harm, and improving other aspects of their mental health and well-being.

This brief is based on this article written by our team (Tennessee Institute for Gambling Education and Research). The full article is available here:

Andersland, M. D., Dow, C. V., Ginley, M. K., Whelan, J. P., & Pfund, R. A. (2025). Cognitive-behavioral therapy techniques for gambling disorder: Practice examples for clinicians, Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2025.10.004

Read more about the doctoral students who led this work:  

Matthew D. Andersland is a doctoral student in clinical psychology at the University of Memphis, a member of the Tennessee Institute for Gambling Education and Research, and a therapist at The Gambling Clinic. His interests include gambling disorder treatment, co-occurring substance use and gambling, and mindfulness in the treatment of gambling disorder. 

Chance V. Dow is a doctoral student in clinical psychology at the University of Memphis, a member of the Tennessee Institute for Gambling Education and Research, and a therapist at The Gambling Clinic. His interests include sports betting among emerging adult populations, responsible gambling, and the intersection between masculinity and gambling. 

Therapists interested in reading more about CBT for addictive disorders may wish to consult Liese and Beck’s (2022) book Cognitive-Behavioral Therapy of Addictive Disorders. For treatment for problem gambling specifically, The Gambling Clinic’s own handbook, Problem Gambling and Gambling Disorder, is a valuable resource (available here).

You may also be interested in the meta-analyses on the benefits of CBT for people experiencing problem gambling:

Free, B. L., Halle Smith, E., Ginley, M. K., Whelan, J. P., & Pfund, R. A. (2024). Does cognitive-behavioral treatment affect putative mechanisms of change among individuals with problem gambling? A systematic review and exploratory meta-analysis. Addictive Behaviors, 158. https://doi.org/10.1016/j.addbeh.2024.108110.

Pfund, R. A., Forman, D. P., King, S. A., Zech, J. M., Ginley, M. K., Peter, S. C., McAfee, N. W., & Whelan, J. P. (2023a). Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis. Addiction. https://doi.org/10.1111/add.16221.

Pfund, R. A., King, S. A., Forman, D. P., Zech, J. M., Ginley, M. K., Peter, S. C., McAfee, N. W., Witkiewitz, K., & Whelan, J. P. (2023b). Effects of cognitive-behavioral techniques for gambling on recovery defined by gambling, psychological functioning, and quality of life: A systematic review and meta-analysis. Psychology of Addictive Behaviors, 37(7), 936–945. https://doi.org/10.1037/adb0000910.