The Role of Meditation and Mindfulness in Gambling Recovery

The Role of Meditation and Mindfulness in Gambling Recovery

As most gambling counselors and therapists will attest, there’s no single treatment that works across the board for all clients. However, meditation and other mindfulness-based therapies, which have increased in popularity, are showing promise in helping people cope with a range of mental health conditions, including gambling addiction.

What is Mindfulness?

First, what exactly is mindfulness? While definitions vary slightly depending on the context, all center around the concept of moment-to-moment awareness without expectation. According to Jon Kabat-Zinn, founder of mindfulness-based stress reduction (MBSR), “mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”

Ollie Stocker, LICSW, LADC, MN-CGC, a therapist at Fairview Recovery Services who both practices meditation personally and encourages his clients to try it, feels that mindfulness and meditation work hand in hand. “I see meditation—in all its various forms, such as focusing on breath, focusing on senses, listening to guided meditations, etc.—to be the basic training, the boot camp of mindfulness. The goal is to do some daily mediation practice that you can then carry over to everyday activities. Even if one is unable to integrate mindfulness practices into everyday living, it is minimally effective to have 20-30 minutes of calming relaxation.”

The concept of “practice” is an important aspect. “I refer to mindfulness as a ‘practice’ because it takes time to develop the skills needed to maintain mindfulness and meditate for any significant amount of time,” says Susan Campion, MS, LACD, ICGC-II, problem gambling group counselor at Fairview Recovery Services. “We generally start open group with a five-minute meditation and encourage clients to grow their practice at home.”

Why Consider Meditation and Mindfulness?

“Gamblers are impulsive and lack self-regulation skills, which makes it difficult for them to manage urges and cravings,” says Ollie. Meditation quiets the “monkey mind” associated with gambling while mindfulness keeps clients in the present and less focused on past mistakes or future concerns. Thus, it can help gamblers, who tend to operate on autopilot and respond to addictive urges without awareness, according to Ollie.

Other reasons that gamblers can benefit from meditation and mindfulness is to realize the cognitive distortions and rationalizations that may take place when they gamble. Additionally, the majority of gambling patients have co-occurring disorders, such as other addictions or mental health issues, which can also benefit from mindfulness practices.

Effectiveness of Mindfulness

Both evidence-based practices and anecdotal reports have supported the notion that mindfulness can be effective. A study conducted in 2010 (“Short-Term Meditation Induces White Matter Changes In the Anterior Cingulate,” by Tang et al.) found improvements in white matter integrity after four weeks of meditation training. These improvements were evident in brain areas involved in neural communication from and to the anterior cingulate cortex, a central area of the brain known to be involved in controlling cognition and emotion.

A study of mindfulness and problem gambling treatment conducted by the Problem Gambling Institute of Ontario at the Centre for Addiction and Mental Health found that participants who completed mindfulness practices averaged a 4.40 MAAS (mindful attention awareness scale) score after treatment compared to 3.65 before. (The MAAS is a 15-item scale designed to assess a core characteristic of dispositional mindfulness, namely, open or receptive awareness of and attention to what is taking place in the present.)

Another study (“Mindfulness-Enhanced Cognitive Behavior Therapy for Problem Gambling: A Controlled Pilot Study,” International Journal of Mental Health and Addiction 12:2, 197-205.) in which one group of participants received cognitive behavioral therapy (CBT) and the other received both CBT and mindfulness training demonstrated that those receiving the mindfulness training experienced significantly reduced gambling urges and psychiatric symptoms. The study further showed that those practicing mindfulness continued to show improved outcomes at three months.

Treatment Implications and Guidance

Given the experiential nature of meditation, patients need to practice it. Ollie says it’s important to include some type of meditation practice in each session and to include daily meditation as part of a patient’s treatment plan. Patients benefit from being given meditation resources to learn about ways to meditate and how to practice it daily.

At Fairview, patients are introduced to meditation in their first group session with a five-minute meditation. Other forms of meditation, such as yoga, coloring, breathing exercises or prayer, are also recommended. “Having clients share how coloring mandalas for 10 minutes helps quiet their brain is a powerful moment for many,” says Susan.

Ideally, gambling counselors that encourage clients to practice meditation are daily meditators or mindfulness practitioners themselves. Counselors are also encouraged to make referrals to meditation or MBSR classes, as meditation is more powerful in group settings according to Ollie. They may also recommend some of the many free resources online and available apps that help patients learn meditation.

If you’d like to view Ollie Stocker’s PowerPoint presentation, including a list of books and resources, please click here.

What About the Family?

What About the Family?

The families and “affected others” of problem gamblers are all too often forgotten in the stress and chaos that’s created by someone with a gambling addiction. Yet, in many ways, the need for help among those in the midst of a problem gambler is just as great as for the gamblers themselves. Friends and families are impacted in various ways, including financial, emotional, social and physical. Fortunately, however, there are options available to help ease these impacts.

Impacts on the Family

Financial. The first and most obvious way that family members suffer is from the drain of financial resources. It’s not uncommon for a family member to learn that vacation or other recreational plans are put off because there’s no money. Worse yet, financial devastation is often something that’s discovered suddenly and without warning. “By the time a family realizes there is a financial problem, there may not be money for food or rent,” says Sheryl Anderson, program director at Project Turnabout. “The level of shock is dramatic and that makes people even angrier,” says Sheryl.

This is in contrast to other types of addictions where families can observe someone’s physical suffering. “Those families don’t feel that the rug was pulled out from under them as much and therefore they tend to be more compassionate,” says Sheryl.

Isolation. Gambling addiction has not yet reached the point where it’s as accepted and generally understood like other addictions. The remaining stigma means that those who suffer from another’s gambling addiction are less apt to search out—and find—a place to share their concerns.

Shame. To the extent that a family member or friend has helped provide money that enabled a gambler to continue gambling (perhaps under the guise of other needs) or otherwise helped to justify their situation to others, there may be shame in acknowledging the role they have played. This can keep such an affected other from seeking help.

Health. While the impacts listed above are more commonly known, there’s less awareness about the fact that spouses and family members of gamblers have higher rates of poor health. They experience more symptoms of stress, depression and anxiety, including disorders such as difficulty sleeping, ulcers, irritable bowel, eating disorders, headaches, muscle aches and pains. Not surprisingly, their relationship with the gambler becomes strained, and they may become abusive.

Members of families in which there’s a gambling addiction are more likely than other “addiction” families to commit suicide. Children are more at risk for developing problems in school because they may think they’re a source of the problem since the gambling addiction is not openly discussed in the family.

What Family Members Can Do to Cope

While family members may learn about the resources available to gamblers, they are typically less aware of the support available to them. This may be partly because they don’t know about them, partly because they are too embarrassed to ask, and partly because they are so occupied picking up the pieces from the damage that has occurred. Yet, there are a number of things that family members can do to help themselves.

Become Educated. The most important thing a friend or family member can do is to become educated about gambling addiction. This will help them understand the behavior they are observing in the gambler and to began to understand how the disorder progresses, including the possibility for relapse. They can also learn about their role in the treatment process. Affected others seeking to learn more about gambling addiction can contact Gam-Anon or Project Turnabout.

Family Counseling. Family counseling can help in several ways. It provides a chance to understand the process of problem gambling and to examine if the family member has played a role in enabling the behavior. It emphasizes setting healthy boundaries and, in the latter stages of a gambler’s treatment, helps address issues such as trust, forgiveness, the acquisition of new leisure skills and the changing roles. Family counseling has been shown to provide a positive impact on treatment retention (continuing care), decreased dropout rates during treatment, and better long-term outcomes.

Institute Financial Controls. At a practical level, controlling the flow of money is key to stopping someone from gambling. One way to accomplish this is to have a neutral third party control spending. The goal is not so much control, though that’s a part of it, but also to demonstrate a desire to be transparent and to build a trusting relationship that emphasizes partnership. “Essentially, the family member becomes a bookkeeper of the business,” says Sheryl. “So, for example, if a gambler is given a certain amount of money for meals, they should be asked to provide receipts, much like a company expense report.”

A family member can also require dual signatures on checks to ensure that disbursements are for expenses unrelated to gambling. Special reloadable cards, such as those designed for the purchases of gas, for example, can be provided to ensure that spending is for designated items only.

Self Care. The most important thing that a gambling addict’s affected other can do is to ensure they’re caring for themselves. “They should implement self-care practices such as walking, relaxing and meditating,” says Sheryl. “They deserve this even if they don’t feel they have the time.”

“In reality, family members are sometimes more ready to get help than the gambler,” says Sheryl. “And while they may think there are no affordable resources available because health insurance may have lapsed, they should know that support can be obtained even without insurance.”

Accelerated Resolution Therapy “Gives Life Back” to Recovering Gambler

Accelerated Resolution Therapy “Gives Life Back” to Recovering Gambler

“Kathy” had been doing well in her recovery from gambling addiction, having abstained for a dozen years with only occasional fleeting thoughts about gambling. But when a workplace assault created new trauma and awakened old feelings from previous traumatic experiences, she suddenly had unprecedented cravings to gamble, even devising a plan to travel far away to engage in a gambling spree.

For nearly a year after the workplace incident, which left her with both physical (torn ligaments and broken bones in both wrists) and psychological damage, Kathy was unable to find relief. “I went through a lot of talk therapy to work through things, but it just wasn’t helping,” says Kathy. “I didn’t feel better and was in a constant state of fear. There were times when I was afraid to leave my apartment, stayed in bed all the time, felt suicidal and was just not living a life.”

As Kathy’s addiction symptoms worsened and her physical pain persisted, she sought out options that would be more effective than traditional talk therapy and medication. A friend mentioned a therapeutic approached called accelerated resolution therapy (ART) that could potentially provide help for both the psychological anguish and the physical pain.

“I was feeling so bad physically and emotionally that I was ready to try anything,” says Kathy. “I went into it accelerated resolution therapy with an open mind.” Kathy had her first ART session in November, ten months after the workplace incident.

To her surprise, Kathy experienced immediate improvement—both for her mental anguish and physical pain. “My psychological pain, as measured by feelings of anger, hurt, depression, anxiety, etc., went from a 9 or 10 at the beginning of the session to zero or 1 at the end of the session. And I was able to decrease the amount of pain medication I needed by approximately 60 percent.”

“It may be hard to believe, but it’s common for one session of ART to have these kind of results,” says Wade Lang, LPCC, LADC, NCGC-II, who led Kathy through accelerated resolution therapy. “Kathy’s anxiety and depression were eliminated, the craving went away and even the pain at the original trauma sites was drastically reduced.” Kathy’s PCL-5 score (the PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD) dropped from the 60s to a 6.

Kathy had two additional ART sessions to solidify the gains she made, but does not anticipate the need for extended therapy lasting for months or years. “For the first time in my life, I’m feeling content,” says Kathy. “I’m experiencing an awareness I haven’t felt for a long time and even found myself asking, ‘When did all the leaves on the trees fall off the trees?’ There’s light in my life.”

Accelerated Resolution Therapy May Help Those with Gambling Disorder

Accelerated Resolution Therapy May Help Those with Gambling Disorder

Among the variety of therapies counselors can choose from to help their clients address gambling addiction, one that’s received relatively little attention is known as accelerated resolution therapy (ART). While ART, deemed an evidence-based therapy in 2015, has historically been studied and used as an alternative to traditional PTSD treatments that use drugs or lengthy psychotherapy sessions, it also may help those who struggle with gambling.

ART is a form of psychotherapy that’s rooted in existing evidence-based therapies and has been shown to achieve benefits much more rapidly (usually within one to five sessions). Clients with depression, anxiety, panic attacks, PTSD, substance abuse, sexual abuse and many other mental and physical conditions can experience benefits starting with in the first session.

ART incorporates a combination of techniques used in many other traditional psychotherapies, including exposure therapy, gestalt therapy, cognitive behavior therapy, eye movement desensitization and reprocessing (EMDR), imagery re-scripting, guided imagery and brief psychodynamic therapy. It works directly to reprogram the way in which distressing memories and images are stored in the brain so that they no longer trigger strong physical and emotional reactions. This is accomplished through the use of rapid eye movements similar to eye movements that occur during dreaming. ART is not hypnosis.

The use of this very specific and directive approach can achieve rapid recovery from symptoms and reactions that may have been present for many years. It combines long-respected, sound treatment practices with safe and effective methods validated by current scientific research studies conducted by the University of South Florida.

The connection between gambling addiction and trauma may not be immediately apparent but the relationship is clear. “Trauma is frequently overlooked as something that can precipitate gambling behavior,” says Wade Lang, LPCC, LADC, NCGC-II, a counselor in southwestern Minnesota and one of only two certified ART therapy trainers in the state.

“Trauma comes in many forms — from the solider with wartime trauma to the person who was always made to feel ‘lesser-than’ or ‘insignificant’ compared to others. Gambling becomes the solution for these people and ends in a maladaptive pattern of chasing or escape.”

When working with clients that have a gambling disorder, Wade asks a client to mentally relive their first gambling experience and has them create new scenarios for a different reality. For example, Wade may plant a suggestion to a client that they never went to the casino and experienced their first big win, or he may have them think that they never went to the casino at all. “It’s that recollection of their first big win and the associated socioeconomic consequences that followed that we’re trying to change,” says Wade.

By using eye movement, ART is able to process hurts and pain that clients may never touch in conventional “talk-therapy” or when completing CBT worksheets. “Science tells us that when a strong memory is recalled it is rendered unstable, and through a process called the reconsolidation window new images can be laid down on the same dendritic spines as the original images, like a film or overlay.” Wade says this science prevents new episodes where the old pain or trauma can be triggered.

Jennifer Briest, MSW, CGC-MN, LADC, LICSW, who has worked with several clients with gambling addiction in her role as a counselor for Western Mental Health Center, has similarly been impressed by the therapy. “I have found ART to be an amazing and effective form of bilateral brain stimulation and positive image overlay,” says Jennifer. “The results are immediate and long lasting.”

While there are no studies focused specifically on using ART for patients with gambling addiction, it’s commonly recognized that individuals with trauma may have a gambling disorder. Several studies have been conducted that demonstrate the effectiveness of ART for patients with psychological trauma. Practice comparisons between ART, EMDR and cognitive processing therapy have also shown that ART offers several advantages. These studies can be viewed at NorthstarProblemGambling.org/for-professional/.

A Tedx Talk that provides background on ART can be found here. For additional information about ART, visit AcceleratedResolutionTherapy.com or contact Wade Lang at wade@wadelang.com.

Financial Counselors Can Provide Valuable Services to Gamblers and Their Families

Financial Counselors Can Provide Valuable Services to Gamblers and Their Families

In addition to the social and emotional devastation of gambling addiction, which may include loss of relationships, residence, physical health and career opportunities, the damage exacted to one’s finances is significant. While therapists and groups such as Gambler’s Anonymous can help address the mental and psychological challenges from a gambling disorder, other experts can help gamblers rebuild their financial house.

Financial counselors can provide a variety of services to both the gambler and their family. By taking appropriate measures, counselors can help gamblers rebuild their credit and safeguard the assets of “affected others,” whose money the gambler may have accessed during their addiction.

Many compulsive gamblers have accumulated a seemingly insurmountable level of debt by the time they seek help. Financial counselors can work on their behalf to obtain special, lower interest rates from creditors to satisfy existing debt. Financial counselors can also consolidate debt so that the recovering gambler pays a single monthly payment, an option known as a debt management plan. While debt consolidation is a tool that’s available for anyone — gamblers and non-gamblers alike — it can be especially helpful for someone who has incurred debt from gambling addiction and requires structure to start on a new path.

Recovering gamblers seeking financial relief should be wary of debt settlements, which are fundamentally different than debt management plans and which have been the subject of scrutiny from the Minnesota Attorney General. Debt settlement is a form of debt relief that is considered to be extremely dangerous by financial experts. The process, which involves the paying off of debt to a creditor after mutually agreeing to a sum less than what is owed, often leaves consumers with damaged credit scores and can sometimes lead to even deeper debt.

In addition to credit card assistance, financial counselors can also help with management of student loans and mortgages. HUD-certified financial counselors specialize in foreclosure prevention and can potentially help those who have lost much of their money from gambling by working with mortgage companies to make mortgage modifications. According to Cate Rysavy, senior director of Financial Services at Lutheran Social Service of Minnesota, people are able to avoid foreclosure 64 percent of the time when working with a housing counselor.

Financial counseling can also come to the aid of family members whose monies may have been stolen by the gambler or who may have unknowingly enabled the gambler by providing financial support. Counselors can provide protection to spouses by offering separate accounts for spouses and others to prevent access by the gambler.

A recovering gambler might also wish to engage a Power of Attorney (POA) to help control the disbursement of funds. By setting up a POA, a gambler can ensure there’s controlled access to monies and specify exactly how the funds are to be used. A POA is a formal contract that must be given great consideration. It can be cancelled by revocation by the individual or a resignation by the POA.

In addition to helping those in financial distress, financial counselors may also be the first to identify someone’s gambling problem. They may note frequent cash withdrawals from a casino or determine that something’s amiss with a client’s expenditures given their budget and income.

Ideally, financial counseling, when necessary, takes place at the same time as treatment for gambling addiction. “If someone’s not acknowledging their addiction and seeking treatment, financial counselors are not in a good position to help,” says Cate, who says the biggest concern when working with gamblers is the possibility of relapse. At Lutheran Social Service, counselors are encouraged to make the call for treatment or to GA while they’re still meeting with the problem gambler.

Gamblers seeking a debt management plan should work through a nonprofit member agency of the National Foundation for Credit Counseling. There are three such credit counseling centers in Minnesota: LSS Financial Counseling (1-888-577-2227), The Village Financial Resource Center (1-800-627-8220) and Family Means (1-800-780-2890).

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