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Themenschwerpunkt

Die Wirksamkeit psychologischer und psychopharmakologischer Interventionen bei pathologischem Glückspiel – eine Metaanalyse

Published Online:August 22, 2011https://doi.org/10.1024/0939-5911.a000120

Abstract

Fragestellung: Die vorliegende Studie berichtet über eine Meta-Analyse zur Wirksamkeit psychologischer und psycho-pharmakologischer Behandlungsmethoden des pathologischen Spiels. Methode: Dazu wurde eine systematische Literaturanalyse bis einschließlich Juli 2006 der Datenbanken PsycInfo, PsyndexPlus, Pascal, Biomed, Medline und Scopus durchgeführt. Von den daraus resultierenden 144 Studien erfüllten 56 mit einem N = 3.551 die Einschlusskriterien. Inkludiert wurden sowohl Studien mit einem Prä-Post-Katamnese-Design wie auch solche mit einer Vergleichs- oder Kontrollgruppe. Effektstärken wurden nach Cohen’s d berechnet. Bei Studien mit mehr als einem Outcome-Kriterium wurden diese gemittelt. Ergebnisse: Psychopharmakologische Behandlungen (d = .83; p ≤ .01; CI(95 %) = .72 – .95) erwiesen sich zum Therapieende als effektiver als psychologische (d = .63; p ≤ .01; CI(95 %) = .54 – .72). Deren Effekte waren zum Follow-up (M = 17 Monate) jedoch hoch (d = 1.26; p ≤ .01; CI(95 %) = 1.15 – 1.37): Wegen fehlender Studien konnten keine entsprechenden Effekte für pharmakologische Behandlungen berechnet werden. Im Hinblick auf die spezifischen Behandlungen erwiesen sich Psycho-Stimulantien und Stimmungsstabilisierer als am effektivsten; bei den psychologischen Methoden waren es multimodale Programme, die aus einer Kombination von Selbsthilfe, Kompetenztrainings und Familieninterventionen bestanden. Allerdings wurden diese primär über Prä-Postvergleiche evaluiert. In diesem Design erwiesen sich jedoch in einer Reanalyse verhaltenstherapeutische Interventionen den multimodalen Programmen überlegen. In den Moderatoranalysen zeigte sich das Studiendesign als einzige bedeutsame Variable. Diskussion: Die Ergebnisse müssen als vorläufig gewertet werden, denn das Feld weist noch viele Mängel auf. So fehlen vor allem kontrollierte randomisierte Studien mit langfristigen Katamnesen. Auch wurden Kombinationstherapien noch nicht untersucht.


Efficacy and Effectiveness of Psychological and Psycho-Pharmacological Treatments in Pathological Gambling – a Meta-Analysis

Aims: The present study reports a meta-analysis of the outcomes of psychological and psycho-pharmacological interventions to treat pathological gambling. Method: The databases PsycInfo, PsyndexPlus, Pascal, Biomed, Medline, and Scopus were systematically analyzed up to July 2006. From the resulting 144 studies, 56 including 3,551 individuals were integrated into the meta-analysis. Effect sizes were calculated using Cohen’s d. For studies without control groups, pre to post-study and pre-study to follow-up comparisons were used. In controlled trials, group means at the end of treatment and at follow up were compared. In studies with more than one criterion, effect sizes were averaged into one study effect size. Results: For psycho-pharmacological interventions, high mean effect sizes were found at the end of treatment (d = .83; p ≤ .01; CI(95 %) = .72 – .95). Because of a lack of studies, no follow-up effect sizes were calculated. For psychological interventions, mean effect sizes were medium sized at the end of interventions (d = .63; p ≤ .01; CI(95 %) = .54 – .72) and high at follow up (M = 17 months) (d = 1.26; p ≤ .01; CI(95 %) = 1.15 – 1.37). Concerning specific pharmacological substances, psycho-stimulants and mood stabilisers were most effective. Multimodal interventions based on an eclectic approach combined with the participation in self-help groups, communication trainings, and family interventions were the most effective psychological treatments. However these interventions primarily were evaluated using within-subjects designs. Reanalyzing the data within this design it was found that cognitive behavioral interventions were much more effective (was the single relevant variable). Conclusions: Although the results favor cognitive-behavioral programs and the application of mood stabilisers or psycho-stimulants for the treatment of pathological gambling, these results must be seen as preliminary, because there are many shortcomings and problems in this field of research. There is a lack of randomized controlled trials, especially with psychological treatments, as well as long-term effects of psychological and pharmacological treatments are not yet studied in a satisfying manner.

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