Treating Problem Gambling with EMDR

1. Treating Problem Gambling with EMDR Beverly Swann, MA, MFT therapy@beverlyswann.com www.beverlyswann.com 925-705-7036

2. Treating Problem GamblingWith EMDRWhy talk about this at an FRSN training?

3. Background – My Practice

4. Research on First Responders and Problem Gambling

5. Research on Law Enforcement and Problem Gambling Abramowitz, A. (2007). The psychological sequelae of police work stress: Exploring potential mediators and moderators. (Doctoral dissertation, University of Illinois at Urbana-Champaign). ProQuest Dissertations and Theses, Retrieved from http://search.proquest.com./docview/304856993?accountid=28180. (304856993).

6. Why It Might Be Worthy • First responders are under more scrutiny than general public and have different kinds of stressors. • Financial issues connected to problem gambling losses may compromise jobs and health, and possibly compromise public safety. • First responders may be reluctant to seek treatment due to concerns about the job finding out. • They may be afraid of being seen as “weak” for having a problem with gambling, similar to problem drinking. • Pressure from spouse/family over gambling problem may add to stress in an already stressful job.

7. Moral of the Story: • If you’re 50 and decide to go back to grad school to get a Ph.D., don’t be an overachiever and pick a topic to write about that has little/no published related research and that appears to really irritate your professor. OR • If you’re looking for a wide-open field to research, try first responders and problem gambling! OR • Problem gambling does affect at least some first responders, and many of them have co-occurring PTSD.

8. Gambling According to Merriam-Webster Online Dictionary: Gamble = to risk losing something valuable or important in order to do or achieve something

9. Risking Losing Things of Value From National Safety Council, Injury Facts 2014

10. When Does Gambling Become a Problem? – DSM-5 Specifically related to gambling with money and not better explained by a manic episode. Need 4 of these in last year: • Need to keep gambling more to get same feeling • Withdrawal – restless and irritable when trying to quit or cut back • Tried unsuccessfully to quit or cut back • Preoccupied with gambling or have intrusive thoughts/memories of gambling – the “First Big Win” • Gambling when feeling negative emotions • “Chasing” – going back to gamble to try to win back previous losses • Lying about how much gambling is happening • Risking or has lost relationships, jobs, or other important opportunities because of gambling • Borrowing or stealing from others to support gambling

11. Problem Gambling Resources in California • California Council on Problem Gambling http://www.calproblemgambling.org/problem-gambling-helpline • 1-800-GAMBLER (426-2537) • Office of Problem Gambling https://problemgambling.securespsites.com/ccpgwebsite/default.aspx • Gamblers Anonymous http://www.gamblersanonymous.org/ga/node/1

12. Free Therapy for Problem Gambling • Through Office of Problem Gambling and UCLA Gambling Studies Program • Funded by $$ from casinos • Offers 8 free sessions, with an additional 8 if needed • Not only for problem gamblers – also includes “affected others”: • Spouse/partner • Children or other family members • Business partners

13. Assessment - Who Has Gambling Problems? • At least 750,000 California residents have had gambling problems at some point in their lives. • Women and men roughly equal when including at-risk, problem, and pathological gambling. Men more than twice as likely to be pathological gambler. • Age groups with highest risks are (a) 40-65 and (b) 30-39, but all groups over age 14 at significant risk. • Caucasian and African American ethnic groups at highest risk, but all ethnic groups have problems – statistics differ based on different types of gambling. **2006 California Problem Gambling Prevalence Survey

14. Assessing – Types of Gambling • Slots, cards, other casino/card room betting • Horse and dog racing • Dog and chicken fighting • Sports betting – in person and online • Internet gambling • Lottery tickets • Office pools • Numbers running • Bingo • Stock market?

15. Assessing Problem Gambling • 20 Questions – Are You a Compulsive Gambler? • http://www.gamblersanonymous.org/ga/content/20-questions • South Oaks Gambling Screen (SOGS) http://www.ncrg.org/sites/default/files/uploads/docs/monographs/sogs.pdf • Co-occurring Disorders: • Alcohol/substance abuse • Anxiety • Depression • PTSD • Rule out bipolar/manic episode

16. Treatment Approaches • CBT – changing habits & behaviors that trigger or support gambling • Motivational Interviewing • Other stuff… • EMDR • Based on Jim Knipe’s “Level of Urge” protocols (J. Knipe., personal communication, March 23, 2012).

17. Using EMDR (FM) to Treat Addictions • “Addiction is initially a ‘solution’ to a problem (J. Knipe, personal communication, March 23, 2012). • Resource Installation: • Empowerment • Worthiness • Acceptance of ending relationship (with addiction) • Positive states

18. EMDR Protocol – Problem Gambling • Assess • Formulate target (whatever has most juice): • Most recent gambling episode • Biggest win • Biggest loss • Partner’s reactions • For target identify: • Snapshot/visual image • Sounds/sights of gambling (particularly casino) • Emotions and physical sensations • Level of Urge (LOU) – 0-10, similar to SUDS

19. EMDR Protocol – Problem Gambling • BLS on target using all of above • What have you got now? • Every few passes, check LOU • LOU may go up at times when remembering past wins or fun times • When significant change ask “tell me about that ___” (whatever LOU is) • BLS on that • Process down to 0

20. EMDR Protocol – Problem Gambling • Can do future template of next time temptation is presented or urge arises • For some clients, one session can entirely resolve addiction. • When co-occurring present, may need multiple sessions and other interventions.

21. Demonstration • Role-play of problem gambling client • Based on composite of clients – does not reflect anyone specific • Will stop periodically to offer explanation • Please hold questions until end

22. Demonstration - Client Client is adult female who works dispatch for CHP. She is married and has 2 adult children who are no longer at home. Her husband works opposite hours and they see each other infrequently.  Eight years ago, client began going to casinos with a friend as entertainment. She likes to have a couple of drinks there to loosen up. This was shortly after her youngest son left for college. At first, she had fun but over time gambling has become a problem. She estimates she lost about $12,000 in the past year, and many times has to borrow money from her sister in order to hide the loss from her husband and pay her bills. In a typical gambling episode, she will lose $400 (the maximum she can take on her debit card) before leaving. Sometimes she loses track of time and stays too long, not getting enough sleep before going back to work. Lately her husband is noticing how much she is gone and is questioning money issues. She tried to quit 2 months ago, but received a coupon in the mail from a casino for free $20 to gamble with. She tried to go and just use the $20, but ended up spending $200 of her own money as well.

23. Q&A Beverly Swann, MFT 925-705-7036 therapy@beverlyswann.com www.beverlyswann.com

24. References • Abramowitz, A. (2007). The psychological sequelae of police work stress: Exploring potential mediators and moderators. (Doctoral dissertation, University of Illinois at Urbana-Champaign). ProQuest Dissertations and Theses, Retrieved from http://search.proquest.com./docview/304856993?accountid=28180. (304856993). • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: APA. • National Safety Council. 2014. Injury facts: 2014 edition. National Safety Council. Retrieved from: http://www.nsc.org/news_resources/injury_and_death_statistics/Documents/2014-Injury-Facts-43.pdf • Volberg, R. Nysse-Carris, K. Gerstein, D. 2006. 2006 California problem gambling prevalence survey. NORC at the University of Chicago: Chicago, IL. Retrieved from: http://www.adp.ca.gov/opg/pdf/CA_Problem_Gambling_Prevalence_Survey-Final_report.pdf