***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Few studies have evaluated efficacy of psychotherapies for  pathological gambling . Pathological gamblers ( N = 231 ) were r and omly assigned to ( a ) referral to Gamblers Anonymous ( GA ) , ( b ) GA referral plus a cognitive- behavioral ( CB ) workbook , or ( c ) GA referral plus 8 sessions of individual CB therapy .  Gambling and related problems were assessed at baseline , 1 month later , posttreatment , and at 6- and 12-month follow-ups . CB treatment reduced gambling relative to GA referral alone during the treatment period and result ed in clinical ly significant improvements , with some effects maintained throughout follow-up ( ps = .05 ) . Individual CB therapy  improved some outcomes compared with the CB workbook . Attendance at GA and number of CB therapy sessions or workbook exercises completed were associated with gambling abstinence . These data suggest the efficacy of this CB therapy approach OBJECTIVE To examine the influence of co-occurring conditions on  gambling treatment outcomes . DESIGN , SETTING AND PARTICIPANTS Prospect i ve cohort study of problem gamblers . Participants were recruited from consecutive referrals to a gambling therapy service in 2008 . Inclusion criteria were : ( i ) assessed as a problem gambler based on a screening interview including DSM-IV criteria for pathological gambling , and ( ii ) suitable for admission to a treatment program . Cognitive-behavioural therapy was based on grade d exposure-to-gambling urge . One-to-one treatment was conducted with 1-hour sessions weekly for up to 12 weeks . MAIN OUTCOME MEASURES Problem gambling screening and co-occurring conditions including depression , anxiety and alcohol use . RESULTS Of 127 problem gamblers , 69 were males ( 54 % ) , mean age was 43.09 years , and 65 ( 51 % ) reported a duration of problem gambling greater than 5 years . Median time for participants ' enrolment in the study was 8.9 months . Results from mixed effects logistic regression analysis indicated that individuals with higher depression levels had a greater likelihood ( 13 % increase in odds [ 95 % CI , 1%-25 % ] ) of problem gambling during treatment and at follow-up . CONCLUSION Addressing depression may be associated with improved treatment outcomes in problem gambling ; conversely , treatment of problem gambling improves affective instability . We therefore recommend a dual approach that treats both depression and problem gambling Sixty-eight individuals were r and omised to either six sessions of imaginal desensitisation plus motivational interviewing ( IDMI ) or Gamblers Anonymous . Individuals assigned to IDMI had significantly greater reductions in Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling total scores , gambling urges and gambling behaviour .  People who failed to respond to Gamblers Anonymous reported significantly greater reduction in pathological gambling symptoms following later assignment to IDMI . Abstinence was achieved by 63.6 % during the acute IDMI treatment period Two brief treatments for  problem gambling  were compared with a waiting-list control in a r and omized trial . Eighty-four percent of participants ( N = 102 ) reported a significant reduction in gambling over a 12-month follow-up period . Participants who received a motivational enhancement telephone intervention and a self-help workbook in the mail , but not those who received the workbook only , had better outcomes than participants in a 1-month waiting-list control . Participants who received the motivational interview and workbook showed better outcomes than those receiving the workbook only at 3- and 6-month follow-ups . At the 12-month follow-up , the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems . Overall , these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling BACKGROUND Pathological gambling ( PG ) , a disabling disorder experienced by approximately 1 % of adults , has few empirically vali date d treatments . A recent study demonstrated that 6 sessions of imaginal desensitization plus motivational interviewing ( IDMI ) was effective in achieving abstinence for a majority of individuals with PG . This study sought to examine whether those benefits were maintained 6 months post-treatment . METHODS Sixty-eight individuals who met DSM-IV criteria for PG were r and omly assigned to 6 sessions of IDMI or Gamblers Anonymous ( GA ) referral over an 8-week period . Participants who failed to respond to GA were offered IDMI after the 8-week acute treatment period . All individuals who responded to IDMI were contacted after 6 months and assessed with measures of gambling severity and psychosocial functioning . RESULTS Forty-four participants completed 6 sessions of IDMI ( 25 initially assigned to IDMI and 19 to GA ) . Thirty-five of the 44 ( 79.5 % ) responded during acute treatment , and all 35 were available for a 6-month evaluation . All gambling severity scales maintained statistically significant gains from baseline , although some measures showed significant worsening compared with post-IDMI treatment . CONCLUSIONS Six sessions of IDMI result ed in statistically significant reductions in PG urges and behavior , which were largely maintained for 6 months AIMS College students experience high rates of problem and pathological gambling , yet little research has investigated methods for reducing gambling in this population . This study sought to examine the efficacy of brief intervention strategies . DESIGN R and omized trial . SETTING College campuses . PARTICIPANTS A total of 117 college student problem and pathological gamblers . INTERVENTIONS Students were assigned r and omly to : an assessment -only control , 10 minutes of brief advice , one session of motivational enhancement therapy ( MET ) or one session of MET , plus three sessions of cognitive-behavioral therapy ( CBT ) . The three interventions were design ed to reduce gambling . MEASUREMENTS Gambling was assessed at baseline , week 6 and month 9 using the Addiction Severity Index-gambling ( ASI-G ) module , which also assesses days and dollars wagered . FINDINGS Compared to the assessment -only condition , those receiving any intervention had significant decreases in ASI-G scores and days and dollars wagered over time . The MET condition decreased significantly ASI-G scores and dollars wagered over time , and increased the odds of a clinical ly significant reduction in gambling at the 9-month follow-up relative to the assessment -only condition , even after controlling for baseline indices that could impact outcomes . The Brief Advice and MET+CBT conditions had benefits on some , but not all , indices of gambling . None of the interventions differed significantly from one another . Conclusions These results suggest the efficacy of brief interventions for reducing gambling problems in college students A substantial proportion of pathological gamblers engage in gambling-related illegal behavior . We examined differences in baseline characteristics and treatment outcomes in two groups : pathological gamblers who did and did not commit gambling-related illegal acts in the year before treatment . Participants were 231 pathological gamblers enrolled in a r and omized study of treatment that included cognitive behavior therapy and referral to Gamblers Anonymous ( GA ) .  Participants reporting recent illegal behavior ( n = 63 ) endorsed more severe lifetime and recent ( past-year ) gambling disorder symptoms and higher gambling-related debt than did gamblers who denied illegal behavior ( n = 168 ) . Those who reported illegal behavior also maintained a significantly higher severity of gambling disorder throughout treatment , although both groups experienced similar improvements in gambling symptoms over time . While pathological gamblers with or without gambling-related illegal behavior appeared to improve at a similar rate regardless of the treatment provided , more intensive treatment may be warranted for individuals with gambling-related illegal behavior , as they demonstrated greater gambling severity throughout treatment and follow-up Effective therapies for pathological gambling exist , but their use is limited to about 10 % of the target population . In an attempt to lower the barriers for help , Internet-based cognitive behavioural therapy ( ICBT ) has been shown to be effective when delivered to a non-depressed sample with pathological gambling . This study sought to extend this finding to a larger , more representative population , and also test a model to predict responder status . Following advertisement , a total of 284 participants started an 8-week  ICBT programme  with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min . The average time spent on each participant , including telephone conversations , e-mail , and administration , was 4 h. In addition to a mixed effects model to evaluate the effectiveness of the treatment , two logistic regression analyses were performed with the following eight pre-defined response predictor variables : work-life satisfaction , primary gambling activity , debts due to gambling , social support , personal yearly salary , alcohol consumption , stage of change , and dissociative gambling .  ICBT result ed in statistically significant reductions in the scores of pathological gambling , anxiety , and depression as well as an increase in quality of life compared to pre-treatment levels . Follow-ups carried out in the treatment group at 6 , 18 , and 36 months indicated that treatment effects were sustained . Using the eight predictor variable model rendered an acceptable predictive ability to identify responders both at post-test ( AUC = .72 , p < .01 ) and at 36-month follow-up ( AUC = .70 , p < .01 ) . We conclude that ICBT for pathological gamblers , even if depressed , can be effective and that outcome can partly be predicted by pre-treatment characteristics This exploratory study investigated the effect of interventions design ed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic . Forty subjects ( 29 males , 11 females , mean age = 37.6 ) meeting DSM-IV criteria ( APA , 1994 ) for pathological gambling were r and omly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions design ed to improve treatment compliance . Compliance was indicated by the completion of all treatment sessions . Outcome measures were DSM-IV criteria assessed by structured clinical interview , South Oaks Gambling Screen scores , and percentage of income gambled . Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome . Compliance-improving interventions significantly reduced dropout rates , result ing in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone . At 9-month follow-up , there was no difference in outcome between treatments , although both produced clinical ly significant change . Comorbid problem drinking , drug use , and problem gambling duration predicted poor compliance . Poor outcome was predicted by comorbid problem drinking . The clinical implication s of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance , outcome , and comorbidity issues This study examined the efficacy of two group treatments for pathological gambling , a node-link mapping-enhanced cognitive-behavioral group therapy ( CBGT-mapping ) and twelve-step facilitated ( TSF ) group treatment .  Forty-nine participants meeting criteria for pathological gambling were recruited from local newspaper advertisements . These participants were r and omly assigned to one of three conditions : TSF ( n = 11 ) , CBGT-mapping ( n = 18 ) , and Wait-List control ( n = 9 ) ; 11 refused treatment prior to r and omization . Outcome measures included number of DSM-IV criteria met , perception of control/self-efficacy , desire to gamble , and frequency of gambling episodes . Analyses revealed a significant treatment group × time interaction ( η²partial = .39 ) . Specifically , the group treatments result ed in significant improvements in the dependent measures , while the Wait-List group remained relatively stable . Overall , CBGT-mapping and TSF had no significant differences on any outcome measure at follow-up assessment s. Analysis of post-treatment and 6-month follow-up reveal a significant improvement in gambling outcomes ( i.e. , fewer DSM-IV criteria met , greater self-efficacy , and fewer gambling episodes ( η²partial = .35 ) , with treatment gains maintained at 6 months . These results are consistent with previous research for group treatment for pathological gambling and provide support for the utility of TSF and a mapping-based CBT therapy as viable intervention for pathological gambling The transtheoretical model has been applied to many addictive disorders . In this study , psychometrics properties of the University of Rhode Isl and Change Assessment ( URICA ) scale were evaluated in 234 pathological gamblers initiating treatment . Four components were identified -- reflective of precontemplation , contemplation , action , and maintenance stages -- with internal consistency from .74 to .88 . Cluster analyses identified 4 patterns of responding , ranging from ambivalent to active change . The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later . A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling . This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers , and it suggests that stage of change may have an impact on outcomes INTRODUCTION Cognitive-behavioural therapy ( CBT ) seems to offer effective treatment for pathological gambling ( PG ) . However , it has not yet been established which techniques yield the best results , or whether exposure and response prevention ( ERP ) techniques are of additional use . OBJECTIVES To evaluate clinical and socio-demographic characteristics of a PG sample at baseline , comparing cognitive-behavioural group intervention , with and without exposure , with response prevention ( CBT + ERP vs. CBT ) , to compare the results of ther 
    Output:
    
Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points .
Likely predictors of successful treatment outcomes also included older age , lower gambling symptom severity , lower levels of gambling behaviours and alcohol use , and higher treatment session attendance .
Mixed results were identified for treatment goal , while education , income , preferred gambling activity , problem gambling duration , anxiety , any psychiatric comorbidity , psychological distress , substance use , prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point .