Outpatient psychotherapeutic treatment of Gambling Disorder — Lessons learned from Bavaria

Bianca Pitzschel^1,2*Rebekka Redel³Martin Tauscher³Gabriele Koller²Elena Gomes de Matos^1,4Eva Hoch^1,2,4Larissa Schwarzkopf^1,5,6

• ¹Institut für Therapieforschung (IFT), Mental Health & Addiction Research, München, Germany
• ²Department of Psychiatry and Psychotherapy, University Hospital of Munich, Munich, Germany
• ³Bavarian Association of Statutory Health Insurance Physicians (BASHIP), Munich, Germany
• ⁴Charlotte Fresenius University, Munich, Germany
• ⁵Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, LMU Munich, Munich, Germany
• ⁶Pettenkofer School of Public Health, Munich, Germany

Abstract Background Psychotherapeutic interventions are an effective treatment for gambling disorder (GD), yet little is known about their uptake in routine care settings. Using data from the Bavarian Association of Statutory Health Insurance Physicians, this study estimates the proportion of patients with disordered gambling behavior receiving psychotherapy, describes their diagnostic characteristics, and outlines treatment patterns. Methods Adults insured by SHI in Bavaria with a confirmed GD diagnosis (ICD-10: F63.0 G) according to the M2Q criterion (i.e., diagnosis in ≥ 2 out of 4 quarters) who received outpatient care between January 2021 and March 2022 were included. Patients were divided into three groups, comprised of patients with (1) at least one billable encounter with a psychotherapist (PT), (2) at least one billable encounter with a neurologist or psychiatrist but none with a PT, and (3) no billable encounters with either. Groups were compared by age, sex, diagnosed comorbid mental disorders, and service utilization. Key elements of psychotherapy were also analyzed. Results Of 3,154 patients with disordered gambling behavior, 589 (18.6%) received psychotherapy. This group was younger (M = 39.7 years, SD = 12.8) than group 2 (M = 44.9 years, SD = 13.8) and group 3 (M = 43.8 years, SD = 14.1) and included a higher proportion of women than group 3 (18.5% vs. 12.4%). Comorbid depression, anxiety, and adjustment disorders were more frequent among patients in psychotherapy. Compared to group 3, they received services from internists, organ-specific specialists, and technical specialists more often. Compared to group 2, they more often used psychiatrists' services. Psychotherapy was most commonly individual cognitive behavioral therapy (CBT) and lasted 352 days on average, with about 18 sessions per patient. Conclusion Patients with disordered gambling behavior (according to ICD-10 criteria for F63.0) who receive psychotherapy often have additional mental disorders and higher overall care needs. This highlights the importance of integrated treatment approaches. The frequent use of CBT aligns with evidence-based practice and suggests potentially favorable therapeutic outcomes.