Calm the Chase: A Therapist Guide to a CBT-Anchored, Shame-Aware Protocol for Harmful Gambling

Behavioural Addiction · CBT · Practice-informed

An eight-session protocol for adults whose gambling has become harmful, with an optional booster. It keeps CBT as its core, in line with a 52-trial network meta-analysis and NICE guidance, and adds urge skills, a compassion-focused session before a values session and a written slip plan. Each approach carries a colour-coded evidence rating, and the guide states plainly what the five source studies show and what is extrapolated.

Underlying mechanism: CBT-Anchored Protocol for Gambling Disorder with Mindfulness-Informed Urge Skills, Compassion-Focused Work and ACT Values Work

What it helps with

  • Giving clinicians a structure that keeps CBT at the centre and adds warmth, urge skills and values work without overclaiming.
  • Teaching clients to ride an urge with the body first, so the urge can pass without a fight and without obeying it.
  • Replacing self-attack after a bet with a kind and honest coach, because shame often fuels the next bet.
  • Planning money safeguards, high-risk times and a slip plan before they are needed.
  • Showing plainly which parts are well supported and which come from practice, so clients and supervisors can judge them.

How clinicians use it

  • Screen for risk, debt and coercion at Session 1, agree the goal and set up the money safeguards the client chooses.
  • Teach nose-low-slow breathing and urge surfing at Session 3. Resonance breathing is optional and later. Do not use breath holds.
  • Keep the compassion session (6) before the values session (7) by design. The order is clinical judgement and has not been tested.
  • Use Session 8 to write the slip plan and review baseline and current scores, then book the booster.

Clinical Implementation Guide

  1. Screen for risk, debt and coercion and agree the goal at Session 1.
  2. Run the sessions in order and keep the compassion session before the values session.
  3. Track days gambled, money lost and strongest urge each week, and review them with the client.

What the worksheet looks like

Therapist Guide: Calm the Chase — worked example
SessionFocusWorksheet(s)
1Engagement, assessment, map and money safeguardsW1
2The chain and the logW2
3Settle the urge: breathing and urge surfingW3
4Thinking traps and chasingW4
5Cues, money and peopleW1, W2, W4
6A kind coach after a bet (CFT), before values on purposeW5
7What my money and time are for (ACT)W6
8Slip plan and consolidationW6

Clinical cautions

Not a diagnostic or risk-assessment tool. Ask directly about suicidal thinking at every session and follow local risk procedures, because suicidal thinking is a recognised risk in people with gambling problems. Deal with debt emergencies, coercion and financial abuse first, and refer to debt advice or legal services. Do not involve a concerned other if there is any sign of coercive control. Screen for alcohol and drug use, depression, ADHD, bipolar disorder and trauma. Avoid shaming language. The National Gambling Helpline (GamCare) is free and open 24 hours a day on 0808 8020 133. Breathwork is optional: stop for dizziness, panic or discomfort, never use breath holds or fast deep breathing, and take extra care with asthma, panic disorder and breathing-linked trauma. Compassion work can briefly raise distress for people who fear kindness, so go slowly. Do not agree a controlled-gambling goal lightly. Check licensing before using any named measure.

References

  1. Megnin-Viggars, O., Mavranezouli, I., Downing, B. C., Welton, N. J., Fricke, A., Francis, J., Reeves, T., Pilling, S., Bowden-Jones, H., Sahakian, B. J., Rahman, M. S., Dawson, R., Geel, A., & Gaskell, M. (2026). Psychological interventions for harmful gambling: Systematic review and network meta-analysis. Journal of Behavioral Addictions, 15(3), 971-980. https://doi.org/10.1556/2006.2025.00445
  2. Tannous, A., Demetrovics, Z., Chhabra, B., Logemann, A., Czakó, A., Griffiths, M. D., & Szabo, A. (2026). Mindfulness-based interventions for gambling disorder: A systematic review. Journal of Behavioral Addictions, 15(1), 115-134. https://doi.org/10.1556/2006.2025.00100
  3. Siste, K., Sen, L. T., Murtani, B. J., Hanafi, E., Kusuma, K. S., Aryani, A., Tan, C., Nainggolan, F. D., Aida, N., & Setiawan, Y. (2026). A randomized double-blind sham-controlled preliminary study of a 5-week protocol of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapy (CBT) for gambling disorder in Indonesia. Addictive Behaviors Reports, 24, 100722. https://doi.org/10.1016/j.abrep.2026.100722
  4. Rabinovitz, S., & Nagar, M. (2026). When rejection backfires: Social exclusion and economic decision-making in gamblers. Journal of Behavioral Addictions, 15(1), 515-523. https://doi.org/10.1556/2006.2025.00095
  5. Riley, B. J., Battersby, M. W., Baigent, M. F., & Smith, D. (2026). Helping Others Promote Engagement in Gambling Support (HOPE-Gam): A feasibility randomised controlled trial. Journal of Gambling Studies, 42(1), 109-130. https://doi.org/10.1007/s10899-025-10468-x
  6. National Institute for Health and Care Excellence. (2025). Gambling-related harms: Identification, assessment and management (NICE guideline NG248). Published 28 January 2025. https://www.nice.org.uk/guidance/ng248
  7. Banzulu Bomba, D., Koffi Nkazi, M., Nguya Makonda, K., Badimanya Albert, C., Lusala Lutsasa, M., & Benangindu Kikumpa, J. (2026). Network structure of gambling-related cognitions and risk behaviors among sports bettors in the Democratic Republic of the Congo: A cross-sectional EBICglasso network analysis. Addictive Behaviors Reports, 24, 100746. https://doi.org/10.1016/j.abrep.2026.100746
  8. Syvertsen, A., Ebrahimi, O. V., Sagoe, D., Kristensen, J. H., & Pallesen, S. (2026). Undirected and directed networks of problem gambling: Follow the money trail. European Psychiatry, 69(1), e100. https://doi.org/10.1192/j.eurpsy.2026.12261
  9. Guillén-Guzmán, E., Del Pino-Gutierrez, A., Granero, R., Santalucia, T., Codina, E., Fernandez-Aranda, F., Valenciano-Mendoza, E., Mora Maltas, B., Tremblay, J., Romero, A., Borjabad-Fraga, I., Sánchez-Salido, L.-T., De Blas-Soto, L., & Jiménez-Murcia, S. (2026). Psychological characteristics and coping strategies of affected others of patients with gambling disorder. Frontiers in Psychology, 17, 1837244. https://doi.org/10.3389/fpsyg.2026.1837244
  10. Diotaiuti, P., Palombo, M., & Mancone, S. (2026). PATH-G: A proposed integrative motivational-cognitive-behavioral protocol for gambling disorder. Frontiers in Psychiatry, 17, 1871785. https://doi.org/10.3389/fpsyt.2026.1871785
  11. Rolvien, L., Buddeberg, L., Gehlenborg, J., Borsutzky, S., & Moritz, S. (2024). A self-guided internet-based intervention for the reduction of gambling symptoms: A randomized clinical trial. JAMA Network Open, 7(6), e2417282. https://doi.org/10.1001/jamanetworkopen.2024.17282
  12. Hitch, C., Leightley, D., Murphy, D., Trompeter, N., & Dymond, S. (2023). Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: A narrative review. European Journal of Psychotraumatology, 14(1), 2178203. https://doi.org/10.1080/20008066.2023.2178203
  13. Sumińska, S., Rynkiewicz, A., & Szulczewski, M. (2026). Resonance frequency versus fixed 0.1 Hz breathing in HRV biofeedback: A four-week randomized comparison. Scientific Reports, 16(1). https://doi.org/10.1038/s41598-026-53333-6
  14. Minjoz, S., Jeanne, R., Pellissier, S., & Hot, P. (2026). Psychophysiological effects of heart rate variability biofeedback versus sham biofeedback: A randomized controlled trial. Biological Psychology, 206, 109254. https://doi.org/10.1016/j.biopsycho.2026.109254
  15. Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 756. https://doi.org/10.3389/fpsyg.2014.00756
  16. Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: A systematic review of its effectiveness and acceptability in clinical populations. Expert Review of Neurotherapeutics, 20(4), 385-400. https://doi.org/10.1080/14737175.2020.1746184
  17. Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41. https://doi.org/10.1111/bjc.12043
  18. A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36. https://doi.org/10.1159/000365764

Copyright and use in research

© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.0, approved 20 October 2026, revised as the evidence develops.

Suggested citation (APA 7th edition): Pomfret, R. (2026). Calm the Chase: A CBT-anchored, shame-aware protocol for adults with harmful gambling (Version 1.0) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/

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