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Wall H, Magnusson K, Hellner C, Andersson G, Jayaram-Lindström N, Rosendahl I. The evaluation of a brief ICBT program with therapist support for individuals with gambling problems in the context of a gambling helpline: a randomized pilot trial. Pilot Feasibility Stud 2023; 9:26. [PMID: 36805024 PMCID: PMC9936663 DOI: 10.1186/s40814-023-01257-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND AND AIMS Gambling helplines are a natural way of first contact for individuals with gambling problems. However, few studies have evaluated the feasibility and effectiveness of brief interventions in a gambling helpline. To reduce this knowledge gap, this study evaluated the feasibility of an online cognitive behavioral therapy (ICBT) program in the context of a gambling helpline as a first step towards a full-scale RCT. DESIGN This is a two-group parallel randomized controlled pilot trial where the participants were randomized to either a brief four-module ICBT program (n = 22) or a control group (n = 21). Participants were followed up weekly during the intervention, post intervention, and 6 weeks upon completion of intervention. PARTICIPANTS A total of 43 self-identified individuals with gambling problems (scoring 3 or more on the Problem Gambling Severity Index) were recruited via the Swedish national gambling helpline, 59% females, mean age 43.7 years. MEASUREMENTS Feasibility of the procedure and intervention (i.e., recruitment pace, attrition, program engagement, and satisfaction) were the primary outcomes; treatment effect (net gambling losses) was the secondary outcome. RESULTS Approximately 2 participants per week were randomized, and retention was low, with 47% lost to follow-up at the 6-week follow-up time-point. Most participants engaged in the online modules (86%) and rated their overall satisfaction with the program as high (7.5 out of 10). Both groups decreased their weekly gambling losses at both follow-up time-points, but the between-group comparisons were inconclusive. CONCLUSION It is not advisable to conduct a full-scale RCT based on the results from this pilot study. Future studies in a gambling helpline should consider interventions that are more suited to be incorporated in a gambling helpline and identify ways to increase participant engagement. TRIAL REGISTRATION The study was retrospectively registered on ClinicalTrials.gov (ID: NCT04609007 , 29/10/2020).
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Affiliation(s)
- Håkan Wall
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden. .,Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden.
| | - Kristoffer Magnusson
- grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden ,grid.425979.40000 0001 2326 2191Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364 Stockholm, Sweden
| | - Clara Hellner
- grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden ,grid.425979.40000 0001 2326 2191Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364 Stockholm, Sweden
| | - Gerhard Andersson
- grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden ,grid.425979.40000 0001 2326 2191Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364 Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nitya Jayaram-Lindström
- grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden ,grid.425979.40000 0001 2326 2191Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364 Stockholm, Sweden
| | - Ingvar Rosendahl
- grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, Sweden ,grid.425979.40000 0001 2326 2191Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364 Stockholm, Sweden
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Boumparis N, Haug S, Abend S, Billieux J, Riper H, Schaub MP. Internet-based interventions for behavioral addictions: A systematic review. J Behav Addict 2022; 11:620-642. [PMID: 36495471 PMCID: PMC9872535 DOI: 10.1556/2006.2022.00054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 05/01/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIMS Behavioral addictions are a public health problem that causes harm to both individuals and society. Internet-based interventions offer potential benefits over face-to-face therapy for the treatment of behavioral addictions, including their accessibility, perceived anonymity, and low costs. We systematically reviewed the characteristics and effectiveness of these interventions. METHODS A systematic literature search was conducted in: PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. A standardized methodological quality assessment was performed on all identified studies via the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. RESULTS Twenty-nine studies were assessed in this systematic review. Between them, considerable heterogeneity was noted in various study characteristics, including screening tools, inclusion criteria, and outcome measures. Attrition rates also ranged widely (9-89%), as did study quality, with three of the 29 studies rated strong, 12 moderate, and 14 weak methodologically. Twenty-two studies focused on gambling disorder, most revealing significant within-group effects for the assessed intervention on gambling-related symptoms and four of these studies identified significant between-group effects. Behavioral addictions studied in the remaining studies included gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder, revealing generally-promising, albeit limited results. CONCLUSIONS Internet-based interventions seem promising at reducing gambling problems, but too few studies have been published, to date, for conclusions to be drawn for other behavioral addictions. Internet-based interventions targeting other behavioral addictions - like gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder - remain under-examined, warranting considerable additional research to assess their effectiveness.
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Affiliation(s)
- Nikolaos Boumparis
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland,Corresponding author. E-mail:
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
| | - Stefanie Abend
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland,Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction at the University of Zurich, Switzerland
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Rodda SN, Bagot KL, Merkouris SS, Youssef G, Lubman DI, Thomas AC, Dowling NA. Gambling Habit Hacker: Protocol for a micro-randomised trial of planning interventions delivered via a Just-In-Time Adaptive Intervention for adult gamblers (Preprint). JMIR Res Protoc 2022; 11:e38919. [PMID: 35881441 PMCID: PMC9364163 DOI: 10.2196/38919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background People with gambling problems frequently report repeated unsuccessful attempts to change their behavior. Although many behavior change techniques are available to individuals to reduce gambling harm, they can be challenging to implement or maintain. The provision of implementation support tailored for immediate, real-time, individualized circumstances may improve attempts at behavior change. Objective We aimed to develop and evaluate a Just-In-Time Adaptive Intervention (JITAI) for individuals who require support to adhere to their gambling limits. JITAI development is based on the principles of the Health Action Process Approach with delivery, in alignment with the principles of self-determination theory. The primary objective was to determine the effect of action- and coping planning compared with no intervention on the goal of subsequently adhering to gambling expenditure limits. Methods Gambling Habit Hacker is delivered as a JITAI providing in-the-moment support for adhering to gambling expenditure limits (primary proximal outcome). Delivered via a smartphone app, this JITAI delivers tailored behavior change techniques related to goal setting, action planning, coping planning, and self-monitoring. The Gambling Habit Hacker app will be evaluated using a 28-day microrandomized trial. Up to 200 individuals seeking support for their own gambling from Australia and New Zealand will set a gambling expenditure limit (ie, goal). They will then be asked to complete 3 time-based ecological momentary assessments (EMAs) per day over a 28-day period. EMAs will assess real-time adherence to gambling limits, strength of intention to adhere to goals, goal self-efficacy, urge self-efficacy, and being in high-risk situations. On the basis of the responses to each EMA, participants will be randomized to the control (a set of 25 self-enactable strategies containing names only and no implementation information) or intervention (self-enactable strategy implementation information with facilitated action- and coping planning) conditions. This microrandomized trial will be supplemented with a 6-month within-group follow-up that explores the long-term impact of the app on gambling expenditure (primary distal outcome) and a range of secondary outcomes, as well as an evaluation of the acceptability of the JITAI via postintervention surveys, app use and engagement indices, and semistructured interviews. This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304). Results The intervention has been subject to expert user testing, with high acceptability scores. The results will inform a more nuanced version of the Gambling Habit Hacker app for wider use. Conclusions Gambling Habit Hacker is part of a suite of interventions for addictive behaviors that deliver implementation support grounded in lived experience. This study may inform the usefulness of delivering implementation intentions in real time and in real-world settings. It potentially offers people with gambling problems new support to set their gambling intentions and adhere to their limits. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12622000497707; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383568 International Registered Report Identifier (IRRID) DERR1-10.2196/38919
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Affiliation(s)
- Simone N Rodda
- Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Psychology, Deakin University, Geelong, Australia
- School of Population Health, University of Auckland, Grafton, New Zealand
| | | | | | - George Youssef
- School of Psychology, Deakin University, Geelong, Australia
| | - Dan I Lubman
- Turning Point and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Anna C Thomas
- School of Psychology, Deakin University, Geelong, Australia
| | - Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
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Wall H, Magnusson K, Berman AH, Bewick BM, Hellner C, Jayaram-Lindström N, Rosendahl I. Evaluation of a Brief Online Self-help Program for Concerned Gamblers. J Gambl Stud 2021; 37:1277-1290. [PMID: 33559778 PMCID: PMC8572834 DOI: 10.1007/s10899-021-10005-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 10/31/2022]
Abstract
The purpose of this study was to evaluate the feasibility and module content of a brief online self-help program for concerned gamblers, i.e., gamblers who perceived a need to change their gambling habits, in the context of a gambling helpline. The program consisted of four modules based on Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT), covering motivation to change, logging gambling behaviors, planning and implementing gambling-free activities, and managing risk situations. Gambling expenditures were also logged in the program, and their development over time were analyzed as longitudinal data using marginalized two-part models. Out of 4655 gamblers recruited via the helpline's webpage, 92% completed content in at least one module, and 23% were active in all four modules. Attrition was in general high, with only 10% retention in the gambling log for longer than 14 days. Gambling expenditures decreased for those who logged them for a shorter time period, whereas it increased for those who logged expenditures for a longer time period. This study shows that it is relatively easy to recruit participants to an online program for concerned gamblers in the context of a gambling helpline. However, since few users logged in to the program more than once, we suggest future online programs to have open modules with all content accessible at once.
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Affiliation(s)
- Håkan Wall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden.
| | - Kristoffer Magnusson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Bridgette M Bewick
- School of Medicine, Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 11364, Stockholm, Sweden
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The therapist experience of internet delivered CBT for problem gambling: Service integration considerations. Internet Interv 2019; 18:100264. [PMID: 31890617 PMCID: PMC6926291 DOI: 10.1016/j.invent.2019.100264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Countries with legalized gambling offer a network of government funded face-to-face therapy, but usage of this expertise is on the decline. One way to address this issue is to recruit therapists from existing services whereby they provide guidance for the delivery of internet delivered CBT. OBJECTIVE To explore the experiences and perceptions of therapists supporting guided online cognitive-behavioural therapy. METHODS Interviewees were a sub-sample of therapists from a randomised trial that investigated the relative efficacy of online guided self-directed versus pure self-directed interventions in Australia. RESULTS In-person, semi-structured interviews with seven service providers were completed, and thematic content analysis identified five themes which related to: participant suitability and screening (e.g., motivation, computer literacy and access); program content and modality acceptability (e.g., amount of content, look and feel); participant information and management (e.g., program engagement and progression); email communication (e.g., use of templates, appointments, rapport building), and; ongoing service integration (e.g., infrastructure, confidence in product). Overall experiences and perceptions of therapists were positive, notwithstanding barriers concerning assessment of participant suitability, participant management systems and low participant engagement. CONCLUSIONS Key themes emphasized the benefits of Internet-based interventions for problem gambling, and suggested several areas for improvement. Results should inform the development of future treatments to enable flexible tailoring of interventions to individuals.
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Anonymous Women? A Scoping Review of the Experiences of Women in Gamblers Anonymous (GA). Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-019-00101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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