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Mide M, Mattiasson J, Norlin D, Sehlin H, Rasmusson J, Ljung S, Lindskog A, Petersson J, Saavedra F, Gordh AS. Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial. Front Psychiatry 2023; 14:1243826. [PMID: 38146277 PMCID: PMC10749366 DOI: 10.3389/fpsyt.2023.1243826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023] Open
Abstract
Objectives Cognitive behavioral therapy (CBT) is the most promising treatment for gambling disorder (GD) but only 21% of those with problematic gambling seek treatment. CBT over the Internet might be one way to reach a larger population. The aim of this study was to assess the effectiveness of Internet-delivered CBT with therapist guidance compared to an active control treatment. Methods Using a single-blinded design, 71 treatment-seeking gamblers (18-75 years) diagnosed with GD were randomized to 8 weeks of Internet-delivered CBT guided by telephone support, or 8 weeks of Internet-delivered motivational enhancement paired with motivational interviewing via telephone (IMI). The primary outcome was gambling symptoms measured at a first face-to-face assessment, baseline (treatment start), every 2 weeks, post-treatment, and 6-month follow-up. Gambling expenditures, time spent gambling, depression, anxiety, cognitive distortions, and quality of life were assessed as secondary outcomes. Analysis was performed on the full analysis sample (n = 60), with intention-to-treat sensitivity analyses (n = 69). Results In the CBT group, 80% stayed in treatment until the final week, compared to 67% in IMI. Post-treatment and at 6-month follow-up, no differences were found between CBT and IMI for any outcome measure. An exploratory analysis of the total sample (n = 60) showed a significant effect of time during treatment on gambling symptoms (d, [95% CI] 0.52, [-1.15, 2.02]) and all secondary outcomes except the gambling diary (depression (0.89, [-1.07-2.65]); anxiety (0.69, [-1.20-2.38])); cognitive distortions (0.84, [-0.73-2.29]); quality of life (0.60, [-0.61-1.70])). Post-treatment, there were no clinical gambling symptoms in either group. Some deterioration was seen between post-treatment and 6-month follow-up on gambling symptoms (0.42, [-1.74-2.43]), depression (0.59, [-0.82-1.86]), and anxiety (0.30, [-0.99-1.48]). Additionally, it was observed that the largest reduction in gambling symptoms was between the first assessment and baseline. Conclusion Both treatments offered in this study were effective at reducing gambling symptoms. It is also possible that the process of change started before treatment, which gives promise to low-intensity interventions for GD. Additional research is needed as this approach could be both cost-effective and has the potential to reach more patients in need of treatment than is currently possible. Clinical trial registration https://www.isrctn.com/, identifier ISRCTN38692394.
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Affiliation(s)
- Mikael Mide
- Department of Addiction Medicine, Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jessica Mattiasson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Norlin
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Sehlin
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Josefine Rasmusson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofia Ljung
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amanda Lindskog
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonna Petersson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fanny Saavedra
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Söderpalm Gordh
- Department of Addiction Medicine, Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
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Dowling NA, Rodda SN, Merkouris SS. Applying the Just-In-Time Adaptive Intervention Framework to the Development of Gambling Interventions. J Gambl Stud 2023:10.1007/s10899-023-10250-x. [PMID: 37659031 DOI: 10.1007/s10899-023-10250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Just-In-Time Adaptive Interventions (JITAIs) are emerging "push" mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed GamblingLess: In-The-Moment and Gambling Habit Hacker, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia.
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia.
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
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3
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Dowling NA, Merkouris SS, Youssef GJ, Lubman DI, Bagot KL, Hawker CO, Portogallo HJ, Thomas AC, Rodda SN. GAMBLINGLESS IN-THE-MOMENT: Protocol for a micro-randomised trial of a gambling Just-In-Time Adaptive Intervention (Preprint). JMIR Res Protoc 2022; 11:e38958. [PMID: 35998018 PMCID: PMC9449828 DOI: 10.2196/38958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID) PRR1-10.2196/38958
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | | | - Dan I Lubman
- Turning Point and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Chloe O Hawker
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Anna C Thomas
- School of Psychology, Deakin University, Geelong, Australia
| | - Simone N Rodda
- School of Psychology, Deakin University, Geelong, Australia
- Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
- School of Population Health, University of Auckland, Grafton, New Zealand
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Bowden-Jones H, Hook RW, Grant JE, Ioannidis K, Corazza O, Fineberg NA, Singer BF, Roberts A, Bethlehem R, Dymond S, Romero-Garcia R, Robbins TW, Cortese S, Thomas SA, Sahakian BJ, Dowling NA, Chamberlain SR. Gambling disorder in the UK: key research priorities and the urgent need for independent research funding. Lancet Psychiatry 2022; 9:321-329. [PMID: 35180386 PMCID: PMC7612512 DOI: 10.1016/s2215-0366(21)00356-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/31/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.
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Affiliation(s)
- Henrietta Bowden-Jones
- National Problem Gambling Clinic & National Centre for Gaming Disorders, London, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK; Faculty of Brain Sciences, University of Sussex, Brighton, UK
| | - Roxanne W Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, IL, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ornella Corazza
- Department of Clinical, Pharmacological and Biological Sciences, University of Hertfordshire, Hatfield, UK
| | - Naomi A Fineberg
- Department of Psychiatry, University of Cambridge, Cambridge, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertforshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Bryan F Singer
- School of Psychology, University of Sussex, Brighton, UK; Sussex Addiction Research and Intervention Centre, University of Sussex, Brighton, UK; Sussex Neuroscience, University of Sussex, Brighton, UK
| | - Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Lincoln, UK
| | | | - Simon Dymond
- Department of Psychology, Swansea University, Swansea, UK; Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Rafa Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Departamento de Fisiología Médica y Biofísica, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Seville, Spain
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shane A Thomas
- School of Health, Federation University, Ballarat, VIC Australia
| | | | - Nicki A Dowling
- School of Psychology, Deakin University, Geelong, VIC, Australia; Melbourne Graduate School of Education, University of Melbourne, VIC, Australia
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK.
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Humphrey G, Chu J, Ruwhui-Collins R, Erick S, Dowling N, Merkouris S, Newcombe D, Rodda S, Ho E, Nosa V, Parag V, Bullen C. Adapting an evidence-based e-learning CBT program into a mobile app for people experiencing gambling-related problems: A Formative Study. JMIR Form Res 2022; 6:e32940. [PMID: 35108213 PMCID: PMC8994147 DOI: 10.2196/32940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 01/19/2023] Open
Abstract
Background Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. Objective This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. Methods Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. Results Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. Conclusions Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness.
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Affiliation(s)
- Gayl Humphrey
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, NZ
| | - Joanna Chu
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, NZ
| | | | | | | | | | - David Newcombe
- Social and Community Health, University of Auckland, Auckland, NZ
| | - Simone Rodda
- Social and Community Health, University of Auckland, Auckland, NZ
| | - Elsie Ho
- Social and Community Health, University of Auckland, Auckland, NZ
| | - Vili Nosa
- Pacific Health, University of Auckland, Auckland, NZ
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, NZ
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, NZ
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Diaz-Sanahuja L, Campos D, Mira A, Castilla D, García-Palacios A, Bretón-López JM. Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial. Internet Interv 2021; 26:100466. [PMID: 34646753 PMCID: PMC8501496 DOI: 10.1016/j.invent.2021.100466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to-treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. TRIAL REGISTRATION Clinicaltrials.gov as NCT04074681. Registered 22 July 2019.
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Key Words
- A, Action
- C, Contemplation
- CBT
- CBT, Cognitive Behavioral Therapy
- CIDI, Composite International Diagnostic Interview
- CONSORT-EHEALTH, Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth
- DERS, Difficulties in Emotion Regulation Scale
- DGOJ, Directorate General for the Regulation of Gambling
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised
- DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
- EDBs, Emotion Driven Behaviours
- EMA, Ecological Momentary Assessment
- EMI, Ecological Momentary Intervention
- Efficacy
- Emotion regulation
- G-SAS, The Gambling Symptom Assessment Scale
- GD, Gambling Disorder
- GE, Gambling Expectancies
- GI, Gambling history interview and current gambling situation and related variables assessment
- GRCS-S, Gambling-Related Cognitions Scale
- GSEQ, Gambling Self-Efficacy Questionnaire
- Gambling
- HADS, Hospital Anxiety Depression Scale
- IB, Interpretative Bias
- IC, Illusion of Control
- ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision
- ISG, Perceived Inability to Stop Gambling
- Internet
- M, Maintenance
- MFS, Monitoring, Feedback and Support
- MI, Motivational Interviewing
- MINI, Mini International Neuropsychiatric Interview
- NA, Negative Affect
- NODS, NORC DSM-IV Screen for Gambling Problems
- OASIS, The Overall Anxiety Severity and Impairment Scale
- ODSIS, The Overall Depression Severity and Impairment Scale
- P, Precontemplation
- PA, Positive Affect
- PANAS, The Positive and Negative Affect Schedule
- PC, Predictive Control
- PFIs, Personal Feedback Interventions
- QLI, Quality Life Index
- RCT, Randomized Controlled Trial
- SCID-P, The Structured Clinical Interview
- SPIRIT, Standard Protocol Items Recommendations for Interventional Trials
- SUS, System Usability Scale
- UPPS-P, The Short UPPS-P Impulsivity Scale
- URICA, The University of Rhode Island Change Assessment Scale
- WL, Waiting List
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Affiliation(s)
- Laura Diaz-Sanahuja
- Universitat Jaume I, Castellón, Spain
- Corresponding author at: Department of Basic Psychology, Clinical and Psychobiology, Universitat Jaume I, Avenida de Vicent Sos Baynat, s/n, 12071 Castellón, (Spain).
| | - Daniel Campos
- Universidad de Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | | | - Diana Castilla
- Universidad de Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Dowling NA, Merkouris SS, Rodda SN, Smith D, Aarsman S, Lavis T, Lubman DI, Austin DW, Cunningham JA, Battersby MW, O SC. GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. J Clin Med 2021; 10:2224. [PMID: 34063826 PMCID: PMC8196610 DOI: 10.3390/jcm10112224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
There is little evidence relating to the effects of adding guidance to internet-based gambling interventions. The primary aim was to compare the effectiveness of an online self-directed cognitive-behavioural gambling program (GamblingLess) with and without therapist-delivered guidance. It was hypothesised that, compared to the unguided intervention, the guided intervention would result in superior improvements in gambling symptom severity, urges, frequency, expenditure, psychological distress, quality of life and help-seeking. A two-arm, parallel-group, randomised trial with pragmatic features and three post-baseline evaluations (8 weeks, 12 weeks, 24 months) was conducted with 206 gamblers (106 unguided; 101 guided). Participants in both conditions reported significant improvements in gambling symptom severity, urges, frequency, expenditure, and psychological distress across the evaluation period, even after using intention-to-treat analyses and controlling for other low- and high-intensity help-seeking, as well as clinically significant changes in gambling symptom severity (69% recovered/improved). The guided intervention resulted in additional improvements to urges and frequency, within-group change in quality of life, and somewhat higher rates of clinically significant change (77% cf. 61%). These findings, which support the delivery of this intervention, suggest that guidance may offer some advantages but further research is required to establish when and for whom human support adds value.
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Affiliation(s)
- Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC 3010, Australia
| | - Stephanie S. Merkouris
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Simone N. Rodda
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
- Turning Point, Eastern Health, 110 Church St, Richmond, VIC 3121, Australia
| | - David Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Stephanie Aarsman
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Tiffany Lavis
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Dan I. Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Richmond, VIC 3121, Australia;
| | - David W. Austin
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - John A. Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Malcolm W. Battersby
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Seung Chul O
- Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
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Ecological Momentary Assessment of the Relationship between Positive Outcome Expectancies and Gambling Behaviour. J Clin Med 2021; 10:jcm10081709. [PMID: 33921069 PMCID: PMC8071390 DOI: 10.3390/jcm10081709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/04/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
Relapse prevention models suggest that positive outcome expectancies can constitute situational determinants of relapse episodes that interact with other factors to determine the likelihood of relapse. The primary aims were to examine reciprocal relationships between situational positive gambling outcome expectancies and gambling behaviour and moderators of these relationships. An online survey and a 28 day Ecological Momentary Assessment (EMA) were administered to 109 past-month gamblers (84% with gambling problems). EMA measures included outcome expectancies (enjoyment/arousal, self-enhancement, money), self-efficacy, craving, negative emotional state, interpersonal conflict, social pressure, positive emotional state, financial pressures, and gambling behaviour (episodes, expenditure). Pre-EMA measures included problem gambling severity, motives, psychological distress, coping strategies, and outcome expectancies. No reciprocal relationships between EMA outcome expectancies and gambling behaviour (episodes, expenditure) were identified. Moderations predicting gambling episodes revealed: (1) cravings and problem gambling exacerbated effects of enjoyment/arousal expectancies; (2) positive emotional state and positive reframing coping exacerbated effects of self-enhancement expectancies; and (3) instrumental social support buffered effects of money expectancies. Positive outcome expectancies therefore constitute situational determinants of gambling behaviour, but only when they interact with other factors. All pre-EMA expectancies predicted problem gambling severity (OR = 1.61–3.25). Real-time interventions addressing gambling outcome expectancies tailored to vulnerable gamblers are required.
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Merkouris SS, Hawker CO, Rodda SN, Youssef GJ, Dowling NA. GamblingLess: Curb Your Urge: Development and usability testing of a smartphone-delivered ecological momentary intervention for problem gambling. INTERNATIONAL GAMBLING STUDIES 2020. [DOI: 10.1080/14459795.2020.1749293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Simone N. Rodda
- School of Psychology, Deakin University, Geelong, Australia
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland New Zealand
| | - George J. Youssef
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, 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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Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol. BMC Public Health 2020; 20:191. [PMID: 32028926 PMCID: PMC7006157 DOI: 10.1186/s12889-020-8304-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
Background The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. Methods An innovative CBT mobile app, based on Deakin University’s GamblingLess online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant’s language and their name (e.g. Kia ora Tāne) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. Discussion If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. Ethics approval NZ Health and Disability Ethics Committee (Ref: 19/STH/204) Trial registration Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.
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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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Abstract
PURPOSE OF REVIEW To assess recent developments in self-directed interventions for gambling disorder and at-risk gambling. RECENT FINDINGS Relevant reviews and meta-analyses were published during 2017 and 2018. These reviews assess the nature and efficacy of self-directed and largely self-directed interventions including self-change, assisted self-change and mutual aid support groups. Additional reviews cover government and industry strategies to reduce harm including gambling venue and site self-exclusion and a variety of responsible gambling and consumer protection measures. Further studies were published that advanced understanding of self-directed and related interventions and identified priorities for development and research. SUMMARY There is variable support for the effectiveness of the foregoing interventions. Some appear to achieve outcomes comparable with professionally delivered therapies. Research is required using more robust designs, larger and more diverse samples and longer follow-up to demonstrate effectiveness and provide a basis for matching at-risk and problem gamblers to interventions of different types and intensity.
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Cunningham JA, Godinho A, Hodgins DC. Pilot randomized controlled trial of an online intervention for problem gamblers. Addict Behav Rep 2019; 9:100175. [PMID: 31193792 PMCID: PMC6542746 DOI: 10.1016/j.abrep.2019.100175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This pilot randomized controlled trial sought to evaluate whether an online intervention for problem gambling could lead to improved gambling outcomes compared to a no intervention control. Participants were recruited through a crowdsourcing platform. METHODS Participants were recruited to complete an online survey about their gambling through the Mechanical Turk platform. Those who scored 5 or more on the Problem Gambling Severity Index and were thinking about quitting or reducing their gambling were invited to complete 6-week and 6-month follow-ups. Each potential participant who agreed was sent a unique password. Participants who used their password to log onto the study portal were randomized to either access an online intervention for gambling or to a no intervention control. RESULTS A total of 321 participants were recruited, of which 87% and 88% were followed-up at 6 weeks and 6 months, respectively. Outcome analyses revealed that, while there were reductions in gambling from baseline to follow-ups, there was no significant observable impact of the online gambling intervention, as compared to a no intervention control condition. CONCLUSIONS While the current trial observed no impact of the intervention, replication is merited with a larger sample size, and with participants who are not recruited through a crowdsourcing platform.Trial registration: ClinicalTrials.govNCT03124589.
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Affiliation(s)
- John A. Cunningham
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
- Australian National University, Canberra, Australia
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Bücker L, Bierbrodt J, Hand I, Wittekind C, Moritz S. Effects of a depression-focused internet intervention in slot machine gamblers: A randomized controlled trial. PLoS One 2018; 13:e0198859. [PMID: 29883479 PMCID: PMC5993308 DOI: 10.1371/journal.pone.0198859] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/18/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Problematic and pathological gambling have been linked to depression. Despite a high demand for treatment and negative financial consequences, only a small fraction of problematic and pathological gamblers seek professional help. The existing treatment gap could be narrowed by providing low-threshold, anonymous internet-based interventions. The aim of the present study was to examine the acceptance and efficacy of an online-intervention for depression ("Deprexis") in a sample of problematic and pathological slot-machine gamblers. We hypothesized that the intervention group would show a greater reduction in both depressive and gambling-related symptoms compared to a wait-list control group. METHOD A total of 140 individuals with self-reported gambling and mood problems were randomly allocated either to the intervention group or to a wait-list control group. After 8 weeks, all participants were invited for re-assessment. The Patient Health Questionnaire - 9 (PHQ-9) served as the primary outcome assessment. Problematic gambling was measured with the Pathological Gambling Adaptation of Yale-Brown Obsessive Compulsive Scale (PG-YBOCS) and the South Oaks Gambling Screen (SOGS). The trial is registered with the German Registry for Clinical Studies (DRKS00013888). RESULTS ITT analyses showed that the intervention led to a significant reduction in depressive symptoms as well as gambling-related symptoms compared to the control group, with moderate to strong effect sizes. PP analyses failed to yield significant results due to high rates of non-completion and limited statistical power. Moderator analyses indicated that Deprexis was particularly beneficial in reducing problematic gambling for those scoring high on baseline gambling-related symptoms and for those who gamble due to loneliness. DISCUSSION Results of the present study suggest that Deprexis might be a useful adjunct to traditional interventions for the treatment of problematic gambling. The potential of internet-based interventions that are more targeted at issues specific to gambling should be evaluated in future studies. TRIAL REGISTRATION German Registry for Clinical Studies DRKS00013888.
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Affiliation(s)
- Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Bierbrodt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Iver Hand
- Ambulatory Healthcare Center Falkenried, Hamburg, Germany
| | - Charlotte Wittekind
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cunningham JA, Hodgins DC, Keough M, Hendershot CS, Bennett K, Bennett A, Godinho A. Online interventions for problem gamblers with and without co-occurring problem drinking: study protocol of a randomized controlled trial. Trials 2018; 19:295. [PMID: 29801520 PMCID: PMC5970494 DOI: 10.1186/s13063-018-2672-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/04/2018] [Indexed: 12/26/2022] Open
Abstract
Background The current randomized controlled trial seeks to evaluate whether providing access to an Internet intervention for problem drinking in addition to an Internet intervention for problem gambling is beneficial for participants with gambling problems who do or do not have co-occurring problem drinking. Methods Potential participants will be recruited online via a comprehensive advertisement strategy, if they meet the criteria for problem gambling. As part of the baseline measures, problem drinking will also be assessed. Eligible participants (N = 280) who agree to partake in the study and to be followed up for 6 months will be randomized into one of two versions of an Internet intervention for gamblers: an intervention that targets only gambling issues (G-only) and one that combines a gambling intervention with an intervention for problem drinking (G + A). For problem gamblers who exhibit co-occurring problem drinking, it is predicted that participants who are provided access to the G + A intervention will demonstrate a significantly greater level of reduction in gambling outcomes at 6 months compared to those provided access to the G-only intervention. Discussion This trial will expand upon the current research on Internet interventions for addictions and inform the development of treatments for those with co-occurring problem drinking and gambling. Trial Registration ClinicalTrials.gov, NCT03323606. Registered on 24 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2672-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John A Cunningham
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada. .,Austalian National University, Canberra, Australia.
| | - David C Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Matthew Keough
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Christian S Hendershot
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | | | - Alexandra Godinho
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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