1
|
Zhang M, Fan C, Ma L, Wang H, Zu Z, Yang L, Chen F, Wei W, Li X. Assessing the effectiveness of internet-based interventions for mental health outcomes: an umbrella review. Gen Psychiatr 2024; 37:e101355. [PMID: 39040128 PMCID: PMC11261690 DOI: 10.1136/gpsych-2023-101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/13/2024] [Indexed: 07/24/2024] Open
Abstract
Internet-based interventions (IBIs) for behavioural health have been prevalent for over two decades, and a growing proportion of individuals with mental health concerns prefer these emerging digital alternatives. However, the effectiveness and acceptability of IBIs for various mental health disorders continue to be subject to scholarly debate. We performed an umbrella review of meta-analyses (MAs), conducting literature searches in PubMed, Web of Science, Embase, Cochrane and Ovid Medline from their inception to 17 January 2023. A total of 87 MAs, reporting on 1683 randomised controlled trials and 295 589 patients, were included. The results indicated that IBIs had a moderate effect on anxiety disorder (standardised mean difference (SMD)=0.53, 95% CI 0.44 to 0.62) and post-traumatic stress disorder (PTSD) (SMD=0.63, 95% CI 0.38 to 0.89). In contrast, the efficacy on depression (SMD=0.45, 95% CI 0.39 to 0.52), addiction (SMD=0.23, 95% CI 0.16 to 0.31), suicidal ideation (SMD=0.23, 95% CI 0.16 to 0.30), stress (SMD=0.41, 95% CI 0.33 to 0.48) and obsessive-compulsive disorder (SMD=0.47, 95% CI 0.22 to 0.73) was relatively small. However, no significant effects were observed for personality disorders (SMD=0.07, 95% CI -0.13 to 0.26). Our findings suggest a significant association between IBIs and improved mental health outcomes, with particular effectiveness noted in treating anxiety disorders and PTSD. However, it is noteworthy that the effectiveness of IBIs was impacted by high dropout rates during treatment. Furthermore, our results indicated that guided IBIs proved to be more effective than unguided ones, playing a positive role in reducing dropout rates and enhancing patient adherence rates. PROSPERO registration number: CRD42023417366.
Collapse
Affiliation(s)
- Mi Zhang
- Research Centre for Translational Medicine, the Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lijun Ma
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Huixue Wang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Zhenyue Zu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Linxi Yang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Fenglan Chen
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Wenzhuo Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoming Li
- Research Centre for Translational Medicine, the Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
2
|
Rolvien L, Buddeberg L, Gehlenborg J, Borsutzky S, Moritz S. A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417282. [PMID: 38904962 PMCID: PMC11193125 DOI: 10.1001/jamanetworkopen.2024.17282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. Objective To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators. Design, Setting, and Participants This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments. Intervention The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing. Main Outcome and Measures The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction. Results A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group. Conclusions and Relevance In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling. Trial Registration bfarm.de Identifier: DRKS00024840.
Collapse
Affiliation(s)
- Lara Rolvien
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Buddeberg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Swantje Borsutzky
- 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
| |
Collapse
|
3
|
Diaz-Sanahuja L, Suso-Ribera C, Lucas I, Jiménez-Murcia S, Tur C, Gual-Montolio P, Paredes-Mealla M, García-Palacios A, Bretón-López JM. A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study. J Gambl Stud 2024:10.1007/s10899-024-10318-2. [PMID: 38795233 DOI: 10.1007/s10899-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 05/27/2024]
Abstract
The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.
Collapse
Affiliation(s)
- Laura Diaz-Sanahuja
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain.
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Ignacio Lucas
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Psychology and Psychobiology, Universidad de Barcelona, Barcelona, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Macarena Paredes-Mealla
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juana María Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Av. Vicent Sos Baynat, S/N, 12071, Castellón de La Plana, Spain
- CIBER de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Segura A, Heyman RE, Ochshorn J, Slep AMS. A Meta-Review to Guide Military Screening and Treatment of Gambling Problems. Mil Med 2024; 189:e1362-e1373. [PMID: 37966458 DOI: 10.1093/milmed/usad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/02/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Excessive gambling can cause substantial biopsychosocial problems (e.g., difficulties with finances, relationships, mental, and physical health). For military Service Members, it can also result in security clearance denial or revocation, failure to achieve promotions, and premature career termination. Recent congressional mandates have obligated the U.S. Department of Defense to screen for problematic gambling, the predictive values of which are a function of (i) problem prevalence and (ii) tool sensitivity and specificity. This meta-review (i.e., systematic review of systematic reviews) on the screening properties of gambling assessment tools and the effectiveness of treatments for gambling disorder is to inform military services on responding to Service Members' gambling problems. MATERIALS AND METHODS EBSCO Discovery Service, PubMed, PsycINFO, Ovid Medline, Social Care Online, Epistemonikos, International Health Technology Assessment, and the Cochrane Central Register of Controlled Trials electronic databases were searched up to December 2022 for systematic reviews and meta-analyses on measurements of adult subclinical or gambling, and interventions targeting individuals with GD. Three and four studies were included in each section of the current meta-review (i.e., assessment tools and treatment). For review 1, the estimated risk of bias was assessed using the Risk of Bias in Systematic Reviews. RESULTS Thirty-one tools were identified through the three systematic reviews. All had modest sensitivities and specificities; combined with low prevalences in the general SM population, positive results would be incorrect 64-99% of the time. However, if screening were conducted with SMs referred for alcohol problems, a positive result on the best screening tools would be correct 76% of the time. Several commonly used treatment approaches had demonstrated efficacy for GD. CONCLUSIONS The combination of low prevalence of GD and subclinical gambling problems in the general population, coupled with modest sensitivity and specificity, makes screening unfeasible in the general SM population. However, dual-phase screening in higher-prevalence subpopulations (i.e., SMs already identified with substance-abuse or mental-health problems) would be viable. Regarding treatment, several interventions-already used in military healthcare-with extensive empirical track records have been successfully used to treat adults with GD.
Collapse
Affiliation(s)
- Anna Segura
- Family Translational Research Group, New York University, New York, NY 10010, USA
- Salut Mental i Innovació Social, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia 08500, Spain
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Jennie Ochshorn
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
| |
Collapse
|
5
|
So R, Emura N, Okazaki K, Takeda S, Sunami T, Kitagawa K, Takebayashi Y, Furukawa TA. Guided versus unguided chatbot-delivered cognitive behavioral intervention for individuals with moderate-risk and problem gambling: A randomized controlled trial (GAMBOT2 study). Addict Behav 2024; 149:107889. [PMID: 37857043 DOI: 10.1016/j.addbeh.2023.107889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Internet-based interventions can be a promising option for individuals with problem gambling facing barriers to seeking help. This study aimed to directly compare the effects of therapist-guided Internet interventions with unguided ones on gambling-related behavior, cognition, and stage of change including help-seeking intention. METHODS We conducted a participant-blinded randomized controlled trial of therapist-guided versus unguided groups with a 12-week follow-up. Both groups received self-help chatbot-delivered cognitive behavioral therapy. Additionally, at baseline and weeks 1, 2, 3, and 4, the guided group received personalized feedback messages from therapists based on their gambling diary and questionnaire responses. The unguided group received reminders of assessments from research assistants. The primary outcome was the change in scores on the Gambling Symptoms Assessment Scale (G-SAS) over 12 weeks. Secondary outcomes included the stage of change including help-seeking intention, money wagered, gambling frequency, and gambling-related cognitions. RESULTS We included 139 participants with a mean Problem Gambling Severity Index total score of 14.6 and a mean G-SAS total score of 27.0 who sought information about gambling problems. Both groups demonstrated substantial decreases in their G-SAS scores from baseline to week 12 (-10.2, 95% CI: -7.67 to -12.7 for the guided group, and 11.7, 95% CI: -9.05 to -14.3 for the unguided group). However, we did not find a significant between-group difference (1.49, 95% CI: -2.20 to 5.17). Regarding the stage of change including help-seeking intention, there were also no between-group differences. CONCLUSIONS Minimum therapist support did not have an additive effect on the self-help chatbot intervention on gambling symptoms, behavior, and the stage of change including help-seeking intention.
Collapse
Affiliation(s)
- Ryuhei So
- Okayama Psychiatric Medical Center, Okayama, Japan; Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; CureApp, Inc, Japan.
| | - Naoki Emura
- Okayama Psychiatric Medical Center, Okayama, Japan
| | | | | | | | | | - Yoshitake Takebayashi
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Japan; Agency for Wellness Assessment Research and Development, Japan
| | - Toshi A Furukawa
- Department of Health Promotion of Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Stenbro AW, Moldt S, Eriksen JW, Frostholm L. "I was Treated by the Program, the Therapist, and Myself": Feasibility of an Internet-Based Treatment Program for Gambling Disorder. J Gambl Stud 2023; 39:1885-1907. [PMID: 37000310 PMCID: PMC10628035 DOI: 10.1007/s10899-023-10199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
The majority of people with problematic gambling behavior never seek or receive professional help. Internet-based treatment approaches have been shown to help patients overcome practical and psychological barriers associated with face-to-face therapy. In this uncontrolled pilot study, we explored the feasibility of the eight-module therapist-guided internet-based treatment program SpilleFri ("Free from Gambling") for patients with gambling disorder (GD). We included 24 patients seeking treatment at a Danish hospital-based treatment clinic. The focus of the feasibility study was evaluation of recruitment and retention rates, data completion rates, treatment response, satisfaction, and program utility. In addition, a series of semi-structured interviews were conducted to explore patient-perceived acceptability and potential barriers to treatment completion and positive outcome. Treatment acceptability among therapists was examined in a focus group interview. Sixteen of the included patients completed the program, yielding an acceptable treatment dropout rate (29.17%), and 82.35% of treatment completers provided full data at all assessment points. Overall, patients were satisfied with the treatment received, and patient interviews highlighted multiple psychological as well as practical benefits associated with the treatment form and content. Patients with more severe gambling symptoms at baseline might be more likely to drop out before treatment completion than patients with less severe symptoms. The results suggest that SpilleFri may be a feasible alternative to face-to-face treatment for GD. However, the uncontrolled design and small sample size of the study limit the robustness of the findings. In the future, the effect of SpilleFri treatment should be examined in a randomized controlled trial.Clinical trial registrations: The study protocol was prospectively registered at clinicaltrials.gov (TRN: NCT05051085; registration date: September 21, 2021).
Collapse
Affiliation(s)
- Anna Westh Stenbro
- Research Clinic for Gambling Disorder, Aarhus University Hospital, Universitetsbyen 4, 1st Floor, 8000, Aarhus C, Denmark.
| | - Stine Moldt
- Research Clinic for Gambling Disorder, Aarhus University Hospital, Universitetsbyen 4, 1st Floor, 8000, Aarhus C, Denmark
| | - Jakob Winther Eriksen
- Research Clinic for Gambling Disorder, Aarhus University Hospital, Universitetsbyen 4, 1st Floor, 8000, Aarhus C, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
8
|
Pfund RA, King SA, Forman DP, Zech JM, Ginley MK, Peter SC, McAfee NW, Witkiewitz K, Whelan JP. Effects of cognitive behavioral techniques for gambling on recovery defined by gambling, psychological functioning, and quality of life: A systematic review and meta-analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:936-945. [PMID: 36821338 PMCID: PMC10444908 DOI: 10.1037/adb0000910] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Individuals who experience gambling harms report that sustained recovery involves changing both gambling behaviors and psychological symptoms, as well as building a meaningful life. However, there is limited understanding about the effect of cognitive behavioral (CB) techniques on psychological symptoms and quality of life. The purpose of the present study was to examine the effect of CB techniques for gambling-related harms on broader recovery outcomes such as psychological symptoms and quality of life. METHOD A systematic article search was conducted to identify randomized controlled trials of CB techniques with nonactive and minimal treatment control groups that assessed psychological symptoms or quality of life as outcomes. Random-effects meta-analysis was used to examine the effect of CB techniques relative to nonactive and minimal treatment control groups. RESULTS A total of nine studies representing 658 participants were included. Eight studies reported outcomes on depression and anxiety, three on substance use, and six on quality of life. CB techniques significantly reduced anxiety (g = -0.44) and depression (g = -0.35) at posttreatment, but not substance use. CB techniques also significantly increased quality of life at posttreatment (g = 0.40). There was a large amount of heterogeneity suggesting the magnitude of effects could vary significantly in future randomized trials. CONCLUSIONS Future studies should examine the longitudinal associations between gambling harms, psychological symptoms, and quality of life and to assess whether changes in gambling harms throughout treatment precede or are a consequence of changes in psychological symptoms and quality of life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Rory A. Pfund
- The Institute of Gambling Education & Research, University of Memphis, TN 38152
| | - Shelby A. King
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614
| | - David P. Forman
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131
| | - James M. Zech
- Department of Psychology, Florida State University, Tallahassee, FL 32306
| | - Meredith K. Ginley
- The Institute of Gambling Education & Research, University of Memphis, TN 38152
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614
| | | | - Nicholas W. McAfee
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS 39216
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131
| | - James P. Whelan
- The Institute of Gambling Education & Research, University of Memphis, TN 38152
| |
Collapse
|
9
|
Korvuo T, Palomäki J, Castrén S. Dissociative experiences reduce online problem gambling treatment effectiveness. Compr Psychiatry 2023; 127:152414. [PMID: 37688936 DOI: 10.1016/j.comppsych.2023.152414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
AIMS To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling. DESIGN Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups. SETTING AND PARTICIPANTS The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021. MEASUREMENTS The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender. FINDINGS Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment. CONCLUSIONS Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.
Collapse
Affiliation(s)
- Tuire Korvuo
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Palomäki
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Gambling Clinic, Helsinki University Hospital, Finland.
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Department of Public Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; University of Turku, Department of Psychology and Speech-Language Pathology, Turku, Finland; University of Helsinki, Department of Medicine, Helsinki, Finland
| |
Collapse
|
10
|
Boumparis N, Baumgartner C, Malischnig D, Wenger A, Achab S, Khazaal Y, Keough MT, Hodgins DC, Bilevicius E, Single A, Haug S, Schaub MP. Effectiveness of a web-based self-help tool to reduce problem gambling: A randomized controlled trial. J Behav Addict 2023; 12:744-757. [PMID: 37659086 PMCID: PMC10562826 DOI: 10.1556/2006.2023.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/06/2023] [Accepted: 07/30/2023] [Indexed: 09/04/2023] Open
Abstract
Background and Aims Problem gambling constitutes a public health concern associated with psychopathological comorbidity, substance use, and financial difficulties. Most individuals with gambling problems avoid counseling services due to perceived stigma and their preference for self-reliance. Treatment accessibility could be improved through web-based interventions. Methods We recruited 360 individuals with gambling problems and randomized them to a web-based intervention (n = 185) or an active control group consisting of a self-help manual for problem gambling (n = 175). The primary outcome was the number of days of gambling in the last 30 days. Secondary outcomes included money spent in the last 30 days, time gambling in the last 7 days, gambling-related problems, consumption of alcohol and cigarettes, and psychopathological comorbidity measured at posttreatment and 6-month follow-up. Results The primary outcome decreased significantly for both groups, with no significant difference between the groups. There were significant group × time interactions according to the Gambling Symptom Assessment Scale (F = 8.83, p <0 .001), the Problem Gambling Severity Index (F = 3.54, p = 0.030), for cigarettes smoked in the last 7 days (F = 26.68, p < 0.001), the Patient Health Questionnaire-9 (F = 19.41, p <0 .001), and the Generalized Anxiety Disorder-7 (F = 41.09, p <0 .001) favoring the intervention group. We experienced an overall high dropout rate (76%). Conclusions Win Back Control seems to be an effective low-threshold treatment option for individuals with gambling problems that might otherwise be unapproachable for outpatient treatment services. Nevertheless, the high dropout rate should be considered when interpreting the study results, as they may have introduced a degree of variability.
Collapse
Affiliation(s)
- Nikolaos Boumparis
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Austria
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Sophia Achab
- Department of Psychiatry, Faculty of Medicine, Clinical and Sociological Research Unit, University of Geneva, Switzerland
- Department of Psychiatry, Treatment Centre ReConnecte, Addiction Division, University Hospitals of Geneva, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
- Department of Psychiatry and Addiction, Montreal University, Montreal, Canada
| | | | | | - Elena Bilevicius
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alanna Single
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Eriksen JW, Fiskaali A, Zachariae R, Wellnitz KB, Oernboel E, Stenbro AW, Marcussen T, Petersen MW. Psychological intervention for gambling disorder: A systematic review and meta-analysis. J Behav Addict 2023; 12:613-630. [PMID: 37450372 PMCID: PMC10562823 DOI: 10.1556/2006.2023.00034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Background and aims Increasingly, gambling features migrate into non-gambling platforms (e.g., online gaming) making gambling exposure and problems more likely. Therefore, exploring how to best treat gambling disorder (GD) remains important. Our aim was to review systematically and quantitatively synthesize the available evidence on psychological intervention for GD. Methods Records were identified through searches for randomized controlled trials (RCTs) evaluating psychological intervention for GD via six academic databases without date restrictions until February 3, 2023. Study quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Primary outcomes were GD symptom severity and remission of GD, summarized as Hedges' g and odds ratios, respectively. The study was preregistered in PROSPERO (#CRD42021284550). Results Of 5,541 records, 29 RCTs (3,083 participants analyzed) were included for meta-analysis of the primary outcomes. The efficacy of psychological intervention across modality, format and mode of delivery corresponded to a medium effect on gambling severity (g = -0.71) and a small effect on remission (OR = 0.47). Generally, risk of bias was high, particularly amongst early face-to-face interventions studies. Discussion and conclusions The results indicate that psychological intervention is efficacious in treating GD, with face-to-face delivered intervention producing the largest effects and with strongest evidence for cognitive behavioral therapy. Much remains to be known about the long-term effects, and investigating a broader range of treatment modalities and digital interventions is a priority if we are to improve clinical practice for this heterogeneous patient group.
Collapse
Affiliation(s)
- Jakob W. Eriksen
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Anne Fiskaali
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Science, Aarhus University, Denmark
- Department of Oncology, Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Denmark
| | - Kaare B. Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Eva Oernboel
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Anna W. Stenbro
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Thomas Marcussen
- The Research Clinic on Gambling Disorders, Aarhus University Hospital, Denmark
| | - Marie W. Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| |
Collapse
|
12
|
Gabellini E, Lucchini F, Gattoni ME. Prevalence of Problem Gambling: A Meta-analysis of Recent Empirical Research (2016-2022). J Gambl Stud 2023; 39:1027-1057. [PMID: 36586057 DOI: 10.1007/s10899-022-10180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/01/2023]
Abstract
Gambling is widely considered a socially acceptable form of recreation. However, for a small minority of individuals, it can become both addictive and problematic with severe adverse consequences. The aim of this systematic review and meta-analysis is to provide an overview of prevalence studies published between 2016 and the first quarter of 2022 and an updated estimate of problem gambling in the general adult population. A systematic review and a meta-analysis were carried out using academic databases, Internet, and governmental websites. Following this search and utilizing exclusion criteria, 23 studies on adult gambling prevalence were identified, distinguishing between moderate risk/at risk gambling and problem/pathological gambling. This study found a prevalence of moderate risk/at risk gambling to be 2.43% and of problem/pathological gambling to be 1.29% in the adult population. As difficult as it may be to compare studies due to different methodological procedures, cutoffs, and time frames, the present meta-analysis highlights the variations of prevalence across different countries, giving due consideration to the differences between levels of risk and severity. This work intends to provide a starting point for policymakers and academics to fill the gaps on gambling research-more specifically in some countries where the lack of research in this field is evident-and to study the effectiveness of policies implemented to mitigate gambling harm.
Collapse
Affiliation(s)
- Eliana Gabellini
- Specific Prevention Unit, Agency for Health Protection of Milan, Milan, Italy
| | - Fabio Lucchini
- Specific Prevention Unit, Agency for Health Protection of Milan, Milan, Italy.
| | | |
Collapse
|
13
|
Pfund RA, Forman DP, Whalen SK, Zech JM, Ginley MK, Peter SC, McAfee NW, Whelan JP. Effect of cognitive-behavioral techniques for problem gambling and gambling disorder: A systematic review and meta-analysis. Addiction 2023; 118:1661-1674. [PMID: 37381589 PMCID: PMC10524575 DOI: 10.1111/add.16221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/14/2023] [Indexed: 06/30/2023]
Abstract
AIMS To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up. METHOD Seven databases and two clinical trial registries were searched to identify peer-reviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect meta-analysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. RESULTS Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = -1.14, 95% CI = -1.68, -0.60, 95% prediction interval [PI] = -2.97, 0.69), gambling frequency (g = -0.54, 95% CI = -0.80, -0.27, 95% PI = -1.48, 0.40) and gambling intensity (g = -0.32, 95% CI = -0.51, -0.13, 95% PI = -0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. CONCLUSIONS Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at post-treatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.
Collapse
Affiliation(s)
- Rory A Pfund
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
| | - David P Forman
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shelby K Whalen
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - James M Zech
- Department of Counseling and Clinical Psychology, Columbia University, New York, New York, USA
| | - Meredith K Ginley
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | | | - Nicholas W McAfee
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James P Whelan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
- Tennessee Institute for Gambling Education & Research, Tennessee, USA
| |
Collapse
|
14
|
Gueta K, Harel-Fisch Y, Walsh SD. Cultural accommodation of internet-based interventions for substance use and related disorders: a proposed comprehensive framework based on a pilot study and a literature review. Front Psychol 2023; 14:1063200. [PMID: 37416542 PMCID: PMC10321598 DOI: 10.3389/fpsyg.2023.1063200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.
Collapse
Affiliation(s)
- Keren Gueta
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Yossi Harel-Fisch
- The International Research Program on Adolescent Well-Being and Health, School of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Sophie D. Walsh
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
15
|
Park JJ, King DL, Wilkinson-Meyers L, Rodda SN. Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review. JMIR Ment Health 2022; 9:e36662. [PMID: 36083612 PMCID: PMC9508667 DOI: 10.2196/36662] [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: 01/19/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated. OBJECTIVE This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior. METHODS A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool. RESULTS The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms. CONCLUSIONS Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.
Collapse
Affiliation(s)
- Jennifer J Park
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Daniel L King
- College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia
| | | | - Simone N Rodda
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
16
|
Preventive Interventions and Harm Reduction in Online and Electronic Gambling: A Systematic Review. J Gambl Stud 2022; 39:883-911. [PMID: 35999322 DOI: 10.1007/s10899-022-10126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 10/15/2022]
Abstract
Gambling possess both entertaining and potentially harmful aspects. It remains a challenge for public health authorities and gambling operators to recommend and implement effective evidence-based interventions to reduce gambling-related harm and prevent problematic gambling behavior. This systematic review examined studies on randomized controlled trials in this field, aiming to describe and evaluate the effect of preventive and harm-reducing interventions for online gambling and electronic gaming machines. A systematic literature search was performed in PsycINFO, PubMed, Embase, and SCOPUS. Study selection, risk of bias assessment, and data extraction were conducted by two reviewers independently, and a synthesis was performed. A total of 18 studies were included, of which the majority were limited by quality issues. The applied interventions focused on restraining gambling, providing feedback, delivering therapeutic and informative content, and priming analytical thinking. The studies varied greatly in terms of specific intervention content, study setting, participants, and outcome measures, and no consistent patterns could be detected between study characteristics and related effects. Although research in the field is growing, there is still a need for further methodologically rigorous investigation and consensus on outcome measures sensitive to effects of preventive and harm-reducing interventions.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Palomäki J, Heiskanen M, Castrén S. Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control. J Behav Addict 2022; 11:75-87. [PMID: 35133289 PMCID: PMC9109628 DOI: 10.1556/2006.2021.00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Online interventions for problem gambling are increasingly popular, but not everyone benefits from them. We describe 12 years of real-world data from an online intervention for gambling problems and aim to find out the extent to which depression, alcohol use, and sense of financial control influence the effectiveness of the program. METHODS We analyzed treatment effectiveness and moderators in the Finnish "Peli Poikki" program (2007-2018)-an 8-week cognitive behavioral therapy and follow-up program for problem gambling. Participants were Finnish-speaking adults over 18 years of age (N = 2011, 66.9% males). We measured the self-reported level of problem gambling, depression, alcohol use, and sense of financial control across four treatment phases (baseline, post-treatment, 6-month follow-up, and 12-month follow-up), as well as the presence of gambling debt, psychological and physiological health, years suffered from gambling problems, and demographic variables. RESULTS Participation grew across years with retention rates of 55%, 30%, and 19% for post-treatment and the two follow-ups, respectively. The average problem gambling scores declined significantly following treatment and remained low throughout the follow-ups. However, this decline (the beneficial treatment effect) was reversed after the follow-ups for those with high depression scores and those who felt they had no control over their finances. DISCUSSION AND CONCLUSIONS The Peli Poikki program is a well-functioning online intervention but less effective in the long term for participants with persisting symptoms of depression or without a sense of financial control. More attention is needed to screen and direct people with comorbidities to the appropriate services.
Collapse
Affiliation(s)
- Jussi Palomäki
- Gambling Clinic (Peliklinikka), Helsinki University Hospital, Siltasaarenkatu 12 A, 00530Helsinki, Finland
| | - Maria Heiskanen
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Helsinki, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Health and Well-Being Promotion Unit, Helsinki, Finland
- Department of Psychology and Speech-Language Pathology, Social Sciences, University of Turku, Turku, Finland
- Department of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
19
|
Client's Experiences Using a Location-Based Technology ICT System during Gambling Treatments' Crucial Components: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073769. [PMID: 35409450 PMCID: PMC8997771 DOI: 10.3390/ijerph19073769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 12/18/2022]
Abstract
Cognitive Behavioral Therapy is the treatment of choice for Gambling Disorder (GD), with stimulus control (SC) and exposure with response prevention (ERP) being its two core components. Despite their efficacy, SC and ERP are not easy to deliver, so it is important to explore new ways to enhance patient compliance regarding SC and ERP. The aim of this study is to describe and assess the opinion of two patients diagnosed with problem gambling and GD that used the Symptoms app, a location-based ICT system, during SC and ERP. A consensual qualitative research study was conducted. We used a semi-structured interview, developed ad-hoc based on the Expectation and Satisfaction Scale and System Usability Scale. A total of 20 categories were identified within six domains: usefulness, improvements, recommendation to other people, safety, usability, and opinion regarding the use of the app after completing the intervention. The patients considered the app to be useful during the SC and ERP components and emphasized that feeling observed and supported at any given time helped them avoid lapses. This work can offer a starting point that opens up new research paths regarding psychological interventions for gambling disorder, such as assessing whether location-based ICT tools enhance commitment rates.
Collapse
|