A randomized controlled trial on a self-guided Internet-based intervention for gambling problems

Lara Bücker, Josefine Gehlenborg, Steffen Moritz, Stefan Westermann, Lara Bücker, Josefine Gehlenborg, Steffen Moritz, Stefan Westermann

Abstract

The majority of individuals with problematic and pathological gambling remain untreated, and treatment barriers are high. Internet-based interventions can help to address existing barriers, and first studies suggest their potential for this target group. Within a randomized controlled trial (N = 150) with two assessment times (baseline and post-intervention), we aimed to investigate the feasibility, acceptance, and effectiveness of a self-guided Internet-based intervention targeted at gambling problems. We expected a significant reduction in gambling symptoms (primary outcome) and depressive symptoms as well gambling-specific dysfunctional thoughts (secondary outcomes) in the intervention group (IG) compared to a wait-list control group with access to treatment-as-usual (control group, CG) after the intervention period of 8 weeks. Results of the complete cases, per protocol, intention-to-treat (ITT), and frequent user analyses showed significant improvements in both groups for primary and secondary outcomes but no significant between-group differences (ITT primary outcome, F(1,147) = .11, p = .739, ηp2 < .001). Moderation analyses indicated that individuals in the IG with higher gambling and depressive symptoms, older age, and comorbid anxiety symptoms showed significant improvement relative to the CG. The intervention was positively evaluated (e.g., 96.5% rated the program as useful). Possible reasons for the nonsignificant between-group differences are discussed. Future studies should include follow-up assessments and larger samples to address limitations of the present study. Trial Registration ClinicalTrials.gov (NCT03372226), https://ichgcp.net/clinical-trials-registry/NCT03372226 , date of registration (13/12/2017).

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
CONSORT flowchart.

References

    1. Slutske WS. Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys. Am. J. Psychiatry. 2006;163:297–302. doi: 10.1176/appi.ajp.163.2.297.
    1. Slutske WS, Blaszczynski A, Martin NG. Sex differences in the rates of recovery, treatment-seeking, and natural recovery in pathological gambling: results from an Australian community-based twin survey. Twin Res. Hum. Genet. 2009;12:425–432. doi: 10.1375/twin.12.5.425.
    1. Melville KM, Casey LM, Kavanagh DJ. Psychological treatment dropout among pathological gamblers. Clin. Psychol. Rev. 2007;27:944–958. doi: 10.1016/j.cpr.2007.02.004.
    1. Toneatto T. A perspective on problem gambling treatment: issues and challenges. J. Gambl. Stud. 2005;21:73–78. doi: 10.1007/s10899-004-1925-7.
    1. Suurvali H, Hodgins DC, Toneatto T, Cunningham JA. Hesitation to seek gambling-related treatment among Ontario problem gamblers. J. Addict. Med. 2012;6:39–49. doi: 10.1097/ADM.0b013e3182307dbb.
    1. Suurvali H, Cordingley J, Hodgins DC, Cunningham J. Barriers to seeking help for gambling problems: a review of the empirical literature. J. Gambl. Stud. 2009;25:407–424. doi: 10.1007/s10899-009-9129-9.
    1. Cunningham JA. Little use of treatment among problem gamblers. Psychiatr. Serv. 2005;56:1024–1025. doi: 10.1176/appi.ps.56.8.1024-a.
    1. Cowlishaw S, et al. Psychological therapies for pathological and problem gambling. Cochrane Database Syst. Rev. 2012;11:CD008937.
    1. Gooding P, Tarrier N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: hedging our bets? Behav. Res. Ther. 2009;47:592–607. doi: 10.1016/j.brat.2009.04.002.
    1. Yakovenko I, Quigley L, Hemmelgarn BR, Hodgins DC, Ronksley P. The efficacy of motivational interviewing for disordered gambling: systematic review and meta-analysis. Addict. Behav. 2015;43:72–82. doi: 10.1016/j.addbeh.2014.12.011.
    1. Dąbrowska K, Moskalewicz J, Wieczorek Ł. Barriers in access to the treatment for people with gambling disorders. Are they different from those experienced by people with alcohol and/or drug dependence? J. Gambl. Stud. 2017;33:487–503. doi: 10.1007/s10899-016-9655-1.
    1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13:288–295. doi: 10.1002/wps.20151.
    1. Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn. Behav. Ther. 2018;47:1–18. doi: 10.1080/16506073.2017.1401115.
    1. Karyotaki E, et al. Efficacy of self-guided Internet-based cognitive behavioral therapy in the treatment of depressive symptoms. JAMA Psychiat. 2017;74:351. doi: 10.1001/jamapsychiatry.2017.0044.
    1. Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014;13:4–11. doi: 10.1002/wps.20083.
    1. Lal S, Adair CE. E-Mental health: A rapid review of the literature. Psychiatr. Serv. 2014;65:24–32. doi: 10.1176/appi.ps.201300009.
    1. Richards D, Viganó N. Online counseling: a narrative and critical review of the literature. J. Clin. Psychol. 2013;69:994–1011. doi: 10.1002/jclp.21974.
    1. Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on Internet-based mental health interventions—a systematic review. Internet Interv. 2014;1:205–215. doi: 10.1016/j.invent.2014.08.003.
    1. Erbe D, Eichert H-C, Riper H, Ebert DD. Blending face-to-face and Internet-based interventions for the treatment of mental disorders in adults: systematic review. J. Med. Internet Res. 2017;19:e306. doi: 10.2196/jmir.6588.
    1. Hedman E, Ljótsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Exp. Rev. Pharmacoecon. Outcomes Res. 2012;12:745–764. doi: 10.1586/erp.12.67.
    1. Karyotaki E, et al. Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis. Psychol. Med. 2015;45:2717–2726. doi: 10.1017/S0033291715000665.
    1. Karyotaki E, et al. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clin. Psychol. Rev. 2018;63:80–92. doi: 10.1016/j.cpr.2018.06.007.
    1. Lüdtke T, et al. Evaluation of a brief unguided psychological online intervention for depression: a controlled trial including exploratory moderator analyses. Internet Interv. 2018;13:73–81. doi: 10.1016/j.invent.2018.06.004.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin. Psychol. Rev. 2012;32:329–342. doi: 10.1016/j.cpr.2012.02.004.
    1. Carlbring P, Smit F. Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. J. Consult. Clin. Psychol. 2008;76:1090–1094. doi: 10.1037/a0013603.
    1. Casey LM, et al. Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: a randomised controlled trial. J. Gambl. Stud. 2017;33:993–1010. doi: 10.1007/s10899-016-9666-y.
    1. 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. doi: 10.1371/journal.pone.0198859.
    1. Dowling NA, et al. GamblingLess: a randomised trial comparing guided and unguided internet-based gambling interventions. J. Clin. Med. 2021;10:2224. doi: 10.3390/jcm10112224.
    1. Luquiens A, et al. The efficacy of three modalities of Internet-based psychotherapy for non–treatment-seeking online problem gamblers: a randomized controlled trial. J. Med. Internet Res. 2016;18:e36. doi: 10.2196/jmir.4752.
    1. Hodgins DC, Cunningham JA, Murray R, Hagopian S. Online self-directed interventions for gambling disorder: randomized controlled trial. J. Gambl. Stud. 2019 doi: 10.1007/s10899-019-09830-7.
    1. Goslar M, Leibetseder M, Muench H, Hofmann S, Laireiter A. Efficacy of face-to-face versus self-guided treatments for disordered gambling: a meta-analysis. J. Behav. Addict. 2017;6:142–162. doi: 10.1556/2006.6.2017.034.
    1. Dowling NA, et al. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a systematic review and meta-analysis. Aust. New Z. J. Psychiatry. 2015;49:519–539. doi: 10.1177/0004867415575774.
    1. Twomey C, O’Reilly G, Meyer B. Effectiveness of an individually-tailored computerized CBT programm (Deprexis) for depression: a meta-analysis. Psychiatry Res. 2017;256:371–377. doi: 10.1016/j.psychres.2017.06.081.
    1. Nower L, Blaszczynski A. Recovery in pathological gambling: an imprecise concept. Subst. Use Misuse. 2008;43:1844–1864. doi: 10.1080/10826080802285810.
    1. Sartor CE, et al. Course of pathological gambling symptoms and reliability of the lifetime Gambling History measure. Psychiatry Res. 2007;152:55–61. doi: 10.1016/j.psychres.2006.05.015.
    1. Eysenbach G, Wyatt J. Using the Internet for surveys and health research. J. Med. Internet Res. 2002;4:E13. doi: 10.2196/jmir.4.2.e13.
    1. Donkin L, et al. Sampling bias in an internet treatment trial for depression. Transl. Psychiatry. 2012;2:e174–e174. doi: 10.1038/tp.2012.100.
    1. Morton V, Torgerson DJ. Regression to the mean: treatment effect without the intervention. J. Eval. Clin. Pract. 2005;11:59–65. doi: 10.1111/j.1365-2753.2004.00505.x.
    1. Furukawa TA, et al. Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatr. Scand. 2014;130:181–192. doi: 10.1111/acps.12275.
    1. Devilly GJ, McFarlane AC. When wait lists are not feasible, nothing is a thing that does not need to be done. J. Consult. Clin. Psychol. 2009;77:1159–1168. doi: 10.1037/a0016878.
    1. Cunningham JA, Kypri K, McCambridge J. Exploratory randomized controlled trial evaluating the impact of a waiting list control design. BMC Med. Res. Methodol. 2013;13:150. doi: 10.1186/1471-2288-13-150.
    1. Bücker L, Schnakenberg P, Karyotaki E, Moritz S, Westermann S. Diminishing effects after recurrent use of self-guided internet-based interventions in depression: Randomized controlled trial. J. Med. Internet Res. 2019;21:e14240. doi: 10.2196/14240.
    1. Rutherford BR, Mori S, Sneed JR, Pimontel MA, Roose SP. Contribution of spontaneous improvement to placebo response in depression: a meta-analytic review. J. Psychiatr. Res. 2012;46:697–702. doi: 10.1016/j.jpsychires.2012.02.008.
    1. Posternak MA, Miller I. Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. J. Affect. Disord. 2001;66:139–146. doi: 10.1016/S0165-0327(00)00304-9.
    1. Apodaca TR, Miller WR. A meta-analysis of the effectiveness of bibliotherapy for alcohol problems. J. Clin. Psychol. 2003;59:289–304. doi: 10.1002/jclp.10130.
    1. Bower P, et al. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. BMJ. 2013;346:f540. doi: 10.1136/bmj.f540.
    1. Warmerdam L, Van Straten A, Twisk J, Cuijpers P. Predicting outcome of Internet-based treatment for depressive symptoms. Psychother. Res. 2013;23:559–567. doi: 10.1080/10503307.2013.807377.
    1. Button KS, Wiles NJ, Lewis G, Peters TJ, Kessler D. Factors associated with differential response to online cognitive behavioural therapy. Soc. Psychiatry Psychiatr. Epidemiol. 2012;47:827–833. doi: 10.1007/s00127-011-0389-1.
    1. Riper H, et al. Effectiveness and treatment moderators of internet interventions for adult problem drinking: an individual patient data meta-analysis of 19 randomised controlled trials. PLOS Med. 2018;15:e1002714. doi: 10.1371/journal.pmed.1002714.
    1. Ebert DD, et al. For whom does it work? Moderators of outcome on the effect of a transdiagnostic Internet-based maintenance treatment after inpatient psychotherapy: randomized controlled trial. J. Med. Internet Res. 2013;15:e191. doi: 10.2196/jmir.2511.
    1. Flückiger C, Del Re AC. The sleeper effect between psychotherapy orientations: a strategic argument of sustainability of treatment effects at follow-up. Epidemiol. Psychiatr. Sci. 2017;26:442–444. doi: 10.1017/S2045796016000780.
    1. Bücker L, Westermann S, Kühn S, Moritz S. A self-guided Internet-based intervention for individuals with gambling problems: study protocol for a randomized controlled trial. Trials. 2019;20:74. doi: 10.1186/s13063-019-3176-z.
    1. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Blaszczynski A, Nower L. A pathways model of problem and pathological gambling. Addiction. 2002;97:487–499. doi: 10.1046/j.1360-0443.2002.00015.x.
    1. Keough MT, Penniston TL, Vilhena-Churchill N, Bagby RM, Quilty LC. Depression symptoms and reasons for gambling sequentially mediate the associations between insecure attachment styles and problem gambling. Addict. Behav. 2018;78:166–172. doi: 10.1016/j.addbeh.2017.11.018.
    1. Pallanti S, DeCaria CM, Grant EJ, Urpe M, Hollander E. Reliability and validity of the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) J. Gambl. Stud. 2005;21:431–443. doi: 10.1007/s10899-005-5557-3.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9—validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Breen RB, Zuckerman M. ‘Chasing’ in gambling behavior: personality and cognitive determinants. Pers. Individ. Dif. 1999;27:1097–1111. doi: 10.1016/S0191-8869(99)00052-5.
    1. Strong DR, Breen RB, Lejuez C. Using item response theory to examine gambling attitudes and beliefs. Pers. Individ. Dif. 2004;36:1515–1529. doi: 10.1016/j.paid.2003.06.001.
    1. Lesieur HR, Blume SB. The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers. Am. J. Psychiatry. 1987;144:1184–1188. doi: 10.1176/ajp.144.9.1184.
    1. Goodie AS, et al. Evaluating the South Oaks Gambling Screen with DSM-IV and DSM-5 Criteria: results from a diverse community sample of gamblers. Assessment. 2013;20:523–531. doi: 10.1177/1073191113500522.
    1. Donker T, van Straten A, Marks I, Cuijpers P. A brief Web-based screening questionnaire for common mental disorders: development and validation. J. Med. Internet Res. 2009;11:e19. doi: 10.2196/jmir.1134.
    1. Schmidt J, Lamprecht F, Wittmann WW. Satisfaction with inpatient management. Development of a questionnaire and initial validity studies. Psychother. Psychosom. Med. Psychol. 1989;39:248–255.
    1. Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD. Assessment of client/patient satisfaction: development of a general scale. Eval. Program Plann. 1979;2:197–207. doi: 10.1016/0149-7189(79)90094-6.
    1. Hayes, A. F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. (Guilford Press, 2013).

Source: PubMed

3
Abonneren