Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial

Abstract

BackgroundDisordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.Methods/designParticipants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.DiscussionThis study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.Trial registrationNetherlands Trial Register, NTR5096. Registered on 11 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2190-2) contains supplementary material, which is available to authorized users.

Dimensions of Impulsivity in Gambling Disorder

“…Specific adjuvant interventions to address the facets of impulsivity associated with GD severity could potentially improve treatment outcomes 4,5 . In this sense, technologically based interventions represent a new frontier for treatment, from the computerized adaptation of neurocognitive tasks to evaluate these processes, such as cognitive and attentional bias 81 , to the use of mobile applications to condition the selection of healthy foods obesity 82 , or serious games for the treatment of impulsivity in gambling disorder 83 , in eating disorders 84,85 and in other mental disorders 86 . It has been observed that the use of therapeutic video games, as an additional therapeutic tool can treat difficulties in emotional regulation and impulsivity 84 .…”

Luck, come here! Automatic approach tendencies toward gambling cues in moderate‐ to high‐risk gamblers

“…As a strong approach bias towards gambling increases the likelihood of persisting in gambling, which implies the risk of ultimately exacerbating gambling problems, it is reasonable to propose that neurocognitive interventions targeting these dysfunctional implicit motivational processes, e.g. re‐training selective attention and approach bias via cognitive bias modification (CBM) , may reduce the risk of problem gambling escalation and/or relapse . By reducing effectively the coding of salient cues in the brain reward system , CBM training programmes have the potential of re‐wiring action‐value representations associated with appetitive gambling cues, particularly when using gambling stimuli tailored to the individual's most familiar and frequently played gambling activities.…”

“…A key‐press version of the AAT was used to assess online gambling approach bias . Participants were instructed to approach (‘pull’) or avoid (‘push’) gambling‐related and neutral pictures by responding as quickly and accurately as possible to the rotation direction (5 degrees) of the pictures with two keys on the keyboard (see the Supporting information for a detailed description of the task).…”

“…Stimuli were drawn from a large set of pictures displaying gambling cues for the four gambling activities (i.e. roulette and dice, card games, slot machines and sports and racetrack betting), and with control stimuli depicting everyday objects or activities unrelated to gambling (see Supporting information, Fig. S1 for some stimulus examples).…”

“…A typical ‘one size fits all’ approach to stimulus selection would not congruously match the specific gambling habits of different gamblers, as many of those stimuli would be of limited or no relevance to any given participant, hampering the internal reliability and construct validity of the task . Stimuli thus matched the two most familiar gambling activities selected by participants .…”