GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions

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.

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

“…Furthermore, we had to deal with a large number of non-completers as only 43% completed the post assessment and replacement of missing values always results in a reduced statistical power. Other studies on Internet-based interventions for pathological gambling report a wide range of completion rates, ranging from 17 to 90% 25 – 30 , with several below 50% 26 , 28 , 29 . Accordingly, our completion rate can be considered comparable to similar studies.…”

“…Results regarding the superiority of guided over purely self-guided programs for gambling problems, however, are not that clear. One study compared self-guided iCBT with guided iCBT (e-mail guidance) and found no difference in effectiveness between groups; both led to a significant reduction in gambling symptom severity, urges, frequency, expenditure and psychological distress at 2- and 3-month follow-up, but the guided iCBT also resulted in significant improvements in quality of life and had higher rates of clinically significant changes 28 . Another study investigating different forms of Internet-based interventions in a sample of individuals with gambling problems found no difference in changes of gambling symptom severity of a guided form compared to an unguided one 29 .…”

Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study

“…GamblingLess [ 42 ] is a comprehensive and intensive web-based CBT program designed to help people with gambling problems. It was designed to emulate the intensity and depth of the face-to-face programs.…”

“…In this study, we describe the formative research that was an integral part of developing a mobile app for gambling harm for use in New Zealand: Manaaki. Specifically, we aim to (1) adapt and refine an evidence- and web-based program, GamblingLess [ 40 - 42 ], into a mobile app intervention and (2) engage domain experts and intended end users to help inform the content conversion and the design, features, and functions of the app and maximize the effectiveness of the program. This study is part of a larger project to evaluate the effectiveness of this designed cognitive behavioral therapy (CBT) mHealth intervention—Manaaki—for people with self-reported gambling problems [ 43 ].…”

Client’s Experiences Using a Location-Based Technology ICT System during Gambling Treatments’ Crucial Components: A Qualitative Study

“…The first promising technology was virtual reality (VR), which emerged as a viable and effective tool for psychological disorders, reporting efficacy in the treatment of GD and the ERP component [ 27 , 28 , 29 , 30 ]. Furthermore, media development has led to the use of the internet to deliver CBT, obtaining adequate results in randomized control trials (RCT) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. The efficacy of these self-guided treatments has been confirmed in many countries by scoping and systematic reviews or meta-analyses [ 14 , 40 , 41 , 42 , 43 ].…”