Internet-based treatment of gambling problems: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background and aimsThe effect of internet-based psychological treatment for gambling problems has not been previously investigated by meta-analysis. The present study is therefore a quantitative synthesis of studies on the effects of internet-based treatment for gambling problems. Given that effects may vary according to the presence of therapist support and control conditions, it was presumed that subgroup analyses would elucidate such effects.MethodsA systematic search with no time constraints was conducted in PsycINFO, MEDLINE, Web of Science, and the Cochrane Library. Two authors independently extracted data using a predefined form, including study quality assessment based on the Cochrane risk of bias tool. Effect sizes were calculated using random-effects models. Heterogeneity was indexed by Cochran’s Q and the I2 statistics. Publication bias was investigated using trim and fill.ResultsThirteen studies were included in the analysis. Random effects models at post-treatment showed significant effects for general gambling symptoms (g = 0.73; 95% CI = 0.43–1.03), gambling frequency (g = 0.29; 95% CI = 0.14–0.45), and amount of money lost gambling (g = 0.19; 95% CI = 0.11–0.27). The corresponding findings at follow-up were g = 1.20 (95% CI = 0.79–1.61), g = 0.36 (95% CI = 0.12–0.60), and g = 0.20 (95% CI = 0.12–0.29) respectively. Subgroup analyses showed that for general gambling symptoms, studies with therapist support yield larger effects than studies without, both post-treatment and at follow-up. Additionally, on general gambling symptoms and gambling frequency, there were lower effect sizes for studies with a control group compared to studies without a control group at follow-up. Studies with higher baseline severity of gambling problems were associated with larger effect sizes at both posttreatment and follow-up than studies with more lenient inclusion criteria concerning gambling problems.Discussion and conclusionsInternet-based treatment has the potential to reach a large proportion of persons with gambling problems. Results of the meta-analysis suggest that such treatments hold promise as an effective approach. Future studies are encouraged to examine moderators of treatment outcomes, validate treatment effects cross-culturally, and investigate the effects of novel developments such as ecological momentary interventions.

Online 8-week cognitive therapy for problem gamblers: The moderating effects of depression symptoms and perceived financial control

“…Cohen’s d values for paired samples comparisons were 1.34 (baseline vs. post-treatment), 1.12 (baseline vs. 6-month follow-up), and 1.02 (baseline vs. 12-month follow-up). These effect sizes are slightly above or similar to the meta-analysis average effect (reported in Sagoe et al, 2021 ) at post-treatment (Hedge’s g = 0.729) and follow-up (Hedge’s g = 1.1), again suggesting strong effects – though the lack of a control group needs to be considered when interpreting the strength of the effect.…”

“…Cohen's d values for paired samples comparisons were 1.34 (baseline vs. post- treatment), 1.12 (baseline vs. 6-month follow-up), and 1.02 (baseline vs. 12-month follow-up). These effect sizes are slightly above or similar to the meta-analysis average effect (reported in Sagoe et al, 2021) at post-treatment (Hedge's g 5 0.729) and follow-up (Hedge's g 5 1.1), again suggesting strong effectsthough the lack of a control group needs to be considered when interpreting the strength of the effect. We also calculated a treatment effect variable by subtracting individuals' post-treatment NODS scores from their 12-month follow-up NODS scores and regressed it on participant-wise average raw MADRS scores (controlling for demographics).…”

“…For significance estimates, we used the lmerTest package ( Kuznetsova, Brockhoff, & Christensen, 2017 ), which applies Satterthwaite’s method for approximating the degrees of freedom and calculating P -values for LMMs. To allow comparison between our findings and those of a recent meta-analysis on online treatments for problem gambling ( Sagoe et al, 2021 ), we also calculated paired samples Cohen’s d values (with Hedge’s correction) of the treatment effect for (1) baseline vs. post-treatment, (2) baseline vs. 6-month follow-up, and (3) baseline vs. 12-month follow-up. Testing multiple interactions without a priori hypotheses inflates researcher degrees of freedom.…”

“…Remote interventions are demonstrably very effective and economical in improving both gambling problems and comorbid conditions ( Abbott et al, 2018 ; Canale et al, 2016 ; Castrén et al, 2013 ; Cunningham et al, 2019 ; Erevik et al, 2020 ; Hodgins, Cunningham, Murray, & Hagopian, 2019 ; Myrseth, Brunborg, Eidem, & Pallesen, 2013 ; Yakovenko & Hodgins, 2016 ) even when compared with traditional programs ( Goslar et al, 2017 ; Pallesen, Mitsem, Kvale, Johnsen, & Molde, 2005 ). However, as noted in a recent meta-analysis on the effectiveness of Internet-based treatments for problem gambling, the factors moderating successful treatment outcomes are not well-understood ( Sagoe et al, 2021 ). Learning more about these factors would help guide individuals to the right type of treatment, tailored to their specific needs to acknowledge the diversity in their conditions.…”

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

“…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 ].…”