Internet-Based Treatment of Pathological Gambling with a Three-Year Follow-Up

Abstract

Effective therapies for pathological gambling exist, but their use is limited to about 10% of the target population. In an attempt to lower the barriers for help, Internet-based cognitive behavioural therapy (ICBT) has been shown to be effective when delivered to anon-depressed sample with pathological gambling. This study sought to extend this finding to a larger, more representative population, and also test a model to predict responder status. Following advertisement, a total of 284 participants started an 8-week ICBT programme with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. The average time spent on each participant, including telephone conversations, e-mail, and administration, was 4 h. In addition to a mixed effects model to evaluate the effectiveness of the treatment, two logistic regression analyses were performed with the following eight pre-defined response predictor variables: work-life satisfaction, primary gambling activity, debts due to gambling, social support, personal yearly salary, alcohol consumption, stage of change, and dissociative gambling. ICBT resulted in statistically significant reductions in the scores of pathological gambling, anxiety, and depression as well as an increase in quality of life compared to pre-treatment levels. Follow-ups carried out in the treatment group at 6, l8, and 36 months indicated that treatment effects were sustained. Using the eight predictor variable model rendered an acceptable predictive ability to identify responders both at post-test (AUC = .72, p < .01) and at 36-month follow-up (AUC = .70, p < .01). We conclude that ICBT for pathological gamblers, even if depressed, can be effective and that outcome can partly be predicted by pre-treatment characteristics.

The Feasibility of eHealth in Mental Health Care

“…eHealth services have been developed for the treatment of a variety of mental health problems [9][10][11][12][13][14][15][16][17][18][19][20] as well as for the purposes of mental health promotion and education [21][22][23]. One of the first eHealth applications applied in mental health care was OC-Check, which was developed in 1987 to assist OCD patients in larger reduction of OCD symptoms by reminding instructions and tracking intensity of the obsessions [10].…”

Internet-Based Interventions for Problem Gambling: Scoping Review (Preprint)

“…In addition to problem gambling improvement (based on problem gambling scores),these studies also found improvements in gambling behaviours, anxiety, and depression [9]. Significant improvements in problem gambling, gambling frequency [8] [11], faulty cognitions surrounding gambling [19], alcohol consumption, [11] and distress [19] [23] were also noted in pre-post intervention studies that did not include a control group. ,.…”

“…Specific gambling related harms scales included the Problem Gambling Severity Index (PGSI) [6] [12] [22] [16] [23], Gambling Attitudes Scale (GAS) [7], South Oakes Gambling Screen (SOGS) [20], SOGS-R [19], and SOGS-RA [7], National Opinion Research Center DSM Screen for Gambling Problems (NODS) [8] [9] [11], Problem Gambling Significant Other Impact Scale (PG-SOIS) [13] and the Diagnostic and Statistical Manual for Mental Disorders criteria for pathological gambling (DSM IV) [6]. Of these scales the PGSI and the NODS were the most popular.…”

“…By gathering minimal personal information when help seeking is initiated, it is possible to gain great insights as to who is accessing problem gambling help, the severity of their gambling problems, their treatment progression, and effectiveness of interventions being offered. For example, by analyzing the characteristics of study participants, Calbring et al [8] were able to provide a predictive model of the sociodemographic characteristics of individuals who benefited from CBT delivered over the Internet . The use of online data collection may also improve the completeness of data by reducing human error in the administration process [27] Internet based interventions may also be effective in targeting groups that are less well-served by traditional face-to-face gambling treatment programs.…”

“…For these studies participants accessed the Internet based inventions voluntarily and gave consent for their information to be used for research purposes. Media advertising was also used by several studies [6], [8], [9] and one study surveyed grade nine students from a single high school in Italy [7].…”