Psychological online interventions for problem gambling and gambling disorder – A meta-analytic approach

Augner, Christoph; Vlasak, Thomas; Aichhorn, Wolfgang; Barth, Alfred

doi:10.1016/j.jpsychires.2022.04.006

Cited by 14 publications

(19 citation statements)

References 49 publications

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“…Due to therapist involvement, Peli poikki has a wait-list period. Thus, it differs from nontherapist-guided online interventions, which are often used in research and for which a wait-list would not be needed (Augner et al, 2022).…”

Section: Methodsmentioning

confidence: 99%

“…Other studies without control groups have further shown that online interventions reduce gambling-related erroneous thoughts, alcohol consumption, and distress (Carlbring et al, 2012;Castrén et al, 2013;Rodda et al, 2018). Similarly, a recent meta-analysis (Augner et al, 2022) on online interventions for gambling disorder, and its less severe forms, found moderate beneficial effects, though only a minority of the studies included guided interventions. While unguided interventions appeared to be the trend, no differences were reported between the outcomes of guided and unguided interventions.…”

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confidence: 99%

“…One way to tackle the barriers to seeking help is offering treatment online. Internet-based therapies have gained popularity especially during the COVID-19 pandemic and they can be delivered with or without therapist contact (Augner et al, 2022). Their advantages include easy accessibility, flexibility, anonymity, and privacy, which help to increase treatment uptake in populations characterized by low-treatment rate and high attrition in traditional treatment settings (Sagoe et al, 2021; van der Maas et al, 2019).…”

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confidence: 99%

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Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

Palomäki¹,

Lind²,

Heiskanen³

et al. 2023

Psychology of Addictive Behaviors

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Objective: There are tens of millions of problem gamblers in the world, many of whom either do not seek treatment or fail to commit to it. Dropout rates are high, and not enough is known about factors predicting treatment adherence. We focus on an online cognitive behavioral therapy program for severe problem gambling to determine the likelihood of treatment discontinuation at three different treatment phases: pretreatment, before halfway, and before the end of the program. Method: Participants were Finnish adults (N = 1,139, 670 males, M age = 34.5) registered in the program between 2019 and 2021. Using logistic regression and five-fold crossvalidated naïve Bayes classification, we predicted discontinuation with demographic-, psychometric-, and other gambling-related variables, including the quality of one's social relations, time spent on the waiting list, and experienced readiness to behavioral change. Results: The models had acceptable predictive ability (area under the curve [AUC] values from .69 to .745; cross-validated balanced classification accuracy = 63.2%). In logistic regressions, treatment discontinuation was prominently associated with younger age ( p = .008), lower education ( p < .001), not being ready to change gambling behavior ( p < .001), problem gambling severity ( p < .0001), longer time spent on the treatment waiting list ( p < .0001), and fewer close social relationships ( p < .001). Conclusions: We found significant new real-world evidence on factors statistically predicting treatment discontinuation, which is crucial when existing programs are modified to better serve those in need. Public Health Significance StatementThis study found that long treatment wait-list periods, few good social relationships, and not being ready to change gambling behavior are highly significant predictors of online problem gambling treatment discontinuation. This knowledge is crucial when existing treatment programs are modified to better serve those in need.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

Palomäki¹,

Lind²,

Heiskanen³

et al. 2023

Psychology of Addictive Behaviors

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“…Moreover, group therapy could offer cost-saving benefits and could reach more people who spend limited time at a single location, such as military personnel attending a military base for mandatory training or a local VA centre for veterans’ healthcare support (Blevins et al, 2011 ). Similarly, technology has the additional benefit of reaching those more resistant to help-seeking, such as veterans (Augner et al, 2022 ; Hom et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review

Hitch

Leightley

Murphy

et al. 2023

European Journal of Psychotraumatology

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Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce. Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD. Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted. Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD. Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation. HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD). There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans. Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

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“…assessment only, waitlists) at post‐treatment, and that CBTs produce greater effects on gambling disorder symptom severity than on gambling behavior (e.g. frequency, intensity and duration) [1, 6, 7, 10, 11]. Nascent evidence suggests that the effect of CBTs may endure at follow‐up/in the months and years following treatment [7, 12].…”

Section: Introductionmentioning

confidence: 99%

Effect of cognitive‐behavioral techniques for problem gambling and gambling disorder: A systematic review and meta‐analysis

et al. 2023

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Aims: To measure the effect of cognitive-behavioral techniques (CBTs) on gambling disorder severity and gambling behavior at post-treatment and follow-up.Method: Seven databases and two clinical trial registries were searched to identify peerreviewed studies and unpublished studies of randomized controlled trials. The Cochrane Risk of Bias tool assessed risk of bias in the included studies. A random effect metaanalysis with robust variance estimation was conducted to measure the effect of CBTs relative to minimally treated or no treatment control groups. Results: Twenty-nine studies representing 3991 participants were identified. CBTs significantly reduced gambling disorder severity (g = −1.14, 95% CI = −1.68, −0.60, 95% prediction interval [PI] = −2.97, 0.69), gambling frequency (g = −0.54, 95% CI = −0.80, −0.27, 95% PI = −1.48, 0.40) and gambling intensity (g = −0.32, 95% CI = −0.51, −0.13, 95% PI = −0.76, 0.12) at post-treatment relative to control. CBTs had no significant effect on follow-up outcomes. Analyses supported the presence of publication bias and high heterogeneity in effect size estimates. Conclusions: Cognitive-behavioral techniques are a promising treatment for reducing gambling disorder and gambling behavior; however, the effect of cognitive-behavioral techniques on gambling disorder severity and gambling frequency and intensity at posttreatment is overestimated, and cognitive-behavioral techniques may not be reliably efficacious for all individuals seeking treatment for problem gambling and gambling disorder.

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Psychological online interventions for problem gambling and gambling disorder – A meta-analytic approach

Cited by 14 publications

References 49 publications

Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

Predicting online problem gambling treatment discontinuation: New evidence from cross-validated models.

Acceptance and commitment therapy for co-occurring gambling disorder and posttraumatic stress disorder in veterans: a narrative review

Effect of cognitive‐behavioral techniques for problem gambling and gambling disorder: A systematic review and meta‐analysis

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