Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial

Abstract

Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to-treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help.

Trial registration: Clinicaltrials.gov as NCT04074681. Registered 22 July 2019.

Keywords: A, Action; C, Contemplation; CBT; CBT, Cognitive Behavioral Therapy; CIDI, Composite International Diagnostic Interview; CONSORT-EHEALTH, Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth; DERS, Difficulties in Emotion Regulation Scale; DGOJ, Directorate General for the Regulation of Gambling; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EDBs, Emotion Driven Behaviours; EMA, Ecological Momentary Assessment; EMI, Ecological Momentary Intervention; Efficacy; Emotion regulation; G-SAS, The Gambling Symptom Assessment Scale; GD, Gambling Disorder; GE, Gambling Expectancies; GI, Gambling history interview and current gambling situation and related variables assessment; GRCS-S, Gambling-Related Cognitions Scale; GSEQ, Gambling Self-Efficacy Questionnaire; Gambling; HADS, Hospital Anxiety Depression Scale; IB, Interpretative Bias; IC, Illusion of Control; ICD-10, International Statistical Classification of Diseases and Related Health Problems 10th Revision; ISG, Perceived Inability to Stop Gambling; Internet; M, Maintenance; MFS, Monitoring, Feedback and Support; MI, Motivational Interviewing; MINI, Mini International Neuropsychiatric Interview; NA, Negative Affect; NODS, NORC DSM-IV Screen for Gambling Problems; OASIS, The Overall Anxiety Severity and Impairment Scale; ODSIS, The Overall Depression Severity and Impairment Scale; P, Precontemplation; PA, Positive Affect; PANAS, The Positive and Negative Affect Schedule; PC, Predictive Control; PFIs, Personal Feedback Interventions; QLI, Quality Life Index; RCT, Randomized Controlled Trial; SCID-P, The Structured Clinical Interview; SPIRIT, Standard Protocol Items Recommendations for Interventional Trials; SUS, System Usability Scale; UPPS-P, The Short UPPS-P Impulsivity Scale; URICA, The University of Rhode Island Change Assessment Scale; WL, Waiting List.