A systematic review and meta-analysis «Sagoe D, Griffiths MD, Erevik EK ym. Internet-base...»1 included 13 studies in their analysis, where nine studies had a control condition whereas four had no control condition (e.g., two active treatments). In two of the studies, participants fulfilled criteria for pathological gambling based on the DSM-IV. In ten studies participants scored above a cut-off score on a relevant diagnostic problem gambling instrument, or the group had an elevated mean score on the PGSI or the SOGS. Finally, in one study, participants were self-referred.
The 13 included studies comprised a total of 22 interventions. Of these, 13 were based on CBT, of which four included feedback/support from a therapist. In one study, CBT was combined with interventions targeting unhealthy alcohol use and mental distress, respectively. Seven CBT based interventions did not provide therapist assistance or any additional treatment components. Two interventions were based on personalized normative feedback, and one was based on monitoring, feedback, and support. One intervention was based on one session of brief advice. Additionally, one intervention was based on an eclectic approach encompassing elements from CBT, MI, and a solution-focused approach with therapist support. Two interventions comprised behavioral couple therapy, one consisted of simple advice via emails, and one was based on avoidance-learning related to gambling stimuli. The number of treatment sessions ranged from a single session to 28 sessions with a weighted mean of 9.9.
Random effects models at post-treatment showed significant effects for general gambling symptoms (g 5 0.73; 95% CI 5 0.43–1.03), gambling frequency (g 5 0.29; 95% CI 5 0.14–0.45), and amount of money lost gambling (g 5 0.19; 95% CI 5 0.11–0.27). The corresponding findings at follow-up were g 5 1.20 (95% CI 5 0.79–1.61), g 5 0.36 (95% CI 5 0.12–0.60), and g 5 0.20 (95% CI 5 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.
Review highlights that internet-based treatment has potential to reach a large proportion of persons with gambling problems. The authors suggest that such treatments are promising as being effective approach yet examining moderators of treatment outcomes and cross-cultural treatment effects should be done in the future.
Comments:
Peli poikki -program, which is an 8-week CBT-based online intervention for problem gamblers was evaluated in two studies. First study explored 12 years (2007-2018) of real-world data from an online intervention for gambling problems and aim to find out the extent to which depression, alcohol use, and sense of financial control influence the effectiveness of the program. «Palomäki J, Heiskanen M, Castrén S. Online 8-week ...»2 Treatment effectiveness and moderators were analysed (N=5 2011, 66.9% males). The self-reported level of problem gambling, depression, alcohol use, and sense of financial control across four treatment phases (baseline, post-treatment, 6-month follow-up, and 12-month follow-up), as well as the presence of gambling debt, psychological and physiological health, years suffered from gambling problems, and demographic variables were measured. The Peli Poikki-program is a well-functioning online intervention but less effective in the long term for participants with persisting symptoms of depression or without a sense of financial control.
In a second study investigated the likelihood of treatment discontinuation at three different treatment phases: pretreatment, before halfway, and before the end of the program. «Palomäki J, Lind K, Heiskanen M ym. Predicting onl...»3 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).