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31-05-2012 | Psychology | Article

Gambling addicts could seek internet help


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MedWire News: An internet-based cognitive behavioral therapy (ICBT) intervention can effectively reduce gambling behavior and improve the life quality of pathologic gamblers even if they are depressed, a study shows.

Per Calbring (Umeå University, Sweden) and colleagues found that ICBT resulted in statistically significant reductions in pathologic gambling, anxiety, and depression, and that the quality of life of pathologic gamblers significantly improved after the intervention.

For their study, reported in Cognitive Behaviour Therapy, Calbring et al investigated the predictors for a successful outcome following ICBT in pathologic gamblers using eight variables collected during screening. These were work-life satisfaction, primary gambling activity, debts due to gambling, social support, personal yearly salary, alcohol consumption, readiness to develop a new, healthier behavior, and dissociative gambling.

The ICBT intervention was completed by 284 participants (mean age 32.2 years, 81% male) who fulfilled the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) criteria for pathologic gambling according to the 1-month version of National Opinion Research Center DSM-IV Screen for gambling problems (NODS). All participants lived in Sweden and had gambled at least once in the past 30 days.

The ICBT intervention was an eight-chapter ebook consisting of modules that included information, exercises, and eight essay-style questions. Participants were required to complete these exercises and post at least one message in an online discussion group about a predetermined topic for each module.

Once a week, 15-minute telephone calls were made to each participant by four social workers with training in motivational interviewing and CBT to provide positive feedback and encouragement, as well as to answer any questions regarding the modules.

The results showed statistically significant improvements for the whole cohort in gambling (according to NODS score), anxiety, depression (both according to Hospital Anxiety Depression Scale [HADS]), and overall life satisfaction (Quality of Life Inventory [QOLI]) from pre- to postintervention.

Indeed, the mean NODS gambling score decreased from 8.1 before the intervention to 1.8 after the intervention, anxiety HADS score decreased from 11.0 to 7.2, depression HADS score decreased from 9.3 to 5.5, and life satisfaction QOLI score increased from 0.3 to 1.3. Significant improvements in all four domains persisted at the 6, 18, and 36-month follow ups.

The changes in pre- to postintervention scores for gambling and anxiety were similar in participants with severe depression (Montgomery-Asberg Depression Rating Scale [MADRS] score ≥21) and those with less-severe depression.

The authors also found that using the eight-predictor variable model rendered an "acceptable predictive ability" to identify ICBT intervention responders at postintervention and at the 36-month follow-up period, at area under the curve scores of 0.72 and 0.70, respectively.

This type of model would enable clinicians to identify which gamblers are likely to benefit from the intervention, and which would need a more intensive intervention, the authors explain.

"The results from this study generally provide evidence for the continued use and development of guided internet-delivered self-help with telephone support for pathologic gamblers," say Calbring et al.

"However, the results need to be replicated to ensure that [they are] not only sample-specific associations," they conclude.

By Piriya Mahendra

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