Improved Outcomes Following a Single Session Web-Based Intervention for Problem Gambling

The role of contextual factors in avenues to recover from gambling disorder: a scoping review

Introduction

Recovery from complex conditions such as gambling disorders (GD) often entail considerable change and require a range of adaptable interventions in the health care system. Outcomes from such avenues to change are influenced by multifarious contextual factors, which are less frequently considered in treatment outcome studies. Accordingly, this scoping review aims to map the level of evidence and explore how contextual factors influence the provision and outcomes of GD interventions.

Methods

A systematic search in selected health and social science research databases yielded a total of 2.464 unique references. The results were screened in three selection steps-titles (n = 2.464), abstracts (n = 284) and full-text (n = 104). The scoping approach was applied to provide a narrative account of the final included references (n = 34).

Results and discussion

Findings suggest that the research on GD treatment is in the early stages of development. Additionally, studies on GD interventions are characterized by cultural biases (Region and ethnicity and Gender perspectives), while three key elements are described as successful avenues to recover from GD (Competence, Perception and Utilization). In line with these findings, proposals for future research and treatment designs are made.

Provider perceptions of the anticipated benefits, barriers, and facilitators associated with implementing a stepped care model for the delivery of addiction and mental health services in New Brunswick: a mixed-methods observational implementation study

BACKGROUND

Providers who work within addiction and mental health (A&MH) services in New Brunswick (NB), Canada completed training in Stepped Care 2.0 and One-at-a-Time (OAAT) therapy as part of a provincial practice change initiative to implement a provincial stepped care model. The present study aimed to identify: (1) the perceived acceptability and feasibility of the SC2.0 model; (2) the perceived benefits, barriers, and facilitators to implement SC2.0 in practice; and (3) perceived impacts on clinical practice.

METHODS

This is a mixed-methods observational implementation study. Quantitative surveys were completed after training courses. Open-ended responses were collected after completion of SC2.0 training. A subset of providers who completed surveys were asked to participate in semi-structured interviews. Descriptive statistics were used to describe results from surveys. Open-ended responses and semi-structured interviews were compiled and thematically synthesized in an iterative process using a grounded theory framework. Quantitative and qualitative data were triangulated to build an in-depth understanding of provider perceptions.

RESULTS

316 providers completed surveys and responded to open-ended prompts. Interviews were completed with 28 of those providers. SC2.0 was deemed to be acceptable, a suitable fit, and feasible to implement. Perceived benefits included: (1) timely access to services; (2) increased practice efficiency; and (3) increased availability of services. Perceived barriers included: (1) insufficient availability of resources to populate a SC2.0 continuum of care; (2) provider complacency with their current practice; and (3) difficulty for clients to accept and adjust to change.

CONCLUSIONS

Identifying the perceived benefits, facilitators, and barriers to adopting stepped care in practice can lead to targeted implementation strategies and the collection of data that can inform continuous improvement cycles.

Virtual self-conversation using motivational interviewing techniques to promote healthy eating and physical activity: A usability study

Introduction

We aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO).

Methods

Fourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0.

Results

Participants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO.

Conclusion

The ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

Clinical efficacy of a virtual reality tool for the treatment of obesity: study protocol of a randomised controlled trial

INTRODUCTION

Previous research has shown that it is feasible to integrate motivational interviewing techniques with behavioural and psychological interventions for the treatment of obesity. Moreover, these combined interventions have the potential to improve health-related outcomes of people living with obesity (PLWO) and to afford maintenance of behavioural changes over time. In addition, the use of virtual reality (VR) embodiment techniques in the treatment of eating disorders and obesity has promising preliminary effectiveness. The objective of this study is to assess the clinical efficacy of a VR intervention that uses embodiment and body-swapping techniques and has been specifically developed to cover the needs of PLWO.

METHODS AND ANALYSIS

A randomised control trial will be carried out with an estimated sample of 96 participants with body mass index (BMI)>30. The whole duration of the trial will be 12 months. Participants will be recruited from the external consultations of the Vall d'Hebron University Hospital and be randomly assigned to three groups. The experimental group 1 will engage in a virtual self-conversation using the ConVRself platform, the experimental group 2 will participate in a 'pre-established discourse' provided by the virtual counsellor, who will give psychoeducation advice, and the control group will continue with treatment as usual. Readiness to change, BMI, eating habits and physical activity, psychological well-being, body image satisfaction, quality of life in relation to body image, and weight bias internalisation will be assessed at baseline, post intervention, 1-week and 4-week follow-up. Finally, variables related to adherence and satisfaction with the VR tool will be evaluated for the experimental groups.

ETHICS AND DISSEMINATION

This study was approved by the Research Projects Committee of the Vall d'Hebron University Hospital. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences and other events for the scientific and clinical community, and the general public.

TRIAL REGISTRATION NUMBER

NCT05094557.

Emerging Gambling Problems and Suggested Interventions: A Systematic Review of Empirical Research

The goal of the present systematic review is to identify emerging gambling problems and the harm minimization strategies proposed to address them. Our interdisciplinary research team conducted this systematic literature review in 5 nations between which there is significant gambling research exchange. A keyword search of the Scopus and Web of Science databases followed by filtering using inclusion criteria identified 1292 empirical gambling studies from peer-reviewed journals. The data obtained from the articles were analyzed using the content analysis technique. We then used a unique approach to identify relationships between harm minimization strategies and gambling problems. The findings reveal that the most frequently reported gambling problems are related to young gamblers, online gambling, electronic gaming machines, and children and adolescents (underage gamblers). Harm minimization strategies to address these included creating educational and awareness programs, further restrictions on gambling advertising, developing an intervention mechanism for online gambling, and remote gambling-related help (i.e., online counseling, online treatment).

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic

BACKGROUND

Cognitive behavioral therapy-pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas.

OBJECTIVE

The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment.

METHODS

We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%).

RESULTS

Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness.

CONCLUSIONS

Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685.

Comparative efficacy of a single-session "Empowered Relief" videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial

BACKGROUND

Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain.

METHODS

Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment.

DISCUSSION

This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04546685 . Registered on 04 September 2020.

Characteristics of Gamblers Who Use the French National Problem Gambling Helpline and Real-Time Chat Facility: Longitudinal Observational Study

Background

Problem gambling is a growing public health issue that is characterized by low rates of face-to-face help seeking. Helplines and real-time chat services could reduce shortfalls in treatment.

Objective

This study aimed to (1) describe the characteristics of gamblers contacting a government-funded help service, (2) study the evolution of their characteristics over time, (3) evaluate the differences between subgroups (ie, gender, media used for gambling, and media used to contact the service), and (4) explore factors influencing referral to care.

Methods

From January 2011 to December 2015, a government-funded gambling helpline and real-time chat website in France received 9474 contacts from gamblers. Counselors filled in a form for each contact, collecting demographics, gambling characteristics, and referrals. Time-series analyses were performed. Univariate logistic models were used to assess differences across subgroups. A multivariate analysis was conducted to determine the variables related to an actual referral.

Results

Gamblers were predominantly men (7017/9474, 74.07%); the average age was 41 years (SD 14). Compared with the men, the women were older (mean 50.7 years, SD 14.0 vs mean 37.9 years, SD 13.0, respectively; P<.001), were more often solely offline gamblers (1922/2457, 78.23% vs 4386/7017, 62.51%, respectively; P<.001), and had different gambling patterns. Compared with helpline contacts, real-time chat contacts were more often men (124/150, 82.7% vs 3643/4881, 74.64%, respectively; P=.04), younger (mean 32.8 years, SD 12.9 vs mean 41.3 years, SD 14.3, respectively; P<.001), more often poker gamblers (41/150, 27.3% vs 592/4881, 12.13%, respectively; P<.001), and more often web-based gamblers (83/150, 55.3% vs 1462/4881, 29.95%, respectively; P<.001). Referral was positively associated with betting (adjusted odds ratio [aOR] 1.46, 95% CI 1.27-1.67; P<.001), casino gambling (aOR 1.38, 95% CI 1.21-1.57; P<.001), scratch cards (aOR 1.83, 95% CI 1.58-2.12; P<.001), poker gambling (aOR 1.35, 95% CI 1.14-1.61; P<.001), lottery (aOR 1.27, 95% CI 1.03-1.56; P=.03), weekly gambling (aOR 1.73, 95% CI 1.40-2.15; P<.001), request for referral (aOR 17.76, 95% CI 14.92-21.13; P<.001), and a history of suicide attempts (aOR 2.13, 95% CI 1.51-3.02; P<.001), and it was negatively associated with web-based gambling (aOR 0.86, 95% CI 0.75-0.98; P=.030) and refusal to be referred (aOR 0.35, 95% CI 0.26-0.49; P<.001).

Conclusions

The governmental helpline and chat contacts included a broad range of sociodemographic profiles. Compared with the helpline, real-time chat exchanges reached a younger population of web-based gamblers, which was the target population. The development of the gambling helpline and help online website is a considerable challenge for the future.

Internet-Based Interventions for Problem Gambling: Scoping Review

BACKGROUND

This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face-to-face treatment. Making treatment resources for problem gambling available through the internet is one way to reduce the impact of those systemic barriers. The use of internet-based resources to address problem gambling has been growing, and a field of research evaluating it has developed as well. However, little has been done to summarize this collection of research.

OBJECTIVE

This study aimed to provide a scoping review of the use of internet-based interventions for problem gambling treatment and prevention to provide an understanding of the current state of the field.

METHODS

A scoping review was performed for 6 peer-reviewed research databases (Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Social Science Abstracts, and Scopus) and 3 gray literature databases (MedEdPortal, Proquest: Dissertations, and OpenGrey). Article inclusion criteria were as follows: published over the 10-year period of 2007 to 2017, including an intervention for problem gambling, and involving the use of internet to deliver that intervention.

RESULTS

A total of 27 articles were found that met the review criteria. Studies were found from several different areas, with particularly strong representation for Australia, New Zealand, and Scandinavia. Cognitive behavioral therapy was the most common form of internet-based intervention. Internet-based interventions were generally shown to be effective in reducing problem gambling scores and gambling behaviors. A wide range of interventions that made use of internet resources included text-based interactions with counselors and peers, automated personalized and normative feedback on gambling behaviors, and interactive cognitive behavioral therapies. A lack of diversity in samples, little comparison with face-to-face interventions, and issues of changes in the treatment dynamic are identified as areas that require further investigation.

CONCLUSIONS

Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help. The state of the current literature is sparse, and more research is needed for directly comparing internet-based interventions and their traditional counterparts.

Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions

Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.