Effectiveness of problem gambling interventions in a service setting: A pragmatic randomised clinical trial

INTERVENTION: This project is a single blind pragmatic randomised clinical trial (RCT) of two psychological interventions for problem gambling, with and without the addition of text‐message support. The interventions comprise: Face‐to‐face Cognitive Behavioural Therapy (CBT), using a balanced and flexible application of cognitive restructuring and graded imaginal and live cue‐exposure. Participants will receive up to ten face‐to‐face CBT sessions over a 12 week period. The approximate duration of each CBT session will be 60 to 90 minutes. The therapy incorporates imaginal and real‐life cue‐exposure to gambling triggers and habituation/urge extinction. It also includes interventions directed towards understanding randomness and erroneous beliefs, awareness of inaccurate perceptions, and cognitive correction to erroneous perceptions. Regular homework sessions will also take place, focusing both on behavioural and cognitive goals, and recorded in diaries. This will be discussed in face‐to‐face sessions and progress reinforced. Face‐to‐face Motivational Interviewing (MI) plus a cognitive behavioural self‐instructional workbook (W) and follow‐up telephone booster sessions (B). Participants will receive one face‐to‐face motivational interview session structured to encourage clients to build a commitment to change by emphasising the reasons why change is desirable. The approximate duration of The MI session will be 60 to 90 minutes. Interviews end with a summary of participants’ stated reasons for changing and specific therapeutic goals. Participants will be given a self‐help workbook based on a cognitive–behavioral model of problem gambling and relapse prevention techniques. The content of the workbook includes the following sections: Self‐assessment, goal setting, strategies, maintenance and other resources for additional support. In addition, they will receive five follow‐up motivational booster telephone sessions of 10‐15 minutes duration at approximately one, two, four, eight and 12 weeks. These sessions will focus on motivation of, and reinforcement for, behaviour change through the use of the workbook. The CBT and MI interventions will be delivered by specialised problem gambling counselors at a problem gambling service. CONDITION: Gambling addiction Gambling behaviour Problem gambling SECONDARY OUTCOME: Alcohol use (AUDIT) Drug Abuse Screening Test (DAST) General psychological distress: The Kessler 10 (K10) questionnaire Quality of life as assessed by the WHOQoL‐8. The Gambling Related Cognitions Scale (GRCS) The Gambling Urge Scale (GUS) The mood and alcohol modules of the Primary Care Evaluation of the Mental Disorders (PRIME‐MD) The nine‐item Problem Gambling Severity Index INCLUSION CRITERIA: Minimum age of 18 years Self‐perception of having a gambling problem Willing to read materials related to the study (to ensure reading ability), Willing to participate in counselling and other treatment components (including owning a mobile phone with ability to receive text messages), Willing to have counselling sessions recorded, and provide follow‐up data on gambling. Half of the participants in the MI condition and half in the CBT condition will also be allocated to receive weekly text messages (an average of two a week) from the 12 week assessment until the 12 month assessment. Message content will be influenced by messaging that has been effective in alcohol and smoking reduction/cessation programmes and the growing literature on mobile health. The messages will be designed to sustain therapeutic gains and facilitate ongoing behaviour change including relapse prevention and recovery. Messages will be tailored to be consistent with each of the two treatment approaches. MI participants will receive messages that encourage self‐reflection on treatment goals and workbook use. CBT participants will receive encouragement for using cognitive and behavioural strategies. PRIMARY OUTCOME: Self‐reported average amount of money lost per day gambling in the previous month (Money lost). A timeline follow‐back interview will be conducted to capture the amount of money lost on each gambling occasion during the follow up period. Pre‐treatment scores will be calculated, averaged over the two months prior to entry. Post‐treatment scores will be calculated for the month following entry into the trial, in the period from one to three months and in the interval from three to 12 months. The corresponding averages at three and 12 months will be used in most analyses with weights proportional to the number of measures thus averaged. Self‐reported number of days spent gambling in the previous month (Days gambled). A timeline follow‐back interview will be conducted to capture the number of days gambling during the follow‐up period. Pre‐treatment scores will be calculated, averaged over the two months prior to entry. Post‐treatment scores will be calculated for the month following entry into the trial, in the period from one to three months and in the interval from three to 12 months. The corresponding averages at three and 12 months will be used in most analyses with weights proportional to the number of measures thus averaged.