Boffo Marilisa, Willemen Ronny, Pronk Thomas, Wiers Reinout W, Dom Geert
Addiction Development and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands.
Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Wilrijk, Belgium.
Trials. 2017 Oct 3;18(1):452. doi: 10.1186/s13063-017-2190-2.
Disordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.
METHODS/DESIGN: Participants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.
This study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.
Netherlands Trial Register, NTR5096 . Registered on 11 March 2015.
问题赌徒在表型和病理方面与物质使用障碍（SUD）患者存在相似之处，包括对环境中具有动机显著性的赌博线索进行过度的自动认知加工（即注意力和趋近偏向）。认知偏差矫正（CBM）是一系列计算机化干预措施，已被证明能有效重新训练SUD患者的这些自动认知偏差。原则上，CBM干预可以在线实施，因此显示出作为传统治疗低成本、低门槛补充手段的潜力。本文介绍了一项试点随机对照试验的设计，该试验旨在探索两种基于网络的CBM干预措施对荷兰和比利时问题及病态赌徒样本中针对赌博线索的注意力和趋近偏向的有效性。
方法/设计：参与者（N = 182）是通过社区招募的有赌博问题的成年人，他们在过去6个月内至少赌博两次，并有改变赌博行为的动机。在基线评估阶段后，参与者被随机分配到四个实验条件之一（注意力或趋近偏向训练，或两种训练的安慰剂版本），并完成六个训练单元。在基线和每个训练单元之前，参与者会收到关于其赌博动机以及戒除或减少赌博原因的自动个性化反馈。干预后、1个月和3个月的随访评估将检查赌博行为的变化，以频率和支出作为主要结果，抑郁症状以及与赌博相关的注意力和趋近偏向作为次要结果。二级分析将探索训练效果对主要结果的可能调节因素（干扰控制能力和特质冲动性）和中介因素（认知偏差的变化）。
本研究首次探索了针对赌博问题的在线CBM干预的有效性。本研究结果对于开发针对赌博问题的电子健康干预措施以及进一步理解问题赌博行为背后动机性内隐认知过程的作用可能极具价值。
荷兰试验注册库，NTR5096。于2015年3月11日注册。
