Bücker Lara, Westermann Stefan, Kühn Simone, Moritz Steffen
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Psychology, UC Berkeley, 2121 Berkeley Way West, 94720, Berkeley, CA, USA.
Trials. 2019 Jan 23;20(1):74. doi: 10.1186/s13063-019-3176-z.
Only a small fraction of individuals with pathological or problematic gambling seek professional help despite available evidence-based treatments such as cognitive behavioral therapy (CBT). Anonymous Internet-based interventions may help to overcome treatment barriers. Results of a pilot study using an Internet-based intervention for depression in a sample of individuals with problematic or pathological gambling behavior show that both depressive and gambling-related symptomatology can be reduced with a generic depression program compared with a wait-list control group. Based on encouraging results of the pilot study, we developed a low-threshold, anonymous and cost-free online self-help program ("Restart") to test whether a program tailored to the needs of gamblers yields better results compared to the effects of the intervention evaluated in the pilot study. The online self-help program is based on CBT, targeting emotional problems and gambling-related symptoms and is accompanied by a smartphone application to sustain treatment benefits.
A randomized controlled trial with two conditions (intervention group and wait-list control group), two assessment times (reassessment after 8 weeks) and a total of 136 participants is planned. The primary outcome will be change in pathological gambling measured with the Pathological Gambling Adaptation of Yale-Brown Obsessive-Compulsive Scale from pre to post intervention. The change in depressive symptoms (assessed with the Patient Health Questionnaire - 9 depression module) and gambling-related dysfunctional thoughts (assessed with the Gambling Attitudes and Beliefs Survey) will represent secondary outcomes. The intervention includes modules on debt management, impulse control, gambling-specific cognitive biases, self-esteem, social competence, sleep hygiene, mindfulness and positive activities.
This study is one of the first investigations of Internet-based self-help programs in a sample of problematic gamblers. Self-guided Internet-based interventions represent a promising possibility to narrow the existing treatment gap while saving expensive and scarce resources (e.g., psychotherapists). The expected findings will add substantial knowledge in the development of effective Internet-based treatments for individuals with gambling problems. The empirical and clinical implications (e.g., broader use and promotion of such interventions in the future) and the limitations of the study will be discussed.
ClinicalTrials.gov, NCT03372226 . Registered on 13 December 2017.
尽管有诸如认知行为疗法（CBT）等循证治疗方法，但只有一小部分患有病理性或问题性赌博症的人寻求专业帮助。基于互联网的匿名干预措施可能有助于克服治疗障碍。一项针对有问题或病理性赌博行为的个体样本进行的基于互联网的抑郁症干预试点研究结果表明，与等待名单对照组相比，通用的抑郁症治疗方案可以减轻抑郁症状和与赌博相关的症状。基于试点研究的鼓舞人心的结果，我们开发了一个低门槛、匿名且免费的在线自助项目（“重启”），以测试一个针对赌徒需求量身定制的项目与试点研究中评估的干预效果相比是否能产生更好的结果。该在线自助项目基于认知行为疗法，针对情绪问题和与赌博相关的症状，并配有一款智能手机应用程序以维持治疗效果。
计划进行一项随机对照试验，设置两个条件（干预组和等待名单对照组）、两个评估时间点（8周后重新评估），共有136名参与者。主要结局指标将是使用耶鲁 - 布朗强迫量表病理性赌博适应版从干预前到干预后病理性赌博的变化。抑郁症状的变化（用患者健康问卷 - 9抑郁模块评估）和与赌博相关的功能失调性思维（用赌博态度和信念调查评估）将作为次要结局指标。干预包括债务管理、冲动控制、特定于赌博的认知偏差、自尊、社交能力、睡眠卫生、正念和积极活动等模块。
本研究是对有问题赌徒样本中基于互联网的自助项目的首批调查之一。基于互联网的自我引导干预是缩小现有治疗差距同时节省昂贵且稀缺资源（如心理治疗师）的一种有前景的可能性。预期的研究结果将为开发针对有赌博问题个体的有效基于互联网的治疗方法增添大量知识。将讨论实证和临床意义（如未来对此类干预措施的更广泛使用和推广）以及研究的局限性。
ClinicalTrials.gov，NCT03372226。于2017年12月13日注册。
