A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial.

Chloe O Hawker,George J Youssef,Nicki A Dowling,Stephanie S Merkouris

doi:10.2196/25786

Abstract

BackgroundLow uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people’s everyday lives.ObjectiveThis study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app–delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems.MethodsThis study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention’s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings.ResultsA total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention’s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention’s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings.ConclusionsThe results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people’s everyday lives.

Highlights

BackgroundProblem gambling is characterized by persistent and recurrent difficulties in limiting time and/or money spent gambling, which impacts the individual, their friends and family, and the community [1]
2 of these apps have undergone initial testing [26,27], with the results supporting their utility for increasing therapeutic homework completion [26] and reducing problem gambling severity [27]. These findings demonstrate the promise of app-delivered gambling interventions, they deliver static content that does not embrace the full potential of apps for delivering dynamic interventions when and where people need them
The secondary aim of this study is to explore the intervention’s preliminary effectiveness, with the intervention hypothesized to (1) reduce real-time gambling craving intensity from immediately before to immediately after using the intervention and (2) reduce the preintervention levels of gambling symptom severity, gambling cravings, gambling frequency and expenditure, craving self-efficacy, and gambling self-efficacy at postintervention and 1-month follow-up evaluations

Summary

Introduction

Problem gambling is characterized by persistent and recurrent difficulties in limiting time and/or money spent gambling, which impacts the individual, their friends and family, and the community [1]. The harms associated with problem gambling are widespread, including financial difficulties, relationship conflict, emotional distress, health decrements, reduced productivity and job losses, and criminal activities [2]. Standardized prevalence rates estimate that 2.3% of the global population display past-year problem gambling. Australian rates estimate 0.4% to 0.6% for problem gambling, 1.9% to 3.7% for moderate-risk gambling, and 3% to 7.7% for low-risk gambling [3,4]. Problem gambling is a major public health issue with a burden of harm on par with depression and alcohol use disorders and almost twice that of substance use disorders, bipolar disorder, eating disorders, and schizophrenia combined [5]. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people’s everyday lives

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Conclusion