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Treatment online? Does it work for problemgamblers?Thomas Nilsson, C. PsychologistEmail: thomas@silabs.se
Talk aboutOnline self help programs for problemgamblers – past present and futureHow does it work?Does it work?If online s...
What I likeAccessibleEasy to useIt is something in betweenprevention, self help and treatmentIt reduces barriers to treatm...
It already started back in2000We where working on developing thenational help line for problemgamblers in Sweden.We wrote ...
Our work is inspired by:             •  Theories on dependencies – gambling, alcohol, drugs…             •  Bandura, Jacob...
For the patient:                   •  Read and do exercises described in the module                   •  Provide answers t...
Modules 1- 4 lead to a decision:                              Stop all together or cut down?                             M...
•  NODS                     •  MADRS-S                     •  HADS-anxiety/-depression                     •  QOLI        ...
Gambling background                              Consequences                                  - economic, relations, heal...
Module 1                              Module 2Texts about:                          Last three gambling situations:   • Ho...
Module 3                             Module 4Ask a family member or a dear        About:friend:                           ...
Module 5                             Module 6• Alternative activities             • Make a plan to avoid relapse• Common n...
Module 7                                Module 8• Listing your debts                    • Reward yourself for job well don...
•  Listen, respect and follow each                                   individual                                •  Show emp...
•    NODS                               •    HADS                               •    Quality of Life Inventory            ...
What at do they thinkabout the program?• Talk to the therapist• The content was spot on• Anonymous• Internet is everywhere...
Problem games       Participants  • VLT               • Mean age: 33.2  • Internet poker    • Male: 81 %                  ...
Screening                                             n=464                                Excluded                       ...
Measure      Mest    SDest     dest        NODS        Pre          8.16    2.48        Post         2.09    2.78      2.3...
Success?Out of the 196 clients 77(40 %) was regarded assuccessful. They meetfollowing criteria on the36 month follow up:  ...
ReferencesCarlbring, P., Smit, F. (2008). Randomized Trail ofInternet-Delivered Self-Help With TelephoneSupport for pathol...
Gambling – the future isalready hereAccessibleDigitalInnovativeInteractiveGlobal
Responsible gambling isevolvingPlayer educationLinks to treatment/forumsVoluntary/obligatorySetting limitsSelf testSelf ex...
In the future?Online (treatment) programs –             therapist             no therapistForums – large online communitie...
Support online- whats next?Our (SI) next step is to test (during2013) an self help program onlineusing the knowledge, expe...
Brand new!This is version 1.0 of our totally interactive self help program forproblem gamblers. Launched January 2013 and ...
Wow! Looks simple?
Looks simple 2
Looks like this
What next?•  Online gambling is growing, so must online support•  Integration with gaming companies, direct links   from g...
For every complex problem there is an easy answer, and it is wrong.                                                     H....
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Thomas Nilsson's presentation on "Treatment Online. Does it Work for Problem Gamblers?" Part of a joint-presentation with Dr. Richard Wood. Presented at the New Horizons in Responsible Gambling conference. January 28-30, 2013 in Vancouver, BC.

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Thomas Nilsson - Treatment Online, Does it work?

  1. 1. Treatment online? Does it work for problemgamblers?Thomas Nilsson, C. PsychologistEmail: thomas@silabs.se
  2. 2. Talk aboutOnline self help programs for problemgamblers – past present and futureHow does it work?Does it work?If online self help programs/treatmentprograms is the future, what will theylook like?
  3. 3. What I likeAccessibleEasy to useIt is something in betweenprevention, self help and treatmentIt reduces barriers to treatmentWe meet a new group of PGYou can try and tryYou can follow your own progressCoast are low
  4. 4. It already started back in2000We where working on developing thenational help line for problemgamblers in Sweden.We wrote a self help book forproblem gamblers 2000 to 2002.Then we meet professor Per Carlbring(www.carlbring.se) who is an worldleader in treatment online and madethe book into a online self helpprogram with CBT therapeuticsupport.We got financial support from TheSwedish National Public HealthInstitute.Then we started 2004!
  5. 5. Our work is inspired by: •  Theories on dependencies – gambling, alcohol, drugs… •  Bandura, Jacobs, Hodgins, Ladoucuer, Heaster & Miller… •  CBT in general and for depression and anxiety in particular •  Work and theories around motivational interviewing (MI) •  Clinical experience •  What works! The self help online program is inspired from: •  Becoming A Winner: Defeating problem Gambling a gambling self-help manual. Hodgins and Makarchuk Gambling research project, University of Calgary and Addiction Centre- Calgary Regional Health Authority •  The self help manual is evaluated by professor, Per Carlbring, Clinical psychology, University of Umeå, Sweden, hisBackground colleagues and students
  6. 6. For the patient: •  Read and do exercises described in the module •  Provide answers to essay questions via e-mail •  Post a comment on a bulletin board •  Talk to a CBT therapist on the phone for approximately 25 to 30 minutes/week For the therapist: •  Therapists judge if a patient is ready to go to the next module, and gives feedbackA typical week in the program
  7. 7. Modules 1- 4 lead to a decision: Stop all together or cut down? Modules 5 - 8 are the actual treatment: Information – e.g. luck, random Cognitive restructuring Risk situations – stopping impulses Sort out the economic situation Filling the void with meaningful activities Pace: One module per weekIn total eight (8) treatment modules
  8. 8. •  NODS •  MADRS-S •  HADS-anxiety/-depression •  QOLI •  Help seeking behaviour •  Social situation, education, work etc •  Us of alcohol and drugs •  Readiness to change questionnaire The screening is made via the •  Self reported gambling (like frequency, magnitude, computer online intensity, etc) •  Jacobs five questions (dissociation) •  And more (in total 99 questions)Screening and decision – yes or no
  9. 9. Gambling background Consequences - economic, relations, health… Function -positive/negative reinforcement in short/long term Present state - Why treatment now? - Actual gambling behaviour? - Expectations and goals? Gambling free periods - coping strategiesFirst telephone session with therapist
  10. 10. Module 1 Module 2Texts about: Last three gambling situations: • How an addiction develops • Triggers, thoughts, feelings before and after gambling • Characteristics for addictionsQuestions about: • Wins and losses last 30 days of • Values and life goals gambling • Costs per month and year • Positive and negative consequences from gambling • Why gambling
  11. 11. Module 3 Module 4Ask a family member or a dear About:friend: •  Acceptance and mindfulness- how has my gambling affected as a toolme? •  The importance of- how has my gambling affected acceptance for the lossesyou? •  Dreams of big wins• Advantages and disadvantageswith either continuing or stop The contract with yourself – stop /gambling control?• Make a decision whether you want Tell families and friends about yourto change gambling behaviour ornot gambling problem
  12. 12. Module 5 Module 6• Alternative activities • Make a plan to avoid relapse• Common negative thoughts • Ask family and friends for help• Miss consumptions about chance • Strategies for handling urgesand luck • Exercise can be an alternative• Erroneous beliefs about gambling
  13. 13. Module 7 Module 8• Listing your debts • Reward yourself for job well done• Making a plan for paying • Laps and relapseback • A plan for change• Strategies to control your economic • Look back on goals and contract • More support?
  14. 14. •  Listen, respect and follow each individual •  Show empathy, normalize •  Reinforce, give hope, encourage •  Encourage self reinforcement •  Increase self confidence/self efficacy •  Encourage acceptance •  Reduce rumination- increase change of behaviour •  Share knowledgeKey words - telephone support
  15. 15. •  NODS •  HADS •  Quality of Life Inventory •  Self reported gambling •  Questions on how they experienced the treatment, contact with the therapist, etcFollow up – post, 6 months, 18 and 36 months
  16. 16. What at do they thinkabout the program?• Talk to the therapist• The content was spot on• Anonymous• Internet is everywhereanytime• Those with social phobia• There are no treatmentwhere they live• The forum• Working on there own (mostclients spend between 2-5hours/week) Client information
  17. 17. Problem games Participants • VLT • Mean age: 33.2 • Internet poker • Male: 81 % • Female: 19 % • Poker • Started playing regularly at 23.7 yrs • Trotting • Problematic gambling since 5.70 yrs • Casino Internet • Debts: M=1354 CADFrom the screening
  18. 18. Screening n=464 Excluded n = 148 Pre treatment data n=316 Never showed up n = 32 Started treatment n=284 M 1: n = 275 Post treatment data: n=219 M 2: n = 214 M 3: n = 186 6 month follow up data: n=197 M 4: n = 174 M 5: n = 158 18 month follow up data: n=181 M 6: n = 150 M 7: n = 147 36 month follow up data: n=196 M 8: n = 148 No M: n = 9Follow up - population
  19. 19. Measure Mest SDest dest NODS Pre 8.16 2.48 Post 2.09 2.78 2.31 6 2.16 2.95 2.21 18 2.25 3.07 2.13 36 2.04 2.98 2.24 HADS-A Pre 11.0 4.38 Post 7.25 4.85 0.81 6 6.56 5.11 0.93 18 6.29 5.33 0.97 36 6.35 5.24 0.96 HADS –D Pre 9.12 3.39 Post 5.53 4.36 0.86 6 4.87 4.60 0.99 18 4.89 4.79 0.97 36 5.05 4.74 0.94 QOLI Pre 0.30 1.72 Post 1.14 1.94 0.46 6 1.37 2.04 0.57 18 1.50 2.12 0.62 36 1.24 2.07 0.50Results – some screening instruments
  20. 20. Success?Out of the 196 clients 77(40 %) was regarded assuccessful. They meetfollowing criteria on the36 month follow up: • 0 points on NODS • no gambling the last month
  21. 21. ReferencesCarlbring, P., Smit, F. (2008). Randomized Trail ofInternet-Delivered Self-Help With TelephoneSupport for pathological Gamblers. Journal ofConsulting and Clinical PsychologyDegerman, N. (2010). Internetbaseradsjälvhjälpsbehandling i kombination medtelefonstöd vid spelmani - En effectiveness-studiepå kort och lång sikt samt prediktion avbehandlingsutfall, avhopp från behandling ochåterfall. Linköpings Universitet. Institutionen förbeteendevetenskap och lärande.Psykologprogrammet.Statens Folkhälsoinstitut. (2010). Internetbaseratsjälvhjälpsprogram för spelberoende. Slutrapport.Carlbring, P., Degerman, N., Jonsson, J., &Andersson, G. (2012). Internet-Based Treatment ofPathological Gambling with a Three-Year Follow-Up. Cognitive Behaviour Therapy. Link:http://dx.doi.org/10.1080/16506073.2012.689323Gainsbury, SM & Blaszczynski, A (2011) Asystematic review of Internet-based therapy for thetreatment of addictions, Clinical PsychologyReview, vol. 31, no. 3, pp. 490-498. ClinicalPsychology. Available at: www.elsevier.com/locate/issn/02727358Publishers version ofarticle available at http://dx.doi.org/10.1016/j.cpr.2010.11.007
  22. 22. Gambling – the future isalready hereAccessibleDigitalInnovativeInteractiveGlobal
  23. 23. Responsible gambling isevolvingPlayer educationLinks to treatment/forumsVoluntary/obligatorySetting limitsSelf testSelf exclusionBlock your selfBehavioural tracking systemsResearchObligatory player card?Proactive approach to PG?
  24. 24. In the future?Online (treatment) programs – therapist no therapistForums – large online communities.No secrets!Player card connected to both onlineand “live” gamblingGaming will be included in gambling– more sophisticated and “internetsmart” groupMore focus on the player and playerexperience - smarter information,more proactive support teams, moreinteractive and multi channelledinformation with the players
  25. 25. Support online- whats next?Our (SI) next step is to test (during2013) an self help program onlineusing the knowledge, experience andresearch we done so far.This is how we think:• Exclude live therapist and includetherapist role in the program• Develop screening and createindividual “playlists”• Motivation loop• Relapse button• Evaluation• Cooperate with large forums• Player education (version 2.0)
  26. 26. Brand new!This is version 1.0 of our totally interactive self help program forproblem gamblers. Launched January 2013 and research is in progress.
  27. 27. Wow! Looks simple?
  28. 28. Looks simple 2
  29. 29. Looks like this
  30. 30. What next?•  Online gambling is growing, so must online support•  Integration with gaming companies, direct links from games to support•  Integration of different online services•  Technology can not be un-invented and the Internet is impossible to fully control. But technology can and does offer some solutions
  31. 31. For every complex problem there is an easy answer, and it is wrong. H.L Mencken THANKS!

Thomas Nilsson's presentation on "Treatment Online. Does it Work for Problem Gamblers?" Part of a joint-presentation with Dr. Richard Wood. Presented at the New Horizons in Responsible Gambling conference. January 28-30, 2013 in Vancouver, BC.

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