RESUMO
Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.
RESUMO
Evidence for approach bias tendencies to underly automatic behavioural impulses towards seeking out gambling activities in the presence of appetitive salient cues was first shown by Boffo et al. (2018) in a Dutch sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers demonstrated stronger approach tendencies towards gambling-related stimuli compared with neutral ones. Moreover, gambling approach bias was associated with past-month gambling behaviour and predictive of gambling activity persistence over time. The current study aimed to replicate these findings within a Canadian sample evaluating the concurrent and longitudinal correlates of gambling approach bias. The study was conducted online, available throughout Canada. Twenty-seven non-treatment-seeking moderate-to-high-risk gamblers and 26 non-problem gamblers community-recruited via multiple channels (i.e., internet and newspaper advertisements, land-based flyers, and university recruitment portals). Participants completed two online assessment sessions 6-months apart. Each session included (1) self-report measures of gambling behaviour (frequency, duration, and expenditure), (2) self-report assessment of problem gambling severity (PGSI), and (3) a gambling approach-avoidance task, utilising culturally relevant stimuli tailored to individual gambling habits. However, our study failed to replicate Boffo et al. (2018) findings in a Canadian sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers did not exhibit greater approach bias tendencies towards gambling-related stimuli compared to neutral stimuli. Moreover, gambling approach bias was not predictive of prospective gambling behaviour (frequency, duration, or expenditure) or severity of gambling problems. Reported results do not provide evidence for approach tendencies contributing to problematic gambling behaviour in a Canadian sample of moderate-to-high-risk gamblers compared to non-problematic gambler controls. Further replications on the topic are needed. Future research should evaluate approach tendencies within the gambling context, considering the potential impact of task reliability to assess approach bias in light of individual gambling modality preferences.
