A telephone and Internet based treament program in Norway

Magnus EidemMagnus.eidem@sykehuset-innlandet.no

Background• Funded by the Norwegian Ministry of Health

(The National Action Plan against Problem Gambling)

• 2006: Developed the program, treatment manual & website design

• Project launched November 2007• Aim to make it easier to seek help, reach out to more

problem gamblers• Only 10% of gamblers seek treatment

– Due to shame, denial, social inhibition, inconvenience

Advantages of Internet therapy

• Cost-effective

• High accessiblity (24/7)

• Lower threshold for treatment seeking? - March 2009: No longer need referrals to participate in treatment (Many problem gamblers do not seek treatment due to shame, denial, inconvenience, geography etc)

Why online treatment?

• Many people live far from treatment services in Norway, we aim to make it easier to seek help and increase number of problem gamblers who receive treatment

• Stigma about seeking help• Reach out to ”new groups” of problem gamblers, such as

online gamblers• Give the problem gambler more flexibility in treatment,

reduce time and money commitment

Treatment

• Participants sign up through the website• Treatment lasts for approximately three months• Weekly telephone meetings between the client and

the therapist• Client assignments provide the structure and content

for the telephone meetings• The assignments are based on cognitive behaviour

therapy

Assignment 1Assignment 1

Sign up throughthe websiteSign up through

the website

Telephone meeting Telephone

meeting

Client interviewClient interview

Open user accountOpen user

account

ScreeningSCL-90R, GBQ,

SOGS-RScreening

SCL-90R, GBQ, SOGS-R

Assignment 9Assignment 9

ConsultationConsultation

Consultation Consultation

Re-test+ summary

Re-test+ summary

Make appointment for client interview

Basics, background, demographic, gambling history, information, motivation, expectations.

Clients sign consent form / program start

(www.spillbehandling.no)

3 m

onth

s3

mon

ths

OnlineDiscussion

Forum

OnlineDiscussion

Forum

ConsultationConsultationScreening feedback

Instruments

• SOGS-R

• GBQ– Luck/Perseverance– Illusion of control

• SCL-90– 9 symptom scales

– (somatization, obsessive-compulsive, interpersonal sensitivity, depresson, anxiety, hostility, fobic anxiety, paranoid ideation, psychotisism)

The 9 client assignments

• Motivation / goals• Readiness to change (the stages) – pros & cons• Analyzing gambling situations• High-risk situations, identify erroneous thoughts• Flashcard & notebook (Self-help tools used in treatment)• Financial situation and challenges• Self-disclosure• Relationships, trust and honesty• Maintaining abstinence, what to do instead of gambling?

• 900 have signed up• About 1/3 completion rate• Majority of «drop outs» did not start at all

• 80% men, 20 % women• Age 16 – 69• Main problem: Online Casino (Internet slotmachines)

• Other games: Sportsbetting, VLT , Poker, Horse betting, Daytrading, MMORPG

Aim of the present study

• To conduct a pilot study with a preliminary description and evaluation of this novel treatment approach in terms of its effectiveness

Conclusion

• Reduction in symptoms of pathological gambling maintained after 3-6 months after treatment completion

• Reduction in symptoms of genereal psychological distress

• Fewer cognitive distortion related to gambling after treatment

Test / re-test SCL 90 R

“Description and pre-post evaluation of an internet based treatment program for pathological gambling in Norway” (Myrseth, Brunborg, Eidem, Pallesen) The International Journal of Gambling Studies, 2013.

• The project has been a success!

• We have reached out to problem gamblers that because of geographical challenges didn’t seek help

• We have made it easier to seek help

So far…

Future goals

• Continiue to run treatment program• Update website / new platform• Develop an APP to help more high risk players• Adopt other kind of problem gaming (MMORPG’s)

Future research directions

• Include control/comparison group to control for non-spesific treatment effects

• Comparison of face-to-face vs. Internet delivered treatment

• More outcome measures• Longer follow-up