JMIR Publications

ABSTRACT

Background:

Low uptake rates of traditional treatments in the gambling field 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.

Objective:

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 through reduced craving intensity in people seeking help for gambling problems.

Methods:

A single-arm, five-week acceptability and feasibility trial (one-week baseline and four-week intervention periods) involving three-times-daily ecological momentary assessments (EMAs). EMAs measured gambling episodes, cravings, and self-efficacy. Online evaluations at baseline, post-intervention, and a one-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, self-efficacy) and the intervention’s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings.

Results:

Thirty-six participants (61.11% male; 94.44% problem gamblers) completed baseline measures, with 61.11% completing the post-intervention evaluation and 58.33% completing the follow-up evaluation. The intervention was found to be acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants also reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behaviour change, intention to change, and help-seeking for gambling cravings. Qualitatively, participants gave suggested improvements (e.g., examples of skill implementation), mixed appraisals of the EMAs, and predominately positive general feedback. Regarding the intervention’s feasibility, compliance rates for the EMA (51.47%) and EMI (14.94%) features were somewhat low, but the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on demand uses. The intervention’s preliminary effectiveness was demonstrated by clustered paired-sample t-tests which 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. Mixed-effects regression results, while non-significant (P>.05), also indicated that intervention use was associated with 59% lowered odds of a gambling episode, 9.2% decrease in craving intensity, and 3.1-3.4% increases in gambling self-efficacy and craving self-efficacy, at the subsequent EMA. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity, cravings (P=.03, .02), frequency (P=.01, 004), and expenditure (P=0.04, .003) at post-intervention and follow-up, and increased mean gambling self-efficacy and craving self-efficacy (P=.01; .01) at post-intervention and gambling self-efficacy (P=.04) at follow-up. At the individual level, over a quarter of participants (27.27-47.62%) were “recovered” or “improved” on gambling symptom severity and cravings.

Conclusions:

The 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.