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The use of self-management strategies for problem gambling: a scoping review

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Abstract

Background

Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern.

Methods

We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool.

Results

We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness.

Conclusions

Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment.

Background

Problem gambling (PG) is a serious chronic health condition and public health concern that affects between 0.12 and 5.8% of the general population worldwide [1], and up to 7% in some studies [2]. Those who are most susceptible to PG often experience other complex health and social concerns such as homelessness, mental health issues, substance use disorders, and incarceration [3,4,5]. Existing services are often not integrated and thus are not designed to address concurrent concerns with PG [6]. Among treatment seeking individuals, there is a need to increase awareness of existing PG-related services and supports [6]. Further, while there are PG interventions that have demonstrated effectiveness, they can be inaccessible to many vulnerable groups due to barriers such as geographical distance, long waitlists, and treatment costs [6,7,8,9,10,11,12]. Barriers to treatment of PG are reflected in low rates of treatment-seeking, as some research has found that only 1 in 10 people experiencing PG seek treatment compared to 1 in 5 people with alcohol-related disorders [13, 14]. There are also important individual barriers to help-seeking that must be considered. Factors such as problem denial, a fear of stigmatization, the belief in the normalization of gambling, and the belief that gambling is not a disease are cited as reasons why many do not seek formal treatment [12, 15,16,17,18]. Several qualitative studies found that emotions such as pride and shame discourage help-seeking [19,20,21]. In particular, some individuals felt a sense of shame in admitting their problem in a group context, and feared additional stigmatization when disclosing their struggles to strangers [17]. Overcoming individual barriers related to cognitions and beliefs about gambling is necessary before a person can meaningfully commence help-seeking behaviour, whether it be seeking formal treatment services or making the decision to engage in self-management. Increased public education and awareness of PG symptomology and treatment plays an important role in reducing shame, stigma and denial in individuals [18]. Likewise, self-management may be an attractive alternative to formalized treatment for individuals concerned with shame and the perceptions of others.

To help address these barriers, self-management may be used as an adjunct or as an alternative to treatment, and may also be effective for people experiencing complex needs such as those with PG [22]. Self-management is defined as, “an individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses the ability to monitor one’s condition and to affect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life” (p. 178) [23]. Self-management interventions are rooted in improving an individual’s self-efficacy to manage symptoms through mastery of skills such as problem solving, decision making, resource utilization, forming a patient/health care provider partnership [24, 25]), modeling, interpreting physical symptoms, and social persuasion [25]. Self-management interventions can be provided individually or in a group setting, and can be facilitated by technology in either context [26, 27].

There is extensive empirical evidence for self-management strategies for a range of chronic health issues [22]. Some preliminary research suggests that self-management interventions may be useful for treating addictions to alcohol [28,29,30] and cannabis [31]. A review found that self-administered treatments (e.g., self-help book) are effective for treating mild alcohol abuse while more severe cases show better outcomes with the use of therapist mediated treatments [32]. Self-management treatments have been used to manage behavioural issues such as nail-biting, poor physical activity, poor diet and excessive internet use [33]. Whiteman et al. [34] conducted a meta-analysis of programs that teach self-management training (e.g., interpersonal skills, trigger identification) and found that the training is effective for dealing with co-occurring mental and physical health issues such as bipolar disorder and asthma. Despite the effectiveness, there is some evidence that self-help treatments may not be well-suited for individuals experiencing severe psychological problems (e.g., personality disorders) and significant interpersonal difficulties [32]. In these more severe cases where individuals may lack capacity, clinician-administered treatments may be bettered suited.

Despite the promising evidence that self-management strategies can be effective for persons with chronic health concerns and complex needs, reviews exploring the current state of the literature on a wide range of self-management strategies for PG are limited. For instance, Raylu et al. [35] reviewed self-help treatment studies up to the year 2008 and found that research on these treatments for PG was still in its infancy. The researchers noted that most studies focused on only two strategies (i.e., self-help manuals and audiotapes), and discussed the importance of exploring a wider range of self-help strategies. In line with this work, Rodda et al. [36] identified six change strategies described by online counselling session clients, and in later examined the perceived helpfulness of 15 cognitive change strategies, noting differences in the helpfulness of particular strategies based on gambling severity as well as age [37]. Although the authors provide an extensive list of strategies, they acknowledge that some strategies may have been missed or conceptualized differently than in past literature. The objective of this scoping review was to build on this work and identify and describe what was reported in the literature on PG self-management strategies.

Methods

Criteria for inclusion and exclusion

The basis for the methodology of this scoping review is the five-stage approach suggested by Arksey and O’Malley: (1) identify the research question, (2) identify relevant studies, (3) select relevant studies, (4) chart the data, (5) collate, summarize and report the results [38]. We followed the guidelines of the PRISMA-P [39] as the PRISMA-ScR [40] was not available during the review process. We completed the PRISMA-ScR as a Additional file 1 document to this paper. We did not provide a critical assessment of the quality of the evidence as this is a developing area of research.

Studies were included if the authors examined PG self-management strategies used by adults (18+) in at least a subset of the sample; and PG was confirmed using a validated diagnostic or screening tool. We defined self-management strategies as techniques used to self-manage gambling activities independently of clinician support. The independent use of a strategy includes use after a therapy session, use after being introduced by a researcher, and use outside of interactions with researchers and therapists. Some examples of self-management strategies that fit this definition include money limiting strategies, self-management components of Cognitive Behavioural Therapy (CBT; e.g., workbooks, thought records, journaling), coping strategies, and mindfulness. We included randomized controlled trials, observational (cohort, cross-sectional, case-control), descriptive, qualitative, and mixed methods studies. We examined systematic, scoping, realist, and narrative reviews to identify additional studies that met our inclusion criteria. Studies were excluded if they only included face-to-face treatment without a self-management component, peer support groups such as Gambler’s Anonymous or online discussion forums, strategies that focused only on gaining knowledge and awareness, and studies examining treatment-seeking behaviour. We also excluded non-peer reviewed works such as reports, theses, dissertations, conference presentations, conference papers, books, book reviews, case studies, trial papers and protocols.

Search strategy

We collected studies for our review using a search strategy developed by an information specialist and the project team (see Additional file 2 for the full MEDLINE strategy). The following databases were searched in June 2017: Medline, PsycINFO, Embase, the Cochrane Library, CINAHL, Applied Social Sciences Index & Abstracts, International Bibliography of the Social Sciences, ProQuest Dissertations & Theses Global, Social Services Abstracts, and Sociological Abstracts.

Our selection of databases ensured interdisciplinary coverage of research in social sciences, allied health professions, nursing and psychology. We used search terms that included a combination of keywords and subject headings for the concepts of gambling and self-management, combined with the Boolean operator “AND.” We limited the search to articles published in English or French between 2000 and June 28, 2017. Papers published in French with an English equivalent translation were considered for the review, but none were identified. We supplemented the database searches with cited reference searching. Citations were managed using EndNote.

Study selection

The next step in the review was to select relevant studies. First, three team members independently reviewed 30 studies to pilot the eligibility criteria for the title and abstract review. Any conflicts were resolved through a larger team discussion. The team refined the inclusion and exclusion criteria based on the pilot and then independently reviewed titles and abstracts of all 2662 studies identified through the search strategy. A total of 169 studies were identified as eligible for full text review. Three team members piloted 17 studies for the full-text review, and then independently reviewed the 169 studies for eligibility and extracted data from 31 articles that met the inclusion criteria. See Fig. 1 for the flowchart of study selection and screening.

Fig. 1
figure1

Flow diagram of study selection Table 1 Characteristics of studies included the review

Data extraction

To chart our data, three team members independently extracted information from eligible publications using a data extraction tool the team developed, piloted and modified. The tool provided detailed instructions and formatting guidelines for the data extraction and charting. The following information was extracted using the tool: publication details (authors, publishing year, journal), research objectives, type and description of self-management strategy, methodology, method, outcome measures, sample information and demographics, information on tools used to measure PG, qualitative findings, and authors’ main conclusions. For the purposes of this review, self-management strategies were organized into four categories: behavioural self-management (n = 19), cognitive self-management (n = 2), coping skills/styles (n = 12), and multi-part interventions (n = 16).

Results

Description of studies

Table 1 describes the characteristics of included studies. Most studies were conducted in Canada (n = 11), Australia (n = 7), and the United States (n = 5). Studies were also conducted in Finland, Sweden, Germany, Switzerland, Spain, Greece, Singapore, and New Zealand. The majority of studies included were quantitative (n = 24), with fewer being qualitative (n = 3) or mixed-methods (n = 4). Most studies had a mix of males and females within their samples (n = 27); only two studies used an all-male sample and two studies used an all-female sample. The majority of studies (n = 17) did not report on race or ethnicity. Of the studies that reported race, most had a majority white sample (n = 11). Some studies reported on ethnicities rather than race (n = 6), with samples in which the majority of participants were Canadian (n = 4), Australian (n = 1), and Chinese (n = 1). Three studies were conducted in a clinical setting. One study included participants from a rural setting, and one study included participants with low-income backgrounds. Of the 31 studies, 16 included participants with mental health and/or substance use comorbidities. Health comorbidities with PG included mood disorders (depression, manic depression, bipolar disorder, dysthymia, suicide ideation), substance use disorders (alcoholism, drugs), impulse control disorders (compulsive buying, compulsive sexual behaviour, kleptomania), anxiety disorders (social phobia, obsessive-compulsive disorder, panic disorder), eating disorders, and experiences of emotional abuse, sexual abuse, physical abuse, loss, stress, and head injury.

Table 1 Characteristics of studies included the review

Self-management strategies

Table 2 provides detailed descriptions and key findings regarding the self-management strategies. From a total of 31 studies, we identified 24 self-management strategies. Most studies examined one strategy (n = 25), three included two strategies [41, 64, 70], three included three or more strategies [59, 67, 69].

Table 2 Self-management strategies described in the included studies

Behavioural strategies

Behavioural self-management strategies are those in which people modify an aspect of their behaviour in order to manage their gambling. Strategies included in this category were self-exclusion [41, 49, 50, 52, 53, 61, 62, 68, 71], money and time limiting [51, 52, 63, 67, 69], alternative activity scheduling [41], direct action [67], social experience [67], delayed gratification [69] and maintenance of balance [69]. While definitions of self-exclusion varied across studies, it was generally defined as entering into formal agreement with a land-based or online gambling venue to be excluded from the venue. In most cases, the terms of the agreement included consequences (e.g., fines, trespassing charges) or restrictions on the collection of winnings (i.e., not allowed to collect winnings) when the agreement was breached. Seven studies examined the effectiveness of self-exclusion for PG and generally reported it to have positive results on its own and in combination with counseling; however, one study reported that over 50% of participants breached self-exclusion agreements within 6 months [62]. Hayer and Meyer [49] reported on the characteristics of people who self-excluded, noting that financial difficulty was the most cited reason for self-exclusion, and that male and middle-aged individuals were most likely to self-exclude. Hing et al. [50] found that people experiencing PG who were involved in problematic internet gambling were less likely to self-exclude from land-based venues (one-fifth of their gambling behavior) and more likely to self-exclude from online gambling sites than their than their land-based counterparts. One study reported that self-exclusion may be more effective in jurisdictions that frame PG as a public health issue because doing so places responsibility on gambling venues instead of people experiencing PG to enforce the ban [71].

Self-limiting strategies with duration of time and the amount of money were described in five studies. Hing et al. [52] described a process in which an individual deposited monetary amounts to bet at the outset of a gambling episode and stopped gambling once that limit was reached. Two studies reported on the effectiveness of limiting strategies, one noting that these strategies predict non-harmful gambling [53] and another reporting limited success [52]. Some evidence indicates that limiting strategies may not be well suited for severe cases of PG. Lalande and Ladouceur [63] reported that those experiencing pathological gambling and those who did not engage in pathological gambling both use money limiting strategies to avoid overspending; however, people experiencing pathological gambling set higher limits and broke these limits more than those who were not experiencing pathological gambling.

Delayed gratification (i.e., quelling the need for immediate results of a gamble) and maintaining balance (i.e., avoiding excesses in behaviour) were self-management strategies reported by older adults (60+) with gambling problems or probable pathological gambling [69]. Alternative activity scheduling (i.e., scheduling non-gambling activities) was effective in reducing PG scores for some women who combined this activity with self-exclusion [41].

Cognitive strategies

Cognitive self-management strategies address thoughts, beliefs and cognitions surrounding gambling. Two studies described cognitive restructuring which involves changing irrational or negative thoughts and beliefs about gambling and replacing them with realistic and positive thoughts and beliefs to limit PG. Jauregui at al [59] reported no significant mediating effect of cognitive restructuring on anxiety between those experiencing pathological gambling and those who did not gamble. Moore et al. [67] examined use of cognitive restructuring for self-regulation of gambling among those with (PG) and without (NPG) gambling problems. They were interested in whether gambling status (PG and NPG) and frequency of gambling (low versus high) was associated with use of cognitive restructuring. They found that the PG-high frequency group was most likely to use cognitive restructuring, followed by PG-low frequency, NPG-high frequency, and NPG-low frequency.

Coping strategies

Four studies described self-management strategies in the form of coping skills and/or self-directed activities to improve coping skills. Both adaptive and maladaptive strategies were described including mindfulness) [70], emotional expression [59], relaxation breathing [64], progressive muscle relaxation [64], social support [59], problem solving [59], avoidance [59, 67], wishful thinking [59], social withdrawal [59], self-criticism [59], and imaginal desensitizationFootnote 1 [48]. Mindfulness and imaginal desensitization reduced gambling severity and gambling urges among a population of people experiencing PG [48, 70]. Maladaptive coping strategies such as avoidance, wishful thinking, social withdrawal, self-criticism, and emotional expression were associated with higher PG scores [59]. In one study, relaxation breathing and progressive muscle relaxation were effective strategies in reducing stress, depression and anxiety, and improving life satisfaction and daily routines (e.g., breakfast and dinner) among people experiencing PG [64].

Multi-part interventions

Multi-part self-management interventions provide a variety of tools to help people who want to change their gambling behavior to monitor their gambling activities, set and monitor goals, use self-reflection to recognize underlying motivations and repercussion of their addiction. These interventions include the use of workbooks, self-directed CBT interventions, self-help toolkits, booklets, and personalized feedback tools.

Self-directed CBT

Two studies described online CBT interventions for use without the assistance of a therapist [44, 45] such as challenging and replacing erroneous thoughts. They also contained other self-management strategies such as debt management, managing high risk situations, recognizing triggers [44, 45], imaginal desensitization, relaxation training, goal setting, emotions maintenance, relapse prevention [44], psychoeducation, and identifying social consequences of gambling [45]. Casey et al. [44] found that a CBT intervention was associated with reduced gambling severity, other PG and mental health outcomes, and greater life satisfaction after the initial treatment and at 12-months follow-up. The CBT intervention in a study by Castrén et al. [45] was associated with reduced gambling-related problems, urges, impaired control of gambling, social consequences, gambling-related cognitive erroneous thoughts and depression.

Workbooks

Nine studies examined online and offline workbooks with exercises meant to manage PG-related outcomes. Although the structure of the workbooks and the topics varied, common elements included motivation to change and the change process [42, 43, 72] and self-reflection and improved self-awareness of gambling related cognitions [43, 70]. Most workbooks contained some CBT content, such as information on cognitive distortions and cognitive- restructuring [43, 54,55,56, 58, 70]. Others included materials and exercises on goal-setting [42] and finances [65]. Most workbooks provided descriptions and information for other self-management strategies noted in this review such as mindfulness [42, 70], limiting strategies [43], self-exclusion [54,55,56], stress management [42] and alternative activity scheduling [54,55,56]. The majority of workbooks included information relating to managing urges and/or relapses, maintenance and resources [42, 43, 54,55,56, 58, 65]. Some studies suggested that workbook-only interventions were effective in reducing harms associated with PG [42, 54] while other studies noted improved outcomes when the workbook was paired with therapist guidance or other formal support [43, 55, 58]. Generally, the workbook interventions were reported to be well-received by clients and described as an approach to expand PG services to individuals.

Booklets and toolkits

Informational booklet [57] and self-help toolkit [60, 66] interventions are similar in structure and content to workbook interventions and were utilized in three studies. Like workbooks, both toolkits and the informational booklets contained resources on managing urges, the change process and relapse prevention. The primary focus of the toolkits was to help individuals self-reflect on their gambling behaviours and included exercises to determine the costs and benefits of gambling behaviour to motivate change. The booklets included additional information on lifestyle balance, financial issues and managing comorbid conditions (e.g., emotional and addiction problems). LaBrie et al. [60] reported improved PG-related outcomes for toolkit recipients and advised that toolkits may be a viable treatment alternative for individuals who do not want to engage in formal treatment courses. Hodgins et al. [57] reported that participants who received repeated mailing of bibliotherapy (relapse prevention booklets) for PG were more likely to meet their gambling-related treatment goals than those who did not receive mailings. However, participants who received repeated mailings did not differ from participants who received a single mailing on gambling frequency or reported gambling losses.

Personalized feedback tool

Online personalized feedback tools were noted in two studies [46, 47]. Personalized feedback tools involve some form of self-assessment of PG behaviour and/or ongoing information gathering to provide a personalized profile of PG behaviour, beliefs and habits. This information is then presented back to the user along with a comparison of their behaviour with the gambling behaviour or cognitions of other users and/or general population to establish a risk level for PG. This feedback is presented along with helpful strategies and techniques to lower risk and limit gambling. Additionally, in cases of continual information gathering/behaviour tracking, individuals could opt-in to have personalized messages sent to them when they were engaging in risky gambling behaviours. Cunningham et al. [46] reported a reduction in the number of days gambled for participants receiving a partial feedback tool (i.e., feedback about behaviour without comparison to norm for that behaviour) in comparison to those who received no intervention. They found no evidence to support the efficacy of a normative feedback tool. Forsström et al. [47] found low continued usage of a personalized feedback tool among participants despite positive opinions of its content.

Discussion

The purpose of this paper was to examine the scope of current published literature on PG self-management strategies. We identified 31 studies and reviewed 23 different self-management strategies for PG, published between 2000 and 2017. In a previous review of self-help for PG (up to April 2008) only two types of self-help had been reported; these were self-help manuals and audiotapes [35]. Our findings show that there is a growing body of literature examining a diverse range of self-management strategies for PG. The most commonly cited strategies in this review were self-exclusion (n = 9), workbooks (n = 8), and money or time limiting strategies (n = 4). Other strategies included various cognitive and behavioural strategies, coping strategies, stress management, and mindfulness. Surprisingly, technological modes of treatment (e.g., virtual reality treatments) were not well-represented in this review. Three studies examining the use of CBT in virtual reality with therapist assistance (therapist-assisted studies were excluded from our review), showed that the technology has promise for the treatment of PG [73]. Although the self-management strategies noted in this review are conceptually similar to those identified in other literature [35,36,37], the labelling and categorization of strategies was found to considerably vary across studies. Future research examining self-management strategies for PG would benefit from standardized conceptualizations of strategies and shared terminology.

Self-exclusion was the most examined approach to self-management in this review, yet there is little evidence for its effectiveness. In fact, compliance rates are quite low (13 to 30%), with inadequate surveillance and enforcement of bans, and complicated enrollment processes which impede use of this option to manage PG [51, 74]. A deeper understanding of self-exclusion, in particular, and other self-management strategies requires consideration of comorbid health and social concerns [6, 75]. People who experience complex health and social concerns such as homelessness, mental health issues, substance use disorders, and incarceration are at greater risk of PG, yet current services do not address multimorbidity [3, 4]. Notably, although some studies in this review included participants with mental health and/or substance use comorbidities, most did not explicitly address these comorbidities with PG (e.g., alcoholism) in the design of self-management strategies. Further research is needed to explore the complex interplay between PG and comorbid conditions and design comprehensive interventions that address multiple needs [6, 75].

In addition, a key finding from this review was a lack of research examining self-management approaches tailored to specific socio-demographic sub-groups (e.g., age, income, gender, ethnicity, geography) [49]. There were few studies among younger populations aged 18 to 35 years old. Only one study focused on older adults who were aged 60 and above [69]. Older adults have their own unique concerns that may affect how they use self-management strategies and the types of strategies that they prefer (e.g., access to and familiarity with technology) [76]. Only one study examined participants with low-income backgrounds [43]. While many studies had mixed-sex samples only one study considered a gendered approach to self-management strategies. One study reported that, within Asian culture, families use a variety of mechanisms to enforce responsible gambling (e.g., family exclusion orders) [69]. Research is needed to understand what self-management approaches may be appropriate and effective for a variety of populations.

Many empirically validated theories of behaviour change, including diffusion of innovations [77], social cognitive theory [78], and the social ecological model [79] assert that social relationships play a significant role in facilitating behavioural change. These findings suggest that we need a better understanding of the role that support networks/circles, and peer support outside the formal treatment environment may play in PG self-management [76, 80].This topic deserves specific exploration of those strategies that may or may not be effective for specific populations, such as people facing poverty and homelessness and those from varying ethnic cultures. This could be accomplished using a realist perspective to understand what works, for whom, and under what conditions [81, 82]. Given the majority of people experiencing PG do not actively seek treatment [13, 14], offering evidence of the effectiveness of personal approaches to self-management is imperative. Moreover, past research suggests that one-third to upwards of 82% of people experience natural recovery from PG with men more likely to report this happening than women [19, 83, 84]. While the literature on PG self-management strategies has evolved since Raylu et al’s paper [35], there is still little evidence of the effectiveness of self-management to reduce harms associated with gambling.

Strengths and limitations

This study has a few limitations that should be noted. It is also possible that some relevant articles were missed, as only articles published between January 1, 2000 and June 28, 2017 were included as well as those published in English. We included French publications in our initial search with the idea that we would review English translations of papers written in French, but no translations were available. None of the authors are proficient in French language. However, our search strategy was comprehensive and guided by an information science specialist. To our knowledge, this is the first review of self-management strategies for PG since a previous review in 2008. The earlier review focused on broad definition of self-help that included forming partnerships with heath care providers [25]. We defined self-management with a narrower scope focusing on self-care outside the health and social service system as we were specifically interested in strategies that people manage on their own (or after active treatment) to reduce personal harms associated with gambling. Our review focused on adults; however, PG among teens and young adults is a serious public health concern. As such it would be prudent to similarly explore self-management among those under age 18 [85, 86]. This is especially important given that gambling seems to differ on a variety of dimensions among youth compared to adults, including reasons for gambling, comorbidities, and consequences of gambling [85, 87,88,89,90]. Individual capacity is an important consideration in any approach to care for gambling concerns, whether through professional treatment or self-care. This becomes complicated by cognitive and intellectual disabilities, multimorbidities, and such social determinants of health as homelessness and poverty. In particular self-management may not be an appropriate approach to care.

Conclusions

Given that it is the minority of people with gambling concerns that seek treatment, that stigma is an enormous barrier to care, that PG services are scarce and do not address multimorbidity [5, 6, 14, 91, 92], it is imperative that we examine the personal management of gambling as an option to formalized treatment. This is the first review to examine self-management of PG and findings indicate that evidence is lacking on this topic. It is imperative that the field explore self-management in PG in more depth and for specialized populations to understand the nuances of recovery for diverse populations.

Notes

  1. 1.

    Imaginal desensitization is an approach through which patients learn to visualize a situation that triggers an impulse to carry out an impulsive behavior (e.g., gambling), and then imagine overcoming the urge using learned relaxation skills. The idea is that with time, an individual gains confidence in their ability to manage urges and becomes “desensitized” to triggering situations.

Abbreviations

CBT:

Cognitive Behavioural Therapy

EGM: CD:

Compact Disk

IDMI:

Imaginal Desensitization plus Motivational Interviewing

M:

Mean

N:

Number

NPG:

Non-problem gambling

PG:

Problem Gambling

PGSI:

qProblem Gambling Severity Index

SD:

Standard Deviation

References

  1. 1.

    Calado F, Griffiths MD. Problem gambling worldwide: an update and systematic review of empirical research (2000–2015). J Behav Addict. 2016;5(4):592–613.

  2. 2.

    Stucki S, Rihs-Middel M. Prevalence of adult problem and pathological gambling between 2000 and 2005: an update. J Gambl Stud. 2007;23(3):245–57.

  3. 3.

    Matheson FI, Devotta K, Wendaferew A, Pedersen C. Prevalence of gambling problems among the clients of a Toronto homeless shelter. J Gambl Stud. 2014;30(2):537–46.

  4. 4.

    Cowlishaw S, Merkouris S, Chapman A, Radermacher H. Pathological and problem gambling in substance use treatment: a systematic review and meta-analysis. J Subst Abus Treat. 2014;46(2):98–105.

  5. 5.

    Ferentzy P, Wayne Skinner WJ, Matheson FI. Illicit drug use and problem gambling. ISRN Addict. 2013;2013:342392.

  6. 6.

    Guilcher SJ, Hamilton-Wright S, Skinner W, Woodhall-Melnik J, Ferentzy P, Wendaferew A, Hwang SW. Matheson FI: “talk with me”: perspectives on services for men with problem gambling and housing instability. BMC Health Serv Res. 2016;16(1):340.

  7. 7.

    Rush B, Moxam R.: Treatment of problem gambling in Ontario: service utilization and client characteristics, January 1, 1998, to April 30, 2000. DATIS report to the Ontario Ministry of Health and Long-Term Care. Toronto: Ontario Ministry of Health and Long-Term Care; 2001.

  8. 8.

    Toneatto T, Ladoceur R. Treatment of pathological gambling: a critical review of the literature. Psychol Addict Behav. 2003;17(4):284.

  9. 9.

    Hodgins DC, Holub A. Treatment of problem gambling. Research and measurement issues in gambling studies; 2007. p. 372–91.

  10. 10.

    Dowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: a systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry. 2015;49(6):519–39.

  11. 11.

    Turner NE, Preston DL, McAvoy S, Gillam L. Problem gambling inside and out: the assessment of community and institutional problem gambling in the Canadian correctional system. J Gambl Stud. 2013;29(3):435–51.

  12. 12.

    Rockloff MJ, Schofield G. Factor analysis of barriers to treatment for problem gambling. J Gambl Stud. 2004;20(2):121–6.

  13. 13.

    Suurvali H, Hodgins D, Toneatto T, Cunningham J. Treatment seeking among Ontario problem gamblers: results of a population survey. Psychiatr Serv. 2008;59(11):1343–6.

  14. 14.

    Cunningham JA, Breslin FC. Only one in three people with alcohol abuse or dependence ever seek treatment. Addict Behav. 2004;29(1):221–3.

  15. 15.

    Suurvali H, Cordingley J, Hodgins DC, Cunningham J. Barriers to seeking help for gambling problems: a review of the empirical literature. J Gambl Stud. 2009;25(3):407–24.

  16. 16.

    Goslar M, Leibetseder M, Muench HM, Hofmann SG, Laireiter A-R. Efficacy of face-to-face versus self-guided treatments for disordered gambling: a meta-analysis. J Behav Addict. 2017;6(2):142–62.

  17. 17.

    Dąbrowska K, Moskalewicz J, Wieczorek Ł. Barriers in access to the treatment for people with gambling disorders. Are they different from those experienced by people with alcohol and/or drug dependence? J Gambl Stud. 2017;33(2):487–503.

  18. 18.

    Gainsbury S, Hing N, Suhonen N. Professional help-seeking for gambling problems: awareness, barriers and motivators for treatment. J Gambl Stud. 2014;30(2):503–19.

  19. 19.

    Hodgins DC, El-Guebaly N. Natural and treatment-assisted recovery from gambling problems: a comparison of resolved and active gamblers. Addiction. 2000;95(5):777–89.

  20. 20.

    Tavares H, Martins SS, Zilberman ML, el-Guebaly N. gamblers seeking treatment: why haven't they come earlier? Addict Disord Treat. 2002;1(2):65–9.

  21. 21.

    Pulford J, Bellringer M, Abbott M, Clarke D, Hodgins D, Williams J. Barriers to help-seeking for a gambling problem: the experiences of gamblers who have sought specialist assistance and the perceptions of those who have not. J Gambl Stud. 2009;25(1):33–48.

  22. 22.

    Taylor SJ, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, Purushotham N, Jacob S, Griffiths CJ, Greenhalgh T. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS–practical systematic review of self-management support for long-term conditions; 2014.

  23. 23.

    Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions. Patient Educ Couns. 2002;48(2):177–87.

  24. 24.

    Center for the Advancement of Health. Essential elements of self-management interventions. Washington, DC: Center for the Advancement of Health 2002.

  25. 25.

    Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.

  26. 26.

    Solomon MR. Information technology to support self-management in chronic care. Dis Manag Health Out. 2008;16(6):391–401.

  27. 27.

    Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012;14(3):e70. https://doi.org/10.2196/jmir.2058.

  28. 28.

    Barrio P, Ortega L, López H, Gual A. Self-management and shared decision-making in alcohol dependence via a mobile app: a pilot study. Int J Behav Med. 2017;24(5):722–7.

  29. 29.

    Quanbeck A, Chih M-Y, Isham A, Johnson R, Gustafson D. Mobile delivery of treatment for alcohol use disorders: a review of the literature. Alcohol Res. 2014;36(1):111.

  30. 30.

    Sakakibara BM, Kim AJ, Eng JJ. A systematic review and meta-analysis on self-management for improving risk factor control in stroke patients. Int J Behav Med. 2017;24(1):42–53.

  31. 31.

    Monney G, Penzenstadler L, Dupraz O, Etter J-F, Khazaal Y. mHealth app for cannabis users: satisfaction and perceived usefulness. Front Psych. 2015;6:120.

  32. 32.

    Mains JA, Scogin FR. The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol. 2003;59(2):237–46.

  33. 33.

    Akın A, Arslan S, Arslan N, Uysal R, Sahranç Ü. Self-control Management and Internet Addiction. Int Online J Educ Sci. 2015;7(3):95–100.

  34. 34.

    Whiteman KL, Naslund JA, DiNapoli EA, Bruce ML, Bartels SJ. Systematic review of integrated general medical and psychiatric self-management interventions for adults with serious mental illness. Psychiatr Serv. 2016;67(11):1213–25.

  35. 35.

    Raylu N, Oei TP, Loo J. The current status and future direction of self-help treatments for problem gamblers. Clin Psychol Rev. 2008;28(8):1372–85.

  36. 36.

    Rodda SN, Hing N, Hodgins DC, Cheetham A, Dickins M, Lubman DI. Change strategies and associated implementation challenges: an analysis of online Counselling sessions. J Gambl Stud. 2017;33(3):955–73.

  37. 37.

    Rodda SN, Bagot KL, Cheetham A, Hodgins DC, Hing N, Lubman DI. Types of change strategies for limiting or reducing gambling behaviors and their perceived helpfulness: a factor analysis. Psychol Addict Behav. 2018;32(6):679–88.

  38. 38.

    Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

  39. 39.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews. 2015;4(1):1.

  40. 40.

    Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

  41. 41.

    Avery L, Davis DR. Women's recovery from compulsive gambling: formal and informal supports. J Soc Work Pract Addict. 2008;8(2):171–91.

  42. 42.

    Boughton RR, Jindani F, Turner NE. Group treatment for women gamblers using web, teleconference and workbook: effectiveness pilot. Int J Ment Heal Addict. 2016;14(6):1074–95.

  43. 43.

    Campos MD, Rosenthal RJ, Chen Q, Moghaddam J, Fong TW. A self-help manual for problem gamblers: the impact of minimal therapist guidance on outcome. Int J Ment Heal Addict. 2016;14(4):579–96.

  44. 44.

    Casey LM, Oei TPS, Raylu N, Horrigan K, Day J, Ireland M, Clough BA. Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: a randomised controlled trial. J Gambl Stud. 2017;33(3):993–1010.

  45. 45.

    Castrén S, Pankakoski M, Tamminen M, Lipsanen J, Ladouceur R, Lahti T. Internet-based CBT intervention for gamblers in Finland: experiences from the field. Scand J Psychol. 2013;54(3):230–5.

  46. 46.

    Cunningham JA, Hodgins DC, Toneatto T, Murphy M. A Randomized Controlled Trial of a Personalized Feedback Intervention for Problem Gamblers. PLoS One. 2012;7(2).

  47. 47.

    Forsström D, Jansson-Fröjmark M, Hesser H, Carlbring P. Experiences of Playscan: interviews with users of a responsible gambling tool. Internet Interv. 2017;8:53–62.

  48. 48.

    Grant JE, Donahue CB, Odlaug BL, Kim SW. A 6-month follow-up of imaginal desensitization plus motivational interviewing in the treatment of pathological gambling. Ann Clin Psychiatry. 2011;23(1):3–10.

  49. 49.

    Hayer T, Meyer G. Self-exclusion as a harm minimization strategy: evidence for the casino sector from selected European countries. J Gambl Stud. 2011;27(4):685–700.

  50. 50.

    Hing N, Russell AMT, Gainsbury SM, Blaszczynski A. Characteristics and help-seeking behaviors of internet gamblers based on most problematic mode of gambling. J Med Internet Res. 2015;17(1).

  51. 51.

    Hing N, Sproston K, Tran K, Russell AM. Gambling responsibly: who does it and to what end? J Gambl Stud. 2017;33(1):149–65.

  52. 52.

    Hing N, Cherney L, Gainsbury SM, Lubman DI, Wood RT, Blaszczynski A. Maintaining and losing control during internet gambling: a qualitative study of gamblers’ experiences. New Media Soc. 2015;17(7):1075–95.

  53. 53.

    Hing N, Russell A, Tolchard B, Nuske E. Are there distinctive outcomes from self-exclusion? An exploratory study comparing gamblers who have self-excluded, received Counselling, or both. Int J Ment Heal Addict. 2015;13(4):481–96.

  54. 54.

    Hodgins DC. Implications of a brief intervention trial for problem gambling for future outcome research. J Gambl Stud. 2005;21(1):13–9.

  55. 55.

    Hodgins DC, Currie SR, Currie G, Fick GH. Randomized trial of brief motivational treatments for pathological gamblers: more is not necessarily better. J Consult Clin Psychol. 2009;77(5):950.

  56. 56.

    Hodgins DC, Currie SR, el-Guebaly N. Motivational enhancement and self-help treatments for problem gambling. J Consult Clin Psychol. 2001;69(1):50.

  57. 57.

    Hodgins DC, Currie SR, el-Guebaly N, Diskin KM. Does providing extended relapse prevention Bibliotherapy to problem gamblers improve outcome? J Gambl Stud. 2007;23(1):41–54.

  58. 58.

    Hodgins DC, Currie S, el-Guebaly N, Peden N. Brief motivational treatment for problem gambling: a 24-month follow-up. Psychol Addict Behav. 2004;18(3):293.

  59. 59.

    Jauregui P, Onaindia J, Estévez A. Adaptive and maladaptive coping strategies in adult pathological gamblers and their mediating role with anxious-depressive symptomatology. J Gambl Stud. 2017;33(4):1081–97.

  60. 60.

    LaBrie RA, Peller AJ, LaPlante DA, Bernhard B, Harper A, Schrier T, Shaffer HJ. A brief self-help toolkit intervention for gambling problems: a randomized multisite trial. Am J Orthopsychiatry. 2012;82(2):278–89.

  61. 61.

    Ladouceur R, Jacques C, Giroux I, Ferland F, Leblond J. Brief communications analysis of a Casino's self-exclusion program. J Gambl Stud. 2000;16(4):453–60.

  62. 62.

    Ladouceur R, Sylvain C, Gosselin P. Self-exclusion program: a longitudinal evaluation study. J Gambl Stud. 2007;23(1):85–94.

  63. 63.

    Lalande DR, Ladouceur R. Can cybernetics inspire gambling research? A limit-based conceptualization of self-control. Int Gambl Stud. 2011;11(2):237–52.

  64. 64.

    Linardatou C, Parios A, Varvogli L, Chrousos G, Darviri C. An 8-week stress management program in pathological gamblers: a pilot randomized controlled trial. J Psychiatr Res. 2014;56:137–43.

  65. 65.

    Luquiens A, Tanguy M, Lagadec M, Benyamina A, Aubin H, Reynaud M. The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non–Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial. J Med Internet Res. 2016;18(2).

  66. 66.

    Martin RJ. The feasibility of providing gambling-related self-help information to college students who screen for disordered gambling via an online health survey: an exploratory study. J Gambl Issues. 2013;28:1–8.

  67. 67.

    Moore S, Thomas AC, Kyrios M, Bates G. The self-regulation of gambling. J Gambl Stud. 2012;28(3):405–20.

  68. 68.

    Nelson SE, Kleschinsky JH, LaBrie RA, Kaplan S, Shaffer HJ. One decade of self exclusion: Missouri casino self-excluders four to ten years after enrollment. J Gambl Stud. 2010;26(1):129–44.

  69. 69.

    Subramaniam M, Satghare P, Vaingankar JA, Picco L, Browning CJ, Chong S, Thomas SA. Responsible gambling among older adults: a qualitative exploration. BMC Psychiatry. 2017;17(1):124.

  70. 70.

    Toneatto T, Pillai S, Courtice E. Mindfulness-enhanced cognitive behavior therapy for problem gambling: a controlled pilot study. Int J Ment Heal Addict. 2014;12(2):197–205.

  71. 71.

    Townshend P. Self-exclusion in a public health environment: an effective treatment option in New Zealand. Int J Ment Heal Addict. 2007;5(4):390–5.

  72. 72.

    Luquiens A, Lagadec M, Tanguy M, Reynaud M. Efficacy of online psychotherapies in poker gambling disorder: an online randomized clinical trial. Eur Psychiatry. 2015;30:1053.

  73. 73.

    Bouchard S, Robillard G, Giroux I, Jacques C, Loranger C, St-Pierre M, Chrétien M, Goulet A. Using virtual reality in the treatment of gambling disorder: the development of a new tool for cognitive behavior therapy. Front Psych. 2017;8:27.

  74. 74.

    Motka F, Grune B, Sleczka P, Braun B, Ornberg JC, Kraus L. Who uses self-exclusion to regulate problem gambling? A systematic literature review. J Behav Addict. 2018:1–14.

  75. 75.

    Kotter R, Kraplin A, Pittig A, Buhringer G. A systematic review of land-based self-exclusion programs: demographics, Gambling Behavior, Gambling Problems, Mental Symptoms, and Mental Health. J Gambl Stud. 2018. https://doi.org/10.1007/s10899-018-9777-8.

  76. 76.

    Matheson FI, Sztainert T, Lakman Y, Steele SJ, Ziegler CP, Ferentzy P. Prevention and Treatment of Problem Gambling Among Older Adults: a scoping review. J GAmbl Issues. 2018;39:6–66.

  77. 77.

    Rogers EM. Diffusion of innovations: Simon and Schuster; 2010.

  78. 78.

    Bandura A. Social cognitive theory. Handbook of social psychological theories. 2012;2011:349–73.

  79. 79.

    Sallis JF, Owen N, Fisher E. Ecological models of health behavior. Health behavior: Theory, research, and practice. 2015;5:43–64.

  80. 80.

    Rash CJ, Petry NM. Psychological treatments for gambling disorder. Psychol Res Behav Manag. 2014;7:285–95.

  81. 81.

    Fitzpatrick S. Explaining Homelessness: a Critical Realist Perspective. Housing, Theory and Society. 2005;(1):1, 17.

  82. 82.

    Vassilev I, Rogers A, Sanders C, Kennedy A, Blickem C, Protheroe J, Bower P, Kirk S, Chew-Graham C, Morris R. Social networks, social capital and chronic illness self-management: a realist review. Chronic Illn. 2011;7(1):60–86.

  83. 83.

    Slutske WS. Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys. Am J Psychiatry. 2006;163(2):297–302.

  84. 84.

    Slutske WS, Blaszczynski A, Martin NG. Sex differences in the rates of recovery, treatment-seeking, and natural recovery in pathological gambling: results from an Australian community-based twin survey. Twin Res Hum Genet. 2009;12(5):425–32.

  85. 85.

    Kryszajtys DT, Hahmann TE, Schuler A, Hamilton-Wright S, Ziegler CP, Matheson FI. Problem gambling and delinquent behaviours among adolescents: a scoping review. J Gambl Stud. 2018:1–22.

  86. 86.

    Neighbors C, Rodriguez LM, Rinker DV, Gonzales RG, Agana M, Tackett JL, Foster DW. Efficacy of personalized normative feedback as a brief intervention for college student gambling: a randomized controlled trial. J Consult Clin Psychol. 2015;83(3):500.

  87. 87.

    Delfabbro P, Thrupp L. The social determinants of youth gambling in south Australian adolescents. J Adolesc. 2003;26(3):313–30.

  88. 88.

    Hardoon KK, Gupta R, Derevensky JL. Psychosocial variables associated with adolescent gambling. Psychol Addict Behav. 2004;18(2):170–9.

  89. 89.

    Lussier ID, Derevensky J, Gupta R, Vitaro F. Risk, compensatory, protective, and vulnerability factors related to youth gambling problems. Psychol Addict Behav. 2014;28(2):404–13.

  90. 90.

    Martins SS, Liu W, Hedden SL, Goldweber A, Storr CL, Derevensky JL, Stinchfield R, Ialongo NS, Petras H. Youth aggressive/disruptive behavior trajectories and subsequent gambling among urban male youth. J Clin Child Adolesc Psychol. 2013;42(5):657–68.

  91. 91.

    Baxter A, Salmon C, Dufresne K, Carasco-Lee A, Matheson FI. Gender differences in felt stigma and barriers to help-seeking for problem gambling. Addict Behav Rep. 2016;3:1–8.

  92. 92.

    Hing N, Russell AM. How anticipated and experienced stigma can contribute to self-stigma: the case of problem gambling. Front Psychol. 2017;8:235.

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Acknowledgements

We wish to thank Guido Tacchini and Natalie Waldbrook for their contributions to the paper.

Funding

The Centre for Urban Health Solutions is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. This study was funded by the Province of Ontario (Province), Ministry of Health and Long-Term Care (Ministry Grant #438). SJTG is supported by the Canadian Institutes for Health Research (CIHR) Embedded Clinician Scientist Award in Transitions in Care (2016–2020). The study was also supported by the Dalla Lana School of Public Health, University of Toronto The views expressed in this publication are the views of the authors and do not necessarily reflect those of the Province or the CIHR.

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FIM, SJTG, SHW designed the original project; FIM, SJTG, SHW, DTK, JLW designed and operationalized the specific research question and methodology for this review; CZ, DTK and JLW conducted the literature searches; DTK, JLW, FIM, SJTG, SHW, LC selected the papers for review and reviewed the final papers; DTK, JLW wrote the first draft of the paper; FIM, SHW, DTK, JLW, LC, CZ, SWH, SJTG revised and finalized the paper. All authors read and approved the final manuscript.

Correspondence to Flora I. Matheson.

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Matheson, F.I., Hamilton-Wright, S., Kryszajtys, D.T. et al. The use of self-management strategies for problem gambling: a scoping review. BMC Public Health 19, 445 (2019) doi:10.1186/s12889-019-6755-8

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Keywords

  • Self-management
  • Gambling
  • Problem gambling
  • Self-efficacy
  • Self-help
  • Coping
  • Strategies
  • Coping skills
  • Self-exclusion
  • Gamblers
  • Scoping review