Table 2 Self-management strategies described in the included studies
From: The use of self-management strategies for problem gambling: a scoping review
Authors | Self-Management Strategy | Details/ Description of Self-Management Strategy | Key Findings and Implementation Considerations related to the Self-Management Strategy |
|---|---|---|---|
Avery et al. (2008) [41] | • Alternative activity scheduling • Self-exclusion | Alternative Activity Scheduling • Person plans non-gambling activities to take the place of gambling (e.g., joining social groups, making plans to fill time) | • Gender differences identified for motivation to stop gambling and supports sought; most women used GA, professional help (or both) • A small proportion (10%) of women recovered on their own from PG using alternative activity scheduling and self-exclusion and had lower PG scores than those receiving professional or GA help |
Self-exclusion • Person relocates away or self-bans from gambling establishments for a fixed period of time. | |||
Boughton et al. (2016) [42] | Workbook (web-based) | • Workbook contains 12 weekly modules • Modules cover: change process, urges and relapses, exploration of how thoughts impact feelings, mindfulness, stress management, relationships, emotional regulation, goals. | • The workbook was well received by participants • Web- and phone-based group sessions are effective to expand PG services |
Campos et al. (2016) [43] | Workbook | • Person reads and completes exercises in workbook on topics such as awareness of PG behaviour and reasons for gambling, motivation for behaviour change, money limiting, changing faulty cognitions about gambling, tools to maintain abstinence. | • Use of self-help workbooks helps reduce PG symptoms and money spent gambling, but using a workbook with therapist guidance had superior outcomes |
Casey et al. (2017) [44] | Internet-based cognitive behavioural therapy | • Six weeks of CBT sessions with exercises. • Sessions cover: awareness of triggers and strategies to cope with urges, challenging thinking errors and replacing them with helpful thoughts, debt management, imaginal desensitization, relaxation training, problem solving, goal setting, emotions, and maintenance and relapse prevention. | • CBT was associated with reduced gambling severity, other beneficial PG and mental health outcomes, and greater satisfaction after initial treatment and 12-month follow-up • Online treatments for gambling may be a valuable tool in increasing help-seeking and treatment engagement |
Castren et al. (2013) [45] | Internet-based cognitive behavioural therapy | • 8 weeks of CBT program with weekly module. • Each CBT module contains information, exercises and homework covering: Psychoeducation and motivation, recognizing high risk situations and triggers, identifying social consequences of gambling, recognizing erroneous thoughts, safe ways to manage high-risk situations, money management. | • CBT was associated with reduced gambling-related problems, urges, impaired control of gambling, alcohol consumption, social consequences, gambling-related cognitive erroneous thoughts and depression |
Cunningham et al. (2012) [46] | Personalized feedback tool | • Person completes Problem Gambling Severity Index (PGSI) and Gambling Cognitions Questionnaire. • Feedback tool provides a summary of the individual’s PGSI scores and summary of cognitive distortions that they endorsed (along with summary of the error of each of these beliefs); a list of techniques to lower gambling risks; a comparison of the amount of money the individual spent in the past year with the average amount of money spent by Canadians of the same sex. | • No evidence for the impact of normative personalized feedback; however, participants who received partial feedback (without norms) reduced the number of days gambled compared to those not receiving the intervention • Personalized feedback interventions were well received and Internet-based personalized feedback tools may improve access to interventions |
Forsstrom et al. (2017) [47] | Personalized feedback tool | • Individual completes a weekly risk assessment test. • Feedback tool provides a risk level based on comparison of gambling patterns with other users, a detailed history of gambling habits and advice about how to limit time and money spent on gambling. | • Participants had a positive view of the tool’s content, which should have promoted use; however, repeated use was low • A lack of feedback from the tool and confusion when signing up may have affected usage; offering users direct feedback may increase usage |
Grant et al. (2011) [48] | Imaginal Desensitization | • 6 sessions of imaginal desensitization plus motivational interviewing (IDMI) over an 8-week period • Audio-recordings of three gambling scenarios are played three times per day which prompt the user to use relaxation coping strategies to cope with urges the scenarios elicit. | • The intervention reduced PG urges and behaviour; effects were largely maintained for 6 months • Participants cited their audiotapes as the primary reason for their improvement. |
Hayer and Meyer (2011) [49] | Self-exclusion | • Once registered, the individual is banned from gambling venues and websites for a fixed period of time. | • Mostly men and middle-aged individuals place themselves on exclusion lists; top motives to self-exclude involve financial difficulties • Self-exclusion is effective when used in combination with additional counseling |
Hing, Russell, Gainsbury et al. (2015) [50] | Self-exclusion | • Once registered, the individual is banned from gambling venues and websites for a fixed period of time. | • Land-based gamblers are more likely to use self-exclusion strategies than problem Internet gamblers |
Hing, Sproston et al. (2017) [51] | Responsible Gambling Strategies • Money and time limiting | • When gambling, Person carries limited money, stops gambling once it is spent, does not carry bank card, does not re-gamble any wins, and places smaller bets. | • Setting money limits and balancing gambling with other activities predict non-harmful gambling |
Hing, Cherney, et al. (2015) [52] | Self-exclusion (online) | • Individual blocks themselves from specific gambling websites using website blocking software. | • Limiting strategies had variable success; most felt that operators needed to implement more responsible gambling measures (e.g., removal of credit betting, imposed bet limits, gambling help pop-up messages, restricted promotions/ advertising) |
Money limit setting (online) | • Individual deposits monetary amounts to bet at the outset of gambling episode and they prohibit themselves from credit betting. | ||
Hing, Russell, Tolchard, et al. (2015) [53] | Self-exclusion | • Individual excludes themselves from a range of venue types (e.g., hotels, clubs and casinos that operate electronic gaming machines) | • Self-excluders abstained from most problematic gambling and fewer had • harmful consequences vs. non-excluders • Self-exclusion may have similar short-term outcomes as counselling alone and may reduce short-term harms |
Hodgins (2005)a [54] | Workbook | • CBT-based workbook includes self-assessment, goal setting, strategies (e.g., self-exclusion, alternative activity scheduling, cognitive restructuring), maintenance and local treatment resources | • Intervention reduced PG behaviour and reduction was maintained at 12- and 24-months |
Hodgins et al. (2009) [55] | Workbook | • CBT workbook includes self-assessment, goal setting, strategies (e.g., self-exclusion, lternative activity scheduling, cognitive restructuring), maintenance and local treatment resources | • Workbook only group participants were just as likely to have significantly reduced their losses over the year and to not meet criteria for pathological gambling as those in brief treatment and brief booster treatment |
Hodgins et al. (2001) [56] | Workbook | • CBT workbook includes self-assessment, goal setting, strategies (e.g., self-exclusion, alternative activity scheduling, cognitive restructuring), maintenance and local treatment resources | • Participants who received a motivational enhancement telephone intervention and a self-help workbook (vs. workbook only) had better outcomes than participants in a wait-list control at 3 and 6 month follow-up, but at the 12-month follow-up, the advantage of the motivational interview and workbook condition was found only for participants with less severe gambling problems. Overall, these results support the effectiveness of a brief telephone and mail-based treatment for problem gambling. |
Hodgins et al. (2007) [57] | Informational Booklets | • Booklets included topics on dealing with urges to gamble; negative emotions as a cause of relapse; “getting back on the wagon” after a relapse; lifestyle balance; financial issues; stages of change; and dealing with comorbid emotional and addiction problems. | • Participants who received booklet summarizing relapse prevention information had improved PG scores, reduced number of gambling days and dollars lost |
Hodgins et al. (2004) [58] | Workbook | • CBT workbook contains five sections: (a) self-assessment, (b) goal setting, (c) strategies, (d) maintenance, and (e) other treatment resources. • Individual completes brief exercises in each section of the workbook. | • Participants who received a motivational telephone intervention plus a self-help workbook had better outcomes (i.e., gambled fewer days, lost less money, and had lower South Oaks Gambling Screen scores) than participants who received only the workbook |
Jauregui et al. (2017) [59] | Coping Strategies and Styles • Problem Solving • Cognitive Restructuring • Social Support • Emotional Expression • Problem Avoidance • Wishful Thinking • Social Withdrawal • Self-Criticism | Problem Solving Strategies: • Individual focuses on eliminating stress by modifying the situation that causes it. | • Pathological gamblers (vs non) obtained significantly higher scores in pathological gambling, anxiety, depression, self-criticism, emotional expression, wishful thinking, problem avoidance, social withdrawal, problem disengagement, emotional disengagement, and disengagement |
Cognitive Restructuring: • Individual modifies the meaning of the stressful situation. | |||
Social Support: • Individual seeks emotional support from social circle. Emotional Expression: • Individual aims to express the emotions that arise in the stress process. | |||
Problem Avoidance: • Individual denies and avoids thoughts and acts related to the stressful situation. | |||
Wishful Thinking: • Individual dreams and thinks about a non-stressful reality. | |||
Social Withdrawal: • Individual distances themselves from significant people associated with the emotional reaction of the stressful situation. | |||
Self-criticism: • Individual engages in self-blame and self-criticism concerning the stressful situation itself and how one dealt with it. | |||
Labrie et al. (2012) [60] | Self-help toolkit | The toolkit provides: • Exercises such as cost-benefit analysis of gambling. • Information about managing urges, managing change that comes with dealing with an addiction, what makes gambling problematic, and gambling facts. • Specific directives about how to quit (i.e., skills building). • Encouragement for people to practice quitting while simultaneously preparing them for failed attempts (i.e., relapse prevention). | • Toolkit recipients reported recently abstaining from gambling • A self-help toolkit and other self-directed resources can assist in remediating gambling-related problems for individuals who do not want formal treatment |
Ladouceur et al. (2000) [61] | Self-exclusion | • Individual excludes themselves from a government operated Canadian casino for periods that range from 6 months to 5 years. | • 30% of participants (95% of participants were severe pathological gamblers) reported that they completely stopped gambling once enrolled in the self-exclusion program |
Ladouceur et al. (2007) [62] | Self-exclusion | • Three self-exclusion programs in Quebec Casinos (Montreal, Gatineau, and Charlevoix), in which individuals exclude themselves from casinos for periods ranging from 6 months to 2 years. | • The self-exclusion program facilitated positive results including: reduced urges to gamble, reduced DSM score, reduced intensity of negative consequences for gambling (daily activities, social life, work, mood) and an increased perception of control • At the 6-month follow-up, more than half the participants had breached their contract or returned to a casino • Self-exclusion detection system needs to be improved |
Lalande and Ladouceur (2011) [63] | Limit-setting | • Person sets a strict money limit before beginning a gambling session and an intention to quit once they reach the limit. | • Both the PG and non-PG groups use monetary loss limit as a form of self-control to avoid overspending • Those in the PG group set a higher limit than those experiencing NPG; those experiencing PG continue spending after reaching their limit, while those who were not engaged in PG stop gambling when reaching their limit • Internal, external, implicit and explicit limits are proposed to operationalize self-control and self-regulation during gambling sessions |
Linardatou et al. (2014) [64] | Stress management • Relaxation Breathing • Progressive Muscle Relaxation | Relaxation Breathing: • Individual engages in a controlled method of breathing to induce relaxation. | • The intervention group demonstrated statistically significant improvements in stress, depression, anxiety symptoms, life satisfaction and better daily routines • Stress management may provide psychosocial benefits and improve the well-being of individuals with pathological gambling • It can be incorporated into PG programs |
Progressive Muscle Relaxation: • Individual engages in consecutive contractions and relaxations of different muscle groups (skeletal, facial and respiratory) in a down-top orientation to induce relaxation. • A CD guides them through the relaxation techniques (10 min RB, 15 min PMR); the CD instructs them to perform the techniques twice a day for 8 weeks at home (maximum 112 sessions) and to notice the difference between being tense and relaxed to improve perception of the relaxation response. | |||
Luquiens et al. (2016) [65] | Self-help book (Workbook) | • The CBT workbook includes content on motivation, financial issues, cognitive distortions, triggers, life reorganization and relapse prevention. | • No significant difference in efficacy between the group with guidance compared to the group without guidance and control group • Internet-based CBT should include intrinsic motivational components to increase engagement |
Martin (2013) [66] | Self-help online toolkit | • Toolkit is designed to help individuals figure out if they need to change their gambling behaviour and decide how to deal with the process of change. • It contains exercises to help determine the costs and benefits of gambling and information on managing urges. | • When completed by a large number of people, online health surveys may be advantageous for screening, intervening and providing self-help information for disordered gambling |
Moore et al. (2012) [67] | Various • Cognitive Approaches • Direct Action • Social Experience • Avoidance • Limit Setting | Cognitive Approaches: • Individual re-orders their priorities with respect to gambling, thinks about it differently and focuses on different things. | • Problem gamblers who were trying to reduce their gambling were more likely to use strategies such as Cognitive Approaches, Direct Action, Social Experience, Avoidance and Limit Setting than other gambler groups |
Direct Action: • Individual uses strategies such as cutting up credit cards or self-exclusion. | |||
Social Experience: • Individual maximizes the likelihood that spending time at gambling venues would be socially oriented rather than gambling focused. | |||
Avoidance: • Individual avoids gambling venues and places personal restrictions on their access o money at venues. | |||
Limit Setting: • Individual sets a strict money or time limit before beginning a gambling session and quits gambling once they reach that limit. | |||
Nelson et al. (2010) [68] | Self-exclusion | • Individual enrolled in the Missouri self-exclusion program are responsible for not entering any casinos in the state. | • Enrolment in the self-exclusion program reduced gambling behaviour at 6 months |
Subramaniam et al. (2017) [69] | Responsible gambling strategies • Delayed Gratification • Setting Limits • Maintaining Balance | Delayed gratification: • Individual quells the need for immediate results. | • The main theme of responsible gambling was comprised of two themes: self-development strategies and limit gambling related harm and family interventions to reduce the harm from gambling • Subthemes included delayed gratification, perception of futility of gambling, settling limits, maintaining balance, help-seeking and awareness of disorders gambling in self or others • Families play a significant role in Asian societies in imposing RG, education and counseling of families is important |
Setting limits: • Individual sets time or ‘money’ limits on themselves. | |||
Maintaining balance: • Individual maintains a sense of balance in terms of their behaviour; curbs their excessive spending, or time spent gambling. | |||
Toneatto et al. (2014) [70] | Workbook; Mindfulness | • Workbook contains CBT and CD-guided mindfulness (15-min mindfulness instruction & 30-min practice session). • Mindfulness content contains exercises and information about awareness of breathing; shifting thoughts of gambling; being present-focused; awareness of cognitive processes (especially thoughts about gambling). • CBT content contains instruction in traditional content-focused techniques, such as behavioural problem-solving & cognitive restructuring. | • Compared to a wait list control, the mindfulness intervention significantly reduced the severity of gambling, gambling urges and psychiatric symptoms at end-of treatment • There was a significant decrease in the proportion of the sample meeting criteria for pathological gambling |
Townshend (2007) [71] | Self-exclusion | Self-Exclusion in New Zealand • Individual self-excludes themselves from a gambling venue for a period up to 2 years and there may be a fine of$500 if they breach the self-exclusion ban. | • Self-exclusion is an effective treatment tool for participants who have an “extreme difficulty” controlling their gambling using other methods • Self-exclusion may be more effective in a jurisdiction with a public health environment than has been reported in other jurisdictions. |
Self-Exclusion in the U.S. • Regulations on self-exclusion vary by state. | |||
Self-exclusion in Canada (British Columbia): • The British Columbia Lotteries Corporation allows for individuals to self-exclude for 6 months, 1, 2 or 3 years and there may be a fine of $5000 if the self-exclusion is violated • This self-exclusion applies to all venues with slot machines, commercial bingo halls across British Columbia and/or the PlayNow locations. |