| 1. |
- Carlbring, Per, et al.
(författare)
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Deposit-limits and online gambling intensity : A randomised controlled trial
- 2019
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Konferensbidrag (refereegranskat)abstract
- Context: Pathological gambling is recognized as a public health issue in a many countries. Consequently, helping individuals control their gambling behaviors is critical. One strategy is setting a pre-committed limit for how much money one can lose, deposit or win. The aim of the study was to compare gambling intensity between online gamblers prompted to set a deposit limit and non-prompted customers.Methods: All customers of the gambling service having registered an account during the study recruitment period were included. Gambling intensity was measured with aggregated net loss, with proportions of limit-setters, sum of deposits and number of gambling days used as secondary outcomes.Intervention: A total of 4328 customers of a gambling operator from Finland were randomized to receive a prompt to set a voluntary deposit limit of optional size either 1) at registration, 2) before or 3) after their first deposit, or 4) to an unprompted control condition.Results: The intervention groups did not differ in either proportion of participants with positive net loss or size of positive net loss. The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive net loss or size of net loss. The intervention groups had higher rates of limit-setters and net loss was highest among participants who had increased/removed a deposit-limit. Conclusions: Prompting online gamblers to set a voluntary deposit limit of optional size did not affect subsequent net loss.
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| 2. |
- Carlbring, Per, et al.
(författare)
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Voluntary deposit-limit as a tool for reducing gambling intensity among customers of an online gambling platform : A randomized controlled trial
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To compare gambling intensity between users of an online gambling service prompted to set a deposit limit and non-prompted customers, in the whole sample and among most active users based on total number of gambling days. Design: A randomized controlled trial with three prompted (N=1098/1110/1055) and one unprompted control condition (N=1065) and gambling activity of each participant followed for 90 days starting at account registration. Setting. A publicly governed online gambling operator from Finland. Interventions: The prompted participants received a one-time prompt to set a voluntary deposit limit of optional size either 1) at-registration, 2) before or 3) after they made their first deposit. Participants in the control condition were not prompted. Participants: All Finnish customers of the gambling service having registered an account during the study recruitment period with online slots as preferred gambling category during the 90 days following the registration. Measures: Gambling intensity was measured with aggregated net loss (NL), with proportions of limit-setters, sum of deposits and number of gambling days used as secondary outcomes. Findings: In the whole sample, the three intervention groups did not differ in either proportion of participants with positive NL (BF10prop=0.007) or size of positive net loss (BF10size=0.016), the results being similar for the most involved gamblers (BF10prop=0.030; BF10size=0.082). The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive NL (OR(95%CI)=0.991(0.836–1.176); p=.921) or size of NL (B(95%CI) =-0.080(-0.229-0.069); p=.291), the results applying to the most involved gamblers (proportion positive NL: OR(95%CI)=0.834(0.492-1.412), p =.498; NL size: B(95%CI)=0.042(-0.359-0.442), p =.838). The three intervention groups had higher rates of limit-setters and NL was highest among participants who have increased/removed a deposit-limit. Conclusion: Prompting users of an online gambling service to set a voluntary deposit limit of optional size did not affect subsequent NL compared to unprompted participants.
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| 3. |
- Ivanova, Ekaterina, et al.
(författare)
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Deposit Limit Prompt in Online Gambling for Reducing Gambling Intensity : A Randomized Controlled Trial
- 2019
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Pre-commitment tools – allowing users of gambling services to pre-set a limit for how much money they may spend – are relatively common. However, there exist no clear evidence of their effectiveness in preventing gamblers from spending more money than they otherwise planned. The aim of the study was to compare gambling intensity between users of an online gambling service prompted to set a deposit limit and non-prompted customers, both in the whole sample and among most active users based on the total number of gambling days. Prospective customers of a publicly governed gambling operator from Finland were randomized to receive a prompt to set a voluntary deposit limit of optional size either (1) at registration, (2) before or (3) after their first deposit, or (4) to an unprompted control condition. Data on customers from Finland with online slots as a preferred gambling category (N = 4328) were tracked in the platform for 90 days starting at account registration, gambling intensity being measured with aggregated net loss. The intervention groups did not differ from each other in either proportion of participants with positive net loss or size of positive net loss. The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive net loss (OR = 1.0; p = 0.921) or size of net loss (B = -0.1; p = 0.291). The intervention groups had higher rates of limit-setters compared to the control condition (ORat-registration/pre-deposit/post-deposit = 11.9/9.2/4.1). Customers who have increased/removed a previously set deposit limit had higher net loss than the limit-setters who have not increased/removed their limit (Bat-registration/pre-deposit/post-deposit/control = 0.7/0.6/1.0/1.3), and unprompted limit-setters lost more than unprompted non-setters (B = 1.0). Prompting online gamblers to set a voluntary deposit limit of optional size did not affect subsequent net loss compared to unprompted customers, motivating design and evaluation of alternative pre-commitment tools. Setting a deposit limit without a prompt or increasing/removing a previously set limit may be a marker of gambling problems and may be used to identify customers in need of help.
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| 4. |
- Ivanova, Ekaterina, et al.
(författare)
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Experiences of responsible gambling tools among non-problem gamblers : A survey of active customers of an online gambling platform
- 2019
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Ingår i: Addictive Behaviors Reports. - : Elsevier BV. - 2352-8532. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools.Methods: A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed.Results: Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95%CI] = 7.17 [3.61–14.23], p < .001).Conclusions: Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.
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| 5. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 0887-6185 .- 1873-7897. ; 44, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.
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| 6. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application
- 2015
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Ingår i: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii). - Linköping : Linköping University Press. ; , s. 9-9
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: As Acceptance and Commitment Therapy (ACT) becomes a part of the clinical practice, the interest for alternative ways of providing it continue to grow. Internet-based CBT, both guided and unguided, has proved to be effective for the treatment of a wide range of psychiatric disorders, including anxiety disorders. Moreover, the tremendous accessibility of smartphones makes them a potentially powerful instrument for providing psychological treatment. The purpose of this study was to investigate the effects of an Internet-based ACT-program for social anxiety disorder and panic disorder using both computers and smartphones, and with and without therapist support. Method: The participants were recruited from the general public by filling out an online screening form, which consisted of LSAS, PDSS-SR, GAD-7, PHQ-9, QOLI (the scales later served as outcome measures) and demographic questions. The individuals who met the inclusion criteria were contacted for a diagnostic telephone interview. The 152 people chosen for participation were then randomized into two treatment groups (guided and unguided) and a waiting list control group. The participants in the treatment groups were given access to an Internet-provided ACT-based treatment program consisting of 8 modules, as well as a smartphone application with content that corresponded to the Internet treatment program. Additionally, the participants in the guided group received minimum therapist support (15 min/week) through the smartphone application from psychology students undergoing their clinical training. The participants worked with the program for 10 weeks. They were evaluated twice during treatment, once after completing treatment, and once again 12-months later as a follow-up measure. A mixed effect model was used to analyze the data. Results: Regardless of diagnosis, as a whole the treated groups showed significant decreases in anxiety, with a moderate within-group effect size. This improvement appeared to be maintained when the groups were evaluated again during the follow-up. The participants suffering primarily from social anxiety disorder showed significant improvements, with moderate within-group effect sizes in both the guided (Cohen's d = 0.79) and unguided group (Cohen's d = 0.71). This improvement also appeared to be maintained when these participants were evaluated during the follow-up. No significant changes were observed in the symptoms of the participants suffering primarily from panic disorder. Discussion: Internet-delivered ACT-based treatment provided via both computer and smartphone can be effective for reducing general anxiety symptoms, as well as social anxiety symptoms. The guided treatment was not clearly superior to the unguided treatment. Some of the study’s uncertainties are likely due to the presence of a large number of different components, which made it difficult to isolate the effects of each individual component.
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| 7. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided transdiagnostic Acceptance and Commitment Therapy for anxiety disorders provided via a computer and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 530-530
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Konferensbidrag (refereegranskat)abstract
- Technology-assisted psychological treatments are becoming well-known in the scientific networks throughout the world and are being implemented into routine health care in a number of countries. The interest in evaluating the potential of different devices is growing. The main objective of the current study was to evaluate the effects of guided and unguided computerand smartphone-based Acceptance and Commitment Therapy (ACT) for social anxiety disorder (SAD) and panic disorder (PD).A total of 152 participants were randomized into a guided treatment group, an unguided treatment group and a waiting list control group. Both treatment groups got access to a computer-based ACT-treatment and a smartphone application (app) with corresponding content. The eight modules treatment program covered a number of topics such as the nature of anxiety, functional analyses, acceptance, mindfulness and valued actions. The purpose of the app was to make it easier for the participants to access the key points of the program and to do homework assignments in their everyday life. Automatic messages in the app aimed to give feedback to the participants on their work as well as to prompt them to continue with the program. In addition to that, the participants in the guided group got therapist support via the app. The therapists were encouraged to work with each of their patient 15 min/week during the 10 weeks treatment period and focus on motivating, validating and correcting mistakes. On the whole group level GAD-7 was used as the primary outcome measure. LSAS and PDSS-SR were used for subgroup analyses in SAD and PD participants respectively. The measurements were collected at pre-, mid- and post-treatment and at 12-months follow-up.There were no significant differences in adherence between the treatment groups except for significantly higher rates of smartphone usage in the guided group. No significant differences in treatment outcome were found between the treatment groups with moderate within-group effects (Cohen’s d = 0.75 for the guided and Cohen’s d = 0.66 for the unguided group). The treated participants improved significantly in comparison to the control group both on the whole group level (between group Cohen’s d = 0.39) and for the participants suffering primarily from SAD (between group Cohen’s d = 0.70). Within group effect sizes were large for the PD-participants (Cohen’s d = 1.00) but the study was very underpowered in this part.Discussion. The treatment program as it was used in the present study appeared to be effective in treating social anxiety disorder and decreasing general anxiety symptoms, but the effects are smaller than seen in previous studies. The guided treatment was not clearly superior to the unguided one. The study contributes to the growing body of evidence on technology-assisted ACT.Conclusion. Computer- and smartphone-based ACT can be made into an effective treatment for anxiety disorders. A smartphone application seems to have a clear potential to partly compensate for the absence of therapist support which needs to be studied further.
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| 8. |
- Ivanova, Ekaterina, 1987-
(författare)
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Responsible provision of online gambling : Effects, usability and gamblers’ experiences of protective measures implemented in online gambling environments
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problem gambling is considered a public health problem in many countries and is associated with serious financial and health-related harms for both problem gamblers and significant others. It is possible to create gambling environments that would promote sustainable gambling behaviors and prevent excessive gambling. However, research on the effectiveness of tools for responsible provision of gambling is scarce and the quality of the research is low. Also, there exists a conflict of interest between making a profit when providing gambling and protecting vulnerable customers. The general aim of the project was to study the effects, usability and gamblers’ experiences of tools for responsible provision of online gambling. Study I evaluated the effects of a prompt to set voluntary deposit-limit of optional size among 4,328 customers of an online gambling platform. During the data collection period, all customers from Finland registering an account on the gambling platform were randomized into being prompted to set a deposit-limit either 1) at-registration, 2) before their first deposit, 3) after their first deposit or 4) to an unprompted control group. Gambling intensity, measured with aggregated net loss, was tracked during 90 days after registration. No differences in gambling intensity between the intervention and control groups were found neither on the whole-group level (B (95% CI) =-0.080 (-0.229-0.069), p=.291), nor in the subgroup of the most involved gamblers (B (95% CI) =0.042(-0.359-0.442), p=.838). Study II aimed at predicting gaming freeze (as a proxy parameter for problem gambling) in online gamblers. For the sample of N=2,618 (N=1,309 freezers), a total of 105 predictors were created based on the data tracked by the gambling platform. The analysis was carried out using the machine learning method Random Forest. The predictive accuracy of the model applied to the dataset was 0.615, with a specificity of 0.686 and a sensitivity of 0.543. Study III aimed at investigating non-problem gamblers’ experiences of protective measures. A total of N=10,200 active customers of an online gambling platform were asked to rate their previous experiences of protective tools, their inclination to abandon a gambling service due to perceived overexposure to protective measures and answer questions on their symptoms of problem gambling. N=1,223 responded to the questionnaire, with the majority of the sample being moderate-risk gamblers (38.5%), followed by low-risk gamblers (26.8%), non-problem gamblers (18.9%) and problem gamblers (15.8%). In general, non-problem gamblers were not more disturbed by protective measures than other categories of gamblers. More problem gamblers have previously abandoned a gambling service due to perceived overexposure to protective measures compared to non-problem gamblers (OR(95% CI)= 7.17(3.61-14.23), p<.001). In conclusion, a prompt to set a voluntary deposit-limit of optional size did not appear to be effective in decreasing gambling intensity in online gamblers, indicating the need of evaluating alternative designs. Predicting gaming freezes in the current project resulted in a low accuracy, indicating that gaming freeze is not suitable as a proxy measurement for problem gambling and suggesting the need for collecting subjective data on symptoms of problem gambling. The results of Study III suggest that protective measures can be tested and implemented without the risk of disturbing recreational gamblers.
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| 9. |
- Ivanova, Ekaterina, et al.
(författare)
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Using the Random Forest Algorithm on Customer Gambling Data for Predicting Gambling Freezes in an Online Gambling Platform
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background. Data on gambling behaviors routinely collected on online gambling platforms can be used to detect individuals at risk of developing or having gambling problems. As only data on gambling activity is available on gambling platforms, it is important to find a proxy measure for gambling problems. Temporarily freezing one or several gambling categories has potential to serve this purpose. Aim. To predict gambling freeze in a sample of active users of an online gambling platform one week before the freeze, based on one week of behavioral data tracked on the platform. Method. N = 105 predictors were created, covering total values, frequencies, variations, and trajectories of monetary and time-related gambling involvement, number and type of games played, point in time when gambling occurred, age, and gender. The random forest algorithm was applied to a sample of N = 2618 gamblers (of which N = 1309 freezers), with the sample divided 70/30 into a training and testing data set. Results. The accuracy of random forest applied to the testing data set was 0.615, with sensitivity of 0.543 and specificity of 0.686. The five most predictive variables were current age, age on registration date, average session length, average sum of winnings per session, and total session length. Discussion. The predictive accuracy of the algorithm in the current study was relatively low, suggesting the need for a more suitable target variable. Also, analyzing data collected during a longer period might be needed to create a tool that could be used to identify at-risk gamblers.
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| 10. |
- Lindner, Philip, et al.
(författare)
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Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application : study protocol for a randomised controlled trial
- 2013
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 14:437
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Tidskriftsartikel (refereegranskat)abstract
- Background: Smartphone technology presents a novel and promising opportunity to extend the reach of psychotherapeutic interventions by moving selected parts of the therapy into the real-life situations causing distress. This randomised controlled trial will investigate the effects of a transdiagnostic, Internet-administered cognitive behavioural (iCBT) self-help program for anxiety, supplemented with a smartphone application. The effect of added therapist support will also be studied. Methods/Design: One hundred and fifty participants meeting diagnostic criteria for social anxiety disorder and/or panic disorder will be evenly randomised to either one of three study groups: 1, smartphone-supplemented iCBT with therapist support; 2, smartphone-supplemented iCBT without therapist support; or 3, an active waiting list control group with delayed treatment. Primary outcome measure will be the Generalised Anxiety Disorder 7-item self-rating scale. Secondary measures include other anxiety, depression and quality of life measures. In addition to pre- and post-treatment measurements, the study includes two mid-treatment (days 24 and 48) and two follow-up assessments (12 and 36months) to assess rapid and long-term effects. Discussion: To our knowledge, this is the first study to investigate the effectiveness of smartphone-supplemented iCBT for anxiety disorders. Hence, the findings from this trial will constitute great advancements in the burgeoning and promising field of smartphone-administered psychological interventions. Limitations are discussed.
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