A treatment seeking population with Gambling Disorder - Internet treatment, severity and gender

Abstract

Gambling is a common pastime all over the world, but can become harmful in excess and can even develop into an addictive behavior, a Gambling Disorder (GD). The aim of this thesis was to contribute to the clinical understanding of treatment seeking individuals with GD, and relevant treatment options for this group. In Paper I, the Gamblers’ Beliefs Questionnaire, a measure of cognitive distortions related to gambling, was translated and validated in a Swedish context. In Paper II, clinical differences between GD severity levels were examined among participants recruited at the “Clinic for Gambling Addiction and Screen Health” at Sahlgrenska University Hospital in Gothenburg. It was found that those with severe GD were more depressed and anxious, and more likely to gamble as a way of “escape”. Gamblers with moderate and severe disorder had greater difficulties regarding emotion regulation. Increasing severity was also associated with more alcohol and drug problems, and an earlier gambling debut. Paper III explored gender differences in a similar clinical sample with GD. Women with GD were found to be older than men, and more commonly engaged in online casino gambling. They were also more often single parents, started gambling later in life, developed problems quicker, and were more often categorized as “emotionally vulnerable gamblers”. Women also had more symptoms of depression and anxiety, while men had more problems with illicit drugs. In Paper IV, Internet-delivered Cognitive Behavior Therapy (ICBT) was compared to a limited internet-delivered control treatment using a randomized controlled trial design. The ICBT was not found to be more effective than the control treatment. Both treatment groups had subclinical symptoms post-treatment and the largest change in gambling behaviors occurred between assessment and treatment start. In conclusion, this thesis contributed a new instrument for use in the clinic and research alike, it found relevant differences among subgroups with GD, and it found that interventions of low intensity might be effective for gambling symptoms. This knowledge is a first step in the future individualization of the treatment of GD.