Abstract The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem ...gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services ( n = 463), family violence services ( n = 95), alcohol and drug services ( n = 47), mental health services ( n = 51), and financial counselling services ( n = 48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine screening, assessment and management of problem gambling and family violence in a range of services.
Countries with legalized gambling offer a network of government funded face-to-face therapy, but usage of this expertise is on the decline. One way to address this issue is to recruit therapists from ...existing services whereby they provide guidance for the delivery of internet delivered CBT.
To explore the experiences and perceptions of therapists supporting guided online cognitive–behavioural therapy.
Interviewees were a sub-sample of therapists from a randomised trial that investigated the relative efficacy of online guided self-directed versus pure self-directed interventions in Australia.
In-person, semi-structured interviews with seven service providers were completed, and thematic content analysis identified five themes which related to: participant suitability and screening (e.g., motivation, computer literacy and access); program content and modality acceptability (e.g., amount of content, look and feel); participant information and management (e.g., program engagement and progression); email communication (e.g., use of templates, appointments, rapport building), and; ongoing service integration (e.g., infrastructure, confidence in product). Overall experiences and perceptions of therapists were positive, notwithstanding barriers concerning assessment of participant suitability, participant management systems and low participant engagement.
Key themes emphasized the benefits of Internet-based interventions for problem gambling, and suggested several areas for improvement. Results should inform the development of future treatments to enable flexible tailoring of interventions to individuals.
•Guidance for iCBT can be integrated into routine service delivery.•Screening for suitable clients is important to guides.•Guidance as it is typically delivered may be constrictive for highly experienced clinicians.•Ongoing service integration was viewed positively in terms of developing a suite of services.
There is a need to establish reliability and the various forms of validity in all measures in order to feel confident in the use of such tools across a wide diversity of settings. The aim of this ...study is to describe the reliability and validity of the Victorian Gambling Screen (VGS) and in particular one of the sub-scales (Harm to Self—HS) in a specialist problem gambling treatment service in Adelaide, Australia. Sixty-seven consecutive gamblers were assessed using a previously validated clinical interview and the VGS (Ben-Tovim et al., The Victorian Gambling Screen: project report. Victorian Research Panel, Melbourne,
2001
). The internal consistency of the combined VGS scales had a Cronbach’s alpha of .85 with the HS scale .89. There was satisfactory evidence of convergent validity which included moderate correlations with another measure of gambling—the South Oaks Gambling Screen. There were also moderate correlations with other measures of psychopathology. Finally, how the VGS may best be used in clinical settings is discussed.
Summary Introduction To evaluate the efficacy of a self-management support program including a 6 week self-management course, individualised phone support and goal setting in osteoarthritis patients ...on a waiting list for arthroplasty surgery. Method Randomised controlled trial of 152 public hospital outpatients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery. Participants were randomised to a self-management program or to usual care. The primary outcome was change in the Health Education Intervention Questionnaire (HeiQ) from randomisation to 6 month follow-up. Quality of life and depressive symptoms were also measured. Changes in pain and function were assessed using the Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Results At 6 month follow-up, health-directed behaviour was significantly greater in the intervention mean 4.29, 95% confidence interval (CI) 3.99–4.58 than the control (mean 3.81, 95% CI 3.52–4.09; P = 0.017). There was also a significant effect on skill and technique acquisition for the intervention (mean 4.37, 95% CI 4.19–4.55) in comparison to control (mean 4.11, 95% CI 3.93–4.29; P = 0.036). There was no significant effect of the intervention on the remaining HeiQ subscales, WOMAC pain or disability, quality of life or depressive symptoms. Discussion The arthritis self-management program improved health-directed behaviours, skill acquisition and stiffness in patients on a joint replacement waiting list, although the observed effects were of modest size (Cohen's d between 0.36 and 0.42). There was no significant effect on pain, function or quality of life in the short term. Self-management programs can assist in maintaining health behaviours (particularly walking) in this patient group. Further research is needed to assess their impact on quality of life and over longer periods.
This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine problem gambling. In this paper the authors describe part one of a two part, linked relapse ...process: the ‘push’ towards relapse. In this two-part process, factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behavioural events that ends with relapse when the ‘push’ overcomes ‘pull’ (part one); or as described in part two, continued abstinence when ‘pull’ overcomes ‘push’. In the second paper, the authors describe how interacting factors ‘pull’ the problem gambler away from relapse. This study used four focus groups comprising thirty participants who were gamblers, gamblers’ significant others, therapists and counsellors. The groups were recorded, recordings were then transcribed and analysed using thematic, textual analysis. With the large number of variables considered to be related to relapse in problem gamblers, five key factors emerged that ‘push’ the gambler towards relapse. These were urge, erroneous cognitions about the outcomes of gambling, negative affect, dysfunctional relationships and environmental gambling triggers. Two theories emerged: (1) each relapse episode comprised a sequence of mental and behavioural events, which evolves over time and was modified by factors that ‘push’ this sequence towards relapse and (2) a number of gamblers develop an altered state of consciousness during relapse described as the ‘zone’ which prolongs the relapse.
IntroductionThe prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for ...alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive–behavioural programme for disordered gambling (GamblingLess: For Life).Methods and analysisThe study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors).Ethics and disseminationThe study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations.Trial registration numberACTRN12615000864527; results.
IntroductionThe primary purpose of this study is to evaluate the relative effectiveness of 2 of the best developed and most promising forms of therapy for problem gambling, namely face-to-face ...motivational interviewing (MI) combined with a self-instruction booklet (W) and follow-up telephone booster sessions (B; MI+W+B) and face-to-face cognitive–behavioural therapy (CBT).Methods and analysisThis project is a single-blind pragmatic randomised clinical trial of 2 interventions, with and without the addition of relapse-prevention text messages. Trial assessments take place pretreatment, at 3 and 12 months. A total of 300 participants will be recruited through a community treatment agency that provides services across New Zealand and randomised to up to 10 face-to-face sessions of CBT or 1 face-to-face session of MI+W+up to 5 B. Participants will also be randomised to 9 months of postcare text messaging. Eligibility criteria include a self-perception of having a current gambling problem and a willingness to participate in all components of the study (eg, read workbook). The statistical analysis will use an intent-to-treat approach. Primary outcome measures are days spent gambling and amount of money spent per day gambling in the prior month. Secondary outcome measures include problem gambling severity, gambling urges, gambling cognitions, mood, alcohol, drug use, tobacco, psychological distress, quality of life, health status and direct and indirect costs associated with treatment.Ethics and disseminationThe research methods to be used in this study have been approved by the Ministry of Health, Health and Disability Ethics Committees (HDEC) 15/CEN/99. The investigators will provide annual reports to the HDEC and report any adverse events to this committee. Amendments will also be submitted to this committee. The results of this trial will be submitted for publication in peer-reviewed journals and as a report to the funding body. Additionally, the results will be presented at national and international conferences.Trial registration numberACTRN12615000637549.
This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine (EGM) problem gambling (PG) by describing the processes and factors that ‘pull’ the problem ...gambler away from relapse contrasted with the ‘push’ towards relapse. These conceptualisations describe two opposing, interacting emotional processes occurring within the problem gambler during any relapse episode. Each relapse episode comprises a complex set of psychological and social behaviours where many factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behaviour events that end (1) with relapse where ‘push’ overcomes ‘pull’ or (2) continued abstinence where ‘pull’ overcomes ‘push’. Four focus groups comprising thirty participants who were EGM problem gamblers, gamblers’ significant others, therapists and counsellors described their experiences and understanding of relapse. The groups were recorded, recordings were then transcribed and analysed using thematic textual analysis. It was established that vigilance, motivation to commit to change, positive social support, cognitive strategies such as remembering past gambling harms or distraction techniques to avoid thinking about gambling to enable gamblers to manage the urge to gamble and urge extinction were key factors that protected against relapse. Three complementary theories emerged from the analysis. Firstly, a process of reappraisal of personal gambling behaviour pulls the gambler away from relapse. This results in a commitment to change that develops over time and affects but is independent of each episode of relapse. Secondly, relapse may be halted by interacting factors that ‘pull’ the problem gambler away from the sequence of mental and behavioural events, which follow the triggering of the urge and cognitions to gamble. Thirdly, urge extinction and apparent ‘cure’ is possible for EGM gambling. This study provides a qualitative, empirical model for understanding protective factors against gambling relapse.
Background The congestive heart failure syndrome has increased to epidemic proportions and is cause for significant morbidity and mortality. Indigenous patients suffer a greater prevalence with ...greater severity. Upon diagnosis patients require regular follow-up with medical and allied health services. Patients are prescribed life saving, disease modifying and symptom relieving therapies. This can be an overwhelming experience for patients. To compound this, remoteness, differentials in conventional health care and services pose special problems for Indigenous clients in accessing care. Additional barriers of language, culture, socio-economic disadvantage, negative attitudes towards establishment, social stereotyping, stigma and discrimination act as barriers to improved care. Recent focus supported by clinical evidence support the role of chronic disease self-management programs. A patient focused, problem identification, goal setting and psychosocial modification based program should in principal highlight these issues and help tailor a patient focused comprehensive care plan to complement guideline based care. At present there are no Indigenous focused chronic disease self-management programs. There is a need for research on ways to provide chronic disease management to this group. We therefore designed a study to assess a model of patient focussed comprehensive care for Indigenous Australians with heart failure. Study design AUSI-CDS is a prospective, cohort, observational study to evaluate the efficacy of the standard “Flinders Program of Chronic Condition Management” for Indigenous patients with chronic heart failure. Eligible patients will be Indigenous, suffering from chronic heart failure, in the Northern Territory. The primary end-point is the satisfaction score based on the PACIC. The study will recruit 20 patients and is expected to last 12 months. Summary The rationale and design of the AUSI-CDS using the Flinders Model is described.
Background
Self-management is seen as a primary mechanism to support the optimization of care for
people with chronic diseases such as symptomatic vascular disease. There are no
established and ...evidence-based stroke-specific chronic disease self-management programs.
Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of
a Phase II randomized-controlled clinical trial.
Methods
Stroke survivors are recruited from a variety of sources including: hospital stroke
services, local paper advertisements. Stroke South Australia newsletter (volunteer peer
support organization), Divisions of General Practice, and community service providers
across Adelaide, South Australia. Subjects are invited to participate in a multi-center,
single-blind, randomized, controlled trial. Eligible participants are randomized to
either;
standard care,
standard care plus a six week generic chronic condition self-management group
education program, or,
standard care plus an eight week stroke specific self-management education group
program.
Interventions are conducted after discharge from hospital. Participants are assessed at
baseline, immediate post intervention and six months.
Study Outcomes
The primary outcome measures determine study feasibility and safety, measuring,
recruitment, participation, compliance and adverse events. Secondary outcomes
include:
positive and active engagement in life measured by the Health Education Impact
Questionnaire,
improvements in quality of life measured by the Assessment of Quality of Life
instrument,
improvements in mood measured by the Irritability, Depression and Anxiety
Scale,
health resource utilization measured by a participant held diary and safety.
Conclusion
The results of this study will determine whether a definitive Phase III efficacy trial
is justified.
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