title: The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non-Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial.
abstract: BACKGROUND
  Internet-based interventions targeted at the most at-risk gamblers could reduce the treatment gap for addictive disorders. Currently, no clinical trial has included non-treatment-seeking patients who have been recruited directly in their gambling environment. This study was the first exclusively Internet-based randomized controlled trial among non-help-seeking problem gamblers with naturalistic recruitment in their gambling environment.
  
  
  OBJECTIVE
  The aim of this study was to assess the efficacy of three modalities of Internet-based psychotherapies with or without guidance, compared to a control condition, among problem gamblers who play online poker.
  
  
  METHODS
  All active poker gamblers on the Winamax website were systematically offered screening. All problem poker gamblers identified with a Problem Gambling Severity Index (PGSI) score of ≥ 5 were eligible to be included in the trial. Problem gamblers were randomized into four groups: (1) waiting list (control group), (2) personalized normalized feedback on their gambling status by email, (3) an email containing a self-help book to be downloaded with a Cognitive Behavioral Therapy (CBT) program without guidance, and (4) the same CBT program emailed weekly by a trained psychologist with personalized guidance. Efficacy was assessed based on the change in PGSI between baseline and 6 weeks (end of treatment) or 12 weeks (maintenance) and supported by player account-based gambling data automatically collected at the three time points.
  
  
  RESULTS
  All groups met high attrition rates (83%), but the group with guidance had a significantly higher dropout rate than the other three groups, including the control group. Although all groups showed some improvement, with a mean decrease of 1.35 on the PGSI, no significant difference in efficacy between the groups was observed. One-third of the problem gamblers fell below the problem gambling threshold at 6 weeks.
  
  
  CONCLUSIONS
  Guidance could have aversively affected problem gamblers who had not sought help. Despite the lack of significant difference in efficacy between groups, this naturalistic trial provides a basis for the development of future Internet-based trials in individuals with gambling disorders. Comorbidities, natural course of illness, and intrinsic motivation seem to be critical issues to consider in future designs.
  
  
  BACKGROUND
  ANSM 2013-A00794-41.
authors.affiliation: Paul Brousse Hospital, APHP, Villejuif - University Paris-Sud - Inserm U1178 - CESP, Department of Addiction, Villejuif cedex, France. amandineluquiens@yahoo.fr.
authors.forename: Amandine
authors.identifier: http://orcid.org/0000-0002-9402-442X
authors.initials: A
authors.lastname: Luquiens
authors.forename: Marie-Laure
authors.identifier: http://orcid.org/0000-0002-2431-2266
authors.initials: ML
authors.lastname: Tanguy
authors.forename: Marthylle
authors.identifier: http://orcid.org/0000-0001-7616-2434
authors.initials: M
authors.lastname: Lagadec
authors.forename: Amine
authors.identifier: http://orcid.org/0000-0002-3679-1858
authors.initials: A
authors.lastname: Benyamina
authors.forename: Henri-Jean
authors.identifier: http://orcid.org/0000-0002-6604-6672
authors.initials: HJ
authors.lastname: Aubin
authors.forename: Michel
authors.identifier: http://orcid.org/0000-0002-0034-1820
authors.initials: M
authors.lastname: Reynaud
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D011613:Psychotherapy / Q000379:methods*
keywords: brief intervention; guidance; internet-based cognitive behavioral therapy; internet-based randomized controlled trial; non-help seeking; poker; problem gambling