title: Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions.
abstract: Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, VIC, 3065, Australia. simone.rodda@aut.ac.nz.|School of Public Health and Psychosocial Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 1142, New Zealand. simone.rodda@aut.ac.nz.
authors.forename: Simone N
authors.initials: SN
authors.lastname: Rodda
authors.affiliation: Health, Medical and Applied Sciences, Central Queensland University, University Drive, Bundaberg, QLD, 4670, Australia.
authors.forename: Nerilee
authors.initials: N
authors.lastname: Hing
authors.affiliation: Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgins
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, VIC, 3065, Australia.|Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, VIC, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Cheetham
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, VIC, 3065, Australia.|Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, VIC, Australia.
authors.forename: Marissa
authors.initials: M
authors.lastname: Dickins
authors.affiliation: Turning Point, Eastern Health, 54-62 Gertrude Street, Fitzroy, VIC, 3065, Australia.|Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, VIC, Australia.
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
mesh_terms: D000328:Adult; D001315:Australia; D002755:Choice Behavior; D003376:Counseling / Q000379:methods; D005260:Female; D005715:Gambling / Q000523:psychology* / Q000628:therapy; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D009042:Motivation; D020377:Self Efficacy; D000068356:Self-Control; D012944:Social Support
keywords: Change strategies; Counselling; Gambling; Internet; Minimal treatment; Self-help; Treatment