Browsing by Subject "online therapy"

Objective: Gambling can induce dissociative states that have many names: in-game dissociation, the zone and dark flow. Many researchers believe dissociation to be associated with problem gambling severity. The aim of the current study was to investigate whether gambling-related dissociation measured at baseline moderates treatment effectiveness of a guided CBT-based intervention for problem gamblers, the hypothesis being that higher levels of dissociation hinder treatment effectiveness. It was also investigated, whether the moderating effect is different depending on whether a single dissociation item or a whole scale is used. An additional aim was to shed light on the temporal persistence of the association between gambling-related dissociation and problem gambling. Methods: The data were collected between 2019 and 2021 from an 8-week guided CBT-based online therapy for problem gamblers called the Peli Poikki (PP) program. The participants (N=1139, 58.8% males) were surveyed at five occasions: screen, baseline, post-treatment, 6 and 12 months after treatment completion. Problem gambling severity was assessed by The National Opinion Research Center DSM Screen for Gambling problems (NODS) and gambling-related dissociation by a modified version of Jacobs’ Dissociative Experience Questions (JDEQ). Treatment effectiveness and the moderating effect of dissociation were analysed with linear mixed models. Gender, income, education and age were controlled for in the models. Results and conclusions: The PP program was effective in reducing symptoms of problem gambling. Gambling-related dissociation measured at baseline moderated treatment effectiveness, higher levels of dissociation predicting a more notable drop in problem gambling symptoms. The results were similar when the single item operationalizations of dissociation were used. The association between problem gambling severity and gambling-related dissociation was strong in all measurement occasions. Thus, the notable reduction of problem-gambling symptoms among participants with high dissociation levels was probably due to them having the highest problem gambling symptoms and thus the most “potential” to benefit. A model with repeatedly measured dissociation revealed, however, that the participants with higher levels of dissociation did not sustain the benefits in the two follow-ups. These results highlight the importance of understanding the individual characteristics of gambling problems to help customize treatment efforts.