An Investigation of Dropout from Face-to-Face and Internet-based Psychological Treatment for Pathological Gamblers

Abstract

This thesis conducted an in-depth analysis of dropout within two psychological treatment programs for pathological gambling: face-to-face and internet-based treatment. The extent of dropout was examined at two different points throughout treatment: pre-treatment dropout and dropout during treatment. One hundred and fifty seven pathological gamblers registered to participate in the face-to-face treatment program. A high rate of dropout (42%) was identified with the majority of dropout occurring during treatment. A high rate of dropout was also found within a sample of 223 pathological gamblers who registered for the internet-based treatment program. Fifty-nine percent of participants dropped out from the internet-based program with the majority of dropout occurring during treatment. The variables associated with dropout were also assessed. Within face-to-face treatment, dropout at any time from registration to completing treatment was associated with using cognitive coping strategies. Dropping out prior to commencing treatment was associated with spending a greater amount of money per day on gambling and using cognitive coping strategies; whilst dropout from treatment sessions was associated with using emotion-focused coping strategies. Within internet-based treatment, dropout at any time was associated with increased impulsivity, decreased frequency of internet use and a negative attitude towards reading. Dropout prior to commencing treatment was associated with increased impulsivity, younger age, a negative attitude towards reading online and not previously seeking professional help for gambling. Participants who dropped out from treatment sessions used the computer or internet less often than completers and were less likely than completers to have noticed a positive change in their gambling behaviour prior to commencing session two.

Qualitative information identified that pathological gamblers had many and varied reasons for dropping out of the face-to-face and internet-based treatment programs including logistical, treatment and psychological difficulties This thesis also evaluated the success of an intervention designed to encourage pathological gamblers who dropped out of internet-based treatment to return to treatment. A return to treatment intervention was developed that addressed a range of variables that may be associated with dropout from the internet-based treatment program. Pathological gamblers who received the intervention were significantly more likely to return to the internet-based treatment after dropping out than those who did not receive the intervention. Overall, these results not only increase our understanding about which pathological gamblers are at greatest risk for dropping out of treatment, but provide evidence that distinct variables are associated with dropout at different stages of treatment and within different forms of psychological treatment for pathological gambling. Furthermore, the findings provide valuable information about intervening to reduce the extent of dropout from internet-based treatment for pathological gambling.