Change 4 Better (C4B)

This study is a 6-month randomized clinical trial for individuals with a gambling disorder enrolled in or seeking treatment for problem gambling at an outpatient treatment facilities affiliated with the Bettor Choice Gambling Treatment Programs in Connecticut or Kindbridge Behavioral Health with locations across the US. The purpose is to evaluate the feasibility and efficacy of a cognitive behavioral therapy-based mobile app (Change4Better; C4B), as an adjunct to treatment as usual (TAU) in community-based outpatient treatment programs. Eligible participants will be randomly assigned to receive either: (1) standard treatment as usual (TAU) or (2) TAU plus access to the Change4Better (C4B) mobile app. TAU will consist of standard services provided at outpatient clinics within the Bettor Choice Programs or Kindbridge Behavioral Health. Clinicians providing TAU within the Bettor Choice Programs or Kindbridge Behavioral Health will not be participants in the research trial, and they will not be asked to perform any additional duties outside of their typical services. Participants assigned to C4B will receive TAU plus access to the C4B mobile app, which they can access as often as desired using their own device. The C4B mobile app will be managed by the Yale research team.

Inclusion criteria

• 18 years of age or older;
• able to speak, read and write in English;
• report gambling in the past 2 months (60 days);
• meet DSM-5 criteria for gambling disorder within past 12 months as determined by the Structured Clinical Interview for Pathological Gambling - DSM-5 version (SCI-PG-DSM);
• at least mild gambling severity as measured by GSAS (Total >8)
• seeking or currently enrolled in treatment for gambling; if seeking treatment, must be deemed appropriate for outpatient level of care by treatment facility clinical team
• own a smartphone with internet access.

Exclusion criteria

• unwilling or unable to provide informed consent due to severe cognitive impairment or inability to read;
• deemed to have current untreated psychosis or mania;
• active suicidal ideation;
• physical dependence on opioids and/or alcohol requiring medical detoxification.