J Gambl Stud

DOI 10.1007/s10899-016-9624-8

REVIEW PAPER

A Critical Review of the Harm-Minimisation Tools

Available for Electronic Gambling

Andrew Harris1 • Mark D. Griffiths1

 The Author(s) 2016. This article is published with open access at [Link]

Abstract The increasing sophistication of gambling products afforded by electronic tech-

nologies facilitates increased accessibility to gambling, as well as encouraging rapid and
continuous play. This poses several challenges from a responsible gambling perspective, in
terms of facilitating player self-awareness and self-control. The same technological
advancements in gambling that may facilitate a loss of control may also be used to provide
responsible gambling tools and solutions to reduce gambling-related harm. Indeed, several
harm-minimisation strategies have been devised that aim to facilitate self-awareness and self-
control within a gambling session. Such strategies include the use of breaks in play, ‘pop-up’
messaging, limit setting, and behavioural tracking. The present paper reviews the theoretical
argument underpinning the application of specific harm-minimisation tools, as well as pro-
viding one of the first critical reviews of the empirical research assessing their efficacy, in
terms of influencing gambling cognitions and behaviour.

Keywords Behavioural tracking
Breaks in play
Harm-minimisation tools
Limit-

setting
Pop-up messaging
Responsible gambling

Background

High-intensity commercial gambling has evolved relatively recently in comparison to other

legalised, hazardous, and consumptive behaviours, such as tobacco and alcohol use
(Adams et al. 2008). Gambling products and their advertising are now almost unavoidable

& Andrew Harris

andrew.harris2015@[Link]
Mark D. Griffiths
[Link]@[Link]
1
International Gaming Research Unit, Psychology Division, Nottingham Trent University,
Nottingham, UK

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and the promotion of gambling has arguably become as a social norm (Parke et al.
2014a, b). The presence of gambling has become ubiquitous, inextricably linked with
national and international sporting events on television, omnipresent in towns and cities in
the form of licensed betting offices, casinos, bingo halls and amusement arcades, and
remote gambling, including gambling via the internet, mobile phone and interactive
television (Griffiths et al. 2014).
Of particular importance is the evolution of gambling products into sophisticated,
electronic platforms that possess structural features that interact with the gambler to
produce ego-dystonic and maladaptive effects (see e.g., Breen and Zimmerman 2002),
which may broadly be described as ‘gambling-related harm’. The strategic approach to
tackling this harm is of great importance, as is the focus on efforts to reduce such harm.
Adams et al. (2008) argue that in a society demonstrating relatively stable consumption, it
is justifiable that attention should be directed towards the treatment of those suffering with
a gambling problem. However, such concentration of effort as Adams et al. (2008) go on to
argue, is less urgent in a rapidly changing environment that is demonstrating escalation of
risk. Instead, effort would be best directed towards attending to the situation itself:
…when a submerged rock pierces a hole in the bottom of a boat, it makes little sense
to attend solely to those who have been injured and it makes considerably more sense
to focus a good deal of energy upon stemming the flow of water through the hole
(Adams et al. 2008; pp. 869).
This analogy may be particularly relevant given the evolving view that the Theory of
Total Consumption (Lederman 1956) is valid for gambling behaviour (Lund 2008). In the
field of alcohol studies, it has long been accepted that there is a positive association
between mean alcohol consumption among a population and the relative proportion of
heavy or problem drinkers in that society (Babor et al. 2003). Such a relationship, origi-
nally proposed by Lederman (1956), is known as the total consumption model, or the
single distribution theory. Emergent evidence suggests the total consumption model is
valid in a wide variety of phenomena (Lund 2008). This has included gambling behaviour,
with several studies finding evidence of increased gambling participation as gambling
accessibility increases (e.g., Room et al. 1999; Turner et al. 1999), with such evidence
being taken as support for the application of the theory of total consumption to gambling.
One assumption of the theory is that when individuals along the entire consumption
continuum increase their gambling, this will also include those gambling at a level below or
just below the limit for heavy or excessive gambling (Lund 2008). Consequently, increased
gambling participation in this subgroup is enough to shift them towards the heavier gambling
group. This is particularly important given the figures that demonstrate that in addition to a
0.5 % prevalence estimate for problem gambling in the UK, an additional 4.2 % of adults can
be classed as ‘at-risk’ for developing a gambling problem (Wardle et al. 2014), equating to
around 2.5 million people. From a total consumption perspective, increased gambling con-
sumption has the potential to shift those at risk into the problem gambling category, as well as
converting those who gamble recreationally, problem-free, to at-risk gamblers. Furthermore,
for every problem gambler there are a number of family, friends and individuals in a com-
munity who are negatively impacted by problem gambling (Dickson-Swift et al. 2005)
although the number of individuals affected is fewer for adolescent problem gamblers
(Griffiths 1995). This provides strong argument for problem gambling to be tackled from a
public health perspective.
The question remains as to how to tackle the promotion of responsible gambling (RG) and
the prevention of problem gambling. This has led to the introduction of many RG and harm-

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minimisation initiatives. For example, one harm-minimisation approach has been to restrict
the availability of gambling by reducing opening hours in licensed gambling premises (Wohl
et al. 2010), as well as reduce the quantity of gambling products by restricting the number of
electronic gambling machines (EGMs) in licensed betting offices in the UK to four (Asso-
ciation of British Bookmakers 2015). Similarly, voluntary self-exclusion programmes allow
individuals who feel they have a problem with gambling to identify themselves to the
gambling venue and mutually agree upon a venue exclusion for a predetermined or indefinite
period of time. It is important to note that such a decision to voluntarily self-exclude may also
be viewed in a positive light and from a preventive approach, as voluntary self-exclusion is
available to those who may not yet have developed a gambling problem, but feel they may be
at risk or simply feel like they do not want to gamble anymore.
The above examples represent the ‘supply reduction’ type of harm-minimisation. Other
approaches include ‘demand reduction’, by adopting policies that make gambling less
attractive, such as limiting or banning in-house smoking or the consumption of alcohol
(Williams et al. 2004). Other demand reduction approaches may aim to educate customers
about the true nature and odds of specific gambling games (e.g., Wohl et al. 2010), in the
hope that this may enlighten gamblers that, statistically speaking, they are likely to lose
money, or dispel cognitive myths relating to illusions of control or specific ‘winning’
gambling strategies, in the hope that this may reduce the desire to gamble.
The final type of harm-minimisation initiative—and the focus of the present paper—is
‘harm reduction’, which operates more from a ‘restrictivist’ philosophical and moral
standpoint in tackling problem gambling. As Collins et al. (2015) identify, a restrictivist
view operates somewhere in the middle of the continuum between prohibitionists and
libertarianism. Unlike prohibitionists, restrictivists disagree that gambling should be ban-
ned outright, and unlike libertarians, they identify that gambling is not like any other
leisure or entertainment business (Collins et al. 2015). This view argues that while gam-
bling should be allowed, restrictions should be put in place to ensure that gambling is done
so as safely and responsibly as possible.
As gambling products become more technologically sophisticated, the same technological
innovation can be used to facilitate the development of harm-minimisation tools to assist
gamblers in maintaining self-control and make rational and controlled gambling-related
decisions. Harm-minimisation tools aim to make the time spent gambling safer, without
reducing the uptake of gambling per se. Such tools have taken on a variety of forms, and while
harm-minimisation as a research field within psychology is on the rise in terms of volume and
quality of empirical research, the evaluation of such tools remains in its infancy. The aim of
the present paper is to conduct a systematic literature review to synthesise and critically
evaluate the empirical evidence available that tests the efficacy of current harm-minimisation
tools. To our knowledge, while some now dated reviews have been undertaken assessing the
evidence for specific harm-minimisation tools, no literature review exists that examines the
collective evidence from across the harm-minimisation literature as a whole.

Methods

Search Strategy

An in-depth literature review was carried out comprising three concurrent phases: (1)
search of online electronic databases; (2) use of professional contacts in the field of

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Table 1 Summary of included harm-minimisation studies

References Main aims Sample (n) HM tool Main findings
(Design/method) assessed
(Game type
assessed)

Breaks in play
Blaszczynski Assessed the effects 141 university Breaks in play Self-reported craving
et al. (2015) of breaks in play of students (78 (Electronic higher in longer
varying lengths in female) blackjack) break condition.
terms of their (Lab-based No effect of break
impact on cravings experimental study on dissociation.
to continue using simulated Therefore, no
gambling and electronic evidence for the
subjective negative blackjack game) use of breaks in
arousal play as a way to
combat
dissociation was
found. However,
there was a
significant and
positive correlation
between feelings of
dissociation and
cravings to
continue play,
supporting role of
dissociation in
continuation of
gambling within a
session. This effect
was mediated by
subjective negative
arousal
Messaging
Monaghan and Comparison of recall 92 undergraduate Static messages 83 vs. 15.6 % of
Blaszczynski for static versus students (69 and pop-up participants were
(2007) dynamic message female) messages able to freely recall
formats. (Lab-based (Electronic the message
experimental gaming content for the
study) machines) dynamic and static
messages
respectively. Cued
recall was also
significantly
greater for the
dynamic messages
(85.1 vs. 24.4 %)

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Cloutier et al. Comparison of 40 undergraduate Warning Correcting messages,

(2006) warning messages students (21 male) messages and compared to pauses
versus pauses in (Participants who breaks in play in play,
play in terms of obtained the (Video lottery significantly
their impact on highest scores on terminals) reduced erroneous
erroneous illusion of control thinking, but no
cognitions and questionnaire from group level effects
gambling-related original sample of were found in
behaviour 768. 14 terms of the
participants were message or pause
low-risk gamblers, influencing
5 were at-risk gambling-related
gamblers, and 1 behaviour
was a probable
pathological
gambler)
(Experimental study
in simulated bar
setting)
Floyd et al. Evaluation of 122 undergraduate Warning Those participants
(2006) warning message’s students (70 messages exposed to warning
impact on female) (Electronic messages reported
gambling-related (Experimental study roulette) fewer irrational
cognitions, in lab-based casino beliefs about
gambling-related simulation) gambling and had
behaviour, as well significantly more
as subjective money remaining
experience during at the end of the
play session compared
to participants in
control condition,
suggesting the
messaging had
some influence on
subsequent
gambling
behaviour.
Exposure to
warning messages
did not negatively
impact on
enjoyment of play

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Monaghan and Evaluated the impact Study 1, 127 regular Self-appraisal Both studies showed
Blaszczynski of self-appraisal EGM messages and that pop-up
(2010b) messaging on self- gamblersfrom warning messages were
reported gambling university sample messages recalled more
behaviour. Such (male = 97) (Electronic effectively than
messages were (Lab-based, gaming static messages
compared to experimental machines) immediately and at
informative style study) two-week follow-
messaging and Study 2, 124 regular up. Pop-up
control message EGM players messages
conditions (male = 81) reportedly had a
(In-vivo significantly
experimental greater impact on
study) within-session
thoughts and
behaviours.
Messages
encouraging self-
appraisal resulted
in significantly
greater effect on
self-reported
thoughts and
behaviours during
both the
experimental
session and in
subsequent EGM
play
Harris and Experimentally 30 gamblers (18 Self-appraisal Computer-generated
Parke (2015) assessed the impact male) from messages self-appraisal
of self-appraisal university sample (Electronic coin- messaging
messaging on reporting gambling toss) significantly
actual gambling within the last reduced the
behaviour and the 6 months average speed of
interaction effect (Lab-based betting in the loss
between gambling experimental condition only,
outcome and study) demonstrating an
messaging efficacy interaction effect
between computer-
generated
messaging and
gambling outcome.
Messages had no
impact on amount
wagered

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Stewart and Assessed the efficacy 59 university Monetary limit Participants

Wohl (2013) of monetary students (43 males; pop-ups receiving monetary
reminder pop-up 17 recreational (Virtual reality limit pop-up
messages in their gamblers (no slot Machines) reminders were
ability to facilitate DSM–IV–TR significantly more
adherence to self- symptoms), 26 sub- likely to adhere to
set monetary threshold monetary limits
limits, and pathological than participants
messaging’s gamblers who did not.
impact on (1–4 DSM-IV-TR Dissociation
dissociation and symptoms), and 16 mediated the
craving pathological relationship
gamblers (5 or between gambling
more DSM-IV-TR symptomatology
symptoms)) and adherence to
(Virtual reality monetary limits,
environment but only among
experimental those who did not
study) receive a monetary
limit pop-up
reminder. Forced
stop in play created
by the pop-up
message did not
heighten craving to
continue gambling
Auer et al. Evaluated the impact 800,000 gambling Pop-up Found a nine-fold
(2014) of pop-up sessions (400,000 messages after increase in the
messages in a prior to pop-up predetermined number of
natural and being introduced number of gambling session
ecologically valid and 400,000 after plays cessations at the
setting in terms of pop-up message (Online Slot 1000-spin mark
messages ability to had been Machine) when exposed to a
facilitate gambling introduced— pop-up message
session cessation approx. 50,000 informing players
online slot machine of the number of
gamblers) plays. However,
(In-vivo, quasi- the percentage of
experimental) total cessations
following the pop-
up message at 1000
spins was low (less
than 1 %)

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Celio and Assessed the impact 136 undergraduate Personalised After 1 week, those
Lisman of a stand-alone students (75 male) normative participants
(2014) personalised reporting gambling feedback receiving PNF
normative in last 30 days (Self-report showed a marked
feedback (Randomised clinical gambling decreased
intervention on trial design) behaviour and perception of other
student gambling computer- students’ gambling,
behaviour based risk as well as
tasks) demonstrated
lower levels of
risk-taking in two
analogue measures
of gambling
Auer and Evaluated efficacy of 1.6 million gambling Personalised Positive increase in
Griffiths personalised sessions analysed normative session cessation
(2015a, b) normative (800,000 feedback for the more
feedback using a evaluating the (Online slot sophisticated
real world sample simple pop-up machine) message containing
in a real online message and normative
gambling 800,000 evaluating feedback. Only a
environment. Also the enhanced pop- very small
compared up message— percentage of
normative approx. 70,000 sessions reached
feedback to more online slot machine 1000 spins,
simplistic pop-up gamblers) meaning it is likely
messages (In-vivo, quasi- these pop-up
experimental messages were
study) only given the most
intense (within-
session) gamblers
Limit-setting
Broda et al. Examined the effects 47,000 subscribed Limit-setting Only 0.3 % of
(2008) of enforced betting users of the online (Sports gamblers exceeded
limits on gambling gambling company gambling) deposit limits at
behaviour and bwin. least once. Those
analysed the (In-vivo, quasi- gamblers who did
behaviour of those experimental were shown to
gamblers who study) have a higher than
typically exceed average number of
limits in daily bets and
comparison to higher average bet
those who adhere sizes, compared to
to monetary limits those who did not
exceed limits.
Indication that
exceeding limits
may be indicative
of the most intense
gambling sub-
group

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Wohl et al. Assessed efficacy of 242 non-problem Animation- Participants exposed

(2010) animation-based gamblers (119 based to animation video
educational video male) education reported a
designed to (Self-report Vvdeo significant
facilitate adherence experimental (Various reduction in
to pre-set limits in study) gambling erroneous
terms of reducing activities) cognitions, an
the exceeding of effect that was
limits retained at 24-hour
and 30-day follow-
up. Exposure to the
video also resulted
in participants
being more likely
to strongly endorse
‘low risk’
gambling practices,
including the use of
limit-setting, but
this effect was not
retained at the
30-day follow up
Wohl et al. Examined if there 72 young adults (51 Animation- Participants exposed
(2013) was an interaction female) with based to the educational
effect between the recreational educational animation video
use of educational gambling video and pop- adhered to pre-set
videos dispelling experience up messages limits more than
erroneous (Virtual reality (Electronic those in a control
cognitions and environment gaming video condition.
promoting safe- experimental machines) Those exposed to
play, including the study) monetary limit
use of limit, and pop-ups also
pop-up messaging showed greater
reminding adherence to pre-
participants when set limits. These
they had reached two main effects
their pre-set limit were qualified by
an interaction
effect, with results
showing that of the
participants who
were not given a
pop-up reminder,
the ones who were
exposed to the
educational
animation video
stayed within their
pre-set monetary
limits more than
those in a control
condition

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Auer and Examined the impact Random sample of Time and Setting limits had
Griffiths of limit-setting on 100,000 players in Monetary significant and
(2013a, b) theoretical loss online gambling Limits positive effect on
among high environment (Online poker, theoretical loss for
intensity gamblers, (In-vivo quasi- online lottery, all sub-groups of
across a variety of experimental and online gamblers. Casino
gambling study) casino games) gamblers showed
activities, in a real- the biggest
world online significant change
setting in theoretical loss
following the
setting of limits
Wohl et al. Designed new and 56 current electronic Monetary Limit- Those exposed to the
(2014) enhanced monetary gaming machine Setting HCI/PSD tool were
limit-setting tool gamblers (37 (Electronic significantly more
using HCI and PSD female) gaming likely to adhere to
principles, and (Virtual reality machines) their pre-set limits
compared this to environment, compared to the
older, more simple experimental standard monetary
iterations of such study) limit tool
tools in terms of
their ability to
facilitate limit
adherence
Kim et al. Assessed the impact 43 non-problem/low Time limit- Participants who
(2014) of prompts risk gamblers setting were prompted to
encouraging the recruited from (Electronic set a time limit did
setting of time- university sample Gaming so with a 100 %
based limits on (26 female) Machines) compliance rate
both the uptake of (Virtual reality compared to one
setting such limits, environment out of 23 for those
and the impact this experimental participants not
had on session study) prompted. Those
duration prompted to set a
limit prior to
engaging in play
gambled for
significantly less
time than those
who were not
prompted

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Behavioural
tracking tools
Auer and Assessed the 16,231 online Behaviour Online gamblers
Griffiths effectives of the gamblers Tracking and receiving
(2015a, b) behavioural (In-vivo, matched Personal personalized
feedback system pairs, quasi- Feedback feedback spent
mentor, in terms of experimental (Various online significantly less
its ability to design) gambling time and money
influence the activities) gambling
amount of time compared to
played and controls that did
theoretical loss not receive
experienced by personalized
gamblers feedback
Wood and Assessed the efficacy 779 online gamblers Behaviour At-risk players who
Wohl (2015) of the PlayScan (694 male) Tracking and used the feedback
behavioural (In-vivo, matched Personal tool significantly
tracking tool, pairs, quasi- Feedback reduced the amount
which provided experimental (Various online of money deposited
gamblers with design) gambling and wagered
behavioural activities) compared to
feedback about players not
their gambling, in utilising the tool,
terms of its impact an effect that was
on gambling obtained for both
behaviour the week following
enrolment and at
24-weeks later.
Those gamblers
who received
behavioural
feedback showed a
significant
reduction in
deposited amounts
compared to the
control group, but
this did not apply
to at-risk or
problematic
gamblers
Note acceptors (prohibition/lower money denomination)
Sharpe et al. Tested the effects of 779 participants of Lower Gaming machines
(2005) several varying problem denomination with modified note
modifications to gambling severity note acceptor acceptors had no
gaming machines, (In-vivo quasi- (Electronic impact on any
including a experimental gaming aspect of gambling
restriction on note study) machines) behaviour
acceptors to a compared to
maximum of a $20 control machines
note

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Table 1 continued

References Main aims Sample (n) HM tool Main findings

(Design/method) assessed
(Game type
assessed)

Hansen and Explored the impact Approx. 60,000 Note acceptor Following
Rossow of prohibition of adolescent prohibition prohibition, slot
(2010) note acceptors on gamblers (Slot machines) machine gambling
slot machine (Questionnaire, frequency was
players in terms of quasi-experimental reduced by 20 %,
its impact on study) the proportion of
gambling ‘frequent’ slot
behaviour and machine gamblers
problem gambling was reduced by
measures (SOGS- 26 %, and overall
RA and Lie/Bet) in gambling
adolescent-aged frequency was
gamblers reduced by 10 %.
In addition, the
proportion of
problem gamblers
was reduced by
20 %

gambling to share personal collection of papers related to harm-minimisation in gambling;

and (3) ‘snowballing’—a method in which reference lists from published papers are
viewed and relevant papers pursued. Electronic databases included the use of the authors’
Library One Search (an all-encompassing database search engine—including, but not
limited to: Academic Search Elite; PsychArticles; PsychInfo; Science Direct; and Scopus)
as a primary source, along with Google Scholar being used as a more general search
engine. The search terms used were ‘gambling’, ‘gaming’, ‘electronic gambling’, and
‘online gambling’, with more specific search terms comprising ‘gambling harm-minimi-
sation’, ‘responsible gambling’, ‘responsible gaming’, ‘pop-up messaging’, ‘responsible
gambling messaging’, ‘pre-commitment’, ‘limit-setting’, ‘behavioural tracking’, and
‘gambling safeguards’.

Inclusion Criteria

To be included as an output to be evaluated, the published paper had to have: (1) addressed
harm-minimisation tools in a within-session [electronic/online] gambling context with the
aim of facilitating controlled gambling (therefore, initiatives such as permanent voluntary
self-exclusion schemes were not included); (2) been written in English language; (3)
reported an empirical study; (4) been published within the last 10 years (2005–2015); and
(5) been published in a peer-reviewed journal.

Harm-Minimisation Tool Categorisation

Once the retrieved papers had been initially filtered according to title and abstract content,
a more in-depth assessment was conducted using the inclusion criteria as guidance. The
remaining papers were then categorised according to the harm-minimisation tool in
question. The categories are based upon previous categorizations in the literature and are

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the terms most likely to be used when searching in literature databases and comprised: (1)
enforced breaks in play, (2) messaging, (3) limit-setting/pre-commitment, (4) behavioural
tracking tools, and (5) note acceptor prohibition or modification. These are categories that
frequently appear in previous gambling harm-minimisation literature. However, it should
be noted that there are several overlaps between the types of tools and the elements
involved. For example, pop-up messages also contain breaks in play, and the setting of
monetary limits can sometimes involve receiving a pop-up message once limits have been
reached. Consequently, each tool was categorised according to its primary purpose. For
example, while pop-ups provide a break in play, the message content itself is the primary
harm-minimisation objective, and is therefore categorised in the ‘pop-ups’ section, and
approaches assessing limit-setting with pop-up reminders when limits are reached is
therefore placed in the ‘limit-setting’ sections. A summary of research findings is provided
in Table 1 and overall evaluation of each tool will be given in the discussion section of this
paper.

Enforced Breaks in Play

Gamblers often enter into states of dissociation (Jacobs 1986) that leads to a loss of control
over time and money spent gambling. RG initiatives that temporarily stop gambling allow
dissociative states to be broken and the re-evaluation of one’s gambling behaviour. Indeed,
the use of enforced breaks in play as an RG tool is derived from robust theoretical
underpinnings. Anderson and Brown (1984) hypothesised that arousal produced within a
gambling session narrows a gambler’s attentional focus and facilitates a secondary reward
of escaping psychologically distressing stimuli and wider distressing life situations. Jacobs
(1986) extended this concept with his general theory of addiction, and proposed that those
vulnerable to addiction were either chronically hypo-aroused or hyper-aroused. Engage-
ment in an addictive pattern of behaviour is therefore seen as a way of maintaining
homeostatic balance of arousal through generated dissociative experiences.
The use of enforced breaks in play, in the absence of supporting mechanisms such as
presentation of self-appraisal messages as a RG tool (e.g., Monaghan and Blaszczynski
2010a, b), may be challenged on theoretical grounds, which indicate that breaks in play
may actually have an adverse effect on the gambler. For example, the Behaviour Com-
pletion Mechanism Model (McConaghy 1980) posits that driven behaviours (includes
pathological gambling), build a neuronal model of behaviour facilitated by conditioning
effects. Exposure to a conditioned stimulus or cue results in the activation of the neuronal
model, and any interruption to the expression of the behaviour results in an aversive state,
or a state of craving, which drives the individual to the completion of the behaviour
(Blaszczynski et al. 2015).
Recent research testing the efficacy of imposing short breaks in play as an RG tool
challenges the use of breaks in play as a standalone RG approach. Blaszczynski et al.
(2015) tested the effects of breaks in play of varying lengths in terms of their impact on
cravings to continue gambling and subjective negative arousal, and compared this to a
control condition featuring no break in play. Their study comprised 141 university students
(78 female) who played a simulated electronic blackjack game, and were randomly
assigned to an 8-, 3-min, or no break condition. Results showed that self-reported craving,
as measured by the Gambling Craving Scale (Young and Wohl 2009), was significantly
higher in the longer break condition, compared to the shorter break and no break condition.

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Significantly higher craving was also reported in the shorter break condition compared to
the no break condition. It was also predicted that forcing breaks in play should reduce
levels of dissociation, which has been theoretically proposed as a mechanism promoting
extended play. However, no relationship between break condition and feelings of disso-
ciation, as measured by the Dissociative Experience Scale (Jacobs 1988) was found.
Therefore, no evidence for the use of breaks in play as a way to combat dissociation was
found. However, there was a significant and positive correlation between feelings of dis-
sociation and cravings to continue play, which supports the theoretical position for the role
of dissociation in continuation of gambling within a session. Furthermore, the effect of the
break condition on craving was mediated by levels of subjective negative arousal.
Given these findings, caution must be taken when implementing breaks in play as a
standalone RG strategy. Breaks with accompanying RG messages show a certain level of
positive efficacy, however, breaks alone may have unintended effects. Such effects include
the promotion of cravings and desire to continue to gamble, rather than breaking disso-
ciative states often experienced by gamblers. Conversely, limited evidence exists to give
indication as to the appropriate length of break required to produce positive effects.
Consequently, the efficacy of breaks should not be disregarded based on one study alone.
For example, the long break condition applied in Blaszczynski et al.’s (2015) research was
only 8 min long, and is open to interpretation as to whether or not this constitutes a ‘long’
break. For example, a much longer period of time may be required before maladaptive
cravings dissipate and the positive effects of a break may begin to surface. However,
recommendations as to what this length of time should be needs to be empirically based,
but is likely to differ on an individual-by-individual basis. In addition, given differences in
responses between university and real life gamblers (Gainsbury et al. 2014), it remains to
be determined if the findings have external validity in terms of how such effects are
applicable to real gamblers in real world gambling environments.

Messaging

Static Messaging Versus Dynamic Messaging

RG messages have evolved in recent times in terms of both their content and style of
delivery. Originally, ‘static’ RG messages were placed at the side of gambling machines, or
accessed via different menu screens on EGMs or online gambling websites (Harris and
Parke 2015). This is a markedly different approach to more modern ‘dynamic messaging’
delivery systems. Dynamic messages (i.e., ‘pop-ups’) appear on-screen and deliver RG-
related content whilst temporarily interrupting play (Monaghan and Blaszczynski 2007).
Empirical research has demonstrated that when secondary information is delivered that
interrupts a primary task, this has an orientating and focusing effect on attention that can
positively impact performance on the primary task. Furthermore, this effect has been
shown to last longer than the duration of presentation for the secondary information itself,
indicating a sustained impact on cognitive performance (Bailey et al. 2001).
This is arguably advantageous over a static messaging approach which requires a
division of attention between the primary task of gambling and processing of secondary
RG information in a separate location, which may either result in messages not being
salient and thus not read, or if messages are read, the information is less likely to be

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processed and retained due to attentional demands, which is hypothesised to be a limited

resource (Broadbent 1958). Pop-up messaging in a variety of disciplines have demon-
strated they have a greater impact in modifying thoughts and behaviour leading to greater
task performance compared to their static counterparts (Betrancourt and Bisseret 1999).
In a gambling context, Monaghan and Blaszczynski (2007) demonstrated that message
content for dynamic messages was significantly more likely to be recalled compared to
static messages. In their study, 83 vs. 15.6 % of participants (92 undergraduate students)
were able to freely recall the message content for the dynamic and static messages
respectively. Cued recall was also significantly greater for the dynamic messages (85.1 vs.
24.4 %). Consequently, it was suggested that to maximise the effectiveness of RG mes-
sages, they should be delivered dynamically.

Informative Messaging

While evidence suggests pop-up messaging may be an effective way to communicate RG

information during a gambling session, it is important to ascertain what type of information
or message should be delivered. It is also important to investigate not only if this infor-
mation is processed but how effective the messages are in modifying thoughts and
behaviour. Monaghan and Blaszczynski (2010a) highlighted the frequent use of educa-
tional campaigns and warning messages in public health initiatives, where the information
is typically presented in the form of an indication of potential risks of specific behaviours.
The ultimate goal is to moderate engagement with potentially hazardous activities and to
minimise harm if individuals engage in such behaviours. It has been argued that presenting
consumers with accurate information about specific products and behaviours reduces
erroneous cognitions and biases, and leads to a facilitation of consumer informed choice
(Monaghan and Blaszczynski 2010b).
The provision of factual information has received some empirical support in a gambling
context, where the behaviour of problem gamblers has been demonstrated to be moderated
by correcting erroneous cognitions, misconceptions or probability, and likelihood of
winning (Ladouceur et al. 2003). Such evidence of informative messaging impacting upon
behaviour is scarce in the gambling literature and indeed other health behaviour literature,
including tobacco and alcohol consumption (Hammond et al. 2006). While providing
gamblers with informative content may draw attention to the nature, odds, and risks
involved in gambling, it has been argued that such information is relatively ineffective in
modifying actual gambling behaviour (e.g., Hing 2004), although there are dated studies
demonstrating informative messaging positively impacting upon gambling-related cogni-
tions and behaviour (see Ladouceur and Sevigny 2003; Steenberg et al. 2004; Benhsain
et al. 2004). More recently, Cloutier et al. (2006) demonstrated that correcting messages,
compared to pauses in play, significantly reduced erroneous thinking among a sample of 40
undergraduate students who scored high on an illusion of control questionnaire. However,
no group level effects were found in terms of the message or pause influencing gambling-
related behaviour.
Floyd et al. (2006) advanced the pop-up messaging research by evaluating the warning
message’s impact on several measures of gambling-related cognitions as well as subjective
experience during play. Results demonstrated that participants in the warning message
group reported fewer irrational beliefs about gambling and had significantly more money
remaining at the end of the session, suggesting the messaging had some influence on
subsequent gambling behaviour. Importantly, while participants reported reading on
average 81 % of the messages, this did not appear to negatively impact the experience of

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play. Unfortunately, it is unknown whether the impact on cognitions and behaviour was
facilitated by the messaging or breaks in play because there was no break condition without
the inclusion of a message, so the mechanisms of change remain largely unclear. In
addition, while participants in the pop-up message condition had significantly more credits
remaining at the end of the session, the level of risk or frequency of bets did not differ
significantly across experimental groups, making it unclear as to how a perceived increase
in self-control was achieved. Furthermore, the frequency of pop-up message exposure
appears particularly intrusive (despite participants not reporting a significant impact on
experience of play) and unrealistic, with exposure to a message occurring every six spins.
Despite some positive results, it appears evidence for the impact of informative mes-
saging on cognition and gambling behaviour is largely inconsistent and limited. Drawing
conclusions from the existing empirical literature, it may be argued that such informative
messaging has a more consistent impact on correcting erroneous cognitions, but that this
effect alone is not strong enough to exert influence over gambling behaviour. However,
this does not negate the use of pop-up messaging as a harm-minimisation strategy as some
effect (albeit weak) appears to occur. Instead, the message content itself may be manip-
ulated to exert a greater effect in promoting RG behaviour. Therefore, the way in which
information is presented, and in turn, perceived, may be critical for its influence over
behaviour.

Self-Appraisal Messaging

Monaghan and Blaszczynski (2010a) argued that ‘‘interventions successful in improving

participants’ statistical understanding of gambling do not result in any changes to gambling
behaviour’’ (p. 71). As a potentially effective alternative, they suggested that delivering
messages that directly encourage a player to self-appraise the time and money spent
gambling within a session, rather than simply describing probabilities, may cause them to
evaluate their behaviour in a more personally relevant manner, resulting in more consid-
ered and informed decisions relating to their gambling.
Autonomy is regarded as fundamental psychological need for the maintenance of
wellbeing and positive psychological functioning (Parke et al. 2014a, b). In support of this
notion, Deci and Ryan’s (1985, 2000) Self-Determination Theory argues that individuals
have a fundamental need to engage in behaviour that is derived via their own value system
and beliefs, rather than their behaviour being dictated from external influences. Conse-
quently, more value is likely to be attributed to messaging that is not overly paternalistic,
intrusive, and does not run contrary to an individual’s belief and value system. Pavey and
Sparks (2010) argue that messages supporting an individual’s right to autonomy will be
met with a less dismissive and defensive attitude.
The argument made by Monaghan and Blaszczynski (2010a) for the use of messaging
that engages an individual in self-appraisal supports an autonomy-centred framework, as
not only are the messages personally relevant, but also the actions taken following pro-
cessing of the message will be derived through engagement with the individuals own
thoughts, reflections, and motivations. This proposition for using self-appraisal messaging
also has good face validity, particularly when considering the factors that contribute to
problem gambling behaviour. Gamblers are often reported as experiencing dissociation
from reality and absorption in the gambling task during gambling, which results in losing
track of time and the experience of feelings of being outside of oneself (Monaghan 2009).
Gamblers also appear to be slower to respond to external stimuli and dissociate from
previous thoughts and moods (Diskin and Hodgins 1999). This overall lack of self-

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awareness can cause players to act in ways not previously intended, such as chasing losses
and spending more money and time than they can afford (Harris and Parke 2015). RG
initiatives aimed at increasing self-awareness thus appear to be a useful approach in
combatting and preventing problem gambling behaviours.
Consequently, the use of self-appraisal pop-up messages as a harm-minimisation tool
has received increased attention in recent years and has received some positive but limited
empirical support. In a laboratory-based computer-simulated gambling experiment, Mon-
aghan and Blaszczynski (2010b) had participants play an EGM with exposure to messages
encouraging self-appraisal of time and monetary expenditure. A self-report experimental
design showed that participants reported the self-appraisal messaging as having a signif-
icant influence on their thoughts and behaviour. In addition, participants also reported that
the messages made them more aware of how long they had been gambling. Overall, the
views of participants provided support for the application of such messages to real gaming
machines in real gambling venues, as they felt that the messages would have similar impact
in such environments.
In the same study, a second experiment evaluated the impact of self-appraisal mes-
saging on self-reported gambling behaviour. Such messages were compared to informative
style messaging and control message conditions. The self-appraisal messages contained
information designed to engage the participant in self-reflection, and were presented in the
form of questions including: ‘‘Do you know how long you have been playing? Do you need
to think about taking a break?’’
In comparison to informative and control messages, results showed that self-appraisal
messaging had a significantly greater self-reported effect on participants’ thoughts,
behaviour, and awareness of the amount of time spent gambling. While results from the
two experiments showed support for the efficacy of self-appraisal messaging in influencing
thoughts and behaviour, the self-report research design prevents understanding how such
messages actually influence behaviour, as the incongruences between thoughts, self-report
intentions, and actual behaviour in high-risk activities are well known. For example, Nevitt
and Lundak (2005) demonstrated that self-report accounts of drinking habits for alcohol-
offenders significantly underreported both drinking severity and the problems caused by
drinking.
Harris and Parke (2015) experimentally assessed the impact of self-appraisal messaging
on actual gambling behaviour. Participant’s pre- and post-pop-up exposure gambling speed
of play and level of risk was measured, and by combining the two variables, betting
intensity [i.e., average speed of play (bets per minute) 9 average stake size] was also
measured. In addition, this was the first study to assess the interaction effect between
gambling outcome (wins/losses) and the impact of harm-minimisation tools on gambling
behaviour. Thirty participants took part in a repeated-measures experiment and were
exposed to a pop-up message after 16 wagering rounds on a computer-simulated coin-toss,
in both a manipulated winning and losing outcome condition, separated by a minimum of
24 h. The message simultaneously contained both instructive and self-appraisal content:
‘‘Play Responsibly…Pause and Think, Are you in Control of your Risk-Taking?’’
Results showed that there was an interaction effect between messaging efficacy and
gambling outcome. In the losing outcome condition, the message significantly reduced
participant speed of play as measured by bets-per-minute. However, no such effect was
found in the winning outcome condition, and the pop-up message failed to reduce the
average wager regardless of outcome condition. In fact, average stake size continued to
increase following exposure to the message. However, several limitations exist, most
notably the fact that participants gambled with tokens rather than their own money. Despite

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the fact there was a monetary prize for the participant with the most tokens at the end of the
experiment, not gambling with one’s own money is likely to have muted the effects of both
the wins and losses, as well as the impact of the pop-up message in both outcome con-
ditions. In addition, the computer-computer simulated and laboratory-based conditions did
not have ecological validity and did not replicate many of the structural and situational
factors associated with in vivo electronic gambling. However, this is often the trade-off
associated with experiments requiring high levels of experimental control. In addition, the
study was unable to identify which part of the message actually exerted a behavioural
influence in terms of speed of gambling. It is not clear whether the instructive part of the
message, the self-appraisal content, or indeed both parts of the message, had the impact.

Monetary and Time-Based Pop-up Messaging

Engaging in potentially addictive behaviours, including gambling, is associated with losing

track of both time and space through a process of dissociation (Jacobs 1988), particularly
among problem gamblers (Diskin and Hodgins 1999, 2001; Griffiths et al. 2006). Disso-
ciation is one potential mechanism believed to explain why many gamblers, especially
problem gamblers, exceed predetermined time monetary limits (Stewart and Wohl 2013).
Similarly to self-appraisal messaging, it has been argued that time and monetary pop-up
reminders may combat such dissociative states as well as the failure to adhere to pre-set
time and monetary limits. Stewart and Wohl (2013) conducted a randomised controlled
experiment assessing the efficacy of monetary reminder pop-up messages in their ability to
facilitate adherence to self-set monetary limits. University students (N = 59) with varying
pre-screened levels of problem gambling severity participated in a virtual reality slot
machine simulation. In support of the use of monetary pop-up reminders, results showed
participants in the pop-up message condition were significantly more likely to stick to their
pre-set limit (89.66 %) compared to a control (no pop-up) condition (43.33 %). Results
also showed that higher gambling symptomology and dissociation were associated with
lower monetary limit adherence. The fact that there was no mediating effect of dissociation
on limit adherence in the pop-up condition (but was found in the control condition) led the
authors to suggest that the presence of the pop-up stopped participants experiencing
dissociation.
Auer et al. (2014) conducted the first ever study evaluating the impact of pop-up
messages in a natural and ecologically valid setting. More specifically they examined
whether a pop-up message presented after 1000 consecutive plays of an online slot
machine would help players cease their gambling. The pop-up message simply informed
players: ‘‘You have now played 1000 slot games. Do you want to continue? (YES/NO).’’
The 1000-spin mark was chosen as this equated to approximately 1 h of play, and
empirical evidence suggests that this is a key point in play where pop-ups may be most
effective (see Ladouceur and Sevigny 2009). The authors’ analysed 800,000 online slot
machine gambling sessions, comprising of approximately 50,000 gamblers. Data sampled
from 400,000 sessions prior to the introduction of a pop-up message showed that of the
4220 games that consisted of 1000 or more consecutive slot machine spins by the same
players, only five sessions ended at 1000 spins. A further 400,000 sessions were analysed
after the introduction of the pop-up message. Of these 400,000 sessions, 4205 contained at
least 1000 consecutive slot spins, which were then in turn exposed to the pop-up message.
Forty-five of these sessions were terminated following pop-up exposure.
While the data set was too large for inferential statistics to be applied, results showed a
nine-fold increase in the number of gambling session cessations at the 1000-spin mark

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when exposed to a pop-up message reminding players of the length of their play. However,
despite this increase, the percentage of total cessations following the pop-up at 1000 spins
was still very low (\1 %). It is important to note that of the 800,000 total sessions
analysed, only a very small number (approximately 1 % of all session), reached 1000
consecutive spins by the same player, indicating that the study largely dealt with the most
gambling-intense individuals. This finding has a number of potential implications. Firstly,
it may be better to introduce pop-ups at an earlier stage of play to capture a larger sample
of gamblers. Secondly, the results of the study indicate the relative ineffectiveness of such
pop-up interventions for most (within-session) gambling-intense individuals.

Normative Feedback and Enhanced Messaging

The use of normative feedback, delivered via the platform of a pop-up message, is a
potential way to facilitate behavioural change, and is beginning to receive attention in the
gambling literature. Personalised normative feedback (PNF) aims to correct an individual’s
perception about the normal levels of engagement in specific behaviours by others. Nor-
mative feedback has been shown to have an influence on a variety of potentially hazardous
behaviours, including smoking, where PNF increased smoking cessation (Van den Putte
et al. 2009), increased condom use (Yzer et al. 2000), and reduced marijuana consumption
(Yzer et al. 2007). The use of PNF also has clinical utility, where it has been shown to be
important when incorporated into motivational interviewing (Miller and Rollnick 1991).
The application of PNF in a gambling context has also received some empirical support,
where it has been shown to exert both perceptual and behavioural influence.1 Celio and
Lisman (2014) assessed the impact of a stand-alone PNF intervention on student gambling
behaviour. Undergraduate students (N = 136; 55 % male) who reported gambling in the
past 30 days were recruited to take part in a randomised clinical trial design. Participants
were assigned to receive either PNF or an attention control task. In addition to self-report,
Celio and Lisman’s (2014) study used two computer-based risk tasks framed as ‘‘gambling
opportunities’’ to assess cognitive and behavioural change at 1 week post-intervention.
Results showed that after 1 week, those participants receiving PNF showed a marked
decreased perception of other students’ gambling, as well as demonstrated lower levels of
risk-taking in two analogue measures of gambling.
Auer and Griffiths (2015a, b) extended the validity of the use of PNF as an RG tool by
evaluating its efficacy using a real world sample in a real online gambling environment.
Furthermore, the research design compared the efficacy of PNF pop-up messages (in
combination with additional message content) to more simplistic forms of pop-up mes-
sages. The simplistic message (as outlined above in their previous pop-up message study)
was enhanced and read:
We would like to inform you that you have just played 1000 slot games. Only a few
people play more than 1000 slot games. The chances of winning does not increase
with the duration of session. Taking a break often helps, and you can choose the
duration of the break (see Auer and Griffiths 2015a, b, p. 3).

1
Recent empirical evidence demonstrates that the delivery of PNF has clinical utility in that it reduces
maladaptive gambling-related cognitions and behaviour amongst gamblers of various problem gambling
severities (see Cunningham et al. 2009; Cunningham et al. 2012; Larimer et al. 2011; Neighbors et al. 2015).
These studies were not included in the current review due to failure to meet within-session gambling harm-
minimisation criteria, however, for a recent review of these studies see Marchica and Derevensky (2016).

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A total of 1.6 million gambling sessions were analysed (800,000 evaluating the simple
pop-up message and 800,000 evaluating the enhanced pop-up message). In the simple pop-
up condition, 11,232 sessions lasted at least 1000 spins and these players were exposed to
the pop-up (1.4 % of the total sessions). Of the 11,232 sessions, 75 were immediately
terminated following pop-up exposure (0.67 %). In the enhanced pop-up condition, 11,878
sessions lasted at least 1000 spins (1.48 % of the total sessions). Of the 11,878, 169 were
immediately terminated following pop-up exposure (1.39 %). The percentage of those
stopping their gambling session at 1000 spins was significantly higher for the enhanced
PNF message compared to the simple message.
While this positive increase in session cessation for the more sophisticated message is
promising from an RG perspective, several limitations are noted. Firstly, the enhanced
message not only contained normative feedback, but also contained informative and self-
appraisal content, so understanding which element or elements of the message had the most
behavioural influence cannot be ascertained. Secondly (and as with their previous study),
only a very small percentage of sessions reached 1000 spins, meaning it is likely these pop-
up messages were only given the most intense (within-session) gamblers. Finally, the
normative part of the message was only a general statement, and therefore the effects of
more specific normalised feedback were not assessed.

Limit-Setting

Gamblers frequently spend more time and money than initially intended (Monaghan and
Blaszczynski 2010a). Furthermore, exceeding financial time and monetary limits within a
gambling session has been identified as a key risk behaviour for the development of
problem gambling. Failure to stick to pre-set limits arguably reflects a loss of, or
impairment in, self-control and self-regulation, which can be undermined by a variety of
factors (Parke et al. 2014a, b). Such factors include an inability to regulate emotion
(Scanell et al. 2000), and the use of emotion in the decision-making process over the use of
problem-focused strategy (Blaszczynski et al. 1990).
Limit-setting is a harm-minimisation strategy that allows gamblers to set time and
monetary limits prior to commencement of a gambling session. Limit-setting is based on
the principles that decisions concerning time and monetary limits (a) should be made in a
state of non-emotional arousal, and (b) once made, must be adhered to for the remainder of
the gambling session (Ladouceur et al. 2012). Limit-setting represents an RG tool designed
to prevent excessive expenditure in individuals prone to impaired self-control, as well as
those who wish to use the feature as a positive, pre-emptive measure. The intention of
limit-setting is to promote rational decisions regarding expenditure in advance of play, and,
by imposing barriers, to ensure compliance with such decisions when emotionally aroused
after losses (Ladouceur et al. 2012), or indeed, wins. Evidence for its use also comes from
the natural recovery literature, where it has been shown that 40–82 % of individuals with a
gambling disorder recover without professional help (e.g., Abbott et al. 1999). One of the
primary techniques adopted by such self-recovery populations was the use of self-imposed
time and/or money limits (Blaszczynski and Nower 2010).
Setting limits on gambling time and monetary expenditure may also be viewed as a
form of public commitment, and past research indicates that publicly committing to a goal
will increase the chances of that goal being reached (Mussell et al. 2000). Outside of

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gambling, such public commitment strategies have been successfully applied in other areas
of health research such as weight loss programmes (e.g., Nyer and Dellande 2010).
Broda et al. (2008) examined the effects of enforced betting limits on gambling
behaviour and analysed the behaviour of those gamblers who typically exceeded limits in
comparison to those who adhered to monetary limits. Two years of sports gambling
behavioural data were analysed from 47,000 subscribed users of the online gambling
company bwin. Only a very small proportion (0.3 %) exceeded deposit limits at least once.
Gamblers who did were shown to have a higher than average number of daily bets and
higher average bet sizes, compared to those who did not exceed limits, indicating that
exceeding limits may be indicative of the most intense gambling sub-group. Furthermore,
behaviour after exceeding limits showed that average bet sizes steeply increased, though
the number of bets reduced. Results indicated that the setting of limits, accompanied by a
reminder once limits have been reached, was enough to deter the vast majority of gamblers
from exceeding those limits. However, the small majority of those who exceeded limits
may represent the most heavily involved gamblers, and arguably, the most in need of help,
suggesting the use of limit-setting may be best placed as a preventative RG tool, rather than
an intervention for those who may already be exhibiting gambling problems.
Wohl et al. (2010) applied the principles of the Health Belief Model (HBM; Janz et al.
2002) to an animation-based educational video designed to facilitate adherence to pre-set
limits. The HBM predicts that healthy and adaptive behaviour will be adopted by indi-
viduals when an intervention has a targeted and specified impact on the knowledge, atti-
tudes, and perceptions of target group members. This was applied in a gambling context,
more specifically, during slot machine gambling, where the HBM suggests that risk
behaviours will be reduced if players come to understand: (1) the true odds of winning, (2)
that odds do not improve with persistence. (3) that the consequences of exceeding financial
limits can be serious and difficult to reverse, (4) that staying within affordable limits
eliminates the chances of developing gambling problems, and (5) that low-risk practices
can be used to stay within affordable limits.
A total sample of 242 non-problem gamblers were recruited. Those exposed to an
educational animation video applying the principles of the HBM, designed to dispel
cognitive distortion, and promote the use of and adherence to time and monetary limits,
reported a significant reduction in erroneous cognitions, an effect that was retained at 24-h
and 30-day follow-up. Exposure to the video also resulted in participants being more likely
to strongly endorse ‘low risk’ gambling practices, including the use of limit-setting, but
this effect was not retained at the 30-day follow up. In addition, the video promoted greater
behavioural intention to use the ‘low-risk’ practices, but again, this effect was not retained
at the 30-day follow-up. Finally, participants exposed to the video reported exceeding their
self-set limits less often (8 vs. 25 % for a control group), but again, the effect was not
retained at 30-day follow-up.
Clearly, the self-report method applied is subject to inaccuracies, and behavioural
intention does not always lead to behavioural execution, particularly in situations where
demand characteristics may be working to provide positive outcomes. Alternatively, the
effects of the animated video may be more subtle and not noticed by participants, meaning
the failure to find a lasting effect at 30-day follow-up may simply be a failure for par-
ticipants to experientially detect a change, and not necessarily portray a lack of change.
What is required is empirical behavioural gambling data to measure pre-and post-inter-
vention effects. It must also be noted that the effects of the video on cognitive distortions
were long-lasting, which may equip individuals well in the long run as a protective factor

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against developing problems with gambling, but longitudinal evidence is required to test
such a proposition.
Using a virtual reality gambling environment, Wohl et al. (2013) examined if there was
an interaction effect between the use of educational videos dispelling erroneous cognitions
and promoting safe-play, including the use of limit-setting, and pop-up messaging
reminding participants when they had reached their pre-set limit. Participants were 72
young adults (mean age = 19.69 years, SD = 1.82) with recreational gambling experi-
ence, and were predominantly female (70.8 %). Participants played an EGM in a virtual
reality environment, gambling with a total of 80 credits ($20). Results showed participants
exposed to the educational animation video adhered to pre-set limits more than those in a
control video condition (97 vs. 77 %). Those exposed to monetary limit pop-ups also
showed greater adherence to pre-set limits (97 vs. 77 %). However, these two main effects
were qualified by an interaction effect, with results showing that of the participants who
were not given a pop-up reminder, the ones who were exposed to the educational ani-
mation video stayed within their pre-set monetary limits more than those in a control
condition (94.1 vs. 61.1 %). However, no difference was found in limit-adherence among
the participants who all received monetary pop-up reminders, but either saw or did not see
the education animation video. The authors concluded that from an RG perspective, there
was no additive effect of exposure to both RG tools, and thus, pop-up messages reminding
gamblers when they have reached their pre-set limits would be the most effective and
efficient RG tool.
It should also be noted that only the education video had a significant effect on reducing
erroneous cognitions, and in the absence of pop-up messages, exposure to the video had an
effect on gambling behaviour in terms of limit adherence. This shows the potential for
education animations as an RG tool, but that it may not be as effective as other measure
such as pop-ups in terms of their efficacy in influencing gambling behaviour during play.
There is potential for strategies such as educational animations, or education in general, to
be applied where pop-ups may not be feasible, for example, in literature in and around
gambling venues, or as part of a mathematics curriculum in schools. However, the effect
on problem gamblers remains unknown.
Auer and Griffiths (2013a, b) examined the efficacy of limit-setting among high
intensity gamblers, across a variety of gambling activities, in a real-world online setting.
Data were initially collected from a representative random sample of 100,000 players, of
which 5000 had opted to use the voluntary time and/or monetary limits. The top 10 % most
intense gamblers, as derived via theoretical loss (house advantage multiplied by amount
wagered; see Auer et al. 2012), were taken from each of the sub-gambling type groups (i.e.,
poker, lottery, and casino games). Results showed that theoretical loss significantly
decreased among the top 10 % most gaming-intense lottery players in the 30 days fol-
lowing all kinds of voluntary limit-setting (time and money) compared to the total theo-
retical loss in the 30 days prior to the implementation of limits. The impact of the cash-in
limits on theoretical loss was higher than playing duration limits. Similarly, limit-setting
decreased the theoretical loss for the top 10 % most intense casino gamblers. However,
time limits had no significant impact on theoretical loss for this subgroup. It was also noted
that casino gamblers showed the biggest significant change among the general gambling
population, with 77 % of the theoretical loss being spent in the 30 days following limit-
setting compared to theoretical loss in the prior 30 days. Among the top 10 % most intense
poker players, the amount lost in the poker rake decreased in the 30 days following limit-
setting, but this was only the case for those who set weekly spend limits and daily time
limits. Overall, time limits had the greatest effect on rake loss for poker players, with those

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setting daily time limits losing 73 % of the loss in the 30 days prior to the setting of limits.
As expected, the setting of daily time and session length limits had a highly significant
effect on overall play duration. This is important given the fact that excessive time spent
gambling, and not just excessive monetary spent, can have deleterious impacts on the lives
of gamblers.
The behavioural tracking paradigm used in this study only gives information about
gamblers on one particular gambling site and does not identify the overall profile and
behaviour of a particular gambler. This is important as the most problematic gamblers have
been shown to play multiple types of gambling platforms concurrently (McCormack et al.
2013), which may mean that reaching monetary or time limits on one site, on one platform,
does not necessarily mean cessation of gambling until such limits are reset. It may simply
mean that gamblers switch from one site to another once a self-set limit has been
exhausted. Pairing (or grouping) of online gambling accounts may be a way around this
issue, much like the facility afforded by gaming operators such as Pokerstars and Full Tilt.
Of course, this relies on cooperation among competing gambling operators to be a viable
option, but it would allow the potential for ‘central’ limits to be set across all of an
individual gambling accounts, rather than several isolate limits set at each of the sites
where and gambler has an account.
The focus on the most intense gamblers is certainly of relevance given the fact that this
sub-group is most likely to benefit from limit-setting. However, the results provided do not
tell us how the majority of gamblers, falling more centrally in the distribution curve,
interact with limit-setting. As limit-setting is often viewed as an RG tool with preventive
utility (see Wohl et al. 2014), such large scale, real-world, behavioural tracking techniques
should also be applied to those gamblers below the threshold for problem gambling
criteria.
Using the principles of Human Computer Interaction (HCI) and Persuasive System
Design (PSD), Wohl et al. (2014) aimed to improve the efficacy of monetary limit-setting
as an RG tool, by improving the way that gamblers interact with such features in electronic
gambling. HCI principles suggest that for technology to be user-centred, potential users
must be involved in the design, testing, and evaluation process. Consequently, they con-
ducted a series of focus groups involving non-problem gamblers discussing their views one
existing limit-setting tools, as well as discussing potential design improvements that may
increase the tools RG utility.
Using information gained from the focus groups, Wohl et al. then designed new
monetary limit-setting with pop-up message reminder, and compared this to older, more
simple iterations of such a design. New monetary reminder pop-up message features
included a traffic light visual display, informing participants of their spend relative to their
limits (i.e., green light ‘safe’, amber ‘close’, red light ‘limit reached’), this was to allow
self-monitoring of behaviour, one of the principles of PSD. Once limits had been reached, a
1-min delay was enforced before players could opt to continue to play. Fifty-six EGM
gamblers (37 females) were recruited and participated in an EGM simulation in a virtual
reality environment. They gambled with 80 credits ($20) and any money left at the end of
experiment was kept by the participant. Gambling outcome was controlled for by the
experimenter to ensure all participants reached their limits.
Only seven participants (three from the HCI/PSD condition, and four from the standard
monetary limit-setting condition) failed to reach their limits and were thus excluded from
subsequent analysis. Results showed that those exposed to the HCI/PSD tool were sig-
nificantly more likely to adhere to their pre-set limits compared to the standard monetary
limit tool (62.2 vs. 2 % respectively). Also of importance was the fact that two participants

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stopped prior to reaching their limits immediately after viewing their player statistics. Self-
report data also indicated that participants perceived more engagement with the HCI/PSD
tool. However, encouragingly, mean ratings for both the HCI/PSD and old design were
above the mid-way point of the scale, showing perceived engagement in both conditions.
Using an EGM simulator in a virtual reality environment, Kim et al. (2014) assessed the
impact of prompts encouraging the setting of time-based limits on both the uptake of
setting such limits, and the impact this had on session duration. Forty-three, non-problem/
low risk Canadian university student gamblers were recruited and given $20 to gamble
with in the experiment. Analysis revealed that participants who were explicitly asked to set
a time limit did so with a 100 % compliance rate (20/20), compared to just one out of 23
for those participants not prompted to set limits. Those prompted to set a limit prior to
engaging in play gambled for significantly less time than those who were not asked to set a
limit (5 vs. 9.48 min respectively). Of note, 11 out of 20 of participants in the limit-setting
group gambled for less time than their self-set limit.
Several limitations exist, including then potential for demand characteristics in the
experimental paradigm to drive the high percentage of participants setting limits. In such a
laboratory environment, many structural and situational characteristics of real gambling
environments are lacking, all of which may draw attention away from the available RG
tools. In addition, participants were only exposed to a single RG tool, and thus, the study
cannot report the relative additive (or deleterious) impact that multiple available tools can
have in moderating gambling behaviour. However, the results indicated that setting limits
on gambling session duration may be effective as an RG tool by reducing the amount of
time an individual spends gambling. The authors note that while some gambling activities
may benefit from the use of monetary limits, some activities may benefit from time limits.
This is perhaps particularly relevant for gambling platforms such as EGMs, where there
may be a tendency to dissociate and lose track of time (see Diskin and Hodgins 2001), or
poker, where tournaments are typically long and cash games have no defined end as such.

Behavioural Tracking Tools

Research indicates that providing gamblers with personalised feedback helps them to better
understand their behaviour and change it if necessary (Auer and Griffiths 2013a, b). Digital
technology affords the opportunity to track behavioural player data, which in turn, allows
the opportunity to profile gamblers, assess behavioural change that may be indicative of a
problem developing, and thus, provide gamblers with personalised feedback to facilitate
awareness of such behavioural change. Behavioural tracking also produces datasets that
allow identification of behavioural markers that may be indicative of harm, which in turn,
further allows the development of understanding related to both responsible and prob-
lematic gambling practices.
Auer and Griffiths (2013a, b) argue that personalised messages can be applied using the
principles of motivational interviewing, where behavioural tracking allows the delivery of
personal, transparent, and motivational feedback. They argue that the target population for
behavioural tracking tools should be those who are ‘at-risk’, or those who are developing a
problem. Behavioural tracking tools may therefore provide motivation for change via the
use of personalised feedback, and for this reason, personalised feedback via behavioural
tracking is in line with the Stages of Change Model (SCM; Prochaska et al. 1994). The
SCM has been applied to a broad range of behaviours, including weight loss and

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alcoholism, where the idea is that behaviour does not change in one step, rather, change
occurs through a series of steps, starting from pre-contemplation, all the way through to
maintenance of a behavioural change (for example, see Prochaska et al. 1994).
Auer and Griffiths (2015a, b) assessed the effectives of the behavioural feedback system
mentor, in terms of its ability to influence the amount of time played and theoretical loss
experienced by gamblers. Behavioural data were obtained from a European online gam-
bling site, with a sample of 1015 gamblers who had used the mentor system. A matched
pairs design was used to compare behavioural change of gamblers who opted into use the
mentor behavioural feedback system, with behaviour of gamblers who did not use the
mentor system (n = 15,216), and were matched for age, gender, playing duration, and
theoretical loss in the 14 days prior to uptake of the mentor system for the experimental
group. The mentor system also applied the principles of HCI and PSD (see Wohl et al.
2014), and provided players with visual feedback in the form of a graphs with the amount
of time and money spent gambling in comparison to normative behaviour of other gam-
blers in the database. Results indicated that of the 1015 gamblers using the mentor system,
625 (62 %) showed a smaller theoretical loss ratio and 60 % showed a shorter playing
duration ratio in comparison to theoretical loss and playing duration of matched control
group ratio (12 and 10 % above chance level respectively). The findings indicated that
overall, gambling behaviour of those using a personalised behavioural feedback system
decreased more than control group members.
While a difference in behaviour as a consequence of the personalised feedback system
was found, the effects were small, which means a degree of caution is required before a full
endorsement of behavioural feedback is made. In addition, a limitation of the study
includes the fact that no information about the gambler’s level of risk or problem gambling
status was obtained. Consequently, it is not known whether the tool was most effective for
those players with problem gambling tendencies, or whether the tool was most effective in
moderating the behaviour of those gamblers who already gambled responsibly. In addition
the study was unable to determine if the gamblers were concurrently using any other
gambling sites or platforms during the evaluation period.
Wood and Wohl (2015) assessed the efficacy of the PlayScan behavioural tracking tool,
which provided gamblers with behavioural feedback about their gambling, in terms of its
impact on gambling behaviour. A sample of 779 gamblers (694 males) who opted into use
Playscan was obtained from the online gambling site Svenska Spel. Gambling behavioural
data was compared for those who opted into use the Playscan system with matched
controls who did not opt in. The behavioural feedback utilised an algorithmic system which
provides players with a colour-coded risk rating according to their expressed behaviours,
with green indicating no issues, yellow being at-risk, and red being problematic. Gambling
expenditure data (deposit and wager amounts) were gathered for the week in which players
enrolled on Playscan, as well as the subsequent week and 24 weeks later. These data were
also gathered for the matched pairs control group.
Results showed that at-risk players (‘yellow’ players) who used the feedback tool
significantly reduced the amount of money deposited and wagered compared to players not
utilising the RG tool. Furthermore, this effect was obtained for both the week following
enrolment and at 24 weeks later. Results indicated that those gamblers who received
behavioural feedback showed a significant reduction in deposited amounts compared to the
control group in the week after enrolment. However, ‘red’ and ‘yellow’ players (i.e., those
showing signs of problematic or risky play) did not significantly reduce their deposit
amounts in this period compared to a control group. Only the ‘green’ group showed a
significant deposit reduction for this period, relative to the control group. However, deposit

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reductions were noticeable over time, with ‘green’ and ‘yellow’ gamblers showing a
significant deposit reduction from week of enrolment to week 24 compared to the control
group. There was no such reduction over this period of time for red players.
In terms of wagering amounts, while ‘red’ players reduced their wagering between
enrolment and 24 weeks later, this amount did not differ compared to the control group.
However, for the same period, ‘yellow’ and ‘green’ gamblers significantly reduced their
wagering amounts compared to a control group. This suggests that behavioural feedback
via behavioural tracking may have a positive impact in keeping controlled gamblers safe,
as well as positively impacting at-risk players, while the effects on those gamblers already
exhibiting problematic symptoms appears minimal. This supports the notion of behavioural
feedback as an RG tool aimed at preventative measures, rather than an intervention for
problem gamblers. However, as the authors noted, the extent to which the colour classi-
fications actually relate to more standardised measures of problem gambling is unknown.

Prohibition and Modification of Note Acceptors

One method that had been implemented in Norway as a way to reduce gambling expen-
diture and gambling-related harm is the prohibition of note acceptors on slot machine,
which produced a 40 % reduction in the turnover produced by slot machines (see Nor-
wegian Gaming Authority 2006, 2007). The prohibition or restriction of note acceptors
appears to be a valid avenue of exploration in RG, particularly given evidence suggesting
problem gamblers more frequently use high denomination bank notes when gambling
compared to non-problem gamblers (Sharpe et al. 2005). Despite evidence from Australia
that (1) suggests problem gamblers prefer to use note acceptors while gambling (Australian
Productivity Commission 1999), and (2) there is a strong correlation between problem
gambling and use of note acceptors (McMillen et al. 2004), there is very little empirical
evidence demonstrating the efficacy of prohibition/restriction of note acceptors in reducing
problem gambling among EGM players.
Sharpe et al. (2005) tested the effects of several modifications to gaming machines,
including a restriction on note acceptors to allow a maximum of a $20 note. The research
was carried out in an ecologically valid environment, with 779 participants of varying
problem gambling severity playing on the modified gaming machines in hotels and bars.
Several proxy measures of gambling behaviour recorded, including time spent gambling,
number of bets, net loss, and lines per wager. However, machines with restrictions on note
acceptors failed to have any significant impact on any aspect of gambling behaviour
compared to control machines.
The authors highlighted several limitations of the research, including the fact that a
large proportion of gamblers approached to take part in the study declined, bringing into
question how representative their sample was. Other limitations included the potential part
that demand characteristics played on participant gambling behaviour, due to the fact that
participants were being observed by the experimenter to record gambling behaviour. In
addition, there were an insufficient number of probable problem gamblers in the sample to
compare whether the machine modifications had differential efficacy in modifying beha-
viour for problem gamblers in comparison to non-problem gamblers.
Hansen and Rossow (2010) explored the impact of prohibition of note acceptors on slot
machine players in terms of its impact on gambling behaviour and problem gambling
measures (SOGS-RA and Lie/Bet) in adolescent-aged gamblers. The samples comprised

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20,703 students in 2004 (pre-intervention); 21,295 in 2005 (pre-intervention); and 20,695

in 2006 (post-intervention). Respondents were mostly 13–19 years old with an average age
of 15 years and there was an approximate 50/50 gender split. Importantly for the efficacy
of note acceptor prohibition as an RG measure, results showed no significant changes in
gambling behaviour and problem gambling at time points one and two (pre-prohibition).
However, significant differences were found at time point three following prohibition.
Following prohibition, and controlling for potential confounding variables, slot machine
gambling frequency was reduced by 20 %, the proportion of ‘frequent’ slot machine
gamblers was reduced by 26 %, and overall gambling frequency was reduced by 10 %. In
addition, the proportion of problem gamblers was reduced by 20 %. No significant gender
differences were found.
Only one-third of adolescent gamblers reported noticing the removal of bank note
acceptors, and two-thirds reported either stopping gambling or reduced gambling following
the prohibition. Hansen and Rossow (2010) reported that only a small fraction of partic-
ipants attributed the changes in their gambling behaviour to the removal of bank note
acceptors. Importantly, no compensatory behaviour in terms of transition to other forms of
gambling was observed after the intervention, and decreases in gambling behaviour were
also observed for both at-risk and problem gamblers.
A limitation of the research is that it does not offer explanatory value in terms of the
mechanisms of change. One argument proposed by Hansen and Rossow (2010) stated that
an inability to use notes slows down the speed of play, where speed of play has frequently
been implemented as a problematic characteristic of electronic gambling (McCormack
et al. 2013). In addition, it is possible that the need to transfer notes into coins may break
up the rhythm of play, which may have the added effect of breaking dissociative states and
raising levels of self-consciousness regarding gambling time and monetary expenditure.
The time taken to transfer notes to coins, or the associated increased time it takes to load a
machine with coins, may be sufficient time to allow any increased levels in stress and
arousal to dissipate, allowing gambling decisions to be made rationally in a ‘cold’ (as
opposed to ‘hot’) emotional state (Parke et al. 2014a, b).

Discussion

It is now widely accepted that delivering RG information during play, to facilitate self-
awareness, self-control, and dispel erroneous cognitions, should be delivered via a dynamic
mode of display using pop-up messaging. In terms of messaging content, despite some
positive results, evidence shows an inconsistent effect of informative style message content
on gambling behaviour. Informative content aimed at dispelling cognitive biases and
erroneous cognitions related to gambling appear to be more effective. However, such an
effect appears to inconsistently transfer to gambling-related behaviour. Such research also
suffers from the limitation that it is often unclear as to whether it is the message content
itself, or the break in play offered by the message, that exerts the behavioural influence.
Recent evidence shows there can be adverse impacts using breaks in play in isolation of
RG messages on cravings and negative valence (Blaszczynski et al. 2015). This suggests
that it is not the break in play afforded by pop-ups in the pop-up literature that facilitates
behavioural change. However, it cannot be established if the two in combination provide
an additive effect.

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As a consequence of the relative inconsistencies of informative messaging on gambling

behaviour, other approaches, such as the use of self-appraisal messaging, normative
feedback, and the use of time and monetary reminders have begun to be explored with
often significant results but small effect sizes. These studies represent a diverse method-
ological approach, encompassing self-report, experimental laboratory work, and ecologi-
cally valid experimentation that offsets the weaknesses of each approach used in isolation.
However, current research carried out in real world environments appears to have a focus
on the most intense gamblers, and while significant results in the intended direction have
been found, particularly in terms of messaging facilitating gambling cessation, the effects
are small, and do not tell us anything about the influence of messaging on the majority of
gamblers who gamble at moderate and safe levels.
Counter to this argument is the fact that the most intense gamblers are likely to be the
ones most in need of help to remain in control, and if messaging is able to help only small
numbers of gamblers, then this should be regarded as positive (given that the mantra of
many gaming operators is that ‘‘one problem gambler is one problem gambler too many’’).
However, RG tools should strive to assist more than a few gamblers, and pop-up messaging
may be regarded as a preventative tool rather than an intervention for problem gambling.
Consequently, longitudinal research may be of value to evaluate the relative effectiveness
of messaging in term of helping the majority of gamblers, and those gambling recre-
ationally, to stay in control.
While significant findings in the intended direction for pop-up messaging are emerging,
it is suggested that researchers and the gaming industry should not be content with the
results, and that research also needs to remain flexible and continue to explore the impact
of other approaches to messaging content, both in isolation and in combination with other
forms of messaging content. For example, it could be that the use of emotional imagery,
emotion-laden content, and self-set messages offer a potentially successful alternative to
current approaches. Implementation of such new approaches should continue to evolve
from controlled laboratory-based investigations to real-world testing before widely
implemented, as well as being tested on the diverse sub-groups of gamblers covering the
entire spectrum of gambling behaviours, ranging from recreational through to pathological.
Combined, empirical data from both laboratory-based and real-world environments has
shown positive results for the use of limit-setting as an RG tool. However, limit-setting
research does not address the issues of gamblers being able to switch gambling platforms
once limits have been reached. Other methodological limitations, such as the failure to
account for concurrent gambling expenditure outside of the boundaries of the studies of
focus, makes it hard to make any conclusive statement about the overall effectiveness of
limit-setting as a harm-minimisation tool. Furthermore, in EGM play, limits can be set,
reached, and then overridden with the continuation of play when gamblers may be in
elevated states of arousal and experiencing negative emotion, albeit following a brief pause
in play.
Currently, limit-setting is not mandatory in most countries. A mandatory limit-setting
system, such as that in Norway, has the advantage of helping both recreational and problem
gamblers adhere to pre-set limits and assists them in avoiding loss chasing, but this does
not avoid the issue of gamblers potentially switching gambling platforms, although how
often this occurs is yet to be established (Parke et al. 2014a, b). A voluntary limit-setting
system does have some advantageous qualities over mandatory limit-setting, in the light of
Self-Determination Theory (Deci and Ryan 1985, Deci and Ryan 2000), in the sense that
the free choice to self-set limits will more likely result in behavioural execution of limit
adherence, as well as instil a more positive attitude towards the tool more generally, given

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the fact that decisions will be derived through the gambler’s own value system and
motivations. This does not address the potential transition from a pre-session gambler,
operating in a ‘cold’ emotional state, making rational decisions, to one who may be
experiencing negative valance following losses, in a highly aroused state, making emotion-
based choices, where reaching their pre-determined limit can be easily overridden fol-
lowing a pop-up reminder. Of course some sites, such as Pokerstars, enforce a much longer
delay period once pre-set deposit limits have been reached, allowing a much longer
‘cooling-off’ period. What may be required for EGMs or online gambling games is for
sessions to be mandatorily terminated once limits have been reached, rather than asking
gamblers if they would like to continue following a reminder and short delay. Although
this would not address the potential for gamblers to switch terminals to the one in their
immediate vicinity, or simply move venues, it may provide the delay required for the
dissipation of highly aroused and emotional states.
Encouragingly, limit-setting research has started to incorporate psychological principles
founded in wider areas of psychological research, and recent evidence shows promise for
the use of HCI and PSD principles. These principles initially show a positive effect in
facilitating limit adherence, although this initial evidence needs to be expanded to include
real-world trialling to support its overall efficacy. However, real-world testing of limit-
setting tools that exist, appear to focus on the most intense sub-groups of gamblers. While
justifiable by the fact that intense gamblers will be the group most likely in need tools to
help them gain control over their gambling behaviour, the vast majority of gamblers play at
safe levels, yet the effects of limit-setting on this group remain unclear.
It is evident that research concerning the setting of time limits has received less
attention. While the one study identified here shows a positive result by demonstrating
reduced gambling session length for those gamblers setting time limits, endorsement
cannot be made using findings from a single study. Indeed, there is potential for mal-
adaptive behaviour to occur when setting time limits. For example, potential unintended
effects may include inadvertently causing gamblers to gamble larger sums of money to
compensate for the shorter session duration they set themselves. Becauseof possible
paradoxical, and unintended effects, full endorsement of the use of time limits cannot be
made at the present time. A systematic and staged trial, encompassing a variety of gam-
bling behaviour intensities, in which the effectiveness of limit-setting is monitored and
evaluated over a sustained period of time appears to be the most advisable strategy moving
forward before limit-setting receives full endorsement as a harm-minimisation tool.
In terms of actual behavioural evidence, results have shown that use of behavioural
tracking tools that feedback to players the amount of time they have been gambling relative
to normative data, show an overall reduced theoretical loss and gambling session duration.
However, this effect is small with results from the mentor system showing its effect is only
slightly (although significantly) above chance level. The use of colour coded feedback
systems, informing players of their level of risk according to expressed gambling beha-
viour, appear to have a positive influence on a majority of gamblers in various sub-groups
categorised according to their level of risk. Overall reductions in deposit limits have been
found as a result of behavioural tracking systems for those gamblers already demonstrating
safe and RG behaviour—an effect that is sustained at a six-month interval. While initial
effects of behavioural tracking are not found for those players demonstrating a greater level
of risk immediately following enrolment to such systems, positive effects begin to emerge
at a six-month interval period, expressed in terms of reduced wagering and depositing,
potentially indicating that behavioural tracking systems offer long-term benefits in the

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absence of immediate gains for more risky players. Evaluation of behaviour over a more
sustained period of time should shed further light on this suggestion.
Unfortunately, the effects of behavioural tracking from the existing studies here either
do not show a positive impact on the most risky gamblers, or such information cannot be
extracted due to the methodological approach failing to distinguish problem gambling
status of the participants. While attempts have been made to categorise risk levels
according to expressed online gambling behaviour using algorithmic software, there is
currently no consensus on how much this actually relates to external and more widely used
screening measures of problem gambling behaviour. While positive evidence exists for the
use of behavioural tracking systems as an RG tool, a future key issue involves determining
which specific features of behavioural tracking tools are the most effective in facilitating
and enabling a positive behavioural change in gamblers. It also needs to be ascertained if
specific features are more effective according to the level of risk of the gambler, rather than
assuming a one-size fits all approach.
A consistent limitation in much of the limit-setting and behavioural tracking research is
that while there was generally a positive effect of the tools on reducing gambling beha-
viour, current research design limitations make it impossible to ascertain whether or not
gamblers simply swap machines or gambling sites once their personal limits have been
reached, or if the same applies as a way of avoiding negative behavioural feedback on
behavioural tracking systems. It is not known how often this occurs, and epidemiological
surveys may be required to ascertain if this is a concern for harm-minimisation research.
One way around this, though arguably unlikely in the foreseeable future, is to have a
centralised ‘hub’ whereby a player may gamble on multiple gambling sites but their overall
expenditure, stake sizing, frequency and duration of play, and limit-setting function, is
governed by a central system where all accounts held by a player all correspond to a unique
identifier code. Thus, setting a limit on the central hub would mean that the personal limits
applied as a maximum spend across all their gambling accounts.
Other harm-minimisation approaches, such as the use of note acceptor prohibition or
modification have received less academic attention. However, note acceptor prohibition
shows promise. Hansen and Rossow (2010) demonstrated a reduction in gambling fre-
quency and problem gambling in a large sample if adolescent-aged gamblers as a result of
note acceptor prohibition. These results were only applicable to one sub-group of gamblers
(i.e., adolescents), though the effects were shown across a range of problem gambling
severity levels.

Conclusion

It is important to bear in mind the heterogeneous structural and situational characteristics

across electronic gambling and online platforms, and the games themselves. Consequently,
endorsing an RG tool fully requires testing it across a diverse range of game types. For
example, tools effective in breaking dissociation in games with smaller stakes but rapid
gameplay speeds, may not necessarily transfer to success in slower speed higher stake
games. For this to happen, it is important to empirically investigate the psychological
mechanisms of change that transfer a gambler from a cognisant state of control to a loss of
self-control, according to specific gambling parameters, if indeed these mechanisms differ
according to game types and their associated structural characteristics.

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Results appear to support the notion that harm-minimisation tools should be viewed as a
responsible gambling prevention measure for those who already gamble safely, or are at
risk of developing a problem, rather than an intervention for those already exhibiting
problem gambling behaviour. That said, non-gamblers or non-problem gamblers make up
the majority of participants in all the studies outlined (compared to the numbers of problem
gamblers). However, some studies did show some RG tool efficacy for high-intensity
gamblers, although how this can be extended to apply to actual diagnostic measurements of
problem gambling scores remains unanswered at present. A danger would be to assume
that new tools and approaches being developed would not work for problem gambling sub-
groups. However, problem gamblers should still be involved in the testing of new
approaches so that opportunities are not missed with regards to assisting this group regain
control of their gambling behaviour.
Whilst the limitations of laboratory-based experimental work are recognised, this does
not expel their relevance in the research field of gambling harm-minimisation. Indeed,
while ecological validity is largely lacking in such studies, they offer a level of experi-
mental control often not afforded by real world research, allowing the impact of specific
game manipulations and tools to be tested for both their positive and negative influences on
behaviour and cognition. This is an important stage in the research process, as RG tools
should demonstrate positive efficacy before being widely implemented in real-world set-
tings, which may prove costly both financially and for the gamblers themselves if tools are
capable of producing unintended effects. However, the progression from laboratory
research to real-world application should not be linear. Where a better conceptualisation
should be one of an iterative or cyclic relationship, with laboratory work paving the way
for real world application, where then in turn, issues, observations, and ideas based on this
real world application are fed back into the laboratory to allow next generation
improvements to RG tools to be made.
Research in this field should remain both creative and flexible to both deal with
potential changing landscapes of gambling, as well as to continue to strive for advance-
ment of current harm-minimisation tool approaches. This creativity should also extend not
only to advancing current ideas, for example, changing the content and layout of pop-up
messaging to bring about greater cognitive and behavioural impact, but also continue to
use science and psychological theory to develop new approaches yet to be investigated.

Compliance with Ethical Standards

Conflict of interest The authors received no specific funding support for this work. However, the second
author has received funding for a number of research projects in the area of gambling education for young
people, social responsibility in gambling, and gambling treatment from the Responsibility in Gambling
Trust, a charitable body which funds its research programme based on donations from the gambling
industry. Both authors have undertaken consultancy for various gaming companies in the area of social
responsibility. Andrew Harris has previously worked full time as research assistant for the Responsible
Gambling Trust (RGT), a charitable body which funds its research programme based on donations from the
gambling industry, a charity who’s goals are directed towards funding research in the prevention of problem
gambling as well as funding problem gambling treatment. This paper was written as part of Andrew’s PhD
studies at Nottingham Trent University, and is no way connected to his previous role at the RGT, or his
current part time research position with the RGT.

Ethical approval This article does not contain any studies with human participants or animals performed
by any of the authors.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 Inter-
national License ([Link] which permits unrestricted use, distribution,

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and reproduction in any medium, provided you give appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons license, and indicate if changes were made.

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