Assessing the Impact of a Therapist-Assisted AI Chatbot on the Awareness of Risky Gambling Behaviours and Overcoming Barriers to Seeking Help Among South Australian (SA) Gamblers

The programmes we have developed at Statewide Gambling Therapy Service (SGTS) and Flinders University over the last 20 years began with people addicted to pokies using cue exposure (behavioural) therapies (CET). We have refined and adapted this model for all forms of gambling, most recently sports betting. Having a proven effective therapy delivered remotely over 6-10 sessions would be a breakthrough in Australia and world-wide. In this trial we are combining CET with an AI chatbot component. Scalable Care collaborated with the University of California San Francisco Institute for Neurosciences to create a digital mental health application for teenagers and young adults called GritX. GritX is an emotionally intelligent chatbot that understands human emotions, intent, and context to deliver evidence-based psychoeducation and interactive wellness tools. It gives participants access to digital mental health resources anytime and anywhere, helping to alleviate care gaps between appointments and waiting to see their therapists or counsellors. If you are taking part in Phase 1, also known as the co-design phase of this study, you will be required to attend either face-to-face or on-line 1 group session (flexible options of timing will be provided) lasting 1.5 to 2 hours consisting of a 20 minute overview of the aim of the project and viewing the existing GritX app with its mental health content and the proposed gambling content. The mental health content will focus on gambling habits, how gambling affects of participants' mood, finances and mental helath. Either individually or in pairs you will then be asked to engage with the chatbot to respond using their own or real-world gambling experience or made up if they wish to protect their privacy (40 minutes). How you engage with the chatbot will be monitored by the research team to ensure safety, appropriate interactions by the chatbot and also to make improvements. You can discuss your preferences on how you want to participate (i.e. individually or in pairs), with the study team. This will also depend on the nature of the content provided to you in each session. You will then be given the option of providing feedback individually either on-line or in a group setting (20 mins). It is important to note that if you take part in Phase 1 providing feedback on the chatbot and content, you will not be able to participate in Phase 2: the pilot trial. Once Phase 1: co-design phase is complete, the study team will make improvements to the chatbot content based on findings/feedback and submit progress reports to the sponsor and the local ethics committee to seek approval before commencing Part 2: the pilot trial. For those participating in Phase 2 of this research project for a pilot of 30 people, once you give consent to be involved, you will also be asked to complete some questionnaires on your gambling and mental health. The questionnaires will take between 10- 20 minutes to complete. Once the questionnaires are completed, our Research Assistants (RAs) will arrange for you to access the GritX-G chatbot trial coach. A Statewide Gambling Therapy Services (SGTS) therapist will make contact with each participant to ensure safety and/or as a contact the person to commence Cue Exposure Therapy (CET). If triaged to, (i) self-help, the chatbot will direct the participant to several existing GritX skills studio: This studio consists of guided exercises to manage emotions, sadness, anger, fear and anxiety, relationships and newly created for this project, gambling education and money management. Participants can spend as much or as little time in the skills studio exploring different exercises. (ii) gambling counselling, they will be directed by the AI coach to local SA gambling help services where typical sessions will take around 1 hour (depending on the individual and their concerns). (iii) to therapy via SGTS they will be offered Cue Exposure Therapy. The first session includes asking the person to put Money Management in place i.e. ceasing or pausing credit card/phone/eftpos access, cancelling phone and internet gambling accounts, arranging for a daily or weekly allowance managed by a significant other. The intervention (therapy) is delivered by trained mental health professionals based at Flinders Medical Centre, Adelaide. This option will take anywhere between 30 minutes to 1 hour, depending on the participants needs and/or schedule. The intervention will consist of up to 28 days of engagement for each participant with the GritX-G chatbot participating in 2-way conversations and offers of follow-up either daily or as determined by the participant. All therapy sessions (should participants be triaged to a therapist depending on their situation) will be conducted online via phone or video conference (i.e., Teams). The intervention is delivered by trained therapists at intervals that suit the participant's needs (i.e., severity of gambling problem, depression and suicidality) and there will be no randomisation. The length of exercises either on the GritX platform or therapy sessions depends entirely on the severity of participants' gambling problems, depression, and suicidality. After consenting to the study, participants will be advised by the research team on how to access and use the GritX-G app either on their mobiles or on their phones (or both). The therapist may recommend activities provided by the chatbot so there is a combined real and guided AI coach who can assist the gambler. The therapists will also monitor the conversations to ensure safety and participants will be contacted if there is any cause for concern. The research team will also have access to the conversations and the questionnaire data for research purposes and for making improvements.