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Data Availability Statement

The datasets presented in this article are not readily available because the raw anonymised data will be made available only if the purpose is consistent with the consent given by participants and in accordance with the legislation in force in France. Requests to access the datasets should be directed to Gaëlle Challet, gaelle.bouju@chu-nantes.fr.

Discussion

The present study investigated the effect of Internet gambling-related pop-up warning messages (self-appraisal and informative messages) compared to that of a control condition on gambling behavior, experience of play, recall of messages, display time of messages, cognitive distortions, and craving, taking into account the type of game and the severity of the participant's gambling practice. According to the literature, we hypothesized that self-appraisal messages would have a larger effect than informative or control conditions. We also hypothesized that the impact would differ according to the gambler's characteristics (status and type of preferred game). The results contradicted our expectations because we observed no significant differences between the three conditions at the end of the gambling session in the quantitative data (gambling behavior, cognitive distortions, and craving).

However, follow-up demonstrated an effect of self-appraisal pop-ups compared to control group with a decrease on time spent gambling (p = 0.0078), but only for sport and horse bettors. This result supports the idea that self-appraisal messages can help gamblers change their gambling behavior and that this effect varies according to gamblers profiles such as favorite gambling-type (25).

Moreover, as demonstrated in the literature, warning messages might help to correct some gambling-related cognitive distortions (22, 36–38). Indeed, we observed a significant decrease of the illusion of control (GRCS-IC) for ARGs in the informative pop-up condition compared to the control condition (p = 0.0072). A reminder of the risks associated with gambling appears to modify gambling-related thoughts in the short term. In contrast to the study of Monaghan (27), we observed that informative messages had a larger influence on reducing cognitive distortions than self-appraisal messages for ARGs. As a consequence, informative messages could also be a useful way to prevent the risks associated with gambling and to facilitate responsible gambling. Moreover, we observed that this influence was more important for ARGs than for LR/NPG. Low risk/non-problem participants gambled within appropriate levels and may not be concerned by this kind of message. This reaction may explain the lack of impact observed. The impact on illusion of control demonstrated that early intervention for ARGs with appropriate messages could decrease the effect of the game on gamblers' cognitions and may secondarily limit the transition to excessive practice. However, the effect of the warning messages on the reduction of cognitive distortions must be put into perspective. While pop-up messages seem to have a positive impact on the illusion of control, no significant effect on other types of cognitive distortions was observed for ARGs. We even observed an increase of gambling-related expectancies (GRCS-GE) (p = 0.0463) for sport and horse bettors with self-appraisal pop-ups condition compared to control condition.

On the other hand, as suggested by Gainsbury et al. (18), the results showed that appropriate recall is not necessary to modify gamblers' thoughts. In fact, despite participants remembering self-appraisal messages better, we only observed an impact of informative messages on cognitive distortions. Moreover, if this result suggested that participants were paying better attention to the self-appraisal messages' content, we observed that, beyond the first message recalled correctly, the majority of participants failed to remember a second message correctly. In accordance with the participants' comments collected after the experiment and as underlined by the study of Hollingshead et al. (28), the results suggested that many gamblers did not pay attention to the pop-up message content, especially in the case of successive pop-ups. Additionally, in contrast to the experiment of Cloutier et al. (39), which found that wagering decreased when players were forced to pause their gambling session for 7 s, and in contrast to Stewart and Wohl (40), which showed that pop-up messages that interrupt gambling sessions reduced dissociation, our results demonstrated that a pop-up message display time longer than 7 s did not impact gambling behavior. It is possible that gamblers did not pay attention to the warning information because they believed they were in control of their gambling behavior and because they knew exactly how much they were spending and how long they had played (41, 42). Consequently, the information provided in the pop-up message may have been redundant with the information they thought they already had (28). In fact, 90% of the participants in our study reported that both time spent and money wagered were appropriate according to their means, and only 14% of the sample felt they had a problem with their gambling during the experiment.

It is important to note that, in contrast to Gainsbury (18), in which only a minority of participants indicated that the messages had reduced their enjoyment (12.2% of informative and 11.7% of self-appraisal groups), we observed that a majority of the participants (53.6%) in our study were disturbed by the pop-ups during their gambling session. This proportion was higher in ARGs (68.7%). The majority of previous studies took place in a laboratory with an EGM simulator (16), while our study targeted Internet gamblers. Users on the Internet generally receive pop-up messages every time they initiate a search on the Internet or activate a new app or programme, for example. A consequence of the excessive frequency of pop-up messages on the Internet is that their content is ignored (43), and increasing the amount of information in the pop-up does not increase attention to the content (28, 44). Thus, Internet gamblers may process gambling pop-ups as they usually process each pop-up received on the Internet. This assumption is supported by the fact that gamblers from the two experimental groups declared that they associated gambling pop-ups to pop-up ads and that this association increased their irritation and frustration. This feeling was probably increased in ARGs because the involvement and the immersion in the game were more important to them than it was to other gamblers. In general, immersion and dissociation are particularly important for Internet gambling, in contrast to studies conducted with EGM simulators in the laboratory (4, 45). Similarly, as demonstrated by Blaszczynski, breaks in play could increase frustration (23). However, we did not observe an effect on enjoyment, probably because breaks in play were accompanied by warning messages. Last, it is possible that this frustration was caused by the excessive frequency of the pop-ups. It could be interesting to test Internet pop-ups with varying frequencies.

Several limitations that could influence the results must be highlighted. Our sample was small, which could lead to a lack of power to detect significant differences between conditions. Therefore, it might be interesting to replicate this study with more participants. Moreover, even though we tried to create an ecological gambling experience, the sessions were conducted in a hospital under experimental conditions. These divergences from a real gambling environment (laboratory being less comfortable than home, impacting immersion) could have influenced the results. For example, in order to facilitate the data collection participants could only play on their favorite website. Even if a majority of the participants were registered on 1 gambling website (73%) or 2 (18%), this obligation could have influenced the gambling session. However, the laboratory design of our study enabled us to have access to gambling experience through face-to-face interviews, which gave us access to richer data, especially regarding subjective gambling experience. Finally, comparisons were limited because of the absence of problem gamblers (not included for obvious ethical reasons) and the exclusion of pure chance gamblers. Moreover, we choose to combine low-risk and non-problem gamblers while a number of them experimented harm related to their gambling. Although a recent study of (46) demonstrated that “PGSI categories are quite sensitive and higher risk PGSI groups consistently reported more harms and more serious harms than lower risk groups.” Nevertheless, the results might be different if we separated our groups differently. It could be interesting to observe the impact of the moderator on problem gamblers, particularly concerning the impact on cognitive distortions and level of disruption. The exclusion of slot machine, scratch ticket, and lottery gamblers could partly explain why we observed few differences between different types of games. Nevertheless, we obtained high ecological validity (participant's favorite gambling website, with her/his own gambling account and with her/his own money, with instructions that they could stop at any time), which increases the authenticity of the participants' responses to the messages and their impact (47). The methodology of the MOD&JEU study was robust, and our results enhance the current knowledge in the literature with the many quantitative and qualitative data collected.

Comparison of “T0–T2” Evolution (Pre-test Vs. 2nd Post-test) Between the Experimental Group and the Control Group According to the Type of Game and the Status of Gamblers

The results are shown in Table 3.

TABLE 3

Table 3. ANOVA results adjusted for the status of gamblers and the type of gambling comparing the 2 experimental conditions with the control condition for differences between the pre-test (T0) and 2nd post-test (T2).

No significant difference between the experimental groups and the control group regarding the evolution of money wagered was found. A significant effect of the interaction of pop-up messages on time spent gambling for skill and chance bank gamblers was demonstrated, with a lower duration in self-appraisal condition compared to control condition (p = 0.0078). Rregarding the secondary outcomes, a significant effect of the interaction of self-appraisal condition on the score of the GRCS-GE compared to the control group for skill and chance bank gamblers was also demonstrated (p = 0.0463). In the control condition, the change score of the GRCS-GE was negative (mean value: −1.08), which indicated that gambling expectancies decreased in comparison of pre-test score. In the self-appraisal condition, the mean value increased in comparison of pre-test score (mean value: +0.95). The results revealed that participants in the pop-up conditions and the control condition significantly differed in the illusion of control dimension of the GRCS (GRCS-IC) according to gambler status. The comparisons revealed a significant decrease in the GRCS-IC for ARGs in the informative pop-up condition (mean value: −1.86) compared to an increase in the control condition (mean value: +2.70) (p = 0.0072).

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