Project ACTIVATE and the ACT Vet app

Supporting Veterans with gambling related harm

Gambling in military or veteran populations, compared to other research areas, has had less exploration. However, the available evidence does tell us there is a range of interventions or treatments that could be used to support veterans with gambling difficulties. There is no one-size-fits-all approach to any sort of mental health or addiction difficulty, but one therapy that is gaining traction in the military-veteran space is Acceptance and Commitment Therapy – or ACT as we call it.

ACT has been used by the US Veteran Affairs Department (VA) since approximately 2015. It is suggested that ACT has produced promising outcomes because it is what we call a ‘transdiagnostic’ tool, meaning it can address more than one difficulty at once. ACT could be used to support those with complex needs. Also, the veteran community seem to resonate with many of ACT’s concepts.

ACT derives from mindfulness, and mindfulness is focused on the idea that it helps people if they bring their attention to the present moment rather than worrying about the past (which we can’t change) or the future (which has not happened yet). ACT is used to create a process called ‘psychological flexibility’, whereby a person develops their ability to be flexible in how they respond to things. Having greater psychological flexibility is linked to a sense of control over one’s actions, and not feeling that they are purely on autopilot because they were triggered by something.

ACT has two main components:

Accept what has happened; we can’t change the past as we don’t have a time machine. Don’t try to think your way around something or challenge it, just practice accepting it. This means accepting that life has ups and downs, good times and bad, positive and negative, and we make space for all of it. We just allow it to exist. So in the context of gambling, people accept they have a gambling difficulty, they are unlikely to gamble in a moderated way, and their gambling could be linked to other things.
A person chooses what to commit to. They decide what they value. They reflect on what the best version of life looks like and head in that direction. Their values become like a compass or an arrow they fire at a target. They commit to working in line with the values they choose. So in the context of gambling a person may value family time, and commit to spending time with loved ones, instead of spending time gambling.

In 2022 the research team conducted an in-depth review of published literature on the usefulness of ACT, or mindfulness-based approaches, for veterans with gambling and/or PTSD. While fewer published studies had used ACT/mindfulness compared to other alternatives, the results were positive.

The studies suggested:

ACT was linked to reduced instances of gambling

ACT was linked to improvements in the management of gambling cravings

ACT was linked to reduced PTSD severity scores

ACT was linked to improvements in emotional regulation scores

Within the review, if ACT had been compared with any other intervention ACT was reported as outperforming the other comparators. There was one exception; the oldest study suggested that ACT was successful in improving PTSD scores but it did not outperform its comparator intervention. Within the review, the mode of delivering ACT seemed to have no bearing on its success. In other words, it didn’t seem to matter if ACT was delivered face-to-face, by telephone, in a group, one-to-one, or through an app.

For the ACT Vet study, the research team extracted information from the literature review and findings taken from our focus group discussions, to develop an app-based intervention.

The ACT Vet intervention:

Is self-directed – each app user works through it without external support

Is manualised – the intervention has been created as a series of steps, designed to provide structure and flow. Each step has a theme, which should be clear from the contents of that step

Is 12 weeks in total

Contains data collection points, so we can assess whether it works or not

Includes a financial incentive of a £75 voucher, for the first 150 to complete the 12 weeks including the data collection points*

*Those eligible to receive the voucher will be:

a) Those who experience gambling harm and/or experience PTSD symptoms as determined by the assessment scores collected during a brief pre-screen.

b) App users who complete all five data collection points across 12 weeks.

The intervention received full ethical approval from the School of Psychology Ethics Board, Swansea University. ACT Vet also has the full support of King’s College, London and Combat Stress (the UK’s leading mental health charity).

We are currently looking for app testers to assess whether it works, as we aim to launch soon.

As per the standard university policy, all data will be saved to a secure server for 10 years. However, all data is anonymous. The two reasons we ask for an email address are to be able to send out the £75 voucher and to ascertain whether anyone is interested in participating in future similar research. Email addresses are only kept for these purposes, as per legislation linked to GDPR.

Further information about the study, and what is required of app testers, can be found here in the Participant Information Sheet and Consent Form.