Internet-based versus synchronous cognitive behavioral therapy for gambling disorder: Study protocol for a...

Despite the availability of effective treatments for Gambling Disorder (GD), help-seeking remains low, and attrition rates are high. Internet-based cognitive behavioral therapy (iCBT) may address barriers to treatment access, but evidence comparing asynchronous iCBT with synchronous CBT (sCBT) is limited.

This study protocol outlines a non-inferiority randomized controlled trial (RCT) comparing the effectiveness of "SpilleFri" (SF), an asynchronous therapist-guided iCBT program, with individual sCBT delivered in-person or via video for adults with GD.

A total of 150 patients diagnosed with GD will be randomized to SF or sCBT. The primary outcome is change in GD severity, measured by the National Opinion Research Center DSM Screen for Gambling Problems (NODS), from baseline to three months post-treatment. Secondary outcomes include gambling behavior, psychological distress, relationship quality, and treatment process variables. Data will be collected at eight time points, including a 12-month follow-up. Non-inferiority will be tested using mixed linear models with a predefined margin of -2 NODS points. Process variables and moderators of treatment response will be explored.

This trial addresses a critical gap in GD treatment research by directly comparing asynchronous and synchronous CBT formats. If SF proves non-inferior to sCBT, it could offer a scalable, flexible, and resource-efficient alternative for GD treatment. Findings may inform stepped-care models and broaden access to evidence-based interventions.