PATH-G: a proposed integrative motivational-cognitive-behavioral protocol for gambling disorder. A theoretically...

Gambling Disorder (GD) is a multifactorial behavioral addiction characterized by persistent gambling despite significant harm, and typically involves cognitive distortions, urge dysregulation, shame, interpersonal strain, avoidant coping, and progressive erosion of self-trust. The present manuscript introduces PATH-G (Progressive Adaptive Treatment Hierarchy for Gambling Disorder), a proposed, theoretically grounded and not yet empirically evaluated, therapist-guided, workbook-assisted, 12-week psychotherapy protocol for adults with GD, followed by a structured maintenance phase and a dedicated relapse module. PATH-G is designed as a clinical pathway to be delivered within psychotherapy rather than as a stand-alone self-help package. A central premise of PATH-G is that motivation should not be treated as a static pretreatment characteristic, but as a fluctuating therapeutic target that requires repeated assessment and active clinical work across the entire pathway. Accordingly, PATH-G integrates motivational interviewing-informed strategies, stage-sensitive treatment planning, values clarification, collaborative goal revision, and relapse-sensitive recommitment procedures alongside cognitive-behavioral, experiential, and schema-informed techniques. PATH-G is intentionally hierarchical rather than loosely eclectic. Cognitive-behavioral therapy (CBT) and motivational work form the evidence-based core; mindfulness, grounding, and impulse-regulation methods function as adjunctive regulatory tools; and schema-informed, reflective, humanistic, and Gestalt-derived exercises are used to deepen formulation, identity reconstruction, and maintenance. The weekly sequence progresses from engagement, assessment, behavioral monitoring, and psychoeducation to trigger analysis, cognitive restructuring, impulse delay, emotional regulation, graded behavioral substitution, consolidation of abstinence, values-based future planning, maintenance, and relapse analysis. Distinctive features include the explicit division between in-session and between-session therapeutic tasks, collaborative treatment commitment and safety planning, self-monitoring forms, graded substitution of gambling time with ordinary-life activities, motivational anchors between sessions, mode-oriented maintenance exercises, and a non-punitive relapse framework. The main contribution of PATH-G is translational and clinical. It operationalizes a multimodal rationale into a progressive workbook that supports therapist guidance, patient participation, and continuity of care, while preserving case formulation, pacing decisions, and individual tailoring. Because PATH-G has not yet been empirically evaluated as a whole, it should be presented as a theoretically grounded intervention model rather than an outcome-validated stand-alone treatment. Future studies should test feasibility, acceptability, fidelity, and multidimensional outcomes of PATH-G in routine clinical settings.