Digital Cognitive Behavioral Therapy for Gambling Disorder: A Pilot Randomized Controlled Trial

Completion of Digital CBT Sessions by Patients

Feasibility of the digital CBT intervention will be assessed in patients assigned to the digital CBT arm as the number and proportion of patients who complete at least 80% of the 12 prescribed digital CBT sessions. Completion of at least 10 of 12 sessions will be considered intervention completion.

Completion of Digital Family Intervention Sessions

Feasibility of the digital family intervention will be assessed among family members assigned to the digital intervention arm as the number and proportion who complete at least 80% of the six prescribed digital sessions. Completion of at least five of six sessions will be considered intervention completion.

Overall Satisfaction With Digital CBT

Overall acceptability of digital CBT will be assessed after completion of the intervention using the overall satisfaction item from a study-specific acceptability questionnaire. Patients rate their overall satisfaction with digital CBT on a 4-point Likert-type scale from 0 (not at all) to 3 (very much), with higher scores indicating greater satisfaction and acceptability. Additional questionnaire items assess perceived usefulness, suitability of digital CBT as an alternative or adjunct to face-to-face treatment, willingness to recommend the intervention, and intervention-related problems or adverse experiences.

Overall Satisfaction With the Digital Family Intervention

Overall acceptability of the digital family intervention will be assessed after completion of the intervention using the overall satisfaction item from a study-specific acceptability questionnaire. Family members rate their overall satisfaction with the digital intervention on a 4-point Likert-type scale from 0 (not at all) to 3 (very much), with higher scores indicating greater satisfaction and acceptability. Additional questionnaire items assess perceived usefulness, suitability of the digital intervention as an alternative or adjunct to face-to-face care, willingness to recommend the intervention, and intervention-related problems or adverse experiences.

Change in Gambling Symptom Assessment Scale (G-SAS) Score

The G-SAS is a 12-item self-report measure assessing gambling symptom severity during the previous week, including gambling urges, gambling-related thoughts and behaviors, anticipatory excitement, emotional distress, and gambling-related personal problems. Total scores range from 0 to 48, with higher scores indicating greater gambling symptom severity. Change in G-SAS score will be assessed across the three study assessments.

Change in Problem Gambling Severity Index (PGSI) Score

The PGSI is a 9-item self-report measure assessing problematic gambling behavior and gambling-related adverse consequences. Items are summed to produce a total score ranging from 0 to 27, with higher scores indicating greater problem gambling severity. Change in PGSI score will be assessed across the three study assessments.

Change in Gambling Urge Scale (GUS) Score

The GUS is a 6-item self-report measure assessing the intensity of current urges to gamble. In the study version, each item is rated from 0 to 7, producing a possible total score from 0 to 42. Higher scores indicate stronger gambling urges. Change in GUS score will be assessed across the three study assessments.

Change in Gambling Related Cognitions Scale (GRCS) Score

The GRCS is a 23-item self-report measure assessing gambling-related cognitive distortions across five domains: gambling expectancies, illusion of control, predictive control, inability to stop gambling, and interpretative bias. In the study version, each item is rated from 0 to 7, producing a total possible score from 0 to 161 when summed. Higher scores indicate greater endorsement of gambling-related cognitive distortions. Change in GRCS score will be assessed across the three study assessments.

Session-Level Acceptability of Digital CBT

After each digital CBT session, patients complete a study-specific acceptability questionnaire consisting of three items assessing: (1) overall usefulness of the session, (2) helpfulness of the session in addressing their gambling disorder, and (3) anticipated use of what was learned in daily life. Each item is rated on a 4-point Likert-type scale from 0 (not at all) to 3 (very much), with higher scores indicating greater session-level acceptability. An optional free-text item allows additional comments or suggestions. Items will be evaluated individually.

Session-Level Acceptability of the Digital Family Intervention

After each digital family-intervention session, family members complete a study-specific acceptability questionnaire consisting of three items assessing: (1) overall usefulness of the session, (2) helpfulness of the session in addressing the family member's gambling-related problems and their impact, and (3) anticipated use of what was learned in daily life. Each item is rated on a 4-point Likert-type scale from 0 (not at all) to 3 (very much), with higher scores indicating greater session-level acceptability. An optional free-text item allows additional comments or suggestions. Items will be evaluated individually.