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. 2025 Nov 13:22:100642.
doi: 10.1016/j.abrep.2025.100642. eCollection 2025 Dec.

Internet-based versus synchronous cognitive behavioral therapy for gambling disorder: Study protocol for a non-inferiority randomized controlled trial

Anna Westh Stenbro  1   2 , Thomas Marcussen  1 , David C Hodgins  3 , Thomas Tandrup Lamm  4 , Lisbeth Frostholm  2   4
Affiliations

Internet-based versus synchronous cognitive behavioral therapy for gambling disorder: Study protocol for a non-inferiority randomized controlled trial

Anna Westh Stenbro et al. Addict Behav Rep. .

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Discussion: 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.

Keywords: Gambling disorder; Internet-based cognitive behavioral therapy (iCBT); Non-inferiority trial; Randomized controlled trial; SpilleFri; Synchronous cognitive behavioral therapy (sCBT).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart.
Fig. 2
Fig. 2
Overview of the SpilleFri treatment.
Fig. 3
Fig. 3
Overview of the sCBT treatment.
See this image and copyright information in PMC

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