Internet-based versus synchronous cognitive behavioral therapy for gambling disorder: Study protocol for a non-inferiority randomized controlled trial
Bibliographic record
Abstract
• First randomized controlled trial to directly compare asynchronous internet-based cognitive behavioral therapy (iCBT) with synchronous cognitive behavioral therapy (sCBT) (in person or remote) for gambling disorder. • Uses a non-inferiority design to assess clinical equivalence of iCBT and sCBT. • Includes detailed process and moderator measures to explore treatment mechanisms. • Employs real-world clinical recruitment to enhance ecological validity. 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".