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Artigos no Europe PMC

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• Europe PMC · 2026

  Acceptability of Internet-Based Therapy: Considerations Expressed by Individuals Struggling with Gambling.

  Syvertsen A, Solberg-Hansen Fondenes B, Pallesen S.

  Aims Internet-based therapy (IBT) is effective in reducing symptoms of gambling disorder (GD), yet limited acceptability may constrain treatment uptake and engagement. This study explored perspectives on the expected acceptability (defined as perceiving the intervention as appropriate) of IBT for GD. Methods Twenty-eight individuals with current or lifetime gambling problems responded to open-ended questions in a qualitative survey, including reflections on a vignette describing a hypothetical patient receiving IBT for GD. Results Data were analyzed using thematic analysis and we identified three themes. The theme "Urgent matters" reflected participants' desire for more emphasis on crisis management and harm reduction early in IBT. "Keeping the same standard" indicated that participants' content preferences match what is typically offered in cognitive behavioral therapy, but with concerns that online delivery might compromise treatment quality. "Risk of pseudotherapy" reflected perceptions that IBT is more susceptible to falsely appearing effective compared to face-to-face therapy. Participants conveyed an understanding that GD characteristics of avoidance and motivational ambivalence can undermine IBT engagement, particularly in the absence of social contact with a therapist or others with lived experience. Conclusions The findings suggest that assessments of IBT acceptability for GD and potential interventions aiming to increase acceptability should account for gambling-specific challenges.

• Europe PMC · 2026

  Early program participation and treatment retention in outpatients with gambling disorder: a real-world retrospective study in Japan.

  Fukui H, Takada R, Noriyama Y, Nishi Y, Araki S, Doi F, Ikehara M, Mizui R, Yamamoto N, Okada T.

  Background Real-world evidence on outpatient program participation and time to treatment discontinuation (treatment retention) in patients with gambling disorder in Japan remains limited. In this study, we characterized baseline clinical and sociodemographic profiles of outpatients receiving care for gambling disorder and described patterns of engagement, including treatment retention, in a group program. Methods We retrospectively enrolled outpatients with gambling disorder who first visited Tarumi Hospital between April 2019 and December 2023 and followed them up until December 2024. Program participation referred to attendance at a structured cognitive behavioral therapy (CBT)-based group program designed as 24 sessions over 1 year, provided in addition to usual outpatient care. The primary analysis used a Cox proportional hazard analysis, with program participation as a time-dependent covariate; a 30-day landmark analysis was used to evaluate retention after day 30 among patients retained in the program for at least 30 days. Abstinence at the final observation was defined as a self report of no gambling in the preceding 2 weeks and was compared between the program participation and non-participation groups among patients who gambled at baseline. Results The program was initiated for 82 patients within 30 days of their first hospital visit, and 55 patients did not participate in the program. By day 30, retention was higher in the participation group than in the non-participation group (89.0% vs. 45.5%). Program participation was associated with a lower estimated hazard of discontinuation (hazard ratio = 0.64, 95% confidence interval 0.40-1.03; p = 0.067), but the estimate was imprecise and compatible with no difference. Among patients retained beyond day 30, retention after day 30 did not differ between groups (log-rank p = 0.886). Abstinence was higher in the participation group than in the non-participation group among patients who discontinued treatment within 3 months but not among those who continued treatment for ≥ 3 or ≥ 6 months. Conclusions Early participation in a structured CBT-based program may be associated with a longer observed retention duration, with divergence occurring within 30 days. Strengthening clinical contact soon after the first visit may be a practical priority; prospective studies with standardized severity and motivational measures are warranted.

• Europe PMC · 2026

  Gambling Disorder: Diagnosis and Treatment.

  Kaminski DM, Naik H, Weiss DS.

  Pathologic gambling, also known as gambling disorder, is a behavioral addiction. The prevalence of gambling disorder has increased in recent years as gambling has become more accessible. Gambling disorder is often underdiagnosed and may have disabling effects on patients. Although men are more often affected, the rate of gambling disorder has been increasing in women. Risk factors include comorbid substance use disorder, mental health diagnoses, lower socioeconomic status, and participation in other risky behaviors. The US Preventive Services Task Force has not addressed screening for gambling disorders. In the United Kingdom, the National Institute for Health and Care Excellence has developed a guideline for case-finding based on expert opinion; the guideline suggests asking a direct question, such as "Do you gamble?," to assess patients for gambling disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision criteria should be used to confirm the diagnosis and classify severity. Pharmacologic interventions such as naltrexone or olanzapine may reduce symptom severity in the short-term, although more study is needed. Psychotherapy, including cognitive behavior therapy and motivational interviewing, offers short-term benefits; however, its long-term effectiveness is uncertain. Self-help and family support groups have limited evidence but provide safe places for affected individuals and loved ones to alleviate the stress associated with the financial and emotional consequences of gambling.

• Europe PMC · 2026

  Targeting emotional vulnerability and impulsivity in gambling disorder: a proof-of-concept study on internet delivered cognitive behavioral therapy for comorbid pathway subtypes.

  Molander O, Johnsson A, Bjureberg J, Jayaram-Lindström N, Dowling NA, Ljótsson B.

  Gambling disorder represents a growing global public health challenge, particularly among populations with high symptom severity and psychiatric comorbidity. This proof-of-concept study aimed to develop a guided, internet-delivered cognitive behavioral therapy intervention based on the etiological Pathways Model and to evaluate its feasibility, within-group changes in outcomes, and potential mediators. The sample included twenty-five participants with high symptom severity of gambling disorder and comorbid psychiatric symptoms, primarily depression and anxiety. During treatment, participants completed an average of 19.9 behavioral exercises (standard deviation = 43.7) targeting gambling disorder, emotional vulnerability, and impulsivity. Participants rated the internet-delivered program as acceptable and user-friendly and reported only expected negative effects related to cognitive behavioral therapy. Gambling symptoms, anxiety symptoms, and depression symptoms decreased significantly with large within-group effects, with seventy-two percent classified as responders at post-treatment and fifty-two percent at three-month follow-up. Exploratory mediation analyses indicated that reductions in gambling symptoms were explained by both gambling disorder-specific and pathway-related factors. The findings support the feasibility of theoretically informed internet-delivered cognitive behavioral therapy for gambling disorder with comorbidities and highlight opportunities to optimize interventions for vulnerable subgroups.

• Europe PMC · 2026

  Tobacco use and gambling disorder: Associations with clinical characteristics, and treatment outcome.

  Mestre-Bach G, Badiella B, Esteve GD, Normand E, Mejías D, Fernández-Aranda F, Jiménez-Murcia S.

  Background and aims Gambling disorder (GD) usually co-occurs with other addictive behaviors. Given shared neurobiological underpinnings, particularly involving dopaminergic pathways, and behavioral similarities such as high reward sensitivity, investigating the link between GD and tobacco use is warranted. Therefore, the present study explored how daily smoking use relates to clinical, personality, and psychopathological profiles, as well as its potential association with treatment outcomes. Methods Our sample included 455 individuals with GD, who completed clinical, personality, psychopathology, impulsivity, and emotion regulation assessments before undergoing a 16-week group cognitive behavioral therapy. Patients were categorized as smokers (daily smokers of conventional cigarettes) or non-smokers to examine differences in clinical profiles and treatment outcomes, specifically dropouts and relapses. Results While no significant differences emerged in overall psychopathology, personality, or emotion regulation, daily tobacco users with GD exhibited higher levels of impulsivity. Trends toward increased treatment dropout and relapse were observed, though these did not reach statistical significance. Discussion and conclusion These findings suggest that while daily tobacco use in GD is associated with heightened impulsivity, its impact on overall clinical profiles may be limited. However, the observed trend toward poorer treatment outcomes warrants further investigation, particularly focusing on interventions targeting impulsivity in populations with co-occurrent disorders.

• Europe PMC · 2026

  A randomized double-blind sham-controlled preliminary study of a 5-week protocol of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapy (CBT) for gambling disorder in Indonesia.

  Siste K, Sen LT, Murtani BJ, Hanafi E, Kusuma KS, Aryani A, Tan C, Nainggolan FD, Aida N, Setiawan Y.

  Gambling disorder (GD) has increased in prevalence particularly in Indonesia where online gambling predominates. Gambling harm may involve not only individuals with GD but also their significant others. This preliminary study aims to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in conjunction with cognitive behavioral therapy (CBT) compared to sham rTMS with CBT in treating individuals with GD. Twenty seven participants diagnosed with GD were randomly assigned to receive either active or sham rTMS over five weeks, alongside a standardized CBT program. Outcomes were assessed at multiple time points using various standardized measures. This protocol was safe and well-tolerated, with minimal adverse events (adverse event rate: 7.2%). Both groups displayed significant reductions in gambling symptoms measured by the Gambling Symptom Assessment Scale. However, no significant differences were observed between the active and sham rTMS groups. The active rTMS group demonstrated faster reductions in gambling craving [B: 2.63 (95% CI 0.55 to 4.70), p: 0.015] and gambling-related cognition, particularly in the domains of gambling expectancies [B: 1.84 (95% CI 0.98 to 2.71), p ≤ 0.001] and the perceived inability to stop gambling [B: 1.70 (95% CI 0.36 to 3.04), p: 0.014]. The results suggest that rTMS may enhance CBT outcomes in treating GD by modulating craving and cognitive biases associated with gambling. Further research is warranted to optimize intervention parameters and assess the long-term effects of rTMS in GD treatment.

• Europe PMC · 2026

  Therapeutic Interventions Targeted at Problematic Use of Digital Technology: Systematic Review and Meta-Analysis of Evidence.

  Balhara YPS, Bhattacharjee O, Bhatia RK, Sanahan R, Ganesh R, Sarkar S, Ranjan R, Kattimani S, Centre for Advanced Research on Addictive Behaviors (CAR-AB).

  Background Problematic use of digital technology has increased across the world. Despite growing research, evidence on treatment effectiveness across digital behaviors remains fragmented. Objective This study aimed to systematically evaluate and compare the effectiveness of therapeutic interventions targeted at problematic use of digital technology across various behavioral domains. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines (PROSPERO: CRD420251052442). Electronic searches of PubMed, Scopus, and Embase (up to April 2025) were conducted. It identified 125 eligible studies, including 73 randomized controlled trials (RCTs), 32 non-RCTs, 14 pre-post studies, and 6 pilot studies. The interventions that were assessed in these studies included psychological therapies, digital or web-based programs, exercise-based interventions, pharmacological treatments, neuromodulation, parent-focused programs, virtual reality-based interventions, educational programs, and multicomponent approaches. Random-effects meta-analyses using standardized mean differences (SMDs) were performed. Results For problematic internet use, psychological treatments showed a strong effect (effect size=-2.68; P Conclusions Overall, structured psychological therapies showed the most consistent benefit. These findings support structured interventions that aim for control of use and reduce cues linked to high use. Evidence remains limited for several emerging digital behaviors. More high-quality studies are needed in clinical settings and for less-studied forms of digital addiction.

• Europe PMC · 2026

  Empathy impairments in patients with gambling disorder.

  Arafat D, Schröer N, Juckel G, Chang DI, Thoma P.

  Introduction In spite of well-documented empathy impairments in substance use disorders and significant overlap in neurobiological and cognitive functioning with behavioral addictions such as gambling disorder (GD), little is known about empathy impairments in GD. The aim of this study was thus to investigate cognitive and emotional empathy and its association with cognitive functioning in GD. Methods Twenty-five treatment-seeking individuals diagnosed with GD, 25 recently detoxified patients diagnosed with alcohol use disorder (AUD), and 25 healthy controls (HCs) were assessed using the Interpersonal Reactivity Index (self-report measure), and the Multifaceted Empathy Test (behavioral measure) to assess cognitive and emotional empathy, along with three clinical and three cognitive measures. Results The GD group scored lower on self-report empathy compared to the AUD group. Additionally, using the behavioral measure, the GD group exhibited lower cognitive empathy compared to HCs but intact emotional empathy. The AUD group, on the other hand, showed higher emotional empathy compared to HCs but intact cognitive empathy. The GD group did not differ from HCs on cognitive measures, but they outperformed the AUD group on the cognitive flexibility task. Specific correlations between cognitive and empathy measures were observed in both clinical groups. Conclusion The behavioral empathy results showed a dissociation between cognitive and emotional empathy impairments in the two different types of addiction, suggesting distinct foci for therapeutic interventions.