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

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.