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.

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.