BackgroundDisordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.Methods/designParticipants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.DiscussionThis study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.Trial registrationNetherlands Trial Register, NTR5096. Registered on 11 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2190-2) contains supplementary material, which is available to authorized users.

Gambling Disorder (GD) is a complex psychopathological phenomenon, characterized by the interaction of multiple etiological factors and a very heterogeneous symptomatological expression. Currently many questions remain concerning the best way of treating GD. Indeed, the traditional used (cognitive) behavioral interventions have at best a modest effect size. In addiction, there remains a large treatment gap, i.e. less than 10% of pathological gamblers ever seek help and enter treatment. E-health interventions could potentially help to close this gap. Cognitive bias modification (CBM) refers to a class of cognitive training paradigms that target specific automatic attentional, behavioral or evaluative biases triggered by addiction-related cues. These biases have repeatedly been shown to play an important role in addiction. Recently a number of studies have shown that modifying these biases has been effective in the treatment of different types of addictions, e.g. alcohol use disorders. An online Approach Bias Modification program, testing both Attention Bias Modification (ABM) and Approach Bias Modification (AppBM), is currently tested with Belgian and Dutch problem and disordered gamblers. Personalized motivational feedback has been added to the training program, to increase training adherence and prevent dropout. The same research group is also launching a second web-based study combining online AppBM with an online standard, protocoled, cognitive behavioral Therapy (CBT) program with guidance of a trained therapist. Participants receive nine CBT sessions through online chat with the therapist and, concurrently, nine sessions of AppBM. Preliminary results will be discussed.Disclosure of interestMember Advisory board Lundbeck-Belgium.Received grant from LOTTO- Belgium to conduct behavioural study that will be discussed in presentation

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