Repetitive Transcranial Magnetic Stimulation (rTMS) and Cognitive Behavioral Therapy (CBT) for Gambling Disorder

Repetitive Transcranial Magnetic Stimulation (rTMS) and Cognitive Behavioral Therapy (CBT) in the Management of Gambling Disorder in Indonesia: a Pilot and Feasibility Study

Treatment options for gambling disorder (GD) remain limited, with no pharmacotherapy proven effective. As of date, cognitive behavioral therapy (CBT) is the preferred therapy for GD, but the improvements often require months to show, highlighting the need for a more comprehensive therapy. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment modality in alleviating craving. Studies have shown potential benefit of combining both CBT and rTMS in substance addiction, but not in GD. Thus, this study aims to determine the feasibility and efficacy of rTMS and CBT combination therapy in the management of GD in Indonesia.

Inclusion Criteria:

• Subjects with pathological gambling (SOGS score ≥ 5)
• Subjects aged 18-70 years old
• Subjects who understand Bahasa Indonesia
• Subjects who agree to participate and receive treatment

Exclusion Criteria:

• Subjects with history of psychotic disorder and personality disorder according to ICD-11
• Subjects with severe neurological disorder comorbidities, which cause seizure or loss of consciousness
• Subjects with intellectual disability
• Subjects with history of neurostimulation
• Subjects with history of medical implant
• Subjects currently or expecting pregnancy
• Subjects fulfilling diagnostic criteria of substance use disorder in the last 6 months