COMpulsive Gambling: Efficacy of DEEP Transcranial Magnetic Stimulation With H7 COIL

The primary outcome will be the change in the severity of gambling disorder (GD), measured using the Gambling Symptom Assessment Scale (G-SAS), the most commonly used scale for assessing changes in GD symptom severity in research studies. Each item on the G-SAS is rated on a 5-point scale, ranging from 0 (no symptoms) to 4 (extreme symptoms). The total score can range from 0 to 48. Higher scores indicate greater severity of gambling-related symptoms.

The Gambling Urge Scale (GUS) is a 6-item questionnaire designed to measure an individual's current urge or craving to gamble, on a 7-point scale. Responses are summed for a total score; higher scores reflect stronger immediate cravings or urges to gamble.

The Visual Analog Scale (VAS) is a continuous measurement instrument used to quantify subjective internal experiences of pain. It consists of a line with word descriptors placed at opposite extremes ("No pain" at 0 mm and "Worst pain imaginable" at 100 mm).

the number of participants who discontinued treatment

Reduction in the severity of obsessive-compulsive symptoms related to GD, measured using the Yale-Brown Obsessive Compulsive Scale adapted for GD (PG-YBOCS). The scale evaluates the intensity, frequency, and impact of gambling urges, thoughts, and behaviors. It features 10 items scored from 0 to 4, yielding a total score from 0 to 40.

Reduction in GD severity, assessed through changes in total scores on the South Oaks Gambling Screen (SOGS), the most widely used instrument for evaluating GD severity. It is a 20-item questionnaire used to screen for problem gambling and pathological gambling behaviors. It contains multiple informational questions, and each "at-risk" answer earns 1 point.

Problem Gambling Severity Index (PGSI) is a widely recognized, standardized 9-item self-report questionnaire used to assess the severity of gambling behaviors and their negative consequences. Each question is scored on a 4-point scale (0 = Never; 1 = Sometimes; 2 = Often; 3 = Almost always / Always), yielding a total score from 0 to 27.

gambling abstinence, assessed daily throughout the intervention period

Reduction in depressive symptoms, measured using the Beck Depression Inventory-II (BDI-II). It is a widely used 21-item self-report questionnaire designed to measure the severity of depressive symptoms. Each item is scored on a 4-point Likert scale ranging from 0 to 3, where higher numbers reflect greater symptom intensity.

Reduction in anxiety symptoms, assessed using the Beck Anxiety Inventory (BAI). It is a 21-item self-report questionnaire used to measure the severity of an adult or adolescent's anxiety symptoms over the past week. It contains questions rated on a 4-point scale from 0 to 3, and greater scores means greater anxiety.

Improvement in quality of life, measured using the Quality of Life Inventory (QOLI), the most frequently used tool for assessing quality-of-life. It measures an individual's happiness and life satisfaction across 16 key areas. It consists of 32 items measuring both the importance of each domain (on a 3-point scale) and current satisfaction with it (on a 6-point scale).

The incidence of adverse events, including headache, neck pain, scalp discomfort, tingling, burning sensations, skin redness, drowsiness, sleep disturbances, back pain, difficulty concentrating, acute mood changes, hearing impairment, facial muscle spasms or twitches, dizziness, nausea, lightheadedness, or any other adverse event (self-reported and recorded by clinicians)

The proportion of patients whose intervention was discontinued due to adverse events