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NCT Number: NCT04467502

Virtual Reality Exposure Therapy for Gambling Disorder

Gambling disorder (GD) is recognized as an addictive disorder in the DSM-5. Craving is a core phenomenon in addiction that can lead to relapse in problem gambling for pathological gamblers. Exposure Therapy (ET) focuses on craving in addiction treatment. ET in Cognitive-Behavioral Therapy (CBT) is based on classical conditioning that addresses the association between contextual cues and the craving response. ET helps the patient to reduce craving when faced with cues triggering craving. ET includes in vivo exposure and imaginal exposure. The literature recommends being as close as possible to the context of addiction to facilitate the extinction of craving but in vivo ET is complicated to perform. For GD, in outpatient consultation, bringing a patient to a casino presents obstacles (e.g., time, human and financial cost, agreement with casino for therapy).

The study will be to assess the effectiveness of Virtual Reality Exposure Therapy (VRET) in a virtual gambling environment. Various trials show that VRET is no more or less effective than classical ET in CBT but has other advantages for motivation to treatment. This research aims to compare efficacy between CBT with VRET and CBT with imaginal exposure for treatment of GD in a multicenter, randomized, controlled, non-inferiority clinical trial.

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Key information

Conditions

Gambling Disorder Behavior Disruptive, Impulse Control, and Conduct Disorders Gambling Mental Disorders Risk-Taking

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

CHU Amiens-Picardie, Amiens, France

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About this study

Main aim:

Show, within patients seeking care for GD, that VRET integrated with CBT is non-inferior to imaginal ET integrated with CBT on GD symptom reduction at the end of 12 treatment sessions.

Secondary objectives:

  • Show that VRET integrated with CBT is non-inferior to imaginal ET integrated with CBT on GD symptom reduction during the first 12 months post-treatment.
  • Compare the effect of the two therapeutic strategies on GD symptoms (measured by complementary assessments to that used in the main aim), at the end of treatment and during the first 12 months post-treatment.
  • Show the efficacy of VRET integrated with CBT compared to imaginal ET integrated with CBT on gambling behavior, craving, and gambling-related cognitions at the end of treatment and during the first 12 months post-treatment.
  • Show the efficacy of VRET integrated with CBT compared to imaginal ET integrated with CBT on the evolution of anxiety and depressive symptoms at the end of treatment and during the first 12 months post-treatment.
  • Compare the quality of the two therapeutic strategies at the end of treatment.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Seek treatment for GD within one of health care facilities participating in the research (first request for treatment and not patients already receiving treatment for gambling disorder in the care center).
  • Meet a current diagnosis of gambling disorder according to DSM-5 criteria and with a South Oaks Gambling Screen (SOGS) score ≥ 5
  • Meet a casino gambling behavior with a casino gambling frequency ≥ 1 time every two months during the last 12 months
  • Have a sufficient understanding of French for therapy
  • Beneficiary of the French social security system
  • Give an informed consent to participate
  • Willing to comply with all study procedures and duration

Exclusion criteria

  • Visual disturbance making impossible the use of virtual reality equipment (e.g. advanced retinal degeneration, central scotoma, age-related macular degeneration)
  • Pregnant woman
  • Minor or adult under guardianship, conservatorship, under judicial protection, persons deprived of their liberty
  • Balance disorder (e.g. cerebellar disorder, inner ear disorder)
  • Photosensitive epilepsy
  • Refusal to participate

Treatment and study plan

cognitive-behavioral therapy for gambling disorder

Other

6 sessions of cognitive-behavioral therapy for gambling disorder

imaginal exposure therapy focus on gambling cues

Other

6 sessions of imaginal exposure therapy focus on gambling cues

virtual reality exposure therapy focus on gambling cues

Other

6 sessions of virtual reality exposure therapy focus on gambling cues

Primary outcomes

  1. Change in South Oaks Gambling Screen (SOGS) between baseline and end of treatment (12 sessions, 6 months)

    Time frame: at the end of treatment (an average of 6 months)

    The SOGS is a 20-item instrument used to screen for pathological gambling. The SOGS is scored by summing the number of items endorsed out of 20 and a cut score of 5 or more indicates a probable pathological gambling. The score ranges from 0 to 20.

Secondary outcomes

  1. Change in South Oaks Gambling Screen (SOGS) between baseline and follow-up at 3, 6 and 12 months after the end of treatment

    Time frame: at baseline, and through study completion, an average of 18 months

    The SOGS is a 20-item instrument used to screen for pathological gambling. The SOGS is scored by summing the number of items endorsed out of 20 and a cut score of 5 or more indicates a probable pathological gambling. The score ranges from 0 to 20.

  2. Change in gambling disorder symptoms between baseline, end of treatment and follow-up assessed by the following criteria: number of DSM-5 criteria for GD

    Time frame: at baseline, and through study completion, an average of 18 months

    Nine criteria for gambling disorder are described in DSM-5. The endorsement of 4-5 criteria means the presence of a mild gambling disorder, 6-7 criteria a moderate gambling disorder and 8-9 criteria a severe gambling disorder. The score ranges from 0 to 9 criteria.

  3. Change in gambling disorder symptoms between baseline, end of treatment and follow-up assessed by the following criteria: Problem Gambling Severity Index (PGSI)

    Time frame: at baseline, and through study completion, an average of 18 months

    The PGSI consists of nine items to assess level of risk for problem gambling. Cut-off scores are 1-2 for low-risk gamblers, 3-7 for moderate-risk gamblers and 8 or more for problem-gamblers. Non-problem gamblers correspond to 0. The score ranges from 0 to 27.

  4. Change in gambling behavior assessed by gambling frequency during the last month

    Time frame: at baseline, and through study completion, an average of 18 months

  5. Change in gambling behavior assessed by amount of money spent in gambling during the last month

    Time frame: at baseline, and through study completion, an average of 18 months

  6. Change in gambling behavior assessed by time spent gambling during the last month

    Time frame: at baseline, and through study completion, an average of 18 months

  7. Change in frequency subscale of gambling Craving Experience Questionnaire (g-CEQ)

    Time frame: at baseline, and through study completion, an average of 18 months

    The frequency subscale of gambling Craving Experience Questionnaire assesses the frequency of craving for gambling during the last week. This questionnaire consists of nine items. A high score means a high frequency of craving during the last week. The score ranges from 0 to 90.

  8. Change in craving reactivity to gambling cues

    Time frame: at baseline, and through study completion, an average of 18 months

  9. Number of craving episodes using daily craving assessed by participants

    Time frame: up to 6 months during the treatment

  10. Cumulative duration of craving episodes using daily craving assessed by participants

    Time frame: up to 6 months during the treatment

  11. Change in gambling-related cognitions assessed by Gambling-Related Cognitions Scale (GRCS)

    Time frame: at baseline, and through study completion, an average of 18 months

    The French version of the Gambling-Related Cognitions Scale consists of 23 items to assess various cognitions related to gambling. A high score means that gambling-related cognitions are typical cognitions of problem gamblers. The score ranges from 23 to 161.

  12. Change in depressive symptoms assessed by Beck Depression Inventory short-form (BDI-SF)

    Time frame: at baseline, and through study completion, an average of 18 months

    Beck Depression Inventory short-form consists of 13 items to assess depressive symptoms. A high score means a high level of depressive symptoms. The score ranges from 0 to 39.

  13. Change in anxiety symptoms assessed by State-Trait Anxiety Inventory (STAI)

    Time frame: at baseline, and through study completion, an average of 18 months

    State-Trait Anxiety Inventory consists of 20 items to assess state-anxiety and 20 items to assess trait-anxiety. A high score means a high level of anxiety symptoms. The score ranges from 20 to 80 both for state-anxiety and trait-anxiety.

  14. Rate of patients who attended the 12 sessions (6 months)

    Time frame: up to 6 months during the treatment

    Quality of the two therapeutic strategies

Study contacts

Contact information is provided by the study sponsor or research team.

Pierre TAQUET, PhD

CONTACT

[email protected]

0320445838 ext. +33

Sponsors and collaborators

Lead sponsor

University Hospital, Lille

Other

Collaborators

  • Ministry of Health, France

Registry information

Official study title

Virtual Reality Exposure Therapy for Gambling Disorder: Randomized Controlled Trial

Acronym: VIRET-GAD

Important dates

Study start
2023
Primary completion
2027
Study completion
2027
First posted
Jul 13, 2020
Registry last updated
May 14, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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