Acceptability of Internet-Based Therapy: Considerations Expressed by Individuals Struggling with Gambling.

Aims: Internet-based therapy (IBT) is effective in reducing symptoms of gambling disorder (GD), yet limited acceptability may constrain treatment uptake and engagement. This study explored perspectives on the expected acceptability (defined as perceiving the intervention as appropriate) of IBT for GD. Methods: Twenty-eight individuals with current or lifetime gambling problems responded to open-ended questions in a qualitative survey, including reflections on a vignette describing a hypothetical patient receiving IBT for GD. Results: Data were analyzed using thematic analysis and we identified three themes. The theme "Urgent matters" reflected participants' desire for more emphasis on crisis management and harm reduction early in IBT. "Keeping the same standard" indicated that participants' content preferences match what is typically offered in cognitive behavioral therapy, but with concerns that online delivery might compromise treatment quality. "Risk of pseudotherapy" reflected perceptions that IBT is more susceptible to falsely appearing effective compared to face-to-face therapy. Participants conveyed an understanding that GD characteristics of avoidance and motivational ambivalence can undermine IBT engagement, particularly in the absence of social contact with a therapist or others with lived experience. Conclusions: The findings suggest that assessments of IBT acceptability for GD and potential interventions aiming to increase acceptability should account for gambling-specific challenges.