Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis

Effects of cognitive behavioral therapy (CBT) on addictive symptoms in individuals with internet gaming disorders: A systematic review and meta-analysis

OBJECTIVE

We examined the effects of Cognitive Behavioral Therapy (CBT) on addiction symptoms in patients with internet gaming disorders and examined the moderating effects of participant characteristics, research methodologies, and features of interventions.

METHODS

We systematically searched nine databases through May 2024 without date restrictions using the following search terms: (cognitive behavio* therapy) AND (addict* OR dependen*) AND ((internet or gaming) AND dis*). Studies included were primary studies with evaluating CBT in patients with internet gaming disorders. Studies were included if they used a control group and were written in English. Both randomized control trials and quasi-experimental designs were included. We used a random-effects model to compute effect sizes (ESs) using Hedges' g, forest plot, and Q and I2 statistics as measures of heterogeneity. We also examined moderator analyses.

RESULTS

We found 13 studies with 1,115 participants (19.08±3.99 years old) that met inclusion criteria for this meta-analysis. Overall, patients with internet gaming disorders in the CBT group demonstrated significantly lower addiction symptoms (g = 0.72, 95 %CI:.420, 1.011, p<.001) compared to controls. Regarding moderators, funding, characteristics' participants at baseline, group discussion, length of intervention and dose were moderators affecting the ES.

CONCLUSION

CBTs are moderately effective interventions to reduce addiction symptoms among patients with internet gaming disorders. Clinicians might consider encouraging CBTs as alternative treatments for patients with internet gaming disorders. CBTs with a long length and high dose of intervention for practicing are likely to have a greater effect in reducing addiction symptoms.

Can playing Dungeons and Dragons be good for you? A registered exploratory pilot programme using offline tabletop role-playing games to mitigate social anxiety and reduce problematic involvement in multiplayer online video games

Gamers with poor self-concept, high social anxiety and high loneliness are more at risk of problematic involvement in video games, such as massively multiplayer online role-playing games. There is a research gap concerning treatment approaches to cater to socially anxious gamers with problematic patterns of gaming involvement. This registered exploratory pilot programme tests the feasibility and initial effect of a structured protocol in which socially anxious online gamers are exposed to real-life social interactions while playing an offline tabletop role-playing game (TTRPG). Our structured protocol lasted 10 weeks and involved 10 sessions organized into three modules in which participants played a TTRPG inspired by the game 'Dungeons and Dragons'. Each module deployed a role-playing scenario designed to challenge the players in game terms and involve them in a story based on maturing relationships with other characters and solving challenges by social means and investigation. Our study used a quasi-experimental multiple single-case design with a three-week baseline across groups (four groups of five gamers with sub-clinical problematic video game use and social anxiety) and a three-month follow-up. Primary outcomes were time spent gaming, gaming disorder symptoms and social anxiety symptoms. Secondary outcomes were assertiveness/social skills, self-concepts and perceived loneliness. In terms of feasibility, we observed that most participants completed the programme (two of the 20 participants dropped out) and were involved in terms of participation and weekly psychometric assessments. Moreover, participants were largely able to attain the progressively more difficult objectives implemented in the TTRPG programme. Multiple single-case analyses showed that most participants benefited from the intervention through a reduction in social anxiety symptoms and problematic gaming symptoms, although to varying degrees. Some participants also reduced their gaming time or presented with reduced perceived loneliness. Assertiveness and self-concepts were not improved. This pilot study shows that a TTRPG intervention approach is feasible and may be used to reduce social anxiety and gaming disorder symptoms. The present programme must now be tested with clinical participants.

Problematic Social Media Use or Social Media Addiction in Pediatric Populations

With the advent of smartphones and the popularization of social media sites at the beginning of the twenty-first century, children and adolescents have been exposed to a world of virtual interactions in social networking sites that are designed to increase engagement of the user for profit. In this article, we review the epidemiology of use of social media, its addictive features, and potential negative consequences of problematic use, and the research on current interventions known to reduce use. We also give recommendations spanning from the policy to the individual level for children to build a healthier relationship with these sites.

Sociotropy and video game playing: Massively multiplayer online role-playing games versus other games

INTRODUCTION

Internet Gaming Disorder (IGD) is associated with several psychiatric disorders. Previous research on IGD has predominantly focused on Massively Multiplayer Online Role-playing Games (MMORPGs), considered to be pro-social games as they foster interpersonal relationships necessary for in-game progress. Sociotropy is a personality trait characterized by a cognitive approach to dealing with interpersonal relationships. Individuals with high sociotropy have a strong desire for approval from others. Beck's cognitive theory of depression posits that high sociotropy can lead to depressive symptoms when faced with interpersonal stress. We used the I-PACE model to account for the consequences of distal factors such as sociotropy on the development and maintenance of IGD. The aim of this study was therefore to compare MMORPG players with players of other game genres in terms of sociotropy, social anxiety and depression. We hypothesized that sociotropy could serve as a predictor of IGD, particularly among MMORPG players.

METHODS

A total of 233 French videogame players recruited from specialized internet gaming forums participated in the study via questionnaires. Different scales were used to assess depression and social anxiety symptoms, IGD intensity, and sociotropy and autonomy.

RESULTS & DISCUSSION

MMORPG players reported higher psychological distress than players of other game genres. For all players, sociotropy, rather than autonomy, was found to be a predictor of social anxiety symptoms and IGD intensity. Sociotropy and depression explained IGD intensity only for MMORPG players and not for players of other game genres. The social dimension appears to be more prominent among MMORPG players and could be one of the main personality traits predicting this specific internet gaming disorder. The treatment implications for internet gaming disorder are discussed.

The longitudinal relationship between loneliness and problematic social networking site use in college students: the mediating role of trait- and state-fear of missing out

Aims

This longitudinal study explored the mechanisms of loneliness, trait-fear of missing out (trait-FoMO), and state-fear of missing out (state-FoMO) on problematic social networking site use (PSNSU) among Chinese college students.

Methods

Data were collected in two waves. Overall, 417 college students (45.08% male and 54.92% female, with an average age of 19.87 ± 1.05) completed measures of loneliness and PSNSU at the first time point (T1), and measures of trait-FoMO, state-FoMO, and PSNSU 12 months later (T2).

Results

(1) There were significant positive correlations among loneliness, trait-FoMO, state-FoMO, and PSNSU; (2) Trait-FoMO and state-FoMO fully mediated the relationship between loneliness and PSNSU; (3) there were two paths of loneliness that influenced PSNSU: loneliness was associated with PSNSU through the mediating role of trait-FoMO alone and the chain mediating role of trait- and state-FoMO.

Conclusion

This study highlights the need to accurately distinguish between trait-FoMO and state-FoMO, considering their different underlying mechanisms in addressing problematic network problems among college students.

Interventions for Digital Addiction: Umbrella Review of Meta-Analyses

BACKGROUND

Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions.

OBJECTIVE

This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses.

METHODS

An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty.

RESULTS

A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD -2.097, 95% CI -2.814 to -1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD -1.417, 95% CI -1.836 to -0.997). Exercise intervention reduced IA scores (SMD -2.322, 95% CI -3.212 to -1.431), depression scores (SMD -1.421, 95% CI -2.046 to -797), and interpersonal sensitivity scores (SMD -1.433, 95% CI -2.239 to -0.627).

CONCLUSIONS

The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.

TRIAL REGISTRATION

PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173.

Longitudinal pathways from emotional abuse to problematic gaming in adolescents: The role of psychoticism

BACKGROUND

Problematic gaming (PG) has emerged as a major concern due to its potential impact on adolescents' everyday lives. Emotional abuse (EA) and psychoticism are considered factors influencing PG, but their long-term interactions have not been extensively studied. This research investigates these relationships over time using the Interaction of Person-Affect-Cognition-Execution (I-PACE) model.

METHODS

The study involved 1902 Italian adolescents (mean age = 15.45, SD = 1.10) in a three-wave longitudinal study. Surveys were conducted at the beginning (T1), after six months (T2), and after twelve months (T3). Structural equation modeling (SEM) was used to evaluate bidirectional relationships and mediation effects among the variables.

RESULTS

The findings indicated that EA consistently predicted both psychoticism and PG, while psychoticism consistently predicted PG. However, psychoticism did not predict EA, and PG did not predict either EA or psychoticism. Significant mediation effects were found from EA at T1 to PG at T3 through EA at T2, psychoticism at T2, and PG at T2, as well as from psychoticism at T1 to PG at T3 through psychoticism at T2 and PG at T2. No significant indirect effect was observed from psychoticism at T2 to PG at T3 through EA at T2.

CONCLUSIONS

The results suggest that adolescents experiencing EA are more prone to PG, with psychoticism worsening this effect. Effective interventions might include emotional support programs and therapies targeting psychoticism traits. Combining these approaches could improve treatment outcomes for adolescents with PG.

Optimal Non-Pharmacological Interventions for Reducing Problematic Internet Use in Youth: A Systematic Review and Bayesian Network Meta-Analysis

The purpose of this network meta-analysis (NMA) is to compare the effect of different non-pharmacological interventions (NPIs) on Problematic Internet Use (PIU). Randomized controlled trials (RCTs) published from their inception to 22 December 2023 were searched in Cochrane Central Register of Controlled Trials, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese BioMedical Literature Database, and WanFang Data. We carried out a data analysis to compare the efficacy of various NPIs using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently. Two reviewers extracted data and evaluated bias using the Cochrane Risk of Bias tool independently. We identified 90 RCTs including 15 different NPIs (5986 participants), namely sports intervention (SI), electroencephalogram biological feedback (EBF), reality therapy (RT), positive psychology therapy (PPT), sandplay therapy (ST), educational intervention (EI), compound psychotherapy (CPT), electroacupuncture therapy (AT), group counseling (GC), family therapy (FT), electrotherapy (ELT), craving behavior intervention (CBI), virtual reality therapy (VRT), cognitive behavior therapy (CBT), and mindfulness therapy (MT). Our NMA results showed that SI, EBF, RT, PPT, ST, EI, CPT, AT, GC, FT, ELT, CBT, CBI, VRT, and MT were effective in reducing PIU levels. The most effective NPI was SI (SMD = -4.66, CrI: -5.51, -3.82, SUCRA = 95.43%), followed by EBF (SMD = -4.51, CrI: -6.62, -2.39, SUCRA = 90.89%) and RT (SMD = -3.83, CrI: -6.01, -1.62, SUCRA = 81.90%). Our study showed that SI was the best NPI to relieve PIU levels in youth. Medical staff should be aware of the application of SI to the treatment of PIU in youth in future clinical care.

Neuromodulatory effect of transcranial direct current stimulation on cue reactivity and craving in young adults with internet gaming disorder: an event-related potential study

Objective

This study assessed the effects of transcranial direct current stimulation (tDCS) on cue reactivity and craving for game-related cues using event-related potentials (ERPs) in internet gaming disorder (IGD) patients.

Methods

At baseline, a series of game-related and neutral pictures were shown to both IGD and healthy controls (HCs) while ERPs were recorded. Late positive potentials (LPP) were used to investigate cue reactivity. During intervention, IGD patients received 10 sessions (two sessions/day for 5 consecutive days, 2 mA for 20 min/session) of tDCS to the left (anode stimulation) and right (cathode) dorsolateral prefrontal cortex. Subjectively assessed craving and LPP component was analyzed before stimulation and at the 1-month follow-up after tDCS in IGD.

Results

At baseline, patients with IGD showed higher LPP amplitudes for game-related cues in the centro-parietal and parietal regions than HCs. After 10 sessions of tDCS, increased LPP amplitudes decreased significantly at 1-month follow-up., as well as subjective craving for gaming.

Conclusion

These findings suggest that neurophysiological arousal in response to game-related cues in the IGD group could be modulated by the effects of tDCS. LPP was a significant neurophysiological marker of the neuroplastic response of cue reactivity underlying the therapeutic effect of tDCS on IGD. Based on the present findings, tDCS could be expanded to the treatment of other addictive disorders, including substance use disorder and behavioral addictions.

Depression, anxiety, and stress in young adult gamers and their relationship with addictive behaviors: A latent profile analysis

BACKGROUND

There is limited research examining latent profiles of gamers based on emotional variables, which has implications for prevention efforts. The study sought to identify young adult gamer profiles based on depression, anxiety, and stress, and to examine differences between the latent profiles in other addictive behaviors (i.e., tobacco, alcohol, cannabis, illegal substance use, gaming, and gambling).

METHODS

A total of 1209 young adults (Mage = 19.37, SD = 1.62; 55.3%males) reported past-year gaming. A latent profile analysis (LPA) was performed to identify distinct profiles, and a set of ANOVA and chi-square analyses characterized the profiles in terms of sociodemographic, addictive behaviors, and emotional variables.

RESULTS

LPA suggested a three-profile solution: profile 1 (n = 660, 'low emotional distress'), profile 2 (n = 377, 'moderate emotional distress'), and profile 3 (n = 172, 'high emotional distress'). Participants with 'moderate' and 'high emotional distress' were mostly women, showed greater gaming severity, higher prevalence of past-month substance use (i.e., tobacco and illegal drugs), and greater consequences of alcohol use.

LIMITATIONS

The cross-sectional nature of the study and sample being university students.

CONCLUSION

Findings revealed three distinct profiles of gamers, which differed in emotional, gaming, and substance use severity. Transdiagnostic prevention programs have the potential to provide significant benefits to college students by addressing the core processes (e.g., emotion regulation) that underlie substance use and gaming.

The symptom network of internet gaming addiction, depression, and anxiety among children and adolescents

Internet gaming addiction (IGA), depression, and anxiety are significant issues among children and adolescents, with substantial social implications. Understanding the specific characteristics of this relationship is crucial for developing effective prevention and intervention strategies. The present study employed network analysis to explore the symptom network of IGA, depression, and anxiety among 1,548 Chinese children and adolescents. The results showed that the core symptoms of IGA among children and adolescents were "tolerance", "withdrawal", and "conflict". There was no significant gender difference in the structure, global strength, and core symptoms of IGA. Although there were no significant differences in the structure of the symptom network of IGA among children and adolescents of different ages, there were significant differences in global strength and some core symptoms ("conflict"). The core symptoms of the comorbidity of IGA, depression, and anxiety in children and adolescents included "feeling downhearted and blue", "breathing difficulty", "difficult to work up the initiative to do things", and "withdrawal". The comorbidity network did not show significant gender and age differences in network structure, but there were significant gender differences in global strength. Furthermore, there were significant gender and age differences in some core symptoms. The social impact of these findings is profound, highlighting the need for targeted interventions in schools and communities to address IGA and its comorbidities. Our results also suggest that interventions should be tailored to consider gender and age differences to maximize effectiveness.

Investigating the Effectiveness of a Virtual-Reality-Based Mindfulness Intervention on Internet Gaming Disorder

Novel treatment approaches for Internet Gaming Disorder (IGD) include the use of mindfulness and technology-based interventions. Mindfulness has been shown as a protective factor against IGD, but the treatment dropout rates are high due to long sessions and treatment duration. Pathological gamers show approach bias towards technological gadgets, and the inclusion of Virtual Reality has been effective in IGD treatment. Due to the effectiveness of mindfulness and the attractiveness of VR, a combined intervention could decrease treatment time and willingness for treatment. Therefore, the aim of this study was to examine the effectiveness of a brief VR-based mindfulness intervention on IGD symptomatology. Nine participants meeting the IGD symptom criteria, ten recreational game users, and eight healthy controls without a gaming history participated in the study. The intervention consisted of four weekly 20-min-long Attentional Focus Mindfulness sessions. The results indicate a significant reduction in IGD symptoms and weekend gaming time in the treatment group. Despite the small sample size in the treatment group (n = 9) and lack of randomization, the findings constitute a valuable starting point. As a cost- and time-effective intervention, this approach could reduce dropout rates and increase treatment adherence, especially in younger gamers. Additional studies with a larger sample size, randomization, and a longitudinal approach are needed to further validate the found results.

Effectiveness of sports intervention: A meta-analysis of the effects of different interventions on adolescent internet addiction

BACKGROUND

To evaluate the effects of different interventions on adolescent internet addiction, a meta-analysis and network meta-analysis were performed to determine the possible intervention effects of these interventions.

METHODS

Computer searches of the China National Knowledge Network, Wanfang, VIP, EMBASE, PubMed, Web of Science, EBSCO, and Cochrane Library databases were performed. The relevant randomized controlled trials were designed to assess the effects of interventions on adolescent internet addiction. The retrieval period ranged from the establishment of the database to January 31, 2024. Literature screening, data extraction, and bias risk assessment were carried out independently by two researchers. CMA 3.3, Stata 17.0 software and Review Manager 5.3 were used for the data analysis.

RESULTS

A total of 89 studies with 6876 samples were included. A traditional meta-analysis of 51 single interventions and controlled studies revealed that sports intervention, cognitive behavior therapy, family therapy, mindfulness intervention, attention bias training and group counseling significantly improved adolescent Internet addiction [standardized mean difference (SMD) = -1.75, 95 % CI (-2.07, -1.44), p < 0.01; I2 = 94 %] compared to no-treatment groups. A network meta-analysis showed that combined intervention (Sucra = 93.5) had the highest probability of being the best intervention for adolescent Internet addiction, and acupuncture interventions showed the most promise as a single intervention modality; however, due to the limited number of studies, we believe that sports intervention could be the most appropriate single intervention.

DISCUSSION

The evidence provided by existing studies shows that compared with other single interventions, combined interventions have the greatest effect on adolescent IA, and sports may be the best single intervention. However, because of the limitations of sample size and quality of individual studies, the strength of the evidence still needs to be further verified by additional standardized and high-quality studies.

Transfer from goal-directed behavior to stimulus-response habits and its modulation by acute stress in individuals with risky gaming behavior

Habitual responses towards addiction-related cues play a relevant role in the development and maintenance of addictions. Such automatic responses may be more likely under stress, as stress has been shown to induce a shift from goal-directed to habitual behavior. The current study investigated these mechanisms in risky gaming behavior. Individuals with risky gaming behavior (n = 68), as established by a structured clinical interview, and a matched control group (n = 67) completed a Pavlovian-to-Instrumental Transfer (PIT) paradigm with gaming-related cues and rewards. After the Pavlovian training, participants underwent a stress (Trier Social Stress Test) or control condition before performing the instrumental training and the transfer phase of the PIT paradigm. To assess habitual behavior, the gaming-related rewards were devalued after half of the transfer phase. In both groups, gaming-related cues enhanced the choice of the gaming-related reward and this gaming PIT effect was reduced, however, not eliminated by the devaluation. Unexpectedly, stress did not significantly increase responding for the gaming-related reward in participants aware of the stimulus-outcome associations, however seemed to enhance habitual responding in unaware participants. Our findings underline the relevance of gaming-related cues in triggering habitual responses, which may undermine attempts to change a problematic gaming behavior.

Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment

BACKGROUND

Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients.

OBJECTIVE

This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy.

METHODS

This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment.

RESULTS

This study started in March 2022 and the recruitment is expected to close in August 2024.

CONCLUSIONS

This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56315.

The Influences of Adverse Childhood Experiences and Social Support on Male Teenagers' Gaming Motivation: A Moderated Network Analysis

INTRODUCTION

Strong gaming motivations can lead to gaming-related health problems, but how gaming motivations are formed is unclear. Therefore, we examined the impact of early life experiences on gaming motivations.

METHODS

Questionnaire data on the gaming motivations, adverse childhood experiences, and social support of 2,171 teenaged online game players were modeled using moderated network analysis.

RESULTS

All adverse childhood experience components positively correlated with achievement and escapism motivations (weight range: 0.08-0.40). Social support from friends (weight = -0.04) negatively moderated the relationship between achievement motivation and other adverse childhood experiences and positively moderated (weight = 0.01) the relationship between escapism motivation and familial dysfunction.

DISCUSSION

The findings indicate that adverse childhood experiences foster negative gaming motivations. Additionally, social support moderates the relationship between adverse childhood experiences and gaming motivations. These findings offer valuable insights that nursing practitioners can apply to gaming-related health problem interventions and prevention in teenagers.

[Digital media use and mental health in adolescents-a narrative review]

The opportunities and hazards of digital media, especially with regard to children and adolescents, are currently the subject of frequent family, school, and social debates.Digital platforms can support the accomplishment of adolescent developmental tasks through gaming and social exchange as well as communication and contact promotion, learning, and health promotion, and are widely used for entertainment. In Germany, almost all adolescents own a smartphone. During the COVID-19 pandemic, an intensification of the use of digital games, social media, and streaming offers by adolescents was observed. Exposure to age-uncensored content such as the depiction of violence, extreme political views, and conspiracy theories, as well as personal attacks through cyberbullying, unfiltered initiation of contact including cybergrooming, dysfunctional role models, and addiction-promoting aspects are associated with mental health risks.Cyberbullying affects about 5% of children and adolescents in Germany. A bidirectional relationship with mental health could be shown. The gaming disorder is the first digital media use disorder (DMUD) that has been included in the ICD-11 and thus internationally recognized as a mental illness. Adolescents are affected disproportionately often and experience impairments in their mental development and levels of functioning.Services are available to promote adolescent media literacy, and their expansion, structured application, and evaluation are needed. Evidence-based prevention and treatment options for DMUD are currently largely lacking. Their development, review, and dissemination should be further supported.

Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis

The prevalence of gaming disorder is assumed to be between 2%-5%. The treatment effect of different therapeutic interventions of gaming disorder has not been studied extensively. This systematic review and meta-analysis sought to identify all intervention studies on gaming disorder with a control group, determine the effect of the interventions, and examine moderators. Studies applying a therapeutic intervention and using an appropriate comparison group were identified by searching electronic databases, previous reviews, and reference lists. Data on type of treatment, name of outcome measurement, symptom level and other study characteristics were extracted and analyzed using meta-analysis and meta-regression. A total of 38 studies and 76 effect sizes, originating from 9524 participants were included. RoB2 and ROBINS-I risk of bias tools were used to assess within-study risk of bias. Correlational hierarchical models with robust variance estimation were fitted to effect size data and yielded a moderate summary estimate. Egger's sandwich test, funnel plot inspections, and other tests were conducted to assess risk of bias between studies. Results indicate that there may be an overall effect of therapeutic interventions for gaming disorder, but confidence in these findings is compromised by small-study effects, possible publication bias, a limited study pool, and a lack of standardization. The field needs more higher quality studies before the evidence-base can support reliable meta-analytic estimates.

Treatment Approaches for Problematic Pornography Use: A Systematic Review

Problematic pornography use (PPU) is an emerging condition associated with several negative psychological and sexual outcomes. This study aimed to systematically review treatment approaches for PPU. Potentially eligible studies were searched for in PubMed/MEDLINE, Embase, PsycINFO, and Web of Science up to April 1, 2023. The quality of the evidence was assessed with the use of the Joanna Briggs Institute's checklists, the Cochrane risk-of-bias tools, and the GRADE approach. A total of 8936 references were retrieved, and 28 studies were included in the systematic review (n = 500 participants). Included studies were case reports (k = 16), case series (k = 1), quasi-experimental investigations (k = 7), and randomized clinical trials (k = 4). The majority of included studies presented overall low quality and significant risk of bias, with all interventions receiving a low or very low rating according to the GRADE approach. Most studies investigated psychological interventions, with the predominance of second and third wave cognitive behavioral therapy interventions. Pharmacological treatments included opioid antagonists (naltrexone in most cases) and antidepressants, while one study investigated a protocol that included rTMS. Several investigations described the combination of psychological and pharmacological approaches. Most studies did not report on side effects, with online and self-help interventions presenting significant issues in terms of treatment adherence. Even though there are promising options that may have efficacy for the treatment of patients with PPU, the literature in the topic still presents significant limitations that compromise the reaching of more definitive conclusions.

An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial

Background

Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap.

Methods

Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models.

Discussion

Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings.

Clinical trial registration

https://drks.de, DRKS00031043.

Effects of non-pharmacological interventions on youth with internet addiction: a systematic review and meta-analysis of randomized controlled trials

Objective

To assess the overall effectiveness of non-pharmacological interventions on internet addiction (IA) in youth.

Method

Randomized controlled trials (RCTs) published from their inception to April 1, 2023 were searched in Cochrane, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese BioMedical Literature Database, and WanFang Data. Two reviewers independently extracted data and evaluated bias using the Cochrane Risk of Bias tool.

Results

Sixty-six studies performed from 2007 to 2023, with a total of 4,385 participants, were identified. The NPIs included group counseling, cognitive behavioral therapy, sports intervention, combined interventions, eHealth, educational intervention, positive psychology intervention, sand play intervention, and electrotherapy. The results revealed that NPIs significantly reduced IA levels (standardized mean difference, SMD: -2.01, 95% confidence interval, CI: -2.29 to -1.73, I2 = 93.0%), anxiety levels (SMD: -1.07, 95%CI: -1.41 to -0.73, I2 = 72.4%), depression levels (SMD: -1.11, 95%CI: -1.52 to -0.7, I2 = 84.3%), and SCL-90 (SMD: -0.75, 95%CI: -0.97 to -0.54, I2 = 27.7%). Subgroup analysis stratified by intervention measure showed that cognitive behavioral therapy, group counseling, sports intervention, combined intervention, educational intervention, positive psychology intervention, sandplay intervention, and mobile health were all effective in relieving symptoms of IA except electrotherapy.

Conclusion

NPIs appear to be effective in the treatment of IA in youth, which would act as an alternative treatment of IA. Further studies with larger sample sizes and robust designs are needed.

Yoga as an Adjuvant with Multimodal Psychological Interventions for Excessive Use of Technology: A Randomized Controlled Trial from India

Background

Multimodal approach of psychotherapy has been found to be effective for managing the excessive use of technology. Yoga, a holistic mind-body therapy, has been observed to be a useful adjuvant in managing substance use disorders. Yoga is also known to reduce stress and enhance overall well-being. The aim of this study was to examine whether yoga as an adjuvant treatment to psychotherapy is better than psychotherapy alone in reducing dysfunction and severity due to excessive technology use.

Methods

A two-arm randomized controlled prospective study design was followed with assessor blinding and allocation concealment. Thirty consenting young adults (22 males), scoring above 36 on the Internet Addiction Test, were randomly allocated to either: Group A = psychotherapy + yoga or Group B = psychotherapy alone. Both groups received 8 sessions of psychotherapy in the 1st month. In addition, Group A received additional 10 sessions a specific yoga program (by trained professionals). After that, monthly booster sessions (supervised yoga sessions performed with direct one-on-one contact with the yoga therapist) were organized and post-assessment was conducted at 12 weeks. Each subject was assessed using the Internet Addiction Test-Short Form, Internet Gaming Disorder Scale-Short Form, Smartphone Addiction Scale-Short Version, and Kessler Psychological Distress Scale at baseline and after 12 weeks.

Results

As compared to Group B, Group A had significantly reduced Internet use (F = 5.61, P = 0.02, ηp 2 = 0.17), smartphone use (F = 4.76, P = 0.03, ηp 2 = 0.15), psychological distress (F = 7.71, P = 0.01, ηp 2 = 0.22), and weekday use (Z = -2.0, P = 0.05, ηp 2 = 0.15) along with enhanced treatment adherence and retention.

Conclusion

Yoga as an adjuvant therapy with multimodal psychological intervention for excessive use of technology was found to be effective. This carries clinical implications for mental health professionals.

Cognitive Patterns and Problematic Use of Video Games in Adolescents: A Cluster Analysis

BACKGROUND

Video game playing (VGP) is an increasingly common leisure activity among children and adolescents, although in some cases, it is accompanied by problems due to misuse.

METHOD

A sample of 2884 children and adolescents aged between 12 and 20, representative of the Community of Madrid (Spain), were studied using a cluster analysis to explore the existence of cognitive patterns associated with engagement, attitudes, and concurrent cognitions. We also explored the relationship between these patterns and problematic VGP, using the 2173 gamers as a reference.

RESULTS

The concurrent cognitions were not qualitatively different between the problematic users and the others. High engagement and high activation of concurrent cognitions (intensity and frequency) showed the greatest relationship with problematic VGP.

CONCLUSIONS

The results suggest the existence of different groups of gamers and the relevance to include psycho-educational aspects in intervention programs, as well as the training of specific skills, especially those related with the control of activation. Limitations related to the sample size and potential supplementary analyses are acknowledged.

Neural mechanisms linked to treatment outcomes and recovery in substance-related and addictive disorders

The present review focuses on potential neural mechanisms underlying recovery from psychiatric conditions characterised by impaired impulse control, specifically substance use disorders, gambling disorder, and internet gaming disorder. Existing treatments (both pharmacological and psychological) for these addictions may impact brain processes, and these have been evaluated in neuroimaging studies. Medication challenge and short-term intervention administration will be considered with respect to treatment utility. Main models of addiction (e.g., dual process, reward deficiency syndrome) will be considered in the context of extant data. Additionally, advanced analytic approaches (e.g., machine-learning approaches) will be considered with respect to guiding treatment development efforts. Thus, this narrative review aims to provide directions for treatment development for addictive disorders.

The epidemiology and effects of video game addiction: A systematic review and meta-analysis

With the increasing popularity and accessibility of video games, the public concern about their effects - positive and negative - has also increased. In this regard, this systematic review sought to identify and thematically analyze recent studies (in the last five years) and report on video games' epidemiological characteristics and outcomes. A systematic database search was done on ScienceDirect, APA PsycINFO, Emerald, and Scopus databases for articles published from January 1, 2017, to April 1, 2022. The Meta XL software - an add-in for Microsoft Excel - was used to calculate the pooled prevalence level of video game addiction. The database search yielded a total of 693 non-duplicate articles. After applying the inclusion and exclusion criteria, 27 articles were selected to be included in the systematic review. Along with this, 12 articles were considered for the final meta-analysis. The pooled prevalence level of gaming addiction was 5.0 % (95 % CI, 2.1-8.8 %). The I2 value was 99.297 with a p-value of 0.000. The factors that accompanied addictive video gaming were psychological, social, and personal. An addictive gaming behavior was characterized by spending an above-average time on gaming, doing most of the gaming online, and gaming activities interfering with sleep patterns. Some predictors of addictive gaming were emotional dependence, social detachment, increased gaming time, preference for playing online than offline, and increased emotional and psychological stress. Engaging in addictive gaming led to adverse outcomes such as lower academic scores, depression, and anxiety, as well as decreased self-esteem, life satisfaction, and social support. From the collected findings it could be concluded that extreme playing of video games can be classified as addictive. Following the identification of risk factors, appropriate corrective or interventional measures should be developed and applied coherently to newer statistical data.

Effectiveness of an integrated motivational cognitive-behavioral group intervention for adolescents with gaming disorder: a randomized controlled trial

AIMS, DESIGN AND SETTING

The aim of this study was to test the efficacy of the integrated cognitive-behavioral therapy with a strength-based motivational approach [integrated cognitive-behavioral therapy (ICBT)] intervention to change gaming disorder (GD) symptoms and other outcomes and to study the therapeutic mechanism. A two-arm parallel randomized waiting-list controlled trial with 3- and 6-month follow-ups were conducted in a secondary vocational school in mainland China.

PARTICIPANTS

Participants comprised 77 Chinese adolescents with GD symptoms with a mean age of 16.36 years [standard deviation (SD) = 0.93]; 88.3% were male INTERVENTIONS: Participants were randomized into an ICBT group (n = 38) and a waiting-list control (WLC, n = 39) group. ICBT intervention comprised eight weekly sessions to encourage participants to identify their interests and strengths and set goals for developing personally meaningful real-life activities.

MEASUREMENTS AND FINDINGS

The outcomes were measured at pre-treatment (t0 ), post-treatment (t1 ), 3-month (t2 ) and 6-month (t3 ) follow-ups. The primary outcome was GD symptoms at t3. Secondary outcomes included GD symptoms at t1 and t2 , and gaming motivation, maladaptive gaming cognition, depression and anxiety symptoms at t1 , t2 and t3 . With the intention-to-treat principle, the GD scores at t3 were significantly different between the CBT and WLC groups [mean difference 62.08 (SD = 10.48) versus 73.64 (SD = 11.70); Hedges' g = 1.15, 95% confidence interval = 0.67-1.62]. Linear mixed-effects modeling showed significant group × time interaction for the secondary outcomes (P < 0.01), with a moderate to strong between-group effect size in the reduction in depression symptoms (g = 0.67-0.84) and anxiety symptoms (g = 0.6-0.64). Path analysis shows ICBT leads to GD reduction through reducing gaming motivation and maladaptive gaming cognition.

CONCLUSIONS

An integrated cognitive-behavioral therapy with strength-based motivational approach intervention reduced gaming disorder symptoms and time spent gaming over a 6-month period by decreasing maladaptive gaming motivation and cognition.

Efficacy of a short-term webcam-based telemedicine treatment of internet use disorders (OMPRIS): a multicentre, prospective, single-blind, randomised, clinical trial

Background

Evidence-based treatments for internet use disorders (IUDs) are limited, and online therapy approaches are poorly studied. We investigated the efficacy of a manualised therapist-guided online intervention (OMPRIS) to reduce IUD symptoms and improve psychological well-being.

Methods

In this multicentre, two-arm, single-blinded trial, individuals ≥16 years suffering from IUD symptoms were recruited in Germany from August 16, 2020, to March 11, 2022, through media advertisements and healthcare providers. Participants were randomly allocated by sequential balancing randomisation (1:1) to either the manualised webcam-based OMPRIS intervention or a waitlist control (WLC) group. OMPRIS provided strategies from motivational interviewing, behavioural therapy, and social counselling. The primary outcome at the end of treatment was a reduction in IUD symptoms as measured by the Assessment of Internet and Computer Scale (AICA-S). Follow-up assessments were conducted at 6 weeks and 6 months. Analyses were performed in the intention-to-treat population. This trial was registered (German Clinical Trial Register, DRKS00019925) and has been completed.

Findings

A total of 180 individuals were randomly assigned to the OMPRIS intervention (n = 89) or WLC (n = 91) arm. After treatment, 81 (91.0%) participants in the OMPRIS intervention group and 88 (96.7%) in the WLC group completed the outcome assessment. The ANCOVA model showed that OMPRIS participants had a significantly greater reduction in AICA-S scores from baseline (mean score 12.1 [SD 4.6]) to post-treatment (6.8 [5.2]) than those in the WLC group (from 12.6 [5.1] to 11.0 [5.4]; estimated mean difference -3.9; [95% CI -5.2 to -2.6]; p < 0.0001; d = 0.92). No adverse events were reported to the trial team.

Interpretation

Webcam-based OMPRIS therapy was effective and superior to waiting list conditions in reducing IUD symptoms. Webcam-based, specialised online therapy thus increases IUD treatment options.

Funding

German Innovation Fund of Germany's Federal Joint Committee (G-BA), grant number 01VSF18043.

The worldwide prevalence of self-reported psychological and behavioral symptoms in medical students: An umbrella review and meta-analysis of meta-analyses

OBJECTIVE

Medical students frequently experience a range of stressors, such as demanding academic requirements, competition and rivalry, self-doubt, and financial distress. As a result, they are at risk for psychological and behavioral symptoms (PBS) including: depression, anxiety, and sleep difficulties as well as maladaptive substance use.

METHODS

To determine the degree of risk for these symptoms, 13 databases, without language restriction., were searched.

RESULTS

A total of 32 meta-analyses were included in this umbrella review. A global analysis of all self-reported PBS combined yielded a pooled prevalence rate of 30.3% [26.9%; 33.7%]; 95% PI [2.2%; 58.3%]. The highest reported prevalence was for sleep problems 42.0% [35.6%; 48.4%], followed by stress 41.7% [35.3%; 48.1%], burnout 35.8% [25.7%; 45.8%], anxiety 32.5% [27.9%; 37.1%], depression 32.5% [28.8%; 36.1%], internet addiction 26.0% [5.5%; 46.5%], substance use 25.2% [18.9%; 31.6%], eating disorders 9.8% [1.1%; 18.4%], and suicidal thoughts/gestures/acts 8.9% [4.8%; 12.9%]. The prevalence estimates were deemed acceptable for all PBS.

CONCLUSION

The evidence shows that fully one-third of medical students experience a range of problematic PBS, likely attributable to the demanding and intense study environment, the hierarchical structure of medical training facilities, and the vulnerability of the young adulthood time period. Appropriately targeted assessment and intervention efforts are clearly warranted to decrease the psychological burden of medical student training. PROSPERO Identifier: CRD42023391800. Open Science Network (OSF) Identifier: DOI 10.17605/OSF.IO/SXQYN.

Neuroimaging correlates of internet gaming disorder: Can we achieve the promise of translating understandings of brain functioning into clinical advances?

Objectives

Here we aimed to consider the neural factors associated with internet gaming disorder (IGD), as well as the associations between these factors and existing treatments for the disorder.

Methods

A narrative review was conducted.

Results

Pharmacological as well as psychological treatments for IGD may be associated with specific changes in multiple brain areas and circuits. In particular, fronto-striatal and subcortical regions and pathways appear relevant to IGD and its treatment.

Conclusions

Neuroimaging holds promise for identifying specific mechanisms underlying IGD interventions. However, to date, firm conclusions are difficult to draw and more research examining neural mechanisms of empirically supported treatments for IGD is needed.

Dissociative Trait as a Mediator of Problematic Internet Use in Children with attention-deficit/hyperactivity Disorder and Learning Disabilities

PURPOSE

This study used data from a national birth cohort study to investigate the duration of internet use at the age of 12 years among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities (IDs) and learning disabilities (LDs) at the age of five and a half years (66 months) to understand whether an ADHD, ASD, ID and LD diagnosis in childhood increases the risk of problematic internet use (PIU) in adolescence. Furthermore, the pathway relationship of dissociative absorptive trait with PIU and these diagnoses was also investigated.

METHODS

The 5.5- and 12-year-old Taiwan Birth Cohort Study dataset was used (N = 17,694).

RESULTS

More boys were diagnosed with LDs, IDs, ADHD and ASD; however, girls were at increased likelihood of PIU. ID and ASD diagnoses were not associated with increasing PIU likelihood. However, children who had been diagnosed with LDs and ADHD, along with higher dissociative absorptive trait, had an indirectly increased likelihood of PIU in adolescence.

CONCLUSIONS

Dissociative absorption was found to be a mediating factor between childhood diagnosis and PIU and can be used as a screening indicator in prevention programs to reduce the duration and severity of PIU in children diagnosed with ADHD and LDs. Furthermore, with the increased prevalence of smartphone usage in adolescents, education policy-makers should pay greater attention to the issue of PIU in female adolescents.

A Systematic Review of Pharmacological Treatments for Internet Gaming Disorder

OBJECTIVE

Internet gaming disorder (IGD) is an increasingly common behavioral addiction, with an estimated global prevalence of 3%. A variety of pharmacological treatments have been used to treat IGD, yet no review to date has synthesized clinical trials evaluating their efficacy. This systematic review therefore synthesized the literature reporting on clinical trials of pharmacological treatments for IGD.

METHODS

We reviewed articles from MEDLINE, Embase, PubMed Central, CINAHL, and PsycINFO that were published as of March of 2022. A total of 828 articles were retrieved for review and 12 articles were included, reporting on a total of 724 participants.

RESULTS

Most participants were male (98.6%), and all were currently living in South Korea. The most common drugs used to treat IGD were bupropion, methylphenidate, and a range of selective serotonin reuptake inhibitors. The Young Internet Addiction Scale was the most frequently used to measure gaming-related outcomes. All studies reported reduced symptoms of IGD from pre- to post-treatment. Across all clinical trials, IGD symptom reductions following the administration of pharmacological treatments ranged from 15.4% to 51.4%. A risk of bias assessment indicated that only four studies had a low risk of bias.

CONCLUSION

Preliminary results suggest that a wide array of pharmacological interventions may be efficacious in the treatment of IGD. Future studies using double-blind randomized controlled trial designs, recruiting larger and more representative samples, and controlling for psychiatric comorbidities are needed to better inform understanding of pharmacological treatments for IGD.

Case report for an internet- and mobile-based intervention for internet use disorder

BACKGROUND AND AIMS

Internet use disorder (IUD), characterized as the inability to control one's internet use, is associated with reduced quality of life and mental health comorbidities such as depression, substance abuse, or anxiety. Evidence-based treatment options are scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions (IMI) may be an effective means to deliver psychological treatment to individuals with IUD as they address affected individuals in their online setting. This study presents a newly developed IMI for IUD disclosing treatment satisfaction and preliminary effects by exemplifying with a case report.

METHODS

The case of a female participant with IUD, characterized by an excessive use of social media, is analyzed. The case report follows the CARE guidelines and presents qualitative and quantitative outcomes regarding potential symptom reduction measured by the Internet Addiction Test (IAT) and Compulsive Internet Use Scale (CIUS), treatment satisfaction measured by the Client Satisfaction Questionnaire (CSQ) and feasibility by analyzing participant's written feedback during treatment.

RESULTS

The case report shows that internet- and mobile-based interventions may be feasible in supporting an individual in reducing symptoms of IUD as well as depressive symptoms, anxiety and procrastination behavior. Treatment satisfaction was reported as good.

DISCUSSION AND CONCLUSIONS

This case report illustrates that IMIs can have the potential to be an easily accessible and possibly effective treatment option for IUD. Case studies on IMIs may provide insights into important mechanisms for symptom change. Further studies are needed to expand our understanding of this diverse disorder to provide adequate treatment.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/,DRKS00015314.

Understanding adolescent esports bettors: Are they a homogeneous group?

With the rapid rise of competitive video gaming (esports), increased attention has been placed on understanding the profiles of youth who wager on esports. With adolescents being at increased risk of gambling problems and endorsing high rates of past year engagement in video games, there is a need for research investigating psychological and social correlates of adolescent esports bettors and to identify whether youth who engage in esports betting are a homogenous group. Survey responses were collected from 5,997 high-school students (48.4 % male, Mage = 14.7 years [SD = 1.6], age range 12-17) from Wood County, Ohio, United States. A latent class analysis was conducted to identify subgroups of esports bettors based on self-reported measures of gambling frequency, risk for problem gambling, gaming frequency, disordered gaming, preference for virtual life and risky loot box use. Results indicated that 5.5 % of the sample reported esports betting over the past year. Four classes of esports bettors were identified which were indicative of a group of low-risk esports bettors, a group of esports bettors at risk of gaming problems, a group of esports bettors at risk of gambling problems, and a group of esports bettors at high risk of both gambling and gaming problems. Although no significant differences based on sex and age were noted between the classes, differences were noted in experienced childhood adversity, mental health symptoms and problem behavior severity. Results are discussed in line with previous findings relevant to adolescent and adult esports betting.

Symptoms, Mechanisms, and Treatments of Video Game Addiction

Video game addiction is defined as the steady and repetitive use of the Internet to play games frequently with different gamers, potentially leading to negative consequences in many aspects of life. As recent technological development has given easy access to gaming on many devices, video game addiction has become a serious public health issue with increased prevalence. Many studies have shown that video game addiction leads to changes in the brain that are similar to those that occur in substance addiction and gambling. Evidence has also shown that there is an association between video game addiction and depression, as well as other psychological and social problems. In light of these issues, our review article aims to increase awareness of video game addiction in society. The main objectives of this review are as follows: to describe the mechanism of addiction, to consider whether video game addiction is a real addiction, and to highlight the signs and symptoms of addiction. In addition, we identify the consequences of video game addiction and possible treatments for addicts. The information was extracted from high-quality research papers and reliable websites like PubMed and ScienceDirect.

A short-term manual for webcam-based telemedicine treatment of Internet use disorders

In recent decades, the number of people who experience their Internet use behavior as problematic has risen dramatically. In Germany, a representative study from 2013 estimated the prevalence of Internet use disorder (IUD) to be about 1.0%, with higher rates among younger people. A 2020 meta-analysis shows a global weighted average prevalence of 7.02%. This indicates that developing effective IUD treatment programs is more critical than ever. Studies show that motivational interviewing (MI) techniques are widely used and effective in treating substance abuse and IUDs. In addition, an increasing number of online-based health interventions are being developed to provide a low-threshold treatment option. This article presents a short-term online-based treatment manual for IUDs that combines MI techniques with therapy tools from cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). The manual includes 12 webcam-based therapy sessions, each lasting 50 min. Each session is framed by a standardized beginning, conclusion, outlook, and flexible session content. In addition, the manual contains example sessions to illustrate the therapeutic intervention. Finally, we discuss the advantages and disadvantages of online-based therapy compared to analog treatment settings and provide recommendations for dealing with these challenges. By combining established therapeutic approaches with an online-based therapeutic setting based on flexibility and motivation, we aim to provide a low-threshold solution for treating IUDs.

Effective interventions for gaming disorder: A systematic review of randomized control trials

Objective

To identify effective intervention methods for gaming disorder (GD) through a rigorous assessment of existing literature.

Methods

We conducted a search of six databases (PubMed, Embase, PsycINFO, CNKI, WanFang, and VIP) to identify randomized controlled trials (RCTs) that tested GD interventions, published from database inception to December 31, 2021. Standardized mean differences with 95% confidence intervals were calculated using a random effects model. Risk of bias was assessed with the Risk of Bias 2 (RoB 2) tool.

Results

Seven studies met the inclusion criteria. Five interventions were tested in these studies: group counseling, craving behavioral intervention (CBI), transcranial direct current stimulation (tDCS), the acceptance and cognitive restructuring intervention program (ACRIP), and short-term cognitive behavior therapy (CBT). Four of the five interventions (the tDCS was excluded) were found to have a significant effect on GD. The results of the quality assessment showed that the included studies had a medium to high risk in the randomization process and a medium to high risk of overall bias.

Conclusion

Rigorous screening identified that four interventions are effective for GD: group counseling, CBI, ACRIP, and short-term CBT. Additionally, a comprehensive review of the literature revealed that improvements could be made in the conceptualization of GD, experimental design, sample representativeness, and reporting quality. It is recommended that future studies have more rigorous research designs and be based on established standards to provide more credible evidence to inform the development of GD interventions.

Cognitive-Behavioral Therapy for Treating Videogame Dependence in School-aged Children

This study examined the effectiveness of cognitive-behaviour therapy on schoolchildren with videogame dependency in a sample of Nigerian schoolchildren. This study was conducted in Enugu metropolis Enugu State Nigeria. A randomized-controlled pretest and posttest design was adopted. Out of 86 schoolchildren that participated in the study, 43 children were exposed to the intervention while 43 did not receive treatment as usual (TAU). The treatment lasted for eight weeks with one session per week. During the study, the participants were assessed at three time points using videogame addiction scale for children. The data collected were statistically analyzed using the multivariate statistical tool. The multivariate statistical result showed that cognitive-behaviour therapy in reducing videogame dependency among schoolchildren. The practice implications, limitations, and conclusions were also drawn in line with the outcome of this study. This study is one among the few studies in Nigeria that have investigated videogame dependency. Another strength is that study tested the participants at three time points to ascertain the impacts of the intervention.

The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services

Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines.

Systematic reviews and meta-analyses of treatment interventions for Internet use disorders: Critical analysis of the methodical quality according to the PRISMA guidelines

RATIONALE

As a result of concerns about predominantly online behavioral addictions, an increasing number of systematic reviews and meta-analyses (SRMA) of treatment interventions for internet use disorders (IUD) are being recorded. This review was designed to (a) systematically identify the evidence base of SRMA and to (b) critically appraise the quality of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

Four databases were searched until August 2022 to systematically identify SRMA. PRISMA indicators were evaluated on a three-level response format to obtain an overall score operationalizing the quality of reporting (score range: 0-84). Additionally, the percentage of adherence to the PRISMA indicators was calculated.

RESULTS

Reporting quality of 23 SRMA, comprising 12 systematic reviews and 11 meta-analyses was evaluated. Quality scores ranged from 25 to 77 (M: 52.91; SD: 17.46). Results of the critical appraisal revealed deviations from the PRISMA indicators, including missing information on (a) registration of a study protocol, (b) statistical synthesis methods (c) evaluation of certainty of evidence, and (d) risk of bias assessment. Eleven (47.83%) of the SRMAs partially adhered, and twelve (52.17%) completely adhered to the PRISMA indicators.

CONCLUSION

This first critical appraisal on the reporting quality of SRMA on treatment interventions for IUD highlights limitations of the evidence base. Inadequate reporting compromises the practical utility and validity of SRMA and may complicate ongoing efforts of consensus on evidence-based interventions for IUD. Future research should focus on sufficient and transparent reporting of the methodological approach.

Telemedicine as bridge to the offline world for person affected with problematic internet use or internet use disorder and concerned significant others

Introduction

Internet use disorder is a disorder of the digital age and presents a growing problem worldwide. It appears that due to structural and personal barriers, many persons affected (PA) and Concerned Significant Others (CSO) do not reach the health care system so far and thus a chronification of the pathology can proceed.

Methods

A telemedicine counseling service for PA and CSO of PA unwilling to enter treatment with two webcam-based sessions of 60 minutes for each group was created with the aim of reaching out to PA and CSO to provide a low-threshold support and refer the participants to the local health care system. Motivational interviewing for PA and CRAFT (Community Reinforcement and Family Training) for CSO were used as methods. Participants answered questions about their Internet use and sociodemographic data and six months after participation, participants were asked via email if they entered the local health care system. CSO answered the questions for themselves and in a third-party rating for PA unwilling to enter treatment.

Results

107 PA (34 years (SD = 13.64), 86% male) and 38 CSO (53 years (SD = 6.11), 28.9% male) participated in the two telemedicine sessions. After participation, 43.9% of the PA and 42.1% of the CSO reached the health care system. When there was consistency between the location of telemedicine consultation and treatment locally, over 90% of participants arrived (PA: 92.3%, CSO: 100%).

Conclusion

The results from this study reveal that telemedicine services could be a promising approach to address PA and CSO and build a bridge to the local health care system. Future studies should verify if these results can be replicated in randomized controlled trials.

Internet addiction in adolescent psychiatric patient population: A hospital-based Study from China

BACKGROUND

Internet is gradually reshaping adolescents' behaviors in China. It is important to identify the prevalence and risk factors to predict Internet addiction among adolescent psychiatric patients.

METHODS

The survey was conducted among inpatient or outpatient adolescent patients with mental disorders. All participants were interviewed face-to-face and completed Young Internet Addiction Test and other relevant assessments. Binary logistic regression analysis was used to exam between-group differences of internet addiction.

RESULT

The prevalence for internet addiction (mild to severe) in adolescent psychiatric patients was 80.2%, where the prevalence for "medium and severe internet addiction was 25.5%. Logistic regression analysis identified two independent predictors for "medium and severe internet addiction" including the total score of Adolescent Non-suicidal-self-injury (NSSI) Behavior Function Assessment Scale (ANBFAS) and the diagnosis of generalized anxiety disorder (GAD) (R² =0.27, p = .02 for total ANBFAS score, p = .01 for GAD) in psychiatric adolescent patients.

CONCLUSION

The prevalence of internet addiction is notably high among adolescent psychiatric patients in China. Coping for Internet addiction in adolescent psychiatric patients should conclude the coping of NSSI and GAD.

Predicting the severity of internet gaming disorder with resting-state brain features: A multi-voxel pattern analysis

BACKGROUND

Internet gaming disorder (IGD) has become a worldwide mental health concern; however, the neural mechanism underlying this disorder remains unclear. Multivoxel pattern analysis (MVPA), a newly developed data-driven approach, can be used to investigate the neural features of IGD based on massive neural data.

METHODS

Resting-state fMRI data from four hundred and two participants with varying levels of IGD severity were recruited. Regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF) were calculated and subsequently decoded by applying MVPA. The highly weighted regions in both predictive models were selected as regions of interest for further graph theory and Granger causality analysis (GCA) to explore how they affect IGD severity.

RESULTS

The results revealed that the neural patterns of ReHo and ALFF can independently and significantly predict IGD severity. The highly weighted regions that contributed to both predictive models were the right precentral gyrus and left postcentral gyrus. Moreover, topological properties of the right precentral gyrus were significantly correlated with IGD severity; further GCA revealed effective connectivity from the right precentral gyrus to left precentral gyrus and dorsal anterior cingulate cortex, both of which were significantly associated with IGD severity.

CONCLUSIONS

The present study demonstrated that IGD has distinctive neural patterns, and this pattern could be found by machine learning. In addition, the neural features in the right precentral gyrus play a key role in predicting IGD severity. The current study revealed the neural features of IGD and provided a potential target for IGD interventions using brain modulation.

Psychological treatments for excessive gaming: a systematic review and meta-analysis

Despite widespread public interest in problematic gaming interventions, questions regarding the empirical status of treatment efficacy persist. We conducted pairwise and network meta-analyses based on 17 psychological intervention studies on excessive gaming (n = 745 participants). The pairwise meta-analysis showed that psychological interventions reduce excessive gaming more than the inactive control (standardized mean difference [SMD] = 1.70, 95% confidence interval [CI] 1.27 to 2.12) and active control (SMD = 0.88, 95% CI 0.21 to 1.56). The network meta-analysis showed that a combined treatment of Cognitive Behavioral Therapy (CBT) and Mindfulness was the most effective intervention in reducing excessive gaming, followed by a combined CBT and Family intervention, Mindfulness, and then CBT as a standalone treatment. Due to the limited number of included studies and resulting identified methodological concerns, the current results should be interpreted as preliminary to help support future research focused on excessive gaming interventions. Recommendations for improving the methodological rigor are also discussed.

Understanding Problematic Social Media Use in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): A Narrative Review and Clinical Recommendations

Attention-Deficit/Hyperactivity Disorder (ADHD) is consistently associated with a host of social problems, such as victimization and difficulties in maintaining close friendships. These problems are not limited to offline relations but also manifest in the online social world, as previous research shows that ADHD is associated with problematic use of social media. Given the ubiquitous nature of social media, the goal of the current review is to understand why adolescents with ADHD demonstrate more problematic social media use than their typically developing peers. To this end, we provide a narrative review on the evidence for the link between ADHD and social media use, and consequently present an integrative framework, which encompasses neurobiological mechanisms (i.e., imbalance theory of brain development and dual pathway model of ADHD) and social mechanisms, including influences from peers and parents. We conclude that empirical work shows most consistent evidence for the link between problematic social media use and ADHD (symptoms), while intensity of social media use is also associated with several other behaviors and outcomes. Finally, we hypothesize how existing interventions for ADHD may work on the identified mechanisms and provide at-hand clinical recommendations for therapists working with adolescents with ADHD who exhibit problematic social media use.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

Effects of different interventions on internet addiction: A meta-analysis of random controlled trials

OBJECTIVE

To evaluate the effects of different interventions on Internet addiction (IA), a meta-analysis and network meta-analyses were performed.

METHODS

We searched PubMed, Cochrane, Embase, Web of Science, PsycINFO, ProQuest, CNKI, WanFang, VIP database, and CBM from their inception to August 2021 to identify randomized controlled trials (RCTs) where the effects of interventions on IA were assessed. The risk of bias was evaluated according to the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). The R studio Software and Stata 14.0 were used to perform traditional meta-analysis and network meta-analyses.

RESULTS

A total of 59 RCTs including 3832 participants were incorporated into meta-analysis. The results of the traditional meta-analysis of 24 studies showed that CBT, group counseling, sports intervention, and Internet-based intervention could significantly reduce IA levels (SMD = -1.90, 95%CI: -2.26 to -1.55, P < 0.01, I2 = 85.9%) as compared to no-treatment control groups. Network meta-analyses based on different scales showed that combined interventions had the highest probability of being the best interventions for IA (SUCRA = 91.0 % based on IAT; SUCRA = 89.0 % based on CIAS).

DISCUSSION

Most interventions have significant effects on the treatment of IA. Compared with single interventions, combined interventions showed a more pronounced improvement in Internet addiction symptoms.