Problem Internet Overuse Behaviors in College Students: Readiness-to-Change and Receptivity to Treatment

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.

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.

Internet addiction is associated with psychological distress in highly schizotypal students

BACKGROUND

There is some limited evidence of an association between technology addictions and emergence of pre-psychotic symptoms, high psychoticism, psychotic like experiences and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk. We aimed to compare smartphone, Internet and Facebook addictions between low and high schizotypal individuals; and to explore the association between these addictions and distress in the high schizotypy group.

METHODS

From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. The Schizotypal Personality Questionnaire, the Bergen Facebook Addiction Scale, the Internet Addiction Test, the Smartphone Addiction Scale-Short Version and the Depression, Anxiety and Stress Scales.

RESULTS

Students of the high schizotypy group displayed significantly greater scores on smartphone (p < .001), Internet (p < .001) and Facebook (p = .001) addictions scales, as compared to those of the low schizotypy group. After controlling for potential confounders, Internet addiction predicted psychological distress in the high schizotypy group (R²  = 0.380, F_(13,55)  = 2.597, p < .001) and explained an additional 19.7% of variation in Depression, Anxiety and Stress Scales total scores in the final model.

CONCLUSION

Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. It is recommended to raise awareness about Internet addiction risks, particularly among vulnerable young adults; and to find ways to turn Internet into a protective rather than stressor factor, by utilizing it as a resource in the care pathway.

Novel approaches for treating Internet Gaming Disorder: A review of technology-based interventions

Internet Gaming Disorder (IGD) has become a significant issue in mental healthcare over the past decades as the number of people engaging in excessive and unhealthy gaming increases with each year. Despite its inclusion in the 5th Edition of Diagnostic Statistical Manual and the development of a number of treatment methods that have been designed and tested for IGD, treatment remains a challenge. This review attempts to give an overview of the current state of IGD and its treatment with a specific focus on the potential of technology-based solutions, such as web-based programs, mobile applications, and virtual reality. The review also highlights the need for additional work in the area of treatment development for IGD and the preliminary evidence for the usefulness and importance of technology-based treatment methods which offer unique advantages, such as accessibility, scalability, and cost-effectiveness, over other existing treatment options.

Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial

IMPORTANCE

Behavioral addictions were introduced as novel mental disorders in the International Classification of Diseases, 11th Revision, based on evidence that human behavior itself can become addictive, similar to addiction to substances. However, previous studies on prevention of gaming disorder and unspecified internet use disorder lacked randomization, follow-up measurements, and diagnostic interviews that assessed incidence rates; this trial was intended to fill this gap.

OBJECTIVES

To investigate whether the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention can reduce the symptom severity and prevent full syndrome and subthreshold onset of gaming disorder and unspecified internet use disorder in at-risk adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter cluster randomized clinical trial conducted recruitment, screening, intervention delivery, and data collection among at-risk adolescents aged 12 to 18 years in 33 high schools in Germany. Inclusion criteria for the study and symptom severity analyses were elevated symptoms of gaming disorder and unspecified internet use disorder. A subsample that met the inclusion criteria for incidence analyses (no full syndrome of gaming disorder or unspecified internet use disorder, depression, or anxiety at baseline) was analyzed for illness onset. Participants were randomized to either the PROTECT intervention group or the assessment-only control group. Participants were assessed at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up between October 1, 2015, and September 30, 2018. Based on intent-to-treat principle, data analyses were conducted from February 8, 2019, to May 7, 2021.

INTERVENTIONS

PROTECT, a theory-driven, manualized, cognitive behavioral therapy-based indicated preventive group intervention that is delivered in 4 sessions by trained psychologists. It targets changes in addictive reward processing and pathological cognitive mechanisms.

MAIN OUTCOMES AND MEASURES

The primary outcome was symptom severity (measured by CSAS [Computerspielabhängigkeitsskala], a modified German video game dependency scale with a score range of 0-56 [higher scores indicating greater pathology]) along with incidence rates (assessed by a structured clinical interview) after 12 months. Secondary outcomes were comorbid psychopathology and problem behaviors.

RESULTS

A total of 422 at-risk adolescents (mean [SD] age, 15.11 [2.01] years; 229 female participants [54.3%]) were randomized to either the PROTECT intervention group (n = 167; mean [SD] risk score, 29.05 [6.98]) or the assessment-only control group (n = 255; mean [SD] risk score, 26.21 [5.01]) and were included in the symptom severity analyses. Compared with the control group, the PROTECT group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder (γ11 = -0.128; 95% CI, -0.246 to -0.011; P = .03), reflecting a 39.8% vs 27.7% reduction of symptoms with an effect size of Cohen d = 0.67 (baseline vs 12-month follow-up) for the PROTECT group. Differences in incidence rates did not reach statistical significance. The PROTECT group showed a significantly greater decrease in procrastination (γ11 = -0.458; 95% CI, -0.735 to -0.180; P < .001) over 12 months, but no significant differences were found for other secondary outcomes.

CONCLUSIONS AND RELEVANCE

Results of this trial showed that the PROTECT intervention effectively reduced symptoms of gaming disorder and unspecified internet use disorder over 12 months. The intervention did not change incidence rates of gaming disorder or unspecified internet use disorder.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02907658.

Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial

INTRODUCTION

In May 2019, the WHO classified internet gaming disorder (IGD) as a mental disorder in the upcoming International Classification of Diseases 11th Revision. However, individuals affected by IGD or internet use disorders (IUDs) are often not provided with adequate therapy due to a lack of motivation or absence of adequate local treatment options. To close the gap between individuals with IUDs and the care system, we conduct an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS).

METHODS AND ANALYSIS

Within the randomised controlled trial, a total of n=162 participants will be allocated by sequential balancing randomisation to the OMPRIS intervention or a waitlist control group. The study includes an extensive diagnostic, followed by a 4-week psychological intervention based on motivational interviewing, (internet-related) addiction therapy, behavioural therapy techniques and additional social counselling. The primary outcome is the reduction of problematic internet use measured by the Assessment of Internet and Computer Game Addiction Scale. Secondary outcomes include time spent on the internet, motivation for change (Stages of Change Readiness and Treatment Eagerness Scale for Internet Use Disorder), comorbid mental symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder Screener-7), quality of life (EuroQoL Standardised Measure of Health-related Quality of Life-5 Dimensions, General Life Satisfaction-1), self-efficacy (General Self-Efficacy Scale), personality traits (Big Five Inventory-10), therapeutic alliance (Helping Alliance Questionnaire) and health economic costs. The diagnosis of (comorbid) mental disorders is carried out with standardised clinical interviews. The measurement will be assessed before (T0), at midpoint (T1) and after the OMPRIS intervention (T2), representing the primary endpoint. Two follow-up assessments will be conducted after 6 weeks (T3) and 6 months (T4) after the intervention. The outcomes will be analysed primarily via analysis of covariance. Both intention-to-treat and per-protocol analyses will be conducted.

ETHICS AND DISSEMINATION

Participants will provide written informed consent. The trial has been approved by the Ethics Committee of the Faculty of Medicine, Ruhr University Bochum (approval number 19-6779). Findings will be disseminated through presentations, peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

DRKS00019925.

Design of a Guided Internet- and Mobile-Based Intervention for Internet Use Disorder-Study Protocol for a Two-Armed Randomized Controlled Trial

Context: Internet Use Disorder (IUD), characterized as the inability to control one's internet use, is emerging as an increasing societal concern as it is associated with reduced quality of life and mental health comorbidities. Evidence-based treatment options are, however, scarce due to the novelty of the diagnosis. Internet- and mobile-based interventions may be an effective means to deliver psychological treatment to individuals with IUD as they address individuals affected in their online setting. The aim of the study is to evaluate the efficacy of a newly developed, guided internet- and mobile-based intervention for IUD. Methods: In a two-armed randomized controlled trial (N = 130), individuals showing problematic internet use patterns (Internet Addiction Test ≥ 49) will be randomly allocated to the internet- and mobile-based intervention or a waiting control group. Assessments will take place at baseline, 7 weeks, 6- and 12 months after randomization. The primary outcome is internet addiction symptom severity (IAT) at 7 weeks. Secondary outcomes include quality of life, depressive symptoms, anxiety, and other psychosocial variables associated with IUD. Intervention: The intervention consists of seven sessions: Goal setting and motivational interviewing, impulse control, problem solving, cognitive restructuring, self-worth, relapse prevention, and a booster session. Participants are supported by an eCoach who provides individual feedback after completion of each session. Participants can choose between several elective sessions based on individual need. Conclusions: This is the first study to evaluate an internet- and mobile-based intervention for IUD, which could be a promising first step to reduce individuals' disease burden. Trial Registration: DRKS00015314. The study is currently ongoing. First participants were enrolled in the study on September 14th 2018. Recruitment will continue approximately through March 2020.

[Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study]

Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study Abstract. Objective: Internet Gaming and Internet Use Disorder (IGD and IUD) have gained increasing attention in the scientific community over the last few years. The inclusion of "Gaming Disorder" in the ICD-11 (International Statistical Classification of Diseases and Related Health Problems) promoted the need for evidence-based and effective treatments. PROTECT+ is such a cognitive-behavioral group therapy program for adolescents with IGD and IUD. The present study evaluates the medium-term effects after 4 months. Method: N = 54 patients, aged 9 to 19 years (M = 13.48, SD = 1.72), participated in the early intervention study between April 2016 and December 2017 in Heidelberg, Germany. Symptom severity was assessed at baseline, at the end of the treatment, and at 4-month follow-up using standardized diagnostic tools. Results: Multilevel analyses showed a significant reduction in symptom severity using the Video Game Dependency Scale (CSAS) at 4-month follow-up. We found a small effect size in self-reported reduction of symptom severity (d = 0.35) and a moderate effect size in parental ratings (d = 0.77). The Reliable Change Index measured by the Compulsive Internet Use Scale (CIUS) indicated a high heterogeneity in individual symptom changes over time. Patients showed high satisfaction regarding the treatment program at 1- und 4-month follow-up. Conclusions: This study is internationally one of the few to show a significant reduction of IGD and IUD symptoms after 4 months.

Internet Gaming Disorder in Adolescents With Psychiatric Disorder: Two Case Reports Using a Developmental Framework

Internet gaming disorder (IGD) has been a controversial entity with various opinions about its clinical relevance as an independent mental disorder. This debate has also included discussions about the relationships between problematic gaming, various psychiatric disorders, and personality traits and dimensions. This paper outlines a developmental-theory based model of Internet gaming misuse inspired by the treatment of two adolescent inpatients. The two clinical vignettes illustrate distinct developmental pathways: an "internalized pathway" via the development of social anxiety, emotional and behavioral avoidance; and an "externalized pathway" with a low level of emotional regulation strategies and impulsivity. In both clinical cases, attachment issues played a key role to understand the specific associations of risk and maintaining factors for IGD, and gaming behaviors may be seen as specific forms of maladaptive self-regulatory strategies for these two youths. These clinical observations support the assumption that gaming use problematic in adolescents should be viewed with a developmental approach, including key aspects of emotional development that represent significant targets for therapeutic interventions.

Treatment of Internet Addiction and Internet Gaming Disorder in Adolescence

Internet use is growing year after year and adolescents represent a large proportion of internet users. There is a scholarly interest in teen internet gaming disorder (IGD) and internet addiction (IA) is constantly increasing, but little is known about the treatments of IA and IGD. This study systematically reviews the literature of the last fifteen years, focusing on two main aspects: adolescence, and IA and IGD intervention programs. The inclusion criteria were (1) contain empirical data, (2) include an analysis relating to IA or IGD, (3) include teen samples aged between 13 and 19 years or with an average age within this range, and (4) provide a full-text article published in English. A total number of 17 papers were included, 7 focused on IA and 10 focused on IGD. Prevalence and different treatment-related outcomes are discussed.

An analysis of integrated health care for Internet Use Disorders in adolescents and adults

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.

The Effect of U.S. University Students' Problematic Internet Use on Family Relationships: A Mixed-Methods Investigation

This is the first study to investigate how college students in the U.S. with problematic Internet use perceive the role the Internet plays within their families of origin. The sample included 27 U.S. university students who self-identified as excessive Internet users. Participants reported spending more than 25 hours a week on the Internet on non-school or non-work-related activities and reported Internet-associated health and/or psychosocial problems. This study provides descriptive statistics from participants' completion of two problematic Internet use measures (i.e., Young's Diagnostic Questionnaire and the Compulsive Internet Use Scale) and reports findings from four focus groups. Three themes emerged from the focus groups: (1) family connectedness, (2) family conflict/family disconnection, and (3) family Internet overuse. The findings of this study are a first step toward the design of effective interventions for problematic Internet use among U.S. college students and serve to inform clinical practice and health policy in this area.