Treatment outcomes in patients with internet addiction: a clinical pilot study on the effects of a cognitive-behavioral therapy program

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.

Pilot data findings from the Gothenburg treatment for gaming disorder: a cognitive behavioral treatment manual

Background

Gaming disorder (GD) is a new diagnosis included in the latest edition of the International Classification of Disease -11. Recently conducted international studies suggest a prevalence rate close to 2% for GD, highlighting the need for effective treatments for this patient population. Internationally there are few studies investigating effective treatments specifically designed for this condition. In this pilot study, we wanted to test a newly developed method, the Gothenburg Treatment for Gaming Disorder (GOT-TO-GO) manual; a 15-week cognitive behavioral therapy treatment for GD.

Method

This study utilized a single group design with pretest, post-test and a three- and six-month follow-up, with measures of severity of GD and mood. The participants (n = 28) were treatment-seeking adults with GD, aged 17 to 49 years.

Results

The results show a statistically significant decrease in symptoms of GD after treatment. Hours of gaming per week also decreased concomitantly with a 100% increase in non-gaming leisure hours. The decrease in symptoms of GD was maintained at the 3-months follow-up after treatment. Correspondingly we saw a decrease in both depression and anxiety that also was upheld 3 months after treatment.

Conclusion

As GD is a new diagnostic concept more research is needed, also taking psychiatric comorbidity into consideration, to arrive at evidence-based conclusions regarding effective treatments. Considering the promising results in this small pilot study with large behavioral changes and reduced symptoms of GD, upheld at least 3 months after treatment, a larger randomized controlled study is warranted.Clinical Trial Registration: https://www.clinicaltrials.gov/ct2/show/study/NCT05328596?term=NCT05328596&draw=2&rank=1, identifier NCT05328596.

Internet Addiction and the Treatment of Depression? A Prospective Naturalistic Outcome Study

The increasing prevalence of Internet addiction (IA) has been linked with a wide range of psychological disorders, including depression. We explored how IA was prospectively associated with effectiveness of treatment for adult patients with depressive symptoms (n = 241) in the context of a New York-based outpatient clinic. Although IA was not correlated with symptoms at intake, patients with higher IA attended fewer total sessions on average. Multilevel regression modeling also revealed that patients with higher IA scores terminated treatment with higher depression scores compared with those with lower IA scores. In addition, those with higher levels of IA were more likely to exhibit rising levels of depressive symptoms toward the end of the treatment, whereas patients with lower levels of IA maintained reduced depressive symptoms through termination. These results suggest that presence of IA may predict a less successful treatment outcome for adults with depression, as IA may slow down the process of symptom reduction and correlate with relapse.

Technological Addictions

PURPOSE OF REVIEW

Modern methods of communication and engagement, such as social media, video games, and online shopping, use a variety of behavioral techniques to encourage and reward frequent use, opening the door to addiction. The technological addictions (TAs) are a set of disorders that accompany the technological advances that define the digital age. The TAs are an active source of research in the literature, with promising treatment options already available.

RECENT FINDINGS

There are promising therapeutic and psychopharmacologic treatments for a broad range of TAs. Stimulants, antidepressants, and cognitive therapies may all be effective for internet gaming disorder (IGD). Cognitive therapies may be effective for other TAs, such as social media addiction (SMA), online shopping addiction (OSA), and online porn addiction. Society's dependence on addictive technologies will only increase. Many of the TAs can be addressed with medication and therapy, with more research and literature developing at a rapid pace.

Online dialectical behavioral therapy for adults with internet addiction: A quasi-experimental trial during the COVID-19 pandemic

The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.

Technological Addictions

Modern technology rewards constant engagement and discourages sparing use, opening the door to unhealthy use and even addiction. The technological addictions (TAs) are a newly described set of disorders that come with the technological advances that define the new era. Internet gaming disorder (IGD) is already codified as a proposed diagnosis in the 5th Edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. Others, such as social media addiction (SMA), are in the earlier stages of our understanding. This article provides an overview of the more common TAs including their evaluation and treatment techniques.

Resource-Strengthening Training for Parents of Adolescents with Problematic Gaming (Res@t-P): A Clinical Pilot Study

Background: Problematic gaming (PG) has become an increasing mental health issue among adolescents during the preceding years. The role of parents and the family environment in the development of PG has been repeatedly emphasized. However, the structured involvement of parents in the therapy is still largely insufficient. Resource-strengthening training for parents of adolescents with PG (Res@t-P) is a new parent-centered 8-week group intervention to fill this substantial gap. The present pilot study aimed to collect first information on its potential effectiveness in improving parental and family factors. Methods: The study was conducted in a clinical setting with N = 43 parents of adolescents with PG, applying a pre- and post-follow-up design. Standardized questionnaires on psychological stress perception, family communication, family functioning, media rules, and adolescent PG symptoms were applied at three measurement points (before, at the end of, and 6 weeks after the training). Conditional growth models were estimated. Results: Over time, an improvement in parental and family aspects as well as a reduction in adolescent PG symptoms could be observed. Conclusions: The results of the present pilot study on the effectiveness of Res@t-P are promising. No causal inferences can be drawn at this stage. A randomized-controlled intervention study is highly warranted.

Substance and Behavioral Addictions, and Their Consequences among Vulnerable Populations

"Vulnerable populations" in health behavior research, practice and policy is generally used to refer to groups that, due to their life circumstances, may require extra consideration, reasonable accommodation, and legitimized protection [...].

Characteristics of Gamers who Purchase Loot Box: a Systematic Literature Review

Purpose of Review

Research has indicated that loot boxes are risky gaming components that could exacerbate Internet gaming disorder due to a link between loot box purchasing and gambling. We conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between loot boxes and gambling, and (c) between loot boxes and other variables.

Recent Findings

Of the 201 studies examined for eligibility, we reviewed 20 studies that met the predefined criteria, which were extracted by searching electronic databases (PsycINFO, PubMed, Ovid, EBSCO, and Web of Science) and the reference lists of included studies, and that were published up to March 27, 2021. Overall, this review identified positive relationships among Internet gaming disorder–related symptoms, disordered gambling symptoms, and engagement with, or investment in, loot boxes. In addition to gaming and gambling, the relationships among some variables, such as mood, gender, physiological state, motivation, and loot box engagement, were examined.

Summary

The present review clarified relationships between loot box engagement, gaming, gambling, and other variables, such as mood, gender, physiological state, and motivation, and partially identified the characteristics of people who purchase loot boxes using real money. Specifically, those who spend more money in-game on loot boxes exhibit Internet gaming–related and/or disordered gambling symptoms and behaviors. Finally, we discussed future directions for clinical psychological studies on loot boxes.

The efficacy of a training program for social skills in reducing addictive Internet behaviors among Palestinian university students

Background

For youth in geopolitically at-risk environments, such as Palestine, the issues related to Internet overuse and addictions are complex. Youth residing in the occupied territories of Palestine as in other highly militarized zones have high levels of environmental stressors (e.g., militarization, poverty, lack of employment opportunities, cultural pressures, etc.) and few chemical or social outlets such as alcohol, intoxicants, and leisure activities. As such, the easily accessible and unrestricted opportunities for stress-reducing social contact of social media can lead easily to excessive and maladaptive Internet use. Therefore, interventions directly aimed at awareness and education on how to manage Internet use are critical for addressing these issues in high risk populations.

Aims

The purpose of the current study was to test the efficacy of a time-limited group training program aimed at improving social skills and reducing addictive Internet behaviors among university students.

Methods and results

The sample consisted of 30 university students who self-reported high scores on an Internet addiction scale. Participants were randomly assigned to either wait list or treatment group (15 in each condition). Results demonstrated that using a social skills training program over an 8-week period improved the level of social skills and reduced addictive Internet behaviors significantly in those who experienced the intervention when compared with a wait list control group.

Conclusions

These findings support the implementation of time limited training programs targeting social skills and addictive patterns of Internet use with university students identified with high levels of Internet addictive behaviors.

The effects of cognitive-behavioral group therapy for reducing symptoms of internet addiction disorder and promoting quality of life and mental health

INTRODUCTION

Internet addiction disorder has reportedly become an important cause of health and social problems. The aim of this study was to investigate the effectiveness of cognitive-behavioral group therapy for internet addiction symptoms, quality of life, and mental health of students with internet addiction.

METHODS

This was a quasi-experimental study with pretest-posttest measures and a control group. The statistical population of the study consisted of all students at Tehran universities in the academic year of 2018-19. The target group was selected through an internet addiction test and a clinical interview using a targeted sampling method and was divided into experimental and control groups by randomization. The experimental group participated in fifteen 90-minute cognitive-behavioral group therapy sessions. Before, immediately after, and 3 months after the treatment, the internet addiction symptoms of both groups were evaluated to assess mental health with the IAT, quality of life (QOL), and SCL-90-R questionnaires. Data were analyzed with ANCOVA analysis using SPSS Statistics 20 software.

RESULTS

After treatment, cognitive-behavioral therapy groups showed reductions in internet addiction scores (p < 0.05). Results showed that the cognitive-behavioral group therapy was effective for improving quality of life (p < 0.05) and mental illnesses (p < 0.05) in students with internet addiction.

CONCLUSIONS

Cognitive-behavioral group therapy can enhance awareness and mental health of students with internet addiction. Therefore, this intervention can be used as a beneficial treatment to reduce internet addiction symptoms and improve the condition of people with behavioral addictions such as internet dependency.

Gaming Disorder: How to Translate Behavioral Neuroscience Into Public Health Advances

Purpose of Review

Gaming disorder (GD), meanwhile classified as a mental disorder in both DSM-5 and ICD-11, is a current public health issue. Theoretical models assume core psychological processes, such as cue reactivity, craving, reward processing, decision-making, cognitive biases, inhibitory control, and stress relief, to be crucially involved in the development and maintenance of GD. This review summarizes neuroscientific findings on these processes in the context of GD as well as treatments and intervention programs addressing these processes.

Recent Findings

We identified overlaps regarding the involvement of neural structures and networks related to psychological processes which may be targeted by public health programs. Complex interactions between executive control, salience, reward, and habit networks are crucially linked to processes involved in GD and public health programs respectively.

Summary

We point at the difficulties of making one to one assignments of neural networks to psychological processes or interventions. Furthermore, new treatment and prevention programs of GD are discussed pointing at possible future directions for neuroscientific research and treatment programs for GD.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Treatments for internet addiction, sex addiction and compulsive buying: A meta-analysis

BACKGROUND AND AIMS

Internet addiction, sex addiction and compulsive buying are common behavioral problems, which share similarities with gambling disorder and substance use disorders. However, little is known about the efficacy of their treatments. The objective of this meta-analysis was to examine the efficacy of the treatments of such problem behaviors, and to draw parallels to gambling disorder and substance use disorders in terms of treatment response.

METHODS

Literature search yielded 91 studies totaling 3,531 participants to provide a comprehensive evaluation of the short-term and long-term efficacy of psychological, pharmacological and combined treatments for internet addiction, sex addiction, and compulsive buying.

RESULTS

Psychological, pharmacological, and combined treatments were associated with robust pre-post improvements in the global severity of internet addiction (Hedges's g: 1.51, 1.13, and 2.51, respectively) and sex addiction (Hedges's g: 1.09, 1.21, and 1.91, respectively). For compulsive buying, psychological and pharmacological treatments were also associated with a large-sized pre-post reduction in global severity (Hedges's g: 1.00 and 1.52, respectively). The controlled pre-post and within-group pre-follow-up effect sizes were in the similar range, with few exceptions. Moderator analyses suggest that psychological interventions are effective for reducing compulsive behaviors, especially when delivered face-to-face and conducted over extended periods of time. Combinations of cognitive-behavioral approaches with medications showed an advantage over monotherapies.

DISCUSSION AND CONCLUSIONS

The results suggest that treatments for common behavioral addictions are effective in the short term, similar to those implemented for gambling disorder and substance use disorders, but more rigorous clinical trials are needed.

Psychological effects of cognitive behavioral therapy on internet addiction in adolescents: A systematic review protocol

BACKGROUND

In this study, we aim to assess the psychological effects of cognitive behavioral therapy (CBT) on internet addiction (IA) in adolescents.

METHODS

This study will search the following databases of Cochrane Library, PUBMED, EMBASE, Scopus, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these electronic databases will be searched from inception to the September 30, 2019 without any language limitation. Two authors will conduct study selection, data extraction, and study quality assessment, respectively. Any disagreements between 2 authors will be solved by a third author through discussion. Statistical analysis will be performed using RevMan 5.3 software.

RESULTS

This study will investigate the psychological effects of CBT on IA in adolescents by measuring psychopathological symptoms, depression, anxiety, time spent on the internet (hours/day), and health-related quality of life.

CONCLUSION

This study summarizes current evidence of CBT on IA in adolescents and may provide guidance for both intervention and future researches.PROSPERO registration number: PROSPERO CRD42019153290.

[Current approaches to the treatment and correction of Internet addiction]

According to WHO consensus decision, gambling disorder, including the form of Internet addiction (IA), should be included in the section 'Impulsive disorders and behavioral addictions' of ICD-11. Population studies in the USA and Europe show the prevalence of IA from 1.5 to 8.2%, and in the countries of Southeast Asia it reaches 20-30% among young people. All this raises questions about the development of standardized approaches to the treatment and correction of this disorder. The review covers pharmacological and non-pharmacological approaches. Several studies and clinical observations have been devoted to pharmacological methods for treating IA, including the successful use of antidepressants such as escitalopram, clomipramine, and bupropion. There are data on the effectiveness of quetiapine, clonazepam, naltrexone and methylphenidate. In general, research was limited to methodological deficiencies, including small sample sizes, lack of control groups etc. Of non-pharmacological and psychotherapeutic approaches, in particular, cognitive-behavioral therapy (CBT) is the most studied. Special programs CBT are developed focused on children and teenagers. In addition to CBT, other psychotherapeutic approaches were used for the correction of IA: reality therapy, Internet interventions, acceptance and responsibility therapy, family therapy, complex methods. In many countries educational medical camps have been established (for example, sports or other outdoor activities) for adolescents with IA. Further studies in the field are needed to develop treatment approaches and diagnostic classification of IA.

Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial

IMPORTANCE

Internet and computer game addiction represent a growing mental health concern, acknowledged by the World Health Organization.

OBJECTIVE

To determine whether manualized cognitive behavioral therapy (CBT), using short-term treatment for internet and computer game addiction (STICA), is efficient in individuals experiencing internet and computer game addiction.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter randomized clinical trial was conducted in 4 outpatient clinics in Germany and Austria from January 24, 2012, to June 14, 2017, including follow-ups. Blinded measurements were conducted. A consecutive sample of 143 men was randomized to the treatment group (STICA; n = 72) or wait-list control (WLC) group (n = 71). Main inclusion criteria were male sex and internet addiction as the primary diagnosis. The STICA group had an additional 6-month follow-up (n = 36). Data were analyzed from November 2018 to March 2019.

INTERVENTIONS

The manualized CBT program aimed to recover functional internet use. The program consisted of 15 weekly group and up to 8 two-week individual sessions.

MAIN OUTCOMES AND MEASURES

The predefined primary outcome was the Assessment of Internet and Computer Game Addiction Self-report (AICA-S). Secondary outcomes were self-reported internet addiction symptoms, time spent online on weekdays, psychosocial functioning, and depression.

RESULTS

A total of 143 men (mean [SD] age, 26.2 [7.8] years) were analyzed based on intent-to-treat analyses. Of these participants, 50 of 72 men (69.4%) in the STICA group showed remission vs 17 of 71 men (23.9%) in the WLC group. In logistic regression analysis, remission in the STICA vs WLC group was higher (odds ratio, 10.10; 95% CI, 3.69-27.65), taking into account internet addiction baseline severity, comorbidity, treatment center, and age. Compared with the WLC groups, effect sizes at treatment termination of STICA were d = 1.19 for AICA-S, d = 0.88 for time spent online on weekdays, d = 0.64 for psychosocial functioning, and d = 0.67 for depression. Fourteen adverse events and 8 serious adverse events occurred. A causal relationship with treatment was considered likely in 2 AEs, one in each group.

CONCLUSIONS AND RELEVANCE

Short-term treatment for internet and computer game addiction is a promising, manualized, short-term CBT for a broad range of internet addictions in multiple treatment centers. Further trials investigating the long-term efficacy of STICA and addressing specific groups and subgroups compared with active control conditions are required.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01434589.

Does cognitive-behavioral therapy reduce internet addiction? Protocol for a systematic review and meta-analysis

BACKGROUND

Cognitive-behavioral therapy has been considered as a means for internet addiction, but its long-term effect and the impact of internet addiction types and culture are still unclear.

OBJECTIVE

This study aims to assess the efficacy of cognitive-behavior therapy for internet addiction symptoms and associated other psychopathological symptoms.

METHOD AND ANALYSIS

We will search PubMed, Web of Knowledge, Ovid Medline, Chongqing Vip Database, Wanfang, and China National Knowledge Infrastructure database. Random-effects model in comprehensive meta-analysis software will be used to conduct main meta-analysis. Cochran Q and I are be used to assess heterogeneity while funnel plots and the Egger test are used to assess publication bias. Risk of bias for each study included is assessed by using the Cochrane risk of bias tool. The primary outcome is internet addiction symptom while secondary outcomes are psychopathological symptoms, time spent online, and dropout.

TRIALS REGISTRATION NUMBER

PROSPERO CRD42019125667.

Problematic interactive media use in teens: comorbidities, assessment, and treatment

Problematic Interactive Media Use (PIMU), aka internet or video game addiction, is increasingly presenting to pediatricians for care. The majority of youth now use mobile media almost constantly to communicate, learn, and entertain themselves, but for some, uncontrolled video gaming, social media use, pornography viewing, and information-bingeing on short videos or websites contribute to functional impairment. PIMU can result in academic failure, social withdrawal, behavioral problems, family conflict, and physical and mental health problems. There is no formal diagnosis to describe the spectrum of PIMU behaviors and therefore no standardized therapeutic interventions. Anticipatory guidance will help identify youth at risk and empower parents to recognize and prevent problems. In addition, epidemiology and etiology indicate that Attention-Deficit/Hyperactivity Disorder (ADHD), affective disorders, and Autism Spectrum Disorder (ASD) may predispose to and, in some cases, result from PIMU, offering opportunities for effective treatment by addressing underlying pathology that is manifesting itself in the interactive media environment. Efforts to establish evidence-based diagnoses, develop and evaluate therapeutic strategies, and to train clinicians in recognition and care of PIMU are reviewed.

[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.

The Current Status of Psychological Intervention Research for Internet Addiction and Internet Gaming Disorder

This integrative review assesses the effectiveness of psychological interventions for reducing the severity of Internet addiction and/or Internet gaming disorder. We searched five databases, and both a narrative synthesis and meta-analyses were conducted. Five randomized controlled trials (RCTs) and six quasi-experimental studies met the inclusion criteria. The included interventions were categorized as cognitive-behavioral therapy, family-based intervention, and counseling program. A meta-analysis showed significant effects of psychological interventions, whereas a narrative synthesis showed some evidence that they could reduce addiction severity. Psychological interventions may help to reduce addiction severity, but further RCTs are needed to identify the most effective type.

Social media addiction and social media reactions: The implications for job performance

We investigate the intersection of social media and the workplace, focusing on job performance impacts of employees' social media addictions and social media reactions through work-family balance and burnout. The research model is grounded in conservation of resources theory, which suggests social media compulsions and emotional reactions to co-worker's social media posts will deplete employees' energetic and constructive resources, making it difficult to achieve work-family balance and increasing the likelihood of job burnout, and will ultimately degrade job performance. A sample of 326 full-time employees revealed a negative relationship between social media addiction and work-family balance and a positive relationship between social media reactions and job burnout. Balance and burnout mediated the relationship between social media and job performance such that social media addiction was negatively related to job performance through work-family balance, and social media reactions were negatively related to performance through burnout and work-family conflict.

Anxiety-Related Coping Styles, Social Support, and Internet Use Disorder

Objective: The Internet can offer a seemingly safe haven for those being disappointed by relationships in the "offline world". Although the Internet can provide lonely people with opportunities to seek for help and support online, complete withdrawal from the offline world comes with costs. It is discussed if people can even become "addicted" to the Internet. Of note, meanwhile, many researchers prefer the term Internet use disorder (IUD) instead of using the term "Internet addiction". To illustrate the importance of one's own social network supporting a person in everyday life, we investigated, for the first time to our knowledge, how social resources in terms of quality and quantity might represent a buffer against the development of IUD. Furthermore, anxiety related coping styles are investigated as a further independent variable likely impacting on the development of an IUD. Method: In the present work, N = 567 participants (n = 164 males and n = 403 females; M_age = 23.236; SD_age = 8.334) filled in a personality questionnaire assessing individual differences in cognitive avoidant and vigilant anxiety processing, ergo, traits describing individual differences in everyday coping styles/modes. Moreover, all participants provided information on individual differences in tendencies toward IUD, the perceived quality of social support received, and the size of their social network (hence a quantity measure). Results: Participants with larger social networks and higher scores in the received social support reported the lowest tendencies toward IUD in our data. A vigilant coping style was positively correlated with tendencies toward IUD, whereas no robust associations could be observed between a cognitive avoidant coping style and tendencies toward IUD. Hierarchical linear regression underlined an important predictive role of the interaction term of vigilance in ego-threat scenarios and perceived quality of social support. Conclusion: The current study not only yields support for the hypothesis that the size of one's own social network as well as the perceived quality of social support received in everyday life present putative resilience factors against developing IUD. It also supports the approach that special coping styles are needed to make use of the social support offered.

Treatment efficacy of a specialized psychotherapy program for Internet Gaming Disorder

BACKGROUND AND AIMS

Internet Gaming Disorder (IGD) has become health concern around the world, and specialized health services for the treatment of IGD are emerging. Despite the increase in such services, few studies have examined the efficacy of psychological treatments for IGD. The primary aim of this study was to assess the efficacy of a specialized psychotherapy program for adolescents with IGD [i.e., the "Programa Individualizado Psicoterapéutico para la Adicción a las Tecnologías de la Información y la Comunicación" (PIPATIC) program].

METHODS

The sample comprised 31 adolescents (aged 12-18 years) from two public mental health centers who were assigned to either the (a) PIPATIC intervention experimental group or (b) standard cognitive-behavioral therapy (CBT) control group. The interventions were assessed at pre-, middle-, and post-treatment phases, as well as a 3-month assessment was carried out after completing the interventions.

RESULTS

No significant differences between either group in the pre-treatment phase were found. Relating to the different interventions examined, significant differences were found at pre-test and post-test on the following variables: comorbid disorders, intrapersonal and interpersonal abilities, family relationships, and therapists' measures. Both groups experienced a significant reduction of IGD symptoms, although the PIPATIC group experienced higher significant improvements in the remainder of the variables examined.

DISCUSSION AND CONCLUSIONS

The findings suggest that PIPATIC program is effective in the treatment of IGD and its comorbid disorders/symptoms, alongside the improvement of intra- and interpersonal abilities and family relationships. However, it should also be noted that standard CBT was also effective in the treatment of IGD. Changing the focus of treatment and applying an integrative focus (including the addiction, the comorbid symptoms, intra- and interpersonal abilities, and family psychotherapy) appear to be more effective in facilitating adolescent behavior change than CBT focusing only on the IGD itself.

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

OBJECTIVE

Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first-line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta-analytic techniques to determine the effectiveness of cognitive-behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming.

METHOD

A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre-post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity.

RESULTS

CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post-test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow-up were nonsignificant across the four treatment outcomes.

CONCLUSIONS

The pooled findings suggest that CBT for IGD is an effective short-term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long-term benefits of CBT for IGD.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive-behavioural therapy for IGD, which is often considered the first-line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short-term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment.

Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions

Over the past several decades, non-substance-use behaviors like gambling, gaming, and sex have received greater consideration as possible foci of addictions. In this article, I will review the recent history and current status of non-substance or behavioral addictions. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. Compulsive sexual behaviors (including problematic pornography use) will be considered, particularly with respect to how behavioral addictions may be considered in the forthcoming 11th edition of the International Classification of Diseases (ICD-11).

Internet gaming disorder in adolescence: Psychological characteristics of a clinical sample

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has become a topic of increasing research interest since its inclusion in Section 3 of the DSM-5. Given the lack of clinical studies concerning IGD, exploring the characteristics of clinical samples with IGD will help to delineate the gaming disorder construct and inform future treatment studies.

METHODS

Data collection consisted of clinical interviews comprising 31 male adolescents diagnosed with IGD. Alongside the clinical interviews, the participants were administered a battery of psychometric tests assessing the following: IGD, personality traits, comorbid symptomatology, emotional intelligence (EI), and family environment characteristics.

RESULTS

The results showed that the adolescents with IGD and their relatives reported a high number of hours per week and high presence of stressful life events in the majority of the sample. High scores on scales assessing depression, anxiety, and somatic disorders were found. However, the findings indicate the presence of several other comorbid disorders meaning that some of the adolescent sample with IGD had different clinical profiles. Several personality traits were found to be highly associated with IGD including introversion, inhibition, submissiveness, self-devaluation, interpersonal sensibility, obsessive-compulsive tendencies, phobic anxiety, and hostility, as well as paranoid and borderline personality traits. Other negative characteristics found in the present sample included a high level of social problems, low EI, and dysfunctional family relationships.

DISCUSSION AND CONCLUSIONS

The findings suggest a more global pattern of key psychological characteristics associated with Internet gaming disorder in adolescence. This may help in understanding the complexity of this proposed disorder and it may also help in designing more specialized interventions for adolescents with IGD. The findings have important implications for clinical practice and interventions.

Policy responses to problematic video game use: A systematic review of current measures and future possibilities

BACKGROUND AND AIMS

Empirical research into problematic video game playing suggests that overuse might cause functional and psychological impairments for a minority of gamers. Therefore, the need for regulation in the case of video games (whether governmental or self-imposed) has arisen but has only been implemented in a few countries around the world, and predominantly in Asia. This paper provides a systematic review of current and potential policies addressing problematic gaming.

METHODS

After conducting a systematic search in the areas of prevention, treatment, and policy measures relating to problematic Internet and video game use, papers were selected that targeted problematic gaming policies (N = 12; six in English and six in Korean). These papers served as the basis of this review.

RESULTS

Policies were classified into three major groups: (i) policy measures limiting availability of video games (e.g., shutdown policy, fatigue system, and parental controls), (ii) measures aiming to reduce risk and harm (e.g., warning messages), and (iii) measures taken to provide help services for gamers. Beyond the attempt to classify the current and potential policy measures, the authors also tried to evaluate their efficiency theoretically and (if data were available) empirically.

DISCUSSION AND CONCLUSIONS

Overall, it appears that although several steps have been taken to address problematic video game playing, most of these steps were not as effective as expected, or had not been evaluated empirically for efficacy. The reason for this may lie in the fact that the policies outlined only addressed or influenced specific aspects of the problem instead of using a more integrative approach.

Effects of a group activity-based motivational enhancement therapy program on social media addictive behaviors among junior high school students in Thailand: a cluster randomized trial

Purpose

This study aimed to assess the effects of a group activity-based motivational enhancement therapy (GA-MET) program on social media addictive behaviors among junior high school students.

Materials and methods

This cluster randomized trial was performed in 245 junior high school students who used social media in the lower part of northeast Thailand. The GA-MET program group and the control group sessions lasted 8 weeks and were followed up 4 weeks later. The addictive social media behaviors, average duration of social media usage during weekdays and weekends (hours/day), child behaviors, self-esteem, and depression were investigated using a self-reported questionnaire. Multivariable linear regression was used to compare the mean and 95% CIs between two groups.

Results

The GA-MET program significantly decreased the average duration of social media usage during weekdays and weekends (hours/day) (−1.27, 95% CI: −2.18,−0.37 and −1.25, 95% CI: −2.22, −0.29, respectively), emotional behavior (−0.69, 95% CI: −1.18, −0.19), and depression (−4.03, 95% CI: −6.07, −1.99) in the treated group compared to the control group.

Conclusion

The GA-MET program could reduce the risk of social media addictive behaviors in junior high school students in Thailand by decreasing time spent on social media, emotional behaviors, and depression.

Adolescent Internet Abuse: A Study on the Role of Attachment to Parents and Peers in a Large Community Sample

Adolescents are the main users of new technologies and their main purpose of use is social interaction. Although new technologies are useful to teenagers, in addressing their developmental tasks, recent studies have shown that they may be an obstacle in their growth. Research shows that teenagers with Internet addiction experience lower quality in their relationships with parents and more individual difficulties. However, limited research is available on the role played by adolescents' attachment to parents and peers, considering their psychological profiles. We evaluated in a large community sample of adolescents (N = 1105) the Internet use/abuse, the adolescents' attachment to parents and peers, and their psychological profiles. Hierarchical regression analyses were conducted to verify the influence of parental and peer attachment on Internet use/abuse, considering the moderating effect of adolescents' psychopathological risk. Results showed that adolescents' attachment to parents had a significant effect on Internet use. Adolescents' psychopathological risk had a moderating effect on the relationship between attachment to mothers and Internet use. Our study shows that further research is needed, taking into account both individual and family variables.

Treatments for Internet gaming disorder and Internet addiction: A systematic review

Problems related to excessive use of the Internet and video games have recently captured the interests of both researchers and clinicians. The goals of this review are to summarize the literature on treatment effectiveness for these problems and to determine whether any treatments meet the minimum requirement of an evidence-based treatment as defined by Chambless et al. (1998). Studies of treatments for Internet gaming disorder (IGD) and Internet addiction were examined separately, as past studies have linked IGD to more severe outcomes. The systematic review identified 26 studies meeting predefined criteria; 13 focused on treatments for IGD and 13 on Internet addiction. The results highlighted a paucity of well-designed treatment outcome studies and limited evidence for the effectiveness of any treatment modality. Studies were limited by methodological flaws, including small sample sizes, lack of control groups, and little information on treatment adherence, among other problems. In addition, the field is beset by a lack of consistent definitions of and established instruments to measure IGD and Internet addiction. The results of this review highlight the need for additional work in the area of treatment development and evaluation for IGD and Internet addiction. Attention to methodological concerns identified within this review should improve subsequent research related to treating these conditions, and ultimately outcomes of patients suffering from them. (PsycINFO Database Record

The Treatment of Internet Gaming Disorder: a Brief Overview of the PIPATIC Program

Over the last decade, there has been an increase in children and adolescents accessing psychology services regarding problematic use of online videogames. Consequently, providing effective treatment is essential. The present paper describes the design process of a manualized PIPATIC (Programa Individualizado Psicoterapéutico para la Adicción a las Tecnologías de la información y la comunicación) intervention program for 12- to 18-year-old adolescents with Internet Gaming Disorder. The design and application of the PIPATIC program integrates several areas of intervention structured into six modules: psychoeducational, treatment as usual, intrapersonal, interpersonal, family intervention, and development of a new lifestyle. The program’s goals are to reduce the addiction symptoms related to online videogames and to improve the well-being of adolescents. Preliminary findings suggest positive and encouraging effects.

Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions

Over the past several decades, non-substance-use behaviors like gambling, gaming, and sex have received greater consideration as possible foci of addictions. In this article, I will review the recent history and current status of non-substance or behavioral addictions. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. Compulsive sexual behaviors (including problematic pornography use) will be considered, particularly with respect to how behavioral addictions may be considered in the forthcoming 11th edition of the International Classification of Diseases (ICD-11).

Treatment and risk factors of Internet use disorders

Recently, many young people have developed Internet use disorders (IUD) as a result of the proliferation of Internet-enabled devices, leading to serious health and social problems worldwide. On occasion, medical and educational institutions, governments, and other groups have sought to take preventive action or treat IUD. In many cases, the preferred treatment for IUD is to set recommendations for appropriate Internet use. Reportedly, psychosocial therapies (including cognitive behavioral therapy, family therapy, and compound therapy) for IUD and pharmacotherapies (including antidepressant drugs and psychostimulants) for comorbid psychiatric or development disorders have been effective at reducing the degree and symptoms of IUD. In some countries, treatment camps have been developed for adolescents with IUD, and preventive education (including lectures and group discussions) has been provided for general adolescents. Such efforts have been effective at reducing the average degree of IUD severity. Some future IUD risk factors (e.g. being male, suffering from attention-deficit hyperactivity disorder, and exhibiting deteriorating psychiatric symptoms) have begun to be identified. However, clinical studies, treatment, and preventive actions are insufficient for treating IUD and standard treatments and preventive systems have yet to be established. Educational and medical institutions, government, families, and others must take greater action and cooperate more effectively in order to treat or prevent IUD.

Treatment of Internet gaming disorder: An international systematic review and CONSORT evaluation

Treatment services for Internet gaming disorder are becoming increasingly prevalent worldwide, particularly in East Asia. This international systematic review was designed to appraise the quality standards of the gaming disorder treatment literature, a task previously undertaken by King et al. (2011) prior to the inclusion of Internet gaming disorder in Section III of the DSM-5 and 'Gaming disorder' in the draft ICD-11. The reporting quality of 30 treatment studies conducted from 2007 to 2016 was assessed. Reporting quality was defined according to the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. The results reaffirmed previous criticisms of these trials, namely: (a) inconsistencies in the definition, diagnosis, and measurement of disordered use; (b) lack of randomization and blinding; (c) lack of controls; and (d) insufficient information on recruitment dates, sample characteristics, and effect sizes. Although cognitive-behavioral therapy has a larger evidence base than other therapies, it remains difficult to make definitive statements on its benefits. Study design quality has not improved over the last decade, indicating a need for greater consistency and standardization in this area. Continuing international efforts to understand the core psychopathology of gaming disorder are vital to developing a model of best practice in treatment.

Treatment with the Self-Discovery Camp (SDiC) improves Internet gaming disorder

INTRODUCTION

Internet gaming disorder (IGD) is a novel behavioral addiction that influences the physical, mental, and social aspects of health due to excessive Internet gaming. One type of intensive treatment for IGD is the therapeutic residential camp (TRC), which comprises many types of therapies, including psychotherapy, psychoeducational therapy, and cognitive behavioral therapy. The TRC was developed in South Korea and has been administered to many patients with IGD; however, its efficacy in other countries remains unknown. We investigated the efficacy of the Self-Discovery Camp (SDiC), a Japanese version of a TRC, and the correlations between individual characteristics and outcome measures.

METHODS

We recruited 10 patients with IGD (all male, mean age=16.2years, diagnosed using the DSM-5) to spend 8 nights and 9days at the SDiC. We measured gaming time as well as self-efficacy (using the Stages of Change Readiness and Treatment Eagerness Scale, a measure of therapeutic motivation and problem recognition).

RESULTS

Total gaming time was significantly lower 3months after the SDiC. Problem recognition and self-efficacy towards positive change also improved. Furthermore, there was a correlation between age of onset and problem recognition score.

CONCLUSIONS

Our results demonstrate the effectiveness of the SDiC for IGD, especially regarding gaming time and self-efficacy. Additionally, age of onset may be a useful predictor of IGD prognosis. Further studies with larger sample sizes and control groups, and that target long-term outcomes, are needed to extend our understanding of SDiC efficacy.

eHealth Intervention for Problematic Internet Use (PIU)

Excessive use of the Internet is considered a problematic behaviour by clinicians and researchers. Cognitive behaviour therapy (CBT) has been advocated for a long time as a treatment approach and has been extended to include family therapy in the recent years. As eTherapy (eHealth) has become an important component in the treatment of many mental health problems, it is prudent to explore the current status of the eHealth approach as an intervention option for this problem. This systematic review aims to examine the current development of online intervention programmes for this particular condition. The PRISMA guidelines for systematic reviews and meta-analysis were employed to conduct the search for literature following a systematic and structured approach. Of the 182 articles screened, three satisfied the selection criteria. Information was extracted and analysed systematically for each study and tabulated. All these studies were pilot studies with small sample sizes. Two of these articles aimed to explore the therapeutic efficacy of newly developed online intervention programmes for Internet addiction (IA) and online gaming addiction. The third article described the design and development of an App for smartphone addiction. The results obtained from this review have provided insight into the on-going development of eHealth interventions as well as the health informatics approaches in offering a possible and practical solution to tackle this growing problem.

Longitudinal Associations between Anhedonia and Internet-Related Addictive Behaviors in Emerging Adults

Internet addiction (including online gaming) has been associated with depression. However, most prior research relating internet addiction symptomatology to depressive symptoms has been cross-sectional, conducted with children and adolescents, and only examined depressive symptoms as a broad construct. The purpose of the current study was to examine potential longitudinal associations between anhedonia (i.e., difficulty experiencing pleasure, a key facet of depression) and internet-related addictive behaviors in 503 at-risk emerging adults (former attendees of alternative high schools). Participants completed surveys at baseline and approximately one year later (9-18 months later). Results indicated that trait anhedonia prospectively predicted greater levels of compulsive internet use and addiction to online activities as well as a greater likelihood of addiction to online/offline video games. These findings suggest that anhedonia may contribute to the development of internet-related addictive behaviors in the emerging adult population. Thus, interventions that target anhedonia in emerging adulthood (e.g., bupropion treatment or behavioral activation therapy) may help prevent or treat internet addiction.

Internet addiction and problematic Internet use: A systematic review of clinical research

AIM

To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science.

METHODS

Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally.

RESULTS

The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment.

CONCLUSION

A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

Behavioral addictions in addiction medicine: from mechanisms to practical considerations

Recent progress has been made in our understanding of nonsubstance or "behavioral" addictions, although these conditions and their most appropriate classification remain debated and the knowledge basis for understanding the pathophysiology of and treatments for these conditions includes important gaps. Recent developments include the classification of gambling disorder as a "Substance-Related and Addictive Disorder" in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and proposed diagnostic criteria for Internet Gaming Disorder in Section 3 of DSM-5. This chapter reviews current neuroscientific understandings of behavioral addictions and the potential of neurobiological data to assist in the development of improved policy, prevention, and treatment efforts.