Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study protocol for a randomized controlled trial

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.

A randomized controlled trial to assess effectiveness of GamE- an e-Health intervention to self-manage gaming with an aim to prevent gaming disorder

Gaming disorder is a health concern associated with significant impairment. Digital technology can be helpful for implementing preventive measures for gaming disorder. This randomized trial aimed to assess the effectiveness of an e-Health intervention to prevent gaming disorder among college students. This randomized trial compared an online intervention module aimed at improving knowledge, skill and attitude of the students and empower them with self- help strategies to monitor and regulate their gaming behavior with an aim to prevent gaming disorder, with wait list control. The sample comprised of 30 cases and 33 controls. The understanding of the concept of gaming, understanding of difference between gaming and gaming disorder, understanding of adverse effects associated with gaming disorder, understanding of screening of gaming disorder and self-help techniques of regulating gaming disorder increased more in the intervention group than control. The participants most favored self-monitoring and strategies to promote healthy lifestyles for regulating gaming. Online digital intervention can be effectively used as a strategy to prevent gaming disorder among college students. Such an intervention can empower students with strategies to regulate their extent of gaming.

Clinical Considerations in Internet and Video Game Addiction Treatment

In order to address etiologic, clinical, and treatment strategies applicable to Internet and video game addiction (IVGA), a working definition of addiction is presented and unique aspects of Internet and screen use disorders and addictive patterns are discussed. Addictions share common neurobiological mechanisms, cause, triggers, and behavioral sequelae-often presenting with similar symptomatology-although severity and impairment vary widely. This article reviews etiologic and neurobiological antecedents to Internet and video game addiction.

Problematic internet use: The effect of comorbid psychopathology on treatment outcomes

Problematic Internet use (PIU) behaviours involve one's maladaptive Internet use and have been often described as secondary manifestations of pre-existing psychopathology. Furthermore, different profiles of PIU sufferers have been proposed. However, little is known of the impact these may be having on treatment responses. Thus, this study aims to investigate the psychopathological profiles of those who seek treatment for PIU within a specialised public outpatient unit and whether these influence treatment outcomes. This research utilised 203 treatment seekers of the Specialized Department of Problematic Internet Use (SD-PIU) of the Psychiatric Hospital of Attica, in Greece (mean age = 26.02; SD = 7.9). To assess psychopathology, the Symptom Checklist-90 Revised (SCL-90-R) was used. Treatment responses were reported either as completed, continued, or drop out. A Latent Class/Profiling-Analysis (LCA) was performed, guided by variations across the SCL-90-R psychopathologies. It indicated two naturally occurring profiles of comorbid psychological symptoms; 66% were classified as the "High Comorbidity" (HC) and 34% as the "Low Comorbidity" (LC) profile. Regarding treatment outcomes, LC patients presented with significantly lower dropout rates and higher levels of completion. The present study poses imperative clinical implications regarding the necessity of specialized treatment planning based on the different PIU treatment seekers psychopathological comorbidities.

[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.

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.

Treatment Considerations in Internet and Video Game Addiction: A Qualitative Discussion

Internet and video game addiction has been a steadily developing consequence of modern living. Behavioral and process addictions and particularly Internet and video game addiction require specialized treatment protocols and techniques. Recent advances in addiction medicine have improved our understanding of the neurobiology of substance and behavioral addictions. Novel research has expanded the ways we understand and apply well-established addiction treatments as well as newer therapies specific to Internet and video game addiction. This article reviews the etiology, psychology, and neurobiology of Internet and video game addiction and presents treatment strategies and protocols for addressing this growing problem.

Under the umbrella

The inclusion of Internet Gaming Disorder as a preliminary diagnosis subsumed in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has provoked mixed reactions. On the one hand, it has been appreciated as an important sign stressing the negative health-related impact of that disorder. Likewise, the definition of diagnostic criteria helps scientists and clinicians to refer to mandatory indicators associated with a health problem. On the other hand, it has been objected that this new diagnosis bears the danger of pathologizing normal behaviors that are a feature of healthy recreational activity for many people. However, the existence of diagnostic criteria is meant to avoid this danger. This emphasizes the necessity of being able to refer to as accurate defined criteria as possible. In its current version, the DSM criteria display not only strengths but also ambiguities. Both types will be discussed and necessary ideas to resolve those ambiguities will be presented for further research.

The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction

Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents' Concerns for Children's Smartphone Activities Scale to measure parental monitoring and supervision of adolescents' smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents' Concerns for Children's Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents' concerns for their children's smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction.

Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy

BACKGROUND

The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life.

OBJECTIVE

This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).

METHODS

Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction.

RESULTS

Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.

CONCLUSIONS

This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.

[Biological basis of problematic internet use (PIN) and therapeutic implications]

The repetitive excessive use of internet has led to an increasing number of reports about the negative consequences of overuse and is now viewed as an important public health issue, although the diagnosis of internet addiction remains problematic. Increasing knowledge about the neurobiological mechanism of behavioral addictions will promote future research and is essential for the development of specific and effective treatment. Growing evidence suggests that the neurobiological substrates and pathways of internet addiction resemble those of substance dependency and other forms of behavioral addictions. This paper reviews the current neuroimaging findings and genetic influencing factors for problematic internet use (PIN)/internet addiction. Recent evidence from neuro-scientific studies has pointed out that certain dysfunctions in the prefrontal cortex possibly driven by impaired dopamine neurotransmission are related to symptoms of internet addiction. Finally the literature on psychological and pharmacological interventions for internet addiction will be discussed. However, due to a lack of methodological sound treatment studies in this field it is currently impossible to recommend any evidence-based treatment of internet addiction.

Internet Gaming Disorder in the DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes in its research appendix a potential new diagnosis-Internet gaming disorder. This article outlines the debate surrounding non-substance addictions and the rationale for including this condition in the "Conditions for Further Study" chapter in DSM-5 Section III. It also describes the diagnostic criteria that DSM-5 recommends and methods to assess Internet gaming disorder. The paper details international research related to prevalence rates, demographic, psychiatric, and neurobiological risk factors, the natural course of the condition, and promising treatment approaches. The paper concludes by describing important issues for research to address prior to official recognition of this condition as a mental disorder.

Altered reward processing in pathological computer gamers--ERP-results from a semi-natural gaming-design

INTRODUCTION

Internet Gaming Disorder has been added as a research diagnosis in section III for the DSM-V. Previous findings from neuroscientific research indicate an enhanced motivational attention toward cues related to computer games, similar to findings in substance-related addictions. On the other hand in clinical observational studies tolerance effects are reported by patients with Internet Gaming disorder. In the present study we investigated whether an enhanced motivational attention or tolerance effects are present in patients with Internet Gaming Disorder.

METHODS

A clinical sample from the Outpatient Clinic for Behavioral Addictions in Mainz, Germany was recruited, fulfilling the diagnostic criteria for Internet Gaming Disorder. In a semi-natural EEG design participants played a computer game during the recording of event-related potentials to assess reward processing.

RESULTS

The results indicated an attenuated P300 for patients with Internet Gaming Disorder in response to rewards in comparison to healthy controls, while the latency of N100 was prolonged and the amplitude of N100 was increased.

CONCLUSIONS

Our findings support the hypothesis that tolerance effects are present in patients with Internet Gaming Disorder, when actively playing computer games. In addition, the initial orienting toward the gaming reward is suggested to consume more capacity for patients with Internet Gaming Disorder, which has been similarly reported by other studies with other methodological background in disorders of substance-related addictions.

A cognitive-behavioral model of Internet gaming disorder: theoretical underpinnings and clinical implications

Cognitive contributions to the behaviors observed in substance and non-substance addictions have been investigated and characterized. Based on models of drug addictions and the extant literature on Internet gaming disorder (IGD), we propose a cognitive-behavioral model for conceptualizing IGD. The model focuses on three domains and their roles in addictive behaviors. The three domains include motivational drives related to reward-seeking and stress-reduction, behavioral control relating to executive inhibition, and decision-making that involves weighing the pros and cons of engaging in motivated behaviors. Based on this model, we propose how behavioral therapies might target these domains in the treatment of IGD.

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

Internet addiction is regarded as a growing health concern in many parts of the world with prevalence rates of 1-2% in Europe and up to 7% in some Asian countries. Clinical research has demonstrated that Internet addiction is accompanied with loss of interests, decreased psychosocial functioning, social retreat, and heightened psychosocial distress. Specialized treatment programs are needed to face this problem that has recently been added to the appendix of the DSM-5. While there are numerous studies assessing clinical characteristics of patients with Internet addiction, the knowledge about the effectiveness of treatment programs is limited. Although a recent meta-analysis indicates that those programs show effects, more clinical studies are needed here. To add knowledge, we conducted a pilot study on the effects of a standardized cognitive-behavioral therapy program for IA. 42 male adults meeting criteria for Internet addiction were enrolled. Their IA-status, psychopathological symptoms, and perceived self-efficacy expectancy were assessed before and after the treatment. The results show that 70.3% of the patients finished the therapy regularly. After treatment symptoms of IA had decreased significantly. Psychopathological symptoms were reduced as well as associated psychosocial problems. The results of this pilot study emphasize findings from the only meta-analysis conducted so far.

Clinical approaches to treatment of Internet addiction

BACKGROUND

Internet appearance was one of the main breakthroughs for the mankind in the latest decades. It revolutionized our lives in many aspects and brought about many undeniably positive changes. However, at the same time caused negative consequences. It has led to the emergence of the Internet addiction (IA). The paper is concerned with the issue of treatment of IA.

METHOD

The paper reviews the current findings on the approaches to IA treatment and evaluates their effectiveness. The main focus of the article concentrates on cognitive and pharmacologic treatment.

RESULTS

The individual approach to IA treatment is advisable. Among drugs for the management of IA, antidepressants, antipsychotics, opioid receptor antagonists, glutamate receptor antagonists, and psychostimulants may be recommended. Some antiepileptics, and especially valproate, are considered as potential drugs for the treatment of IA.

CONCLUSION

Effective therapy may require an individual approach and best results are expected when psychological and pharmacological treatments are combined.

Der Zusammenhang von Mobbingerfahrungen, Copingstilen und pathologischem Internetgebrauch bei Jugendlichen

Fragestellung: In der vorliegenden Studie wurde untersucht, ob ein Zusammenhang zwischen pathologischem Internetgebrauch, Mobbing und Copingstilen bei Jugendlichen mit Mobbingerfahrungen besteht. Methodik: Im Rahmen einer europäischen schulbasierten Studie (SEYLE) wurde eine repräsentative Querschnittsuntersuchung an 1357 Schülern aus Heidelberg und Umgebung durchgeführt (710 weibliche/647 männlich Jugendliche; mittleres Alter 14.7; SD 0.8). Pathologischer Internetgebrauch wurde mit dem Young Diagnostic Questionnaire erhoben. Mobbing wurde in verbales, körperliches Mobbing und Mobbing in der Beziehung unterteilt. Hinsichtlich der Copingstile wurden aktives Coping, Vermeidung, Hilfe suchen und sonstige Strategien unterschieden. Als Kovariate wurde die psychische Symptombelastung mittels Strengths and Difficulties Questionnaire erfasst. Ergebnisse: 4.8 % der Schüler wiesen einen pathologischen Internetgebrauch auf, 14.4 % zeigten einen problematischen Internetgebrauch. Insgesamt berichteten 52.3 % der Jugendlichen über Erfahrungen mit Mobbing (38.7 % verbales Mobbing, 19.8 % körperliches Mobbing, 34.1 % Mobbing in der Beziehung). Es bestand ein signifikanter Zusammenhang von Mobbingerfahrungen und pathologischem Internetgebrauch, der zum Teil durch die psychische Symptombelastung erklärt werden konnte. Hinsichtlich der Copingstile bei stattgefundenem Mobbing bestand kein signifikanter Unterschied zwischen Schülern mit normalem, problematischem und pathologischem Internetgebrauch. Schlussfolgerungen: Aufgrund des Zusammenhanges zwischen Mobbing, psychischer Symptombelastung und pathologischem Internetgebrauch sind in der Zukunft schulbasierte sowie familienbezogene Präventionsmaßnahmen und evaluierte Therapieprogramme erforderlich.

Addressing the question of disorder-specific risk factors of internet addiction: a comparison of personality traits in patients with addictive behaviors and comorbid internet addiction

Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction.

[The future of psychotherapy in psychosomatic medicine]

OBJECTIVE

To review the current perspectives and trends of psychotherapy as a key area of psychosomatic medicine with regard to both societal and scientific challenges as well as patient health care services. Also, to draw conclusions regarding the future training and practice of psychosomatic medicine and psychotherapy.

RESULTS

Psychotherapy is confronted with many new challenges because of the high prevalence of mental and psychosomatic disorders, because of their increasing recognition as major health problems and because of the rapid technological and demographic changes going on in modern society. Despite its growth, psychotherapeutic care is still limited in many, especially rural, regions and for patients with complex psychosomatic and somatopsychic disorders.

CONCLUSIONS

New models of training as well as integrated and multimodal care are needed in order to provide both, rapid, low-threshold and specialized, disorder-specific care.