Gamification for Internet Gaming Disorder Prevention: Evaluation of a Wise IT-Use (WIT) Program for Hong Kong Primary Students

Ambivalent User Needs as a Challenge and Chance for the Design of a Web-Based Intervention for Gaming Disorder: Qualitative Interview Study With Adolescents and Young Adults

BACKGROUND

In Germany, there are still many young people with gaming disorder (GD) who do not use or cannot access existing treatment services. Given the increasing prevalence of internet use disorders and GD, especially among young people in Germany, there is a need to provide additional low-threshold treatment options that are easily accessible anywhere. Web-based interventions (WBIs) can be used to achieve this goal.

OBJECTIVE

The aim of this study was to explore the treatment needs of young people with GD in Germany and derive implications for the development of a self-guided WBI for GD.

METHODS

Using a qualitative study design, we conducted a focus group with 3 young male adults and semistructured individual interviews with 3 male adolescents. Data were analyzed using qualitative content analysis. The reporting of this study followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

RESULTS

Participants' expectations of web-based help in general and of a self-guided WBI for GD revealed a wide variety of sometimes conflicting user needs. For example, by analyzing participants' experiences with successful strategies, we found that external stabilizers (eg, parental control and support group meetings) were helpful in managing GD. However, with regard to a WBI, participants described it as a barrier if the WBI created "too much pressure." On the other hand, "not enough pressure" (ie, not enough external control) was also mentioned as a barrier. The belief that gaming is rewarding and that only equally rewarding activities are successful alternatives to gaming is in tension with the fact that changing problematic gaming behavior can be stressful and not feel rewarding at all. The data also showed that, on the one hand, a WBI should be designed to be attractive (eg, by incorporating gaming elements) but that it should not be too attractive as this, in turn, could trigger GD.

CONCLUSIONS

A self-guided WBI for GD should consider and address conflicting user needs. Ambivalence of needs in the face of coping with GD should not be seen as a problem but as a normal part of a change process and, therefore, actively integrated into the WBI concept and storyline.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00032334; https://drks.de/search/en/trial/DRKS00032334.

Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review

BACKGROUND

Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions.

OBJECTIVE

We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use.

METHODS

We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website.

RESULTS

We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions.

CONCLUSIONS

As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation.

TRIAL REGISTRATION

PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387.

Decoding and modifying dynamic attentional bias in gaming disorder

With the spread of smartphones and computer games, concerns have escalated regarding the rising prevalence of gaming disorder. Patients often display attentional biases, unconsciously turning their attention towards gaming-related stimuli. However, attempts to discover and ameliorate these attentional deficits have yielded inconsistent outcomes, potentially due to the dynamic nature of attentional bias. This study investigated neural mechanisms underlying attentional bias state by combining neuroimaging (functional magnetic resonance imaging -fMRI) with an approach-avoidance task tailored to an individual's gaming preference. We conducted a multivariate pattern analysis of endogenous brain activity in 21 participants with probable gaming disorder. Our analyses revealed that activity patterns in the insula tracked temporal attentional bias states specific to gaming stimuli. A broad network of frontal and parietal regions instead appeared to predict a general temporal attentional bias state. Finally, we conducted a proof-of-concept study for 'just-in-time' attentional bias training through fMRI-decoded neurofeedback of insula activity patterns, named decoded attentional bias training (DecABT). Our preliminary results suggest that DecABT may help to decrease the attractiveness of gaming stimuli via a insula- and precuneus-based neural mechanism. This work provides new evidence for the insula as an endogenous regulator of attentional bias states in gaming disorder and a starting point to develop novel, individualized therapeutic approaches to treat addiction.This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Evaluation of a multicomponent positive psychology program to prevent gaming disorder and enhance mental wellness in primary pupils: A randomized controlled trial

Background and Aims

Gaming disorder (GD) is a prevalent and complex issue that has recently been recognized as a condition that impairs mental health, underscoring the urgent need for early prevention measures. This evaluation study examined the effectiveness of the Digital Netizen Alliance (D.N.A.) program, a new multicomponent positive psychology program for preventing GD and bolstering mental wellness among Chinese children.

Methods

Drawing on gamification and positive psychology principles, the program builds four key positive skills collectively referred to as the P-A-G-E framework: psychological resilience, active coping, growth mindset, and emotion regulation. A randomized controlled trial was conducted with 264 primary school pupils attending fourth, fifth, or sixth grade in Hong Kong (63% female; mean age = 10.83, SD = 1.18).

Results

The findings revealed that participation in the program effectively promoted active coping, a growth mindset, and emotion regulation. Moreover, program participation alleviated GD symptoms and reduced negative affect. These desirable changes were fully explained by the P-A-G-E framework.

Discussion and Conclusions

The new D.N.A. program, which cultivates the positive psychology skills specified in the P-A-G-E framework, facilitates favorable psychological changes among children. These results emphasize the importance of using multicomponent frameworks for interventions targeting GD prevention.

Preventive Interventions for Internet Addiction in Young Children: Systematic Review

BACKGROUND

In this digital age, children typically start using the internet in early childhood. Studies highlighted that young children are vulnerable to internet addiction due to personal limitations and social influence (eg, family and school). Internet addiction can have long-term harmful effects on children's health and well-being. The high risk of internet addiction for vulnerable populations like young children has raised questions about how best to prevent the problem.

OBJECTIVE

This review study aimed to investigate the existing interventions and explore future directions to prevent or reduce internet addiction risks in children younger than 12 years.

METHODS

The systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for relevant literature from 4 research databases (Scopus, Web of Science, PubMed, and PsycINFO). We included 14 primary studies discussing the interventions to prevent or reduce internet addiction risks in young children and their efficacy outcomes.

RESULTS

The preventive interventions identified were categorized into four approaches as follows: (1) children's education, (2) parenting strategy, (3) strategic physical activity, and (4) counseling. Ten interventions showed promising efficacy in preventing or reducing internet addiction risks with small-to-medium effect sizes. Interventions that enhance children's competencies in having appropriate online behaviors and literacy were more likely to show better efficacy than interventions that force children to reduce screen time. Interventions that shift children's focus from online activities to real-world activities also showed promising efficacy in reducing engagement with the internet, thereby preventing addictive behaviors. We also identified the limitations of each approach (eg, temporariness, accessibility, and implementation) as valuable considerations in developing future interventions.

CONCLUSIONS

The findings suggest the need to develop more sustainable and accessible interventions to encourage healthy online behaviors through education, appropriate parenting strategies, and substitutive activities to prevent children's overdependence on the internet. Developing digital tools and social support systems can be beneficial to improve the capability, efficiency, and accessibility of the interventions. Future interventions also need to consider their appropriateness within familial context or culture and provide adequate implementation training. Last, policy makers and experts can also contribute by making design guidelines to prevent digital product developers from making products that can encourage overuse in children.

Impact of National Lockdown Measures on the Association Between Social Media Use and Sleep Disturbance During COVID-19: A Meta-Analysis of 21 Nations

During the COVID-19 pandemic, the extensive lockdown measures implemented for disease mitigation triggered a surge in round-the-clock social media use, giving rise to widespread concerns regarding its impact on sleep health. This meta-analysis examined the association between social media use and sleep disturbance during the pandemic, along with potential moderators. The dataset included 43 independent samples comprising 68,247 residents of 21 countries across 7 world regions. The three-level mixed-effects meta-analysis revealed a weak, positive overall effect size (r = 0.1296, 95% confidence interval: 0.0764-0.1828, k = 90). The magnitude of the effect size varied by the type of social media use: compulsive use exhibited a moderately strong effect size, whereas information-focused use showed marginal significance. The effect size was more pronounced in countries imposing stricter (vs. less strict) lockdown measures. Lockdown status also moderated this association, with a marginally significant effect size observed during lockdowns but a significant effect size after lockdowns. For demographics, samples involving emerging adults demonstrated moderately strong effect sizes, whereas those involving the general population had modest effect sizes. Notably, the interaction between the type of social media use and lockdown status was significant. Specifically, the positive association with information-focused use was significant only during lockdowns, whereas that with general use was significant after, but not during, lockdowns. However, compulsive use showed a moderately strong effect size both during and after lockdowns. These findings underscored the importance of considering multiple factors-such as the type of social media use, context, and demographics-when studying social media use and sleep health.

Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives

BACKGROUND

Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions.

OBJECTIVE

This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children.

METHODS

This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis.

RESULTS

Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps' functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy.

CONCLUSIONS

The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children's competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children's internet use, providing tailored or personalized content to suit users' characteristics, and considering the provision of training and information about the use of interventions and privacy agreements.

The effect of gamification-based training on the knowledge, attitudes, and academic achievement of male adolescents in preventing substance and internet addiction

BACKGROUND

Preventing addiction through training takes precedence over treatment and plays a crucial role in enhancing the well-being of adolescents. Utilizing inclusive and participatory methods can significantly enhance the effectiveness of education. Numerous studies have demonstrated that gamification, as an interactive and comprehensive approach, has the potential to boost teenagers' motivation to engage in learning and contributes to better comprehension.

AIM

This study aimed to assess the impact of gamification-based training to prevent substance and internet addiction on the knowledge and attitudes of male adolescents. Additionally, the study examined this educational program's effects on male adolescents' academic achievement.

METHODS

This study employed a quasi-experimental design with a control group. One hundred fourteen male adolescents were randomly assigned to the intervention or control groups. They completed a pre-intervention questionnaire assessing addiction-related knowledge, attitudes, and academic achievement. Subsequently, the intervention group received the gamification-based drug and internet addiction prevention training. Post-tests were conducted immediately after the training and again one month later for both groups.

RESULTS

Before the intervention, there were no significant differences in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement between the intervention and control groups (P > 0.05). However, after the intervention, the intervention group demonstrated significantly higher scores in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement compared to the control group (P < 0.001).

CONCLUSION

The current study highlights the positive impact of gamification-based training on enhancing male adolescents' knowledge, attitudes, and academic achievement.

Gamification: a Novel Approach to Mental Health Promotion

PURPOSE OF REVIEW

Gamification has emerged as a novel technique for improving mental health and enhancing treatment effectiveness. This paper provides an overview of gamification approaches to mental health intervention, identifies factors that may be related to variations in treatment effectiveness, and discusses possible strategies for tailoring gamified interventions to clients' needs.

RECENT FINDINGS

Recent research has documented the potential of gamified mental health interventions for bolstering mental wellness and mitigating psychological symptoms. However, their effectiveness may vary depending on study design-related factors and gender-specific considerations. Literature reviews have also identified yet-to-be resolved issues surrounding the possible strengths and weaknesses of the personalization versus standardization of gamification, as well as the potential benefits of gamification for increasing engagement versus the potential risks of over-engagement and behavioral addiction to gamified components. This review highlights the need for careful planning and execution of gamified mental health interventions to optimize their effectiveness and suitability for meeting clients' individual needs and preferences.

Digital Addiction Intervention for Children and Adolescents: A Scoping Review

Digital devices play a significant role in the learning and living of children and adolescents, whose overuse or addiction has become a global concern. This scoping review seeks to synthesize existing studies to investigate relevant interventions and their effects on digital addiction in children (ages 0-18). To understand the latest advances, we have identified 17 studies published in international peer-reviewed journals between 2018-2022. The findings revealed that, first, most interventions for digital addiction in children and adolescents were cognitive-behavioral therapies (CBT) or CBT-based interventions, which could improve anxiety, depression, and related symptoms of digital addiction. Second, rather than directly targeting addictive behaviors, some family-based interventions aim to strengthen family functions and relationships. Finally, digital-based interventions, such as website-based, application-based, and virtual reality interventions, are promising in adolescent digital addiction interventions. However, these studies shared the same limitations: small sample sizes, short intervention durations, no control group, and nonrandomized assignments. The small sample size problem is difficult to solve by offline intervention. Meanwhile, online digital-based intervention is still in its infancy, resulting in limited generalizability of the findings and the inability to popularize digital intervention. Accordingly, future intervention studies should integrate various assessments and interventions to form an integrated platform to provide interventions for addicted children and adolescents worldwide.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Unpacking the relation between children's use of digital technologies and children's well-being: A scoping review

Over the last decade, a substantial number of studies have addressed children's use of technologies and their impact on well-being. Nonetheless, there is still a lack of clarity on the operationalisation of technology use, well-being, and the relation between the two. This scoping review intended to shed lights on Digital Technologies Use, its operationalisation, and the relation between Digital Technologies Negative Use (DTNU) and children's well-being. For the scope of the special issue we focused on negative use. Results showed two conceptualisations of DTNU: compulsive/addictive use of devices and the Internet (e.g., Internet addiction) and negative online experiences/risky behaviours (e.g., cyberbullying). Well-being in relation to DTNU was mainly studied in terms of psycho/social dimensions (e.g., depression), and a gap in cognitive well-being studies was identified. Study designs were largely quantitative, and, in most studies, well-being was considered as a predictor of DTNU. Also, research with children under 12 years was lacking. Future research on DTNU should look at: how dimensions of addiction and negative online experiences relate; provide more evidence on cognitive well-being; explore the interplay of well-being multiple components relying on integrative conceptual frameworks. The recent notion of digital well-being should also be explored considering the results of this review.

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.

The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis

BACKGROUND

There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming.

OBJECTIVE

This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD.

METHODS

We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation.

RESULTS

The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions.

CONCLUSIONS

This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Internet Gaming Disorder, Risky Online Behaviour, and Mental Health in Hong Kong Adolescents: The Beneficial Role of Psychological Resilience

In the present cyber age, Internet gaming disorder (IGD) and risky online behaviour are prevalent, and adolescents are especially vulnerable to such emergent problems. Few studies have explored the protective factors that mitigate harm caused by IGD and various common risky online behaviours. This study examined the prevalence of IGD and risky online behaviour, their hypothesised associations with depressive symptoms, and the beneficial role of psychological resilience as an underlying psychological mechanism. The participants included 1,099 Chinese junior secondary school students (33% boys, mean age = 13.5 years, age range = 10-17 years) who completed a battery of validated self-report questionnaires at their schools. The results revealed that 4% of the participants were at high risk of IGD and 6% were at an overall risk level of IGD. Depressive symptoms were positively associated with IGD and risky online behaviour, and psychological resilience mediated both of these associations. These results imply that clinicians and teachers should incorporate psychological resilience training into intervention approaches to mitigate IGD and risky online behaviour.