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

IMPORTANCE

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

OBJECTIVES

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

DESIGN, SETTING, AND PARTICIPANTS

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

INTERVENTIONS

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

MAIN OUTCOMES AND MEASURES

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

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02907658.

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.

Efficacy of single-session transcranial direct current stimulation on addiction-related inhibitory control and craving: a randomized trial in males with Internet gaming disorder

BACKGROUND

Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (dlPFC) may reduce substance use and other addictive behaviours. However, the cognitive mechanisms that underpin such effects remain unclear. Impaired inhibitory control linked to hypoactivation of the prefrontal cortex may allow craving-related motivations to lead to compulsive addictive behaviours. However, very few studies have examined whether increasing the activation of the dlPFC via anodal tDCS could enhance inhibitory control over addiction-related distractors. The current study aimed to enrich empirical evidence related to this issue.

METHODS

Thirty-three males with Internet gaming disorder underwent active (1.5 mA for 20 minutes) and sham tDCS 1 week apart, in randomized order. We assessed inhibitory control over gaming-related distractors and craving pre- and post-stimulation.

RESULTS

Relative to sham treatment, active tDCS reduced interference from gaming-related (versus non-gaming) distractors and attenuated background craving, but did not affect cue-induced craving.

LIMITATIONS

This study was limited by its relatively small sample size and the fact that it lacked assessments of tDCS effects on addictive behaviour. Future tDCS studies with multiple sessions in larger samples are warranted to examine the effects on addictive behaviours of alterations in addiction-related inhibitory control.

CONCLUSION

These findings demonstrate that stimulation of the dlPFC influences inhibitory control over addiction-related cues and addiction-related motivation. This is the first empirical study to suggest that enhanced inhibitory control may be a cognitive mechanism underlying the effects of tDCS on addictions like Internet gaming disorder. Our finding of attenuated background craving replicated previous tDCS studies. Intriguingly, our finding of distinct tDCS effects on 2 forms of craving suggests that they may have disparate underlying mechanisms or differential sensitivity to tDCS.

CLINICAL TRIALS #

NCT03352973.

The Modulation of Reward and Habit Systems by Acupuncture in Adolescents with Internet Addiction

Purpose

Acupuncture is an effective therapy for Internet addiction (IA). However, the underlying mechanisms of acupuncture in relieving compulsive Internet use remain unknown. Neuroimaging studies have demonstrated the role of the ventral striatum (VS) in the progress of IA; hence, the aim of this study was to explore the effects of acupuncture on the resting-state functional connectivity (rsFC) and relevant network of VS in IA.

Methods

Twenty-seven IA individuals and 30 demographically matched healthy control subjects (HCs) were recruited in this study. We acquired the functional magnetic resonance imaging (fMRI) data in IA subjects before and after 40 days of acupuncture treatment. Seed-to-voxel and ROI-to-ROI analyses were applied to detect the rsFC alterations of the VS and related network in IA subjects and to investigate the modulation effect of acupuncture on the rsFC.

Results

Compared with HCs, IA subjects exhibited enhanced rsFC of the right ventral rostral putamen (VRP) with the left orbitofrontal cortex (OFC), premotor cortex (PMC), cerebellum, and right ventromedial prefrontal cortex (vmPFC). In the network including these five ROIs, IA also showed increased ROI-to-ROI rsFC. Using a paired t-test in IA subjects before and after 40 days of acupuncture, the increased ROI-to-ROI rsFC was decreased (normalized to HC) with acupuncture, including the rsFC of the right VRP with the left OFC, PMC, and cerebellum, and the rsFC of the left cerebellum with the left OFC, PMC, and right vmPFC. Furthermore, the change in rsFC strength between the right VRP and left cerebellum in IA individuals was found positively correlated with the Internet craving alleviation after acupuncture.

Conclusions

These findings verified the modulation effect of acupuncture on functional connectivity of reward and habit systems related to the VS in IA individuals, which might partly represent the underlying mechanisms of acupuncture on IA.

Testing the efficacy of group cognitive-behavioral therapy for pathological internet use among undergraduates in Nigeria

INTRODUCTION

The aim of this study was to examine the effect of group cognitive-behavioral therapy (GCBT) on pathological internet use (PIU).

METHOD

The study applied a group randomized controlled trial design to assign participants to intervention and control groups. A total of 40 college students aged 18 to 30 who were pathological internet users (PIUs) participated in this study and were randomly assigned to treatment and control groups. Participants completed a self-report scale entitled the Problematic Internet Use Scale (PIUS) at three time points. The intervention lasted 8 weeks. The data collected were statistically analyzed using repeated-measures analysis of variance (ANOVA).

RESULTS

The results showed that GCBT has significant efficacy, decreasing the symptoms of PIU among the GCBT participants compared to those in the control group and that the improvements were maintained at follow-up. We also found a significant interaction effect by time for PIU.

CONCLUSION

From the study findings, we can conclude that GCBT has significant benefit for mitigating the severity of PIU in college students. Therefore, mental health professionals are encouraged to explore the benefits of GCBT in treating symptoms associated with PIU in school settings and beyond.

A Qualitative Study of Practitioners' Views on Family Involvement in Treatment Process of Adolescent Internet Addiction

Despite emerging evidence of the effectiveness of a family-focused approach as an Internet addiction (IA) treatment modality for adolescents, little research has been done to explore family involvement in the treatment process from the clinician's perspective. This study employed a qualitative design to examine practitioners' views pertaining to the roles and challenges of family participation in IA intervention. In total, 10 practitioners working with adolescents with IA were interviewed. Thematic analysis was used to analyze the transcribed interviews. Three overreaching themes were synthesized: That family involvement in IA intervention is challenging yet important; shifting the focus from the adolescent to the relationship; and provision of individualized services and intervention to address the heterogeneous nature of cases. The findings show that family participation in IA treatment is successful in enhancing positive outcomes. The needs of adolescents with IA and family members are addressed through individual counseling and psychoeducation, respectively. Conjoint therapy sessions foster effective communication, improve family interactions and functioning, and restore relationships. However, caution regarding family dynamics is required when considering whether family involvement is appropriate. Practitioners need to establish therapeutic alliances and be flexible when working with family members in terms of the degree and arrangement of participation.

Cognitive Behavioral Therapy-Based Short-Term Abstinence Intervention for Problematic Social Media Use: Improved Well-Being and Underlying Mechanisms

Problematic social media use is detrimental to users' subjective well-being. Based on cognitive behavioral therapy (CBT), we proposed a short-term abstinence intervention to treat this problem. A mixed method study with 65 participants was conducted to examine the effectiveness of this intervention and to reveal the underlying mechanisms of how the intervention influences participants. While the experimental group (N = 33) took eight 2.5-h breaks from social media over two weeks and had daily dairies, the control group (N = 32) used social media as usual and had daily diaries. The results demonstrated that the intervention has a positive effect on life satisfaction. The effect varied with the time users conducted abstinence (work hours vs. off hours) and the level of social media addiction (heavy users vs. normal users). Qualitative findings from dairies and interviews unveiled associations among users' behaviors, feelings, and cognitions during and after abstinence. These results extend the understanding of the CBT-based short-term abstinence intervention and suggest opportunities to alleviate problematic social media use.

Effectiveness of a mobile app-based educational intervention to treat internet gaming disorder among Iranian adolescents: study protocol for a randomized controlled trial

BACKGROUND

The use of video games, a hobby for many teenagers in their leisure time, has brought with it a new potential for concerns. Internet gaming disorder (IGD) is a mental condition classified as a disorder due to addictive behaviors. It may include use of video games, both online and offline. Consequences of IGD may include introversion, social anxiety, mood swings, loneliness, sleep problems, behavioral problems, depression, low self-esteem, and increased violence. In order to design an app-based intervention for adolescents, a transtheoretical model (TTM) has been used. This widely used model in the field of behavioral change is also practical for health education programs. In addition, cognitive-behavioral therapy (CBT) has been used to make people more aware of their behaviors, feelings and thoughts and how to achieve behavioral change. The present study seeks to determine the effectiveness of this app-based intervention in in the treatment of IGD among adolescents.

METHOD

In this single-blinded, randomized, controlled trial, 206 high-school adolescents aged 13 to 18 years in Qazvin city will be recruited. Eligible adolescents will be randomly assigned into intervention and control groups. Eight consecutive sessions delivered over 2 months and based on the TTM and CBT will be delivered through the `app (named HAPPYTEEN) to the intervention group. The control group will receive a sleep hygiene intervention (8 consecutive sessions for 2 months) via the app. Data collection tools include the Internet Gaming Disorder Scale, Insomnia Severity Index, Depression, Anxiety, and Stress Scales, Stages of Change Questionnaire, Decision Balance, and Self-Efficacy. The study measures will be completed at baseline, post intervention, and 1 month and 3 months after the intervention.

DISCUSSION

The results of this intervention could be used as adjunct therapy for adolescents with IGD.

TRIAL REGISTRATION

Clinical Trial Registration Center of Iran (IRCT) IRCT20181226042140N1 . Registered on June 9, 2020.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

Applying the theory of planned behavior to predict online addiction treatment intention

METHODS

This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men.

RESULTS

Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment.

CONCLUSION

As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

A meta-review of screening and treatment of electronic "addictions"

Concerns surrounding electronic addictions, an umbrella term including any clinically significant technology-based addictive problem, have increased as technology has advanced. Although researchers and clinicians have observed detrimental effects associated with excessive technology use, there is no agreed-on definition or set of criteria for these problems. The lack of a consistent understanding of electronic addictions has led to a lack of consistency in both assessment and treatment studies, precluding strong recommendations for effective screening and clinical intervention. This meta-review integrates findings from 22 systematic reviews and meta-analyses of electronic addictions to determine which measures and interventions may effectively measure and treat electronic addictions. We conducted a meta-review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings suggest that although some measures may have good internal consistency and reliability among college students, there was a general lack of consistency in how measures were used across studies, making comparison difficult. Psychological and exercise-based interventions were shown to reduce symptoms of electronic addictions short-term, but no treatment was superior to others in overall symptom reduction. Most included reviews raise serious concerns about the lack of consensus on what constitutes an electronic addiction. Consequently, it was not possible to draw conclusions about the overall efficacy of any measurement tools or interventions. We provide suggestions for next steps to establish the phenomenology of electronic addictions before additional research on assessment and intervention is conducted.

Features related to the presence of internet gaming disorder and their impact on the treatment outcomes

Background and aims

Internet gaming disorder (IGD) is a highly engrossing activity with the individual spending up to 10 h per day gaming, this causes issues in accomplishing their tasks and personal goals. Also, to generate in them increased anxiety, impulsivity and lack of social skills, this impacts the good personal development and individual's quality of life. Therefore, it is vital to better understand, in terms of treatment, which factors are associated with therapeutic outcomes (largely to achieve control over the use of video games and the lack of relapses) following a standardized Cognitive Behavioral Therapy (CBT) protocol. This study aimed to explore sociodemographic and personality variables and their relation to treatment outcome in patients with IGD.

Method

The sample included n = 105 patients with IGD, considered between January 2005 and December 2022 and recruited from the Behavioral Addictions Unit at the University Hospital of Bellvitge. Data at baseline was registered (sociodemographic and clinical measures), as well as the therapy outcomes (compliance with the guidelines, presence of relapses and dropouts).

Results

Patients were mainly males (n = 95) with a mean age of 24.97 (SD = 12.03). All patients included in this sample had individual CBT treatment in relation to their problematic gaming behavior. In terms of patients who relapsed, they had higher interpersonal sensitivity, hostility and persistence with lower self-directedness. Patients who dropped out were males with an older age of IGD onset. When looking at treatment noncompliance, it was related to higher psychoticism and reward dependence, and lower cooperation. Patients with IGD show higher levels of treatment noncompliance.

Conclusion

These findings evidence a positive and promising effect of CBT on IGT. The factors identified as predictors of good and poor treatment outcomes should be considered for developing new evidence-based interventions focused on learning healthier key coping strategies to manage both cravings and triggers.

Network meta-analysis of the effectiveness of different interventions for internet addiction in college students

BACKGROUND

Internet addiction jeopardizes teenagers' physical and mental health, as well as their academic performance, and causes a variety of cognitive dysfunctions and psychological and mental health illnesses, among other things. It is a huge issue that families, schools, and society must address immediately.

OBJECTIVES

This study used network meta-analysis to evaluate the impact of several interventions on college students' Internet addiction. The goal was to identify the most effective interventions and establish a reference for future interventions. We systematically searched relevant literature in domestic and international databases such as Web of Science, PubMed, EMBASE, Cochrane Library, Pro Quest, China Knowledge, Wan fang, Wipo, etc. We assessed the risk of bias according to the revised Cochrane Randomized Trials Risk of Bias Tool (RoB2) and used R Studio Software and Stata 14.0 for traditional meta-analysis and network meta-analysis. A network meta-analysis based on the IAT scale showed that comprehensive interventions had the highest probability of being the best intervention for IA (SUCRA = 90.6 % based on IAT); focused solution short-term therapy had the highest probability of being the best intervention for IA based on the CIAS-R (19 White Feather) scale (SUCRA = 100 %).

CONCLUSIONS

The majority of interventions have a significant influence on the treatment of IA, and improvements in Internet addiction symptoms are more noticeable when a combination of interventions is used rather than just one.

Effectiveness of a web-based group intervention for internet addiction in university students

The phenomenon of Internet addiction has been systematically addressed with numerous studies highlighting its association with deficits in self-regulation. Despite the extensive literature elucidating the adverse effects of Internet addiction on university students, the availability of relevant interventions has remained constrained. The current study aimed at evaluating a web-based, group intervention, which aimed to prevent Internet addiction and enhance self-regulation. The sample consisted of 47 undergraduate and postgraduate university students (Ν = 47, Mage=21, SD = 3), who were divided into an intervention (n = 24) and a control group (n = 23). The participants were asked to complete a) the Internet Addiction Test (Young, 1998), and b) the Self-Regulation Questionnaire (Brown et al., 1999), prior to the commencement of the intervention, after its conclusion, and one and a half months after the intervention. The web-based intervention consisted of 6 sessions, over a two-week period. Results indicated an improvement of self-regulation and Internet addiction levels for the intervention group, compared to the control group. These results were maintained at the one and a half months follow-up. Implications for designing and implementing web-based group interventions for Internet addiction are discussed.

Health Economic Evaluation of an Online-Based Motivational Program to Reduce Problematic Media Use and Promote Treatment Motivation for Internet Use Disorder-Results of the OMPRIS Study

Internet Use Disorders (IUD) have a relevant effect on national economies. In the randomized, controlled, multicenter, prospective, and single-blinded OMPRIS study (pre-registration number DRKS00019925; Innovation Fund of the Joint Federal Committee of Germany, grant number 01VSF18043), a four-week online program to reduce media addiction symptoms, was evaluated for cost-effectiveness. The intervention group (IG) was compared to a waiting control group (WCG) from German statutory health insurance (SHI) and a societal perspective. Resource use, namely indirect and direct (non) medical costs, was assessed by a standardized questionnaire at baseline and after the intervention. Additionally, intervention costs were calculated. Determining the Reliable Change Index (RCI) based on the primary outcome, assessed by the "Scale for the Assessment of Internet and Computer Game Addiction" (AICA-S), individuals with and without reliable change (RC) were distinguished. The incremental cost-effectiveness ratio was calculated using the difference-in-difference approach. There were 169 (IG n = 81, WCG n = 88) persons included in the analysis. The mean age was 31.9 (SD 12.1) years. A total of 75.1% were male, and 1.8% diverse. A total of 65% (IG) and 27% (WCG) had an RC. The cost per person with RC was about EUR 860 (SHI) and EUR 1110 (society). The intervention leads to an improvement of media addiction symptoms at moderate additional costs.

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effect of the Reassured Self-Compassion-Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study

BACKGROUND

The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported.

OBJECTIVE

This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia.

METHODS

A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models.

RESULTS

Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference -4.11, 95% CI -6.98 to -1.24; P=.005) and video game addiction (mean difference -1.62, 95% CI -2.83 to -0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI -0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention.

CONCLUSIONS

The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions.

Efficacy and neural mechanisms of approach bias modification training in patients with internet gaming disorder: A randomized clinical trial

BACKGROUND

Internet gaming disorder (IGD) is a prevalent behavioral addiction linked to neural alterations and significant negative outcomes. Approach bias modification (ApBM) training aims to correct imbalances in reflective and impulsive systems, reducing cravings and addictions. This study examined the effectiveness of ApBM training in IGD patients and explored the brain response changes associated with the intervention.

METHODS

Fifty-one patients with IGD were randomly assigned to an ApBM group (n = 26) or a sham-ApBM group (n = 25). Resting-state functional magnetic resonance imaging scans and behavioral assessments, including Internet Addiction Test scores, DSM-5 criteria, game craving levels, and automatic approach bias, were conducted before and after a ten-day training with five sessions. An analysis of variance (ANOVA) was employed to assess time (pre- and post-test) × group (ApBM group vs. sham-ApBM group) effects on behavioral measures. Functional connectivity (FC) analyses focused on regions of interest identified through regional homogeneity and degree centrality calculations. Additionally, we analyzed the relationship between neuroimaging variables and intervention outcomes.

RESULTS

Significant group × time interactions were found for automatic approach bias, Internet Addiction Test scores, DSM-5 criteria, and game craving levels. Post-training, these measures significantly decreased in the ApBM group but showed no significant changes in the sham-ApBM group. FC analysis revealed increased connectivity within executive control regions, enhanced connectivity between executive control and reward-related regions, and decreased connectivity within reward-related regions, exclusively in the ApBM group.

CONCLUSIONS

ApBM training effectively reduces gaming cravings in patients with IGD, enhancing executive control and mitigating impulsive behaviors.

Assessing the effectiveness of group motivational interviewing in raising awareness of mobile gaming addiction among medical students: a pilot study

OBJECTIVE

Group Motivational Interviewing may raise awareness of mobile gaming addiction. MI has reported reduction of gaming addiction in adolescents, although its effectiveness among medical students remains underexplored. This study assessed the effectiveness of group MI in raising awareness of mobile gaming addiction among medical students.

RESULTS

Significant progression in Stages of Change at pre- to post-intervention (χ² = 41.891, p < 0.001; Cramer's V = 0.555) and from post- to two-months post-intervention (χ² = 87.083, p-value < 0.001; Carmer's V = 0.800). IAIM scores improved over time (χ² = 9.349, p = 0.009), with the highest improvement at two-months. A moderate positive correlation (ρ = 0.517, n = 34, p < 0.002) was found between self-reported and mobile game usage at two-months. This pilot study provides early evidence that GMI may enhance motivation to reduce mobile gaming and support progression through stages of change. Future studies could employ larger randomized controlled trials (RCT) with longer follow-up periods.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number (ISRCTN) Registry ISRCTN93544148. Date of registration 05/02/2025. Retrospectively registered.

Approach bias modification reduces automatic gaming tendencies and enhances brain synchronization in internet gaming disorder

BACKGROUND

Automatic approaches to gaming-related cues are key factors in internet gaming disorder (IGD). Approach bias modification (ApBM) has been shown to reduce addictive behaviors, but its neurobiological effects remain poorly understood. This study examined changes in brain activities in the 'natural' state in IGD patients after ApBM.

METHODS

Fifty-five (of 61) IGD patients were randomly assigned to the approach-avoidance task (AAT, n = 30) and sham-AAT (n = 25) groups. Participants completed the pre-test, five real/sham ApBM sessions, and the post-test. In the pre-and post-tests, fMRI data were collected while viewing gaming and neutral videos. Inter-subject correlation (ISC) and functional connectivity (FC) analyses were conducted to explore the ApBM-related changes.

RESULTS

ANOVA of behavioral data revealed that ApBM significantly decreased the approach bias and addiction scores. The ISC analyses revealed increased synchronization in the paracentral lobule, precuneus, and insula regions in the ATT group after ApBM. Additionally, decreased FC was observed between the insula and superior frontal gyrus, precuneus, and orbitofrontal cortex in the AAT group.

CONCLUSIONS

Preliminary findings suggest that ApBM may be effective in reducing automatic approach tendencies toward gaming cues, highlighting its potential as an intervention strategy. However, it is important to note that the neurobiological evidence in this study only provides a possible association, and the results should be interpreted with caution. Future research is needed to further examine the clinical efficacy of ApBM in IGD, whether as a stand-alone treatment or as an adjunct to formal therapy.

Protocol for a Randomized Controlled Trial to Enhance Executive Function via Brief Mindfulness Training in Individuals with Internet Gaming Disorder

BACKGROUND

Internet Gaming Disorder (IGD) is characterized by uncontrolled gaming behavior, leading to emotional distress, neglect of academic or life responsibilities, and damage to interpersonal relationships, all of which have serious negative impacts on individuals and society. IGD has been associated with neuropsychological impairments, especially executive function deficits, and emotional difficulties. Mindfulness interventions have been indicated to improve executive functions to varying degrees in individuals with IGD. The purpose of this study is to investigate whether the three subcomponents of executive function (i.e., inhibition, updating, and shifting) are impaired in individuals with internet gaming disorder, as well as to examine the effectiveness of a brief mindfulness intervention on executive function.

METHODS

A total of 82 individuals diagnosed with IGD and 40 non-addicted gamers will be recruited for this study. These participants will be evenly divided into an intervention group and a control group at a ratio of 1:1. The intervention group will undergo a 7-day mindfulness training program focusing on breathing meditation, while the control group will receive progressive muscle relaxation training. Both groups' outcomes will be assessed at seven different time points. Primary outcome measures will include electroencephalography (EEG) data (band power, functional connectivity, source localization, and N2/P3 amplitudes), behavioral metrics (response times and accuracy from psychological experimental paradigms), physiological indices (specifically heart rate variability), self-reported measures (game craving and mindfulness levels, executive function performance, and impulsivity emphasizing inhibitory control). Secondary outcome measures will encompass anxiety, stress, positive and negative affect, sleep quality, and other indicators such as demographic information, physical and mental health status, and the Big Five personality traits.

DISCUSSION

This study aims to explore the efficacy of a brief mindfulness intervention on executive function impairments in IGD individuals and to elucidate its underlying neural mechanisms. It is anticipated that the findings will contribute to more targeted intervention strategies for executive function research, offering novel insights into the treatment of IGD and related cognitive dysfunctions. This study is expected to explore the effectiveness of brief mindfulness intervention on IGD and its underlying brain functional mechanisms, particularly providing more targeted intervention strategies for improving executive functions in this population.

TRIAL REGISTRATION

Trial registration number: ChiCTR2400081509, registered on March 4th 2024. Protocol Version1.0.

Acupuncture for Internet addiction: A protocol for systematic review

BACKGROUND

Internet addiction (IA) has become a global problem characterized by excessive use of the internet, compulsive, and deleterious personal behaviors. Acupuncture has gained more and more attention in the treatment of IA. However, evidence of its effectiveness is lacking. The purpose of this systematic review is to evaluate the efficacy and safety of acupuncture in the treatment of IA.

METHODS

The following databases will be searched from the inception to September 30, 2020: the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wan-fang database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database. The research on acupuncture and IA meets the screening criteria, and two independent reviewers performed citation screening, data extraction, and risk assessment of bias. We used Cochrane Review Manager 5.3 software for statistical analysis.

RESULTS

The findings will be published at scientific conferences or in a peer-reviewed journal. This study is based on the existing research, so there is no need for ethical approval.

CONCLUSION

This systematic review provides evidence for the efficacy of acupuncture in treating IA disorder, and it is of great significance for effective clinical routine treatment of IA.

TRIAL REGISTRATION NUMBER

INPLASY 2020120099.

Emotional Working Memory Training Treatment for Young Adult Problem Online Sports Bettors: A Preliminary Randomized Controlled Trial

One of the key features of gambling disorder (GD) is impairment in cognitive-emotional control. Considering the negative consequences of GD, the present study investigated the effectiveness of emotional working memory training (eWMT) in improving cognitive control, attention, working memory capacity, and cognitive emotion regulation strategies (CERS) among young adults with GD compared to a placebo group. Following the initial assessment in the pre-test phase, eligible participants were randomly assigned to one of two groups: experimental (n = 34) and placebo (n = 30). These groups completed eWMT and a feature matching task for 20 sessions respectively. The post-test and follow-up measures indicated that eWMT significantly improved cognitive control, attention, working memory capacity, and the use of maladaptive cognitive emotion regulation strategies, but it had no significant effect on adaptive CERS. The promising results of the present study suggest the use of eWMT as a new intervention to improve cognitive-emotional control among individuals with online gambling problems.