Cognitive-behavioral approaches to outpatient treatment of internet addiction in children and adolescents

Resilience as a predictor of internet addictive behaviours: a study among Ghanaian and Saudi samples using structural equation modelling approach

This study aimed to examine the relationship between resilience and internet addictive behaviours, focusing on cross-cultural contexts involving tertiary education students in Ghana and Saudi Arabia. Using a cross-sectional survey design, data were collected from 738 students across selected universities in both countries. Structural equation modeling (SEM) techniques were employed to analyse the data. The findings indicated that most respondents exhibited low resilience levels alongside a high prevalence of internet addictive behaviours. A significant positive relationship was identified between resilience levels and various dimensions of internet addiction, as well as the overall composite of internet addictive behaviours. Interestingly, while low resilience levels were found to increase the risk of internet addiction, higher resilience levels also appeared to heighten susceptibility to addictive behaviours. These results suggest the need for targeted interventions to address internet addiction. Programs should focus on enhancing resilience through resilience-building initiatives, promoting digital well-being, and integrating mental health support services. These approaches can help mitigate the risks associated with internet addiction while fostering healthier coping mechanisms in students across diverse cultural settings.

Effects of emotional working memory training on problematic internet use, inhibition, attention, and working memory among young problematic internet users: A randomized control study

Problematic internet use (PIU) has been defined as an inability to control impulses to use the internet, and is associated with psychological, social, educational, and/or occupational problems. Considering the harmful effects of PIU, the present study evaluated a treatment intervention aimed at controlling PIU. A randomized control study investigated the effectiveness of emotional working memory training (eWMT) in improving inhibition, attention, and working memory among individuals with PIU in comparison with a placebo group. Young adults (N = 36) with PIU were either trained for 20 sessions in an n-back dual emotional task (eWMT; n = 18) or a feature matching task (placebo; n = 18). Results showed that 20 continuous sessions of eWMT significantly reduced the symptoms of PIU and improved participants' working memory, attention, and inhibition (compared to the placebo group). These preliminary findings suggest that eWMT can be considered a promising treatment to reduce PIU by improving individuals' cognitive and emotional functioning.

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.

Cognitive-Behavioral Therapy for Treating Videogame Dependence in School-aged Children

This study examined the effectiveness of cognitive-behaviour therapy on schoolchildren with videogame dependency in a sample of Nigerian schoolchildren. This study was conducted in Enugu metropolis Enugu State Nigeria. A randomized-controlled pretest and posttest design was adopted. Out of 86 schoolchildren that participated in the study, 43 children were exposed to the intervention while 43 did not receive treatment as usual (TAU). The treatment lasted for eight weeks with one session per week. During the study, the participants were assessed at three time points using videogame addiction scale for children. The data collected were statistically analyzed using the multivariate statistical tool. The multivariate statistical result showed that cognitive-behaviour therapy in reducing videogame dependency among schoolchildren. The practice implications, limitations, and conclusions were also drawn in line with the outcome of this study. This study is one among the few studies in Nigeria that have investigated videogame dependency. Another strength is that study tested the participants at three time points to ascertain the impacts of the intervention.

Telemedicine as bridge to the offline world for person affected with problematic internet use or internet use disorder and concerned significant others

Introduction

Internet use disorder is a disorder of the digital age and presents a growing problem worldwide. It appears that due to structural and personal barriers, many persons affected (PA) and Concerned Significant Others (CSO) do not reach the health care system so far and thus a chronification of the pathology can proceed.

Methods

A telemedicine counseling service for PA and CSO of PA unwilling to enter treatment with two webcam-based sessions of 60 minutes for each group was created with the aim of reaching out to PA and CSO to provide a low-threshold support and refer the participants to the local health care system. Motivational interviewing for PA and CRAFT (Community Reinforcement and Family Training) for CSO were used as methods. Participants answered questions about their Internet use and sociodemographic data and six months after participation, participants were asked via email if they entered the local health care system. CSO answered the questions for themselves and in a third-party rating for PA unwilling to enter treatment.

Results

107 PA (34 years (SD = 13.64), 86% male) and 38 CSO (53 years (SD = 6.11), 28.9% male) participated in the two telemedicine sessions. After participation, 43.9% of the PA and 42.1% of the CSO reached the health care system. When there was consistency between the location of telemedicine consultation and treatment locally, over 90% of participants arrived (PA: 92.3%, CSO: 100%).

Conclusion

The results from this study reveal that telemedicine services could be a promising approach to address PA and CSO and build a bridge to the local health care system. Future studies should verify if these results can be replicated in randomized controlled trials.

Experimental longitudinal evidence for causal role of social media use and physical activity in COVID-19 burden and mental health

Aim

The COVID-19 outbreak has severely impacted people's mental health. The present experimental study investigated how to reduce this negative effect by a combination of two interventions.

Subject and methods

Participants (N total = 642) were users of social media in Germany. For two weeks, the social media group (N = 162) reduced its social media use (SMU) by 30 minutes daily, the physical activity group (N = 161) increased its physical activity by 30 minutes daily, the combination group (N = 159) followed both instructions, and the control group (N = 160) did not get specific instructions. Online surveys assessed variables of SMU, physical activity, mental health, COVID-19 burden, and lifestyle at six measurement time points up to six months after the intervention.

Results

In the experimental groups, (addictive) SMU, depression symptoms, and COVID-19 burden decreased, while physical activity, life satisfaction, and subjective happiness increased. All effects were stronger and more stable in the combination group in the longer-term. Smoking behavior decreased in the social media group only.

Conclusion

Thus, the conscious combination of less SMU and more physical activity leads causally to more psychological resilience against negative pandemic impacts and to higher levels of mental health over six months. Prevention programs could improve their effectiveness by integrating the time- and cost-efficient interventions - separately or in combination.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01751-x.

A Communication Study of Young Adults and Online Dependency during the COVID-19 Pandemic

People use digital media and the Internet daily. The time that young people spend connected to digital devices will increase as technology advances, which could have severe health risks and behavioral dependence implications. In the context of the current pandemic, in which socializing, studying, and working is changing, this question has become particularly relevant. Therefore, we propose to investigate the perceptions of young university adults—understood as generation Z—regarding their digital media practices, particularly during the pandemic, and to study the consequences of a permanent connection to these formats on the development of an addiction to the Internet. Our quantitative method approach applied questionnaires to a sample of 407 young university adults studying in Portugal. Through this survey, we could target a specific user group, quantify their consumption, and measure their online experiences. The results point to an increase in dependence on the Internet during confinement. While it is true that carrying out academic work is one of the reasons for this growth, it is noteworthy that the respondents sought the online world in a significan way to pass the time and escape their routine. In addition, they confess to experiencing some consequences of excessive use, such as sleep disturbances and adverse emotional reactions—such as instabilities, depression, and nervousness—when not online. We conclude that the pandemic has intensified online dependence. However, above all that, it is necessary to look at the mental and general health consequences that this excessive use has brought, which may not be visible or manifested by the youth in the short term, and may come to have consequences in the long term.

Cognitive behavioral intervention in dealing with Internet addiction among Arab teenagers in Israel

The current study examines the effectiveness of a cognitive-behavioral intervention program for improving self-control and reducing Internet addiction among Arab adolescents in Israel. The study sample included 160 students who were 7th to 9th graders, recruited from eight schools in northern Israel. All participants exhibited high scores on a questionnaire indicating elevated symptoms of Internet addiction. Students were randomized to one of two groups: the experimental group underwent a systematic intervention to reduce Internet addiction and the control group met once a week for a group conversation. The experimental group (n = 80) included 58 boys and 22 girls with an average age of 13.45 (SD = 1.46). The control group (n = 80) included 54 boys and 26 girls with an average age of 13.91 (SD = 1.92). Each intervention consisted of 8 sessions, with the experimental group receiving cognitive-behavioral treatment and the control group having a weekly classroom conversation. The results demonstrated preliminary efficacy for the intervention, as higher levels of self-control were reported among the experimental group (p < .01) but not the control group, and this contributed to a reduction in scores on the questionnaire assessing Internet addiction in the experimental group (p < .01). The findings suggest that cognitive-behavioral treatments may be a promising avenue for enhancing self-control and reducing symptoms of Internet addiction among this unique student population.

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.

Internet addiction, substance use and alexithymic dimensions in two different faculties' students

OBJECTIVES

The aim of this study was to evaluate the relationship between internet addiction, substance use and alexithymia among students of education faculty and medical faculty.

METHODS

This cross-sectional analytical study included 1,257 faculty students aged 18 and over, studying at Meram Medical Faculty and Ahmet Keleşoğlu Faculty of Education. Young's Internet Addiction Scale, Toronto Alexithymia Scale, Fagerström Tobacco Addiction Test and CAGE alcohol use tests were applied to collect data.

RESULTS

The mean age of the participants was 21.12 ± 1.96 years, 71% (n = 893) of them were females and 29% (n = 364) were males, 37.9% (n = 477) were training at medical faculty, 62.1% (n = 780) were training at the faculty of education. Of the students, 1.5% were internet addicts, 15.3% were possible addicts, and 22.8% had alexithymia. Internet addiction was higher in those with higher alexithymia scores (p < 0.001). Internet addiction was significantly higher in male students, the third grade, ones with lower academic success, students who work their lessons less than 2 hours a week. Internet addiction was also significantly higher in smokers and alcohol users (p < 0.001). While there was a low negative correlation between the first internet using age and internet addiction (p < 0.001), there was a moderately significant positive correlation between spending uninterrupted time on the internet and internet addiction (p < 0.001).

CONCLUSION

In this study, it was determined that the teacher and doctor candidates, who are studying at the faculties of education and medicine, were at risk of internet addiction. A teacher or a doctor who cannot develop social skills due to excessive internet use will not be a good model to communicate correctly with the target population.

Non-Substance Addiction in Childhood and Adolescence

BACKGROUND

Around 5.8% of adolescents and 2.8% of young adults have an Internet-related disorder. These figures underline the widespread concerns in our society regarding the potential dangers and risks associated with Internet and digital media use.

METHODS

Selective literature search for records on Internet-related disorders in children and adolescents.

RESULTS

Internet-related disorders are now viewed as belonging to the behavioral addiction. Research has revealed similarities to substance-related disorders. There are often associations with other mental illnesses such as depression, anxiety, attention deficit/hyperactivity disorder, and personality disorders, as well as disturbed sleep patterns, increased risk taking, nicotine abuse, an unbalanced diet, and lack of exercise. Female adolescents are statistically significantly more often affected than male adolescents (7.1% versus 4.5%). The German STICA study, the first randomized controlled trial worldwide, demonstrated that cognitive behavioral therapy was effective compared with a waiting group (odds ratio 10.10, 95% confidence interval [3.69; 27.65]).

CONCLUSION

Internet-related disorders have not yet been conclusively conceptualized and operationalized. Further work is urgently required to refine the concepts of both the illness and and its treatment.

Does interpersonal sensitivity and paranoid ideation predict nomophobia: an analysis with a young adult sample

Nomophobia has been studied extensively due to its negative effects on human health and psychology. In terms of clinical psychology, nomophobia has been linked consistently to depression and anxiety. Studies also investigated whether it is a dependency, an impulse control problem, an obsession or a phobia; however, no clear clinical representation was confirmed. Although it was proposed to be added as an official diagnosis to DSM-5, these attempts were inconclusive. In this study, nomophobia was examined clinically by SCL-90 factors. A hierarchical regression analysis was performed by controlling anxiety, depression, phobia and obsessions by putting them in the first step. At the next step, paranoid ideation was entered while interpersonal sensitivity was introduced at the last step. The variables were assigned according to the steps according to their connections confirmed by the literature, the correlation coefficients and β weights obtained in the current study. The hierarchical regression analysis confirmed that after controlling anxiety, depression, phobia and obsessions, nomophobia is explained by interpersonal sensitivity. Paranoid ideation is also an important variable in step 2, but it lost its significance in the last step. Nevertheless, it was thought that what makes people sensitive to interpersonal issues is a kind of fear of missing out others’ experiences (FoMO) which is related to nomophobia. This fear of missing out might prepare people to constantly check on mobile phones thinking paranoid about what they might have been missing or deprived of. Clinical implications and limitations were discussed.

The Mediating Roles of Emotional Regulation on Negative Emotion and Internet Addiction Among Chinese Adolescents From a Development Perspective

Previous researches indicated that emotional regulation can be associated with depression and anxiety, which may be an important mediating factor between emotional regulation and internet addiction. However, the mechanism between these associations has received little attention and it is still unclear. This study has examined 716 Chinese adolescents, 341 were males (47.6%), aged 13 to 18(Mean = 14.58, SD = 1.50), using a cross-sectional survey involving Young's Diagnostic Questionnaire for Internet Addiction, the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety (GAD-7) scale, and the Emotion Regulation Questionnaire (ERQ). Correlation analysis, multiple-group analysis and structural equation modeling were carried out in SPSS Statistics version 23 (IBM, Armonk, NY) and AMOS version 21. Cognitive reappraisal had a significantly negative direct effect on Internet addiction (β = -0.118, p < 0.05). Furthermore, negative emotions mediated the relationships between expression suppression and Internet addiction [β = 0.149, 95% CI = (0.099, 0.212)] and the relationship between cognitive reappraisal and Internet addiction [β = -0.101, 95% CI = (-0.147, -0.065)]. The differences in the structure path coefficients for different development stages demonstrated that recognitive reappraisal showed more protective roles for negative emotion (p < 0.01), and negative emotion also predict Internet addiction more effectively in high school students (p < 0.001). However, cognitive reappraisal directly predicted negative Internet addiction in junior high school students. Therefore, the intervention on adolescents for internet addiction should not only focus on emotional regulation and negative emotion, but also development stages of adolescents.

Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program

Background

Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce.

Objective

This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users’ VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data.

Methods

Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend’s gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed.

Results

Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test–gaming scores (r=.300, P=.03) but positively with users’ motivation (r=.312, P=.02).

Conclusions

The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management.

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.

The Role of Cognitive Emotion Regulation Strategies on Problematic Smartphone Use: Comparison between Problematic and Non-Problematic Adolescent Users

Prior work has suggested that individuals with deficits in emotion regulation skills are prone to compulsive behaviour and to following maladaptive coping strategies, such as smartphone overuse, to manage negative moods. Adolescence is a vulnerable developmental stage for deficits in emotion regulation, and these are linked to excessive smartphone use. The present study is the first to examine the links between the use of specific cognitive emotion regulation (CER) strategies and problematic smartphone use in a sample of adolescents. A total of 845 Spanish adolescents (455 females) completed the Spanish versions of the Cognitive Emotion Regulation Questionnaire and the Smartphone Addiction Scale, along with a socio-demographic survey. The adolescents were divided into two groups: Non-problematic smartphone users (n = 491, 58.1%) and problematic smartphone users (n = 354, 41.9%). Significant group differences were found, with the problematic users reporting significantly higher scores for all maladaptive CER strategies, including higher self-blame, rumination, blaming of others and catastrophising. The results from logistic regression analyses show that rumination, catastrophising and blaming of others were the most important variables for distinguishing between the two groups, along with gender and parental control outside the home. In summary, these findings suggest the importance of specific maladaptive CER strategies in problematic smartphone use and provide insight for relevant targets for intervention designs.

[Internet-related disorders-old and new challenges. Conference report on the 10th symposium of the German Association on Internet-Related Disorders]

Internet-related disorders have become a growing challenge for psychosocial healthcare and society. For ten years, the German Association on Internet-Related Disorders has been a cooperative network, bringing together caregiving professionals and researchers, fostering our knowledge and expertise in facing this health issue. The conference "Categorically after 10 years," held in November 2018, was the annual meeting of these experts.This proceeding aims to depict the history of the conference, by referring to the many national and international experts of the past years that had crucial impact on the growing expertise of the association's members. The current conference mainly dealt with the expected inclusion of "gaming disorder" as a new diagnosis and other internet-related disorders in the ICD-11 that were announced by the World Health Organization (WHO) in summer 2018.Internet-related disorders have been clinically described as excessive and poorly controlled online behaviors that are causing detrimental consequences and result in decreasing psychosocial functioning. The main subtypes of internet-related disorders encompass the uncontrolled use of (online) computer games, pornography, and social networking sites.As in past years, this conference again offered the opportunity for exchange between researchers and healthcare professionals. The program contained an eclectic mix of lectures and workshops, offering a sound review of current developments in internet-related disorders and future perspectives of prevention, diagnostics, and intervention strategies. A particular emphasis was set on the addictive potential of modern computer games, for instance by the implementation of monetarization strategies.

Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective

Problems related to high levels of gaming and Internet usage are increasingly recognized as a potential public health burden across the developed world. The aim of this review was to present an international perspective on prevention strategies for Internet gaming disorder and related health conditions (e.g., Internet addiction), as well as hazardous gaming and Internet use. A systematic review of quantitative research evidence was conducted, followed by a search of governmental reports, policy and position statements, and health guidelines in the last decade. The regional scope included the USA, UK, Australia, China, Germany, Japan, and South Korea. Prevention studies have mainly involved school-based programs to train healthier Internet use habits in adolescents. The efficacy of selective prevention is promising but warrants further empirical attention. On an international scale, the formal recognition of gaming or Internet use as a disorder or as having quantifiable harms at certain levels of usage has been foundational to developing structured prevention responses. The South Korean model, in particular, is an exemplar of a coordinated response to a public health threat, with extensive government initiatives and long-term strategic plans at all three levels of prevention (i.e., universal, selective, and indicated). Western regions, by comparison, are dominated by prevention approaches led by non-profit organizations and private enterprise. The future of prevention of gaming and Internet problems ultimately relies upon all stakeholders working collaboratively in the public interest, confronting the reality of the evidence base and developing practical, ethical, and sustainable countermeasures.

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.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSIONS

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

Prevalence and factors of self-corrective intention among Hong Kong secondary school students who are self-assessed Internet addiction cases

BACKGROUND

Adolescent Internet addiction (IA) is prevalent. No study, however, has applied the health belief model (HBM) to investigate issues on IA nor investigated factors associated with intention to correct one's perceived IA problem (self-corrective intention). Such information facilitates design of related interventions, which are warranted.

METHODS

This cross-sectional study surveyed 9,618 Chinese secondary school students in Hong Kong; 4,111 (42.7%) self-assessed that they had IA (self-assessed IA cases); 1,145 of these self-assessed IA cases (27.9%) were also classified as IA cases (concordant IA cases), as their Chen Internet Addiction Scale score exceeded 63.

RESULTS

The prevalence of self-corrective intention among these two subsamples was only 28.2% and 34.1%, respectively. In the self-assessed IA subsample, the HBM constructs including perceived susceptibility to IA [adjusted odds ratio (ORa) = 1.24, 95% CI = 1.16, 1.34], perceived severity of IA (ORa = 2.28, 95% CI = 2.09, 2.48), perceived benefits for reducing Internet use (ORa = 1.21, 95% CI = 1.18, 1.24), self-efficacy to reduce Internet use (ORa = 1.07, 95% CI = 1.03, 1.11), and cues to action to reduce Internet use (ORa = 1.15, 95% CI = 1.11, 1.20) were positively, while perceived barriers for reducing Internet use (ORa = 0.95, 95% CI = 0.94, 0.97) were negatively, associated with self-corrective intention. Similar factors were identified in the concordant IA subsample.

CONCLUSIONS

A large proportion of the students perceived that they had IA but only about one-third intended to correct the problem. Future interventions may consider altering students' HBM constructs, and focus on the segment of concordant IA with self-corrective intention, as they show readiness for changes.

The brave blue world: Facebook flow and Facebook Addiction Disorder (FAD)

The present study investigated the relationship between flow experienced when using Facebook (Facebook flow; i.e., experience of intensive enjoyment and pleasure generated by Facebook use due to which the Facebook activity is continued even at high costs of this behavior) and Facebook Addiction Disorder (FAD). In a sample of 398 Facebook users (age: M (SD) = 33.01 (11.23), range: 18-64), the significant positive association between Facebook flow and FAD was positively moderated by the intensity of Facebook use. Exploratory factor analysis revealed that all six items assessing FAD loaded on the same factor as two items belonging to the subscale telepresence of Facebook flow. Therefore, the close link between Facebook flow and FAD may in particular result from the immersion in an attractive online world created by Facebook, where users escape to forget their everyday obligations and problems. Present results provide first evidence that Facebook flow may be an anteceded of FAD and indicate the mechanisms that may contribute to its development and maintenance. Practical applications for future studies and limitations of present results 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.

The effectiveness of a parental guide for prevention of problematic video gaming in children: A public health randomized controlled intervention study

Background and aims Excessive use of video games among children and adolescents is a growing concern. The aim of this study was to investigate the effectiveness of a brief parental guide with advices and strategies for regulating video gaming in children. Methods A random sample of guardians of children between the age of 8-12 years old (N = 5,864) was drawn from the Norwegian Population Registry and equally randomized into an intervention and a control condition. A parental guide based on clinical and research literature was distributed by postal mail to those in the intervention condition. A 4-month follow-up survey comprising questions about problematic video gaming, gaming behavior, sleep activity, and parental video game regulation behavior was administered. Results Independent t-tests revealed no significant differences between the two conditions (N = 1,657, response rate 30.1%) on any outcome measure. An ANOVA with planned comparisons showed that respondents who reported that they had read and followed the parental guide reported more video game problems and used more parental mediation strategies than those who did not read and follow the guide. Conclusions We found no evidence for the effectiveness of the psychoeducational parental guide on preventing problematic video gaming in children. However, the guide was read and positively assessed by a significant proportion of guardians. Differences between those who studied the guide and those who did not may indicate that parental guides are better aimed at providing important information to those who already have problems rather than as a mean of primary prevention.

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

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

Internet Gaming Disorder in Children and Adolescents

The American Psychiatric Association recently included Internet gaming disorder (IGD) as a potential diagnosis, recommending that further study be conducted to help illuminate it more clearly. This paper is a summary of the review undertaken by the IGD Working Group as part of the 2015 National Academy of Sciences Sackler Colloquium on Digital Media and Developing Minds. By using measures based on or similar to the IGD definition, we found that prevalence rates range between ∼1% and 9%, depending on age, country, and other sample characteristics. The etiology of IGD is not well-understood at this time, although it appears that impulsiveness and high amounts of time gaming may be risk factors. Estimates for the length of time the disorder can last vary widely, but it is unclear why. Although the authors of several studies have demonstrated that IGD can be treated, no randomized controlled trials have yet been published, making any definitive statements about treatment impossible. IGD does, therefore, appear to be an area in which additional research is clearly needed. We discuss several of the critical questions that future research should address and provide recommendations for clinicians, policy makers, and educators on the basis of what we know at this time.

Is Internet addiction transitory or persistent? Incidence and prospective predictors of remission of Internet addiction among Chinese secondary school students

BACKGROUND

Internet addiction (IA) is prevalent among adolescents but it is potentially revertible. Only three Taiwan adolescent studies reported IA remission and a few related factors. We investigated incidence and predictors of remission among Hong Kong Chinese secondary school students with a 12-month longitudinal study.

METHODS

IA was defined as Chen Internet Addiction Scale (CIAS) score>63. Validated measures were used to assess students' psychosocial wellbeing at baseline and follow-up.

RESULTS

Of 1545 students with IA at baseline, 1296 (83.9%) provided matched baseline/12-month follow-up data; their data were analyzed. Incidence of remission (CIAS≤63 at follow-up) was 59.29/100 person-years. Significant predictors included: 1) baseline CIAS score (ORa=.95), 2) baseline health belief model (HBM) constructs [perception of having severe IA (ORa=.34), perceived susceptibility to IA (ORa=0.82), perceived barrier (ORa=0.95), cue to action from parents (ORa=0.82), and self-efficacy for reducing Internet use (ORa=1.13)], and 3) baseline psychosocial health measures [self-esteem (ORa=1.03), severe depression (ORa=0.72) and social anxiety (ORa=0.96)] and their changes over time [depression (ORa=.95), anxiety (ORa=.94), loneliness (ORa=.93), self-esteem (ORa=1.07), positive affect (ORa=1.10) and family support (ORa=1.03)]. Two-thirds (64.3%) of the remission group presented reduced CIAS score>1.5 SD, and recorded larger improvements in psychosocial status over time than the non-remission group.

CONCLUSION

Without noticeable interventions, incidence of remission was high and related to improvements in psychosocial health. Most of the HBM constructs, and baseline/changes in psychosocial measures predicted remission. Interventions to increase remission should modify these factors.

"Internet Addiction": a Conceptual Minefield

With Internet connectivity and technological advancement increasing dramatically in recent years, “Internet addiction” (IA) is emerging as a global concern. However, the use of the term ‘addiction’ has been considered controversial, with debate surfacing as to whether IA merits classification as a psychiatric disorder as its own entity, or whether IA occurs in relation to specific online activities through manifestation of other underlying disorders. Additionally, the changing landscape of Internet mobility and the contextual variations Internet access can hold has further implications towards its conceptualisation and measurement. Without official recognition and agreement on the concept of IA, this can lead to difficulties in efficacy of diagnosis and treatment. This paper therefore provides a critical commentary on the numerous issues of the concept of “Internet addiction”, with implications for the efficacy of its measurement and diagnosticity.

Reciprocal Relationship between Internet Addiction and Network-Related Maladaptive Cognition among Chinese College Freshmen: A Longitudinal Cross-Lagged Analysis

This study explored the reciprocal relationship between Internet addiction (IA) and network-related maladaptive cognition (NMC) in Chinese college freshmen. A short-term longitudinal survey with a sample of 213 college freshmen was conducted in Shandong province, China. The results revealed that IA can significantly predict the generation and development of NMCs, and that when such maladaptive cognitions have been established, they can further adversely affect the extent of the students' IA. A vicious cycle was observed between these two variables, with IA having predictive priority in its relationship with NMC. This study also determined that the relationship between these two variables was the same for both males and females; therefore, the final model we established can be extensively applied to Chinese college freshmen, regardless of gender. Understanding the reciprocal relationship between these two variables can assist in interventions in IA at the outset of students' college life.

A randomized efficacy trial of a cognitive-behavioral group intervention to prevent Internet Use Disorder onset in adolescents: The PROTECT study protocol

Background

The reduction of prevalence rates of Internet Use Disorder (IUD) and its effective treatment are at high priority in both public health and educational policies. School-based preventive interventions facilitate a low-threshold approach for individuals with IUD, who are typically characterized by high therapy avoidance. Moreover, indicated approaches which target adolescents at high-risk show larger effects than universal prevention programs. Simultaneously, they reduce unnecessary burden for the majority of high-school students that is not at-risk. The PROTECT group intervention for indicated prevention of IUD in school settings was developed based on these preventive strategies.

Methods

Three-hundred and forty adolescents, aged 12–18 years, from 40 secondary schools in Germany, screened for high-risk of IUD onset, are randomly assigned to a) PROTECT preventive intervention group or b) assessment only control group. The tested intervention consists of a cognitive-behavioral 4-session brief-protocol. Follow-up assessments are at 1, 4 and 12 months after admission. Primary outcome is the 12-months incidence rate of IUD. Secondary outcomes are the reduction of IUD and comorbid symptoms as well as the promotion of problem solving, cognitive restructuring and emotion regulation skills.

Conclusion

The indicated preventive intervention PROTECT follows the APA-guidelines for psychological prevention, i.e., it is theory- and evidence-based and addresses both risk-reduction and strength-promotion, it considers current research and epidemiology and ethical standards such as professional secrecy and is designed as a systemic intervention at the school-level. It is expected that the intervention decreases risk of IUD onset (incidence rate).

Trial registration

ClinicalTrials.gov: NCT02907658.

Functional characteristics of the brain in college students with internet gaming disorder

Internet gaming disorder (IGD) is a subtype of internet addiction disorder (IAD), but its pathogenesis remains unclear. This study investigated brain function in IGD individuals using task-state functional magnetic resonance imaging (fMRI). It is a prospective study in 19 IGD individuals and 19 matched healthy controls. They all received internet videogame stimuli while a 3.0 T fMRI was used to assess echo planar imaging. Brain activity was analyzed using the Brain Voyager software package. Functional data were spatially smoothed using Gaussian kernel. The threshold level was positioned at 10 pixels, and the activation range threshold was set to 10 voxels. Activated brain regions were compared between the two groups, as well as the amount of activated voxels. The internet videogame stimuli activated brain regions in both groups. Compared with controls, the IGD group showed increased activation in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, right superior temporal gyrus, and left brainstem. There was a significant difference in the number of activated voxels between the two groups. An average of 1078 voxels was activated in the IGD group compared with only 232 in the control group. Internet videogame play activates the vision, space, attention, and execution centers located in the occipital, temporal, parietal, and frontal gyri. Abnormal brain function was noted in IGD subjects, with hypofunction of the frontal cortex. IGD subjects showed laterality activation of the right cerebral hemisphere.

eHealth Intervention for Problematic Internet Use (PIU)

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

Systematic review of research investigating psychotherapy and information and communication technologies

INTRODUCTION

Information and communication technologies (ICTs) are devices, services and knowledge that reproduce, process and distribute information. Psychotherapy has been influenced by these technologies, and there is a tendency for their role to expand.

OBJECTIVE

To describe the current panorama of the scientific literature on psychotherapy and ICTs.

METHOD

This is a systematic and descriptive review. Searches were run on the electronic databases Biblioteca Virtual em Saude (BVS), PsycINFO, Scopus, PePSIC, ScienceDirect and Index Psi, using the Boolean operator AND and the descriptors psychotherapy, computers, Internet, cell phones and social networks.

RESULTS

A considerable volume of empirical research was found, published recently in many different parts of the world, especially in the United States. There is very little Brazilian research on the subject. The majority of the studies identified assess the efficacy or describe the development of techniques and psychotherapies, via ICTs, for prevention, diagnosis or treatment of mental and behavioral disorders. The psychopathology most investigated in this area is depression and it was not possible to draw conclusions on a possible trend for research into the subject to increase. The technology most investigated was the Internet and cognitive-behavioral therapy was the most common theoretical approach in these studies.

CONCLUSIONS

Systematic reviews of published studies can detect gaps in the research agenda within a specific field of knowledge.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of Internet Addiction and Its Association With Psychological Distress and Coping Strategies Among University Students in Jordan

PURPOSE

The purpose of this study was to measure the prevalence of Internet addiction (IA) and its association with psychological distress and coping strategies among university students in Jordan.

DESIGN AND METHODS

A descriptive, cross-sectional, correlational design was used with a random sample of 587 university students in Jordan. The Perceived Stress Scale, Coping Behavior Inventory, and Internet Addiction Test were used.

FINDINGS

The prevalence of IA was 40%. IA was associated with high mental distress among the students. Students who used problem solving were more likely to experience a lower level of IA.

PRACTICE IMPLICATIONS

This study should raise awareness in nurses and other healthcare providers that IA is a potential problem for this population.

Using metaphors to investigate cognition-behavior link in problematic Internet use among college students

INTRODUCTION

This study employed metaphor analysis as a novel approach to explore college students' metaphorical representations of the Internet and their associations with problematic Internet use (PIU). It aimed to find out whether normal and problematic Internet users conceive the Internet through the same cognitive framework.

METHODS

The sample included 370 college students in Turkey. A questionnaire was conducted to gather metaphorical conceptions of the Internet, patterns of Internet usage, and PIU status. Data were analyzed both qualitatively and quantitatively.

RESULTS

Of the sample, 8.6% were diagnosed with PIU. Home access and entertainment gratification were strong correlates of PIU. Gender and major had no effects on PIU. Participants produced 66 metaphors that were grouped into eight conceptual categories: information source, immensity, basic need, addictive substance, double-edged sword, transporter, mood regulator, and supporter.

DISCUSSION

PIU was the highest in the addictive substance category, followed by basic need and mood regulator categories, with cigarette, water, and friend being the dominant metaphors in these categories, respectively. Problematic users are less likely to conceptualize the Internet as a supportive entity. Normal users are able to verbalize the good and bad aspects of the Internet, but those negatively affected appear to have lost sight of the most useful function of the Internet.

Epidemiology of internet behaviors and addiction among adolescents in six Asian countries

Internet addiction has become a serious behavioral health problem in Asia. However, there are no up-to-date country comparisons. The Asian Adolescent Risk Behavior Survey (AARBS) screens and compares the prevalence of Internet behaviors and addiction in adolescents in six Asian countries. A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year. Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined. The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea. Moreover, participation in online gaming ranges from 11% in China to 39% in Japan. Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%). Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%). Internet addictive behavior is common among adolescents in Asian countries. Problematic Internet use is prevalent and characterized by risky cyberbehaviors.

The alteration of gray matter volume and cognitive control in adolescents with internet gaming disorder

Objective: Internet gaming disorder (IGD) has been investigated by many behavioral and neuroimaging studies, for it has became one of the main behavior disorders among adolescents. However, few studies focused on the relationship between alteration of gray matter volume (GMV) and cognitive control feature in IGD adolescents.

Methods: Twenty-eight participants with IAD and twenty-eight healthy age and gender matched controls participated in the study. Brain morphology of adolescents with IGD and healthy controls was investigated using an optimized voxel-based morphometry (VBM) technique. Cognitive control performances were measured by Stroop task, and correlation analysis was performed between brain structural change and behavioral performance in IGD group.

Results: The results showed that GMV of the bilateral anterior cingulate cortex (ACC), precuneus, supplementary motor area (SMA), superior parietal cortex, left dorsal lateral prefrontal cortex (DLPFC), left insula, and bilateral cerebellum decreased in the IGD participants compared with healthy controls. Moreover, GMV of the ACC was negatively correlated with the incongruent response errors of Stroop task in IGD group.

Conclusion: Our results suggest that the alteration of GMV is associated with the performance change of cognitive control in adolescents with IGD, which indicating substantial brain image effects induced by IGD.

Internet addiction and physical and psychosocial behavior problems among rural secondary school students

The aim of this study was to determine secondary school students' levels of Internet addiction and the physical and psychosocial behavior problems they face while using the Internet. This descriptive study was conducted in three state secondary schools in a rural area in the western part of Turkey. This study's sample consisted of 549 students who agreed to participate, with the consent of their families, and who had an Internet connection at home. The data were evaluated using t-tests and variance analyses. In this study the students' score of Internet addiction was at medium level (mean addiction score 44.51 ± 17.90). There were significant differences between the students' Internet addiction scores and the presence of physical behavior problems (going to bed late, skipping meals, eating meals in front of the computer) and psychosocial behavior problems (suffering from conditions such as restlessness, anger, heart palpitations, or tremors when they could not connect to the Internet, decreased relationships with family and friends, feelings of anger, arguing with parents, and finding life boring and empty without an Internet connection).