A cognitive behavioral therapy (CBT)-based intervention found moderate success preventing gaming and internet addiction in at-risk youth, according to German researchers.
Compared to a control group, adolescents who participated in the PROTECT intervention experienced a significantly greater reduction in symptoms related to gaming disorder and unspecified internet use disorder over 12 months (27.7% vs 39.8% reduction, effect size d=0.67), Katajun Lindenberg, PhD, of Goethe-University Frankfurt in Germany, and colleagues reported.
“The excessive use of video games and internet applications has been growing (particularly during the ongoing COVID-19 pandemic), which underlines the need for prevention and early intervention,” Lindenberg’s group wrote in JAMA Network Open.
Intervention participants had taken part in four 90-minute group sessions at their schools with two trained psychologists and were assessed at baseline, 1 month, 4 months, and 12 months. Those in the control group only received the assessments.
The PROTECT intervention also yielded significantly greater reduction in procrastination, according to Lindenberg and colleagues. Previous studies had found gaming addiction and procrastination to be closely related, they noted.
Meta-analyses conducted pre-COVID have estimated the prevalence of internet gaming disorder among adolescents to be 4.6% and of internet addiction to be 6.0%.
Since the pandemic, more children have turned to gaming and the internet to fill their newfound extra time from online schooling and the cancellation of extracurricular activities. However, “unlike other pandemic-driven activities, such as gardening and bread-making among adults, internet use and gaming behaviors among youth have addictive qualities that could magnify long-term risk,” Evelyn Stewart, MD, of the University of British Columbia in Vancouver, wrote in a corresponding editorial.
“With their work, Lindenberg [and colleagues] issued a reminder to proactively address subclinical behaviors that are potentially addictive among adolescents,” Stewart wrote. “A guiding ray of hope to diminish mental illness in this population may lie in prevention rather than in clinically based interventions after disease onset. game on!”
Interestingly, the trial showed that symptom severity at 1 month increased in the intervention group but decreased in the control group. The researchers said they observed a similar pattern in their PROTECT+ study, which was based on the same concepts as this study.
“This paradox reaction could be explained by an elevated awareness of problematic internet behavior, which was induced by the PROTECT intervention,” they suggested.
Six students each in the intervention and control groups developed unspecified internet use disorder. Another 40 participants were diagnosed with subthreshold gaming or internet use disorder, the two groups sharing similar incident rates.
Yet what these conditions actually describe is not clear-cut, according to Linda Kaye, PhD, of Edge Hill University in England, who was not affiliated with the study.
“The conceptual basis of both ‘internet addiction’ and ‘gaming disorder’ are quite shaky,” she told MedPage Today. They have described in many terms, such as “gaming addiction, gaming disorder, internet gaming disorder” and lack insight as to “what specifically is ‘addictive.'”
It’s unlikely that the act or process of gaming by itself is addictive, “but rather specifics of the type of game and how this interacts with an individual player’s context,” Kaye said. “Research often tends to take a broad measure of ‘gaming disorder’ or ‘gaming addiction’ and so on, but not really control or measure the types of games people play and how this may vary on the measurements taken.”
Gaming disorder made its debut in the ICD-11 just recently put in effect. Unspecified internet use disorder, on the other hand, is still categorized with other disorders related to addiction.
The present study screened over 5,500 high school students from schools in the Rhine-Neckar metropolitan region of Germany using the German version of the Compulsive Internet Use Scale. Of those, 422 students who were determined to be at risk for gaming or internet addiction were randomized in the PROTECT intervention arm (n=167) or the control arm (n=255).
Mean age of the students was 15 years, and 54.3% were female. Race and ethnicity data were not collected.
Adolescents in the intervention arm attended group sessions with no more than 11 participants. The mean number of sessions attended was 3.7 out of 4 total sessions.
Lindenberg and colleagues said their trial is the first to examine the long-term impacts of a school- and CBT-based prevention intervention for gaming disorder and unspecified internet use disorder compared to a control group.
Nevertheless, they acknowledged that just one in five eligible students participated in their study, which may limit the generalizability of the findings. They also noted that their sample size left the incidence analysis underpowered.
Lindenberg reports grants from the Federal Ministry of Education and Research of Germany (BMBF) and Ministry for Social Affairs and Integration Baden-Württemberg.
Stewart reported serving as a member of the clinical and scientific advisory board for the International OCD Foundation.