Problem gaming-related harm experienced by partners and parents of individuals with gaming problems and their help-seeking experiences.

Background and aims: Limited research has investigated how individuals' problem gaming affects significant others. The present study investigated the extent to which partners and parents were personally affected by their partner or child's problematic gaming behavior and what steps, if any, were taken in relation to treatment and other help-seeking by the gamers and the respondents themselves. Methods: Two targeted samples (parents, n = 104; partners, n = 264) in Australia were recruited and administered an online survey. The survey assessed gaming-related harm across multiple domains, including financial, relationship, emotional wellbeing, physical health and work/study. Treatment and help-seeking questions referred to seeking psychological assistance, self-help, and community support. Non-parametric tests compared groups on harm measures based on GD status. Results: Parents and partners of individuals rated in the 'problem gaming' range reported significantly greater harms compared to those in the at-risk and non-problem categories. The most frequently endorsed harms were in the relationship domain, including neglected household responsibilities, withdrawal from social events, and relationship conflict. Some parents consult with friends and family (15%) to resolve their child's gaming-related problems. Partners reported to seek outside support and assistance for themselves, including 30% who sought a psychologist. No partners reported having consulted a psychologist for their gaming partner. Discussion: Problem gaming affects significant others across multiple life areas, but few seek outside help or support, suggesting there may be significant unmet needs. Conclusions: Further research should examine factors that influence acceptance and engagement with problem gaming help options. Harm indicators may be useful for evaluating targeted interventions and other measures to reduce problem gaming.

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.

Treatment outcomes of a CBT-based group intervention for adolescents with Internet use disorders.

BACKGROUND AND AIMS: Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. METHODS: N = 54 patients (16.7% female), aged 9-19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. RESULTS: Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. DISCUSSION AND CONCLUSIONS: The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT).

[Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study]. / Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie.

Effectiveness of an early intervention program for adolescents with Internet Gaming and Internet Use Disorder: Medium-term effects of the PROTECT+ Study Abstract. Objective: Internet Gaming and Internet Use Disorder (IGD and IUD) have gained increasing attention in the scientific community over the last few years. The inclusion of "Gaming Disorder" in the ICD-11 (International Statistical Classification of Diseases and Related Health Problems) promoted the need for evidence-based and effective treatments. PROTECT+ is such a cognitive-behavioral group therapy program for adolescents with IGD and IUD. The present study evaluates the medium-term effects after 4 months. Method: N = 54 patients, aged 9 to 19 years (M = 13.48, SD = 1.72), participated in the early intervention study between April 2016 and December 2017 in Heidelberg, Germany. Symptom severity was assessed at baseline, at the end of the treatment, and at 4-month follow-up using standardized diagnostic tools. Results: Multilevel analyses showed a significant reduction in symptom severity using the Video Game Dependency Scale (CSAS) at 4-month follow-up. We found a small effect size in self-reported reduction of symptom severity (d = 0.35) and a moderate effect size in parental ratings (d = 0.77). The Reliable Change Index measured by the Compulsive Internet Use Scale (CIUS) indicated a high heterogeneity in individual symptom changes over time. Patients showed high satisfaction regarding the treatment program at 1- und 4-month follow-up. Conclusions: This study is internationally one of the few to show a significant reduction of IGD and IUD symptoms after 4 months.

School-Related Risk Factors of Internet Use Disorders.

A growing body of research focusing on the risk factors of Internet use disorder (IUD) underlines the effect of sociodemographic variables like age and gender or comorbid mental disorders on IUD symptoms. The relation between IUD symptoms and school-related variables has to date been insufficiently studied. The present study closes this gap by investigating the relation between school-relevant factors such as absenteeism, school grades, procrastination, school-related social behavior, and learning behavior and IUD symptoms in a high-risk sample. n = 418 students between 11 and 21 years of age (M = 15.10, SD = 1.97), screened for elevated risk of IUD, participated in the study. Sociodemographic data, school grades and absent days, Internet use variables (time spent online and gaming), as well as school-related psychological variables (procrastination, learning behavior, and social behavior) were assessed via self-report questionnaires. IUD symptoms were assessed with an adapted version of the German Video Game Dependency Scale (CSAS), which is based on the 9 criteria for Internet gaming disorder in the DSM-5. The instrument was adapted to include the assessment of non-gaming IUD symptoms. Taking the hierarchical structure of the data into account, a multilevel modeling approach was used to analyze the data. Procrastination, time spent online, and gaming were significant predictors of IUD symptoms at the individual level, whereas social behavior significantly predicted symptoms of IUD at the school level. In addition to previous findings on risk factors of IUD, this study indicates the importance of school-related factors in the development of IUD, especially psychological factors that play a role in the school setting. The early age of IUD onset and the high relevance of prevention of IUD at the school age underline the relevance of this finding.

A Phenotype Classification of Internet Use Disorder in a Large-Scale High-School Study.

Internet Use Disorder (IUD) affects numerous adolescents worldwide, and (Internet) Gaming Disorder, a specific subtype of IUD, has recently been included in DSM-5 and ICD-11. Epidemiological studies have identified prevalence rates up to 5.7% among adolescents in Germany. However, little is known about the risk development during adolescence and its association to education. The aim of this study was to: (a) identify a clinically relevant latent profile in a large-scale high-school sample; (b) estimate prevalence rates of IUD for distinct age groups and (c) investigate associations to gender and education. N = 5387 adolescents out of 41 schools in Germany aged 11-21 were assessed using the Compulsive Internet Use Scale (CIUS). Latent profile analyses showed five profile groups with differences in CIUS response pattern, age and school type. IUD was found in 6.1% and high-risk Internet use in 13.9% of the total sample. Two peaks were found in prevalence rates indicating the highest risk of IUD in age groups 15-16 and 19-21. Prevalence did not differ significantly between boys and girls. High-level education schools showed the lowest (4.9%) and vocational secondary schools the highest prevalence rate (7.8%). The differences between school types could not be explained by academic level.

An analysis of integrated health care for Internet Use Disorders in adolescents and adults.

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.