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Short-term CBT May Curb Internet and Computer Game Addiction

July 17, 2019

By Marilynn Larkin

NEW YORK—Short-term cognitive behavioral therapy (CBT) may address internet and computer game addiction in adults, a new study suggests.

At the end of the 15-week intervention, "We found a strong remission rate for internet and computer game addiction in the treatment group compared to a waitlist control group," Dr. Klaus Wolfling of the University Medical Center of the Johannes Gutenberg-University Mainz told Reuters Health by email.

"This indicates a strong treatment effect, so I think our study was a first step," he said.

Early implementation of abstinence and a thorough examination of life problems "serve as important supporters for the treatment," he added.

As reported online July 10 in JAMA Psychiatry, Dr. Wolfling and colleagues randomized 143 men (mean age, 26) to CBT using a manualized program they developed called short-term treatment for internet and computer game addiction (STICA) or a wait list. About half of the participants had comorbid mental disorders (mostly mild or moderate depression), and 14.7% were receiving psychotropic medication.

The main problems were online computer games (56.6%), online pornography (16.1%), generalized internet addiction (20.9%), and offline computer games (6.3%).

STICA, which aimed to help participants recover functional internet use, consisted of 15 weekly group sessions and up to eight 60-minute individual sessions. Sessions were conducted by CBT therapists specifically trained in STICA by the study authors.

One hundred patients finished treatment as scheduled, 70% of the STICA group and 75% of the waitlist control group. Fifty STICA patients (69%) achieved remission compared with 17 patients (23.9%) in the waitlist control group.

After adjustment for internet addiction baseline severity, comorbidity, treatment center, and age, remission at the end of the intervention was higher in the STICA group (odds ratio, 10.10). Treatment effects were seen for time spent online on weekdays, psychosocial functioning, and depression.

Adverse events were defined as any significant unfavorable change in the patient's pretreatment mental condition, regardless of its relationship to treatment. Fourteen adverse events and eight serious adverse events occurred; a causal relationship with treatment considered likely for two adverse events, one in each group.

Longer-term follow-up data collected six months after the end of the intervention are currently being analyzed, Dr. Wolfling said.

Also, he said, "We see good effects (with STICA) in other patient groups - e.g., females or elderly persons who are affected. Further studies should address these (groups) on an evidence-based level."

Some clinicians in Germany are currently using the program, and the team is working on an English translation of the manual, Dr. Wolfling noted. They are also developing a specific program for online pornography addiction, which he described as "one of the most addictive domains of internet use besides gambling."

Dr. Kimberly Asner Self, director of the Mental Health Counseling Program at Touro College in New York, commented by email, "I have found group counseling to be effective in reducing shame and isolation in people struggling with a variety of issues. Group members share a sense of belonging, learn to give and receive support, develop empathy and self-awareness, and learn interpersonal skills and ways to cope with stress."

"Some men became more depressed during treatment," she noted. "Clinicians need to be aware of this and schedule additional one-on-one time to assess and address these issues while reinforcing the skills learned during group."

"We do not know how or whether STICA is effective for women, non-Western people, and/or ethnically diverse persons with internet gaming addictions," she added. Further, "the clinicians in this study were trained and clinically supervised by the creators of STICA. Ethically, should clinicians choose to use STICA, they may need to seek some form of consultation, support, and/or continuing education."

Dr. Mayumi Okuda Benavides, Director of the Columbia Gambling Disorders New York City also noted that CBT requires training and delivery by experienced clinicians. "We have used CBT for gambling addiction, with good effects," she told Reuters Health by email. Although the manual used in the study is not yet available for Columbia's use, "the treatment is probably very similar to the one being used for gambling disorder."

"Given the findings, clinicians should be aware of the need to assess for co-occurring disorders and treat those concomitantly," she said. "Likewise, it would be key to assess for suicidal thoughts as the treatment progresses. Medications to treat the co-occurring conditions should be strongly considered, as well. These could likely enhance the effects of the therapy."


JAMA Psychiatry 2019.

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