Review of: Wölfling K et al, JAMA Psychiatry 2019;76(10):1018–1025

While many of us likely spend far too much time on our various devices—whether for fun or for work—between 0.3% and 1% of the general population might qualify for an internet gaming disorder (Przybylski AK et al, Am J Psychiatry 2017;174(3):230–236). Defined as excessive preoccupation with online gaming despite negative life consequences, internet gaming disorder was identified in the 2013 publication of the DSM-5 as a condition warranting more clinical research and experience before it might be considered for inclusion as a formal disorder. In a recent multicenter randomized clinical trial, researchers evaluated the effectiveness of short-term cognitive behavioral therapy (CBT) for internet addiction.

The study randomly assigned 143 patients with DSM-5-proposed research criteria for internet and computer game disorder to short-term CBT (n = 72) or wait-list control (n = 71) and followed them for 6 months. The mean age was 26.2 years, and most participants were single, high school educated, and unemployed. All were male, which was intentionally reflective of the preponderance of treatment seekers.

The treatment group underwent 15 weekly groups of manualized CBT and up to 8 individual sessions that conceptualized their disorder as resulting from an interaction of individual factors, features of online activity, dysfunctional coping strategies, and disorder-specific cognitive biases. The primary outcome was remission based on a self-report measure, the Assessment of Internet and Computer Game Addiction (AICA-S). Secondary outcomes included time spent gaming or online, psychosocial functioning, and depressive symptoms.

The researchers found 69.4% of patients in short-term CBT achieved remission compared with 23.9% of those wait-listed (p < .001). There was a greater likelihood of remission in short-term CBT vs wait-list after controlling for age, baseline severity, and comorbidity (adjusted odds ratio 10.10; 95% confidence interval 3.69–27.65). Both groups had improved depression ratings, which may have reflected repeat assessments and the prospect of future treatment for those wait-listed. At 6-month follow-up of half the patients in the short-term CBT group, 80.6% were in remission, but the authors claim this result is difficult to interpret owing to high rates of study dropout and the fact that follow-up data was not sought for the control group.

CATR’s Take
The results of this study offer hope for effective treatment of internet and computer game addiction. Still, more research is needed to better define these conditions, examine treatments among women, and compare short-term CBT with other treatments. When managing a patient struggling with problematic gaming and/or internet use, consider CBT as an option, especially as it is widely used for other addictive disorders.