Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial

Abstract

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.

Figure 1.. CONSORT Diagram

AICA-C indicates Assessment of Internet and Computer Game Addiction self-report; AICA-S, Assessment of Internet and Computer Game Addiction clinical expert rating; GAF, Global Assessment of Functioning; LOCF, last observation carried forward; t1, time factor, midtreatment; t2, time factor, termination; t3, time factor, 6-month follow-up; and WLC, wait-list control.

Figure 2.. Changes of the Mean Subjective Assessment of Internet and Computer Game Addiction (AICA-S) Scores Across Measurement Points

Comparison of short-term treatment for internet and computer game addiction group with wait-list control group. The horizontal line in the middle of each box indicates the median. The diamond within each box indicates the mean. Top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The whiskers above and below the box mark the 90th and 10th percentiles. The circles beyond the whiskers are outliers. t0 indicates time factor, baseline; t1, time factor, midtreatment; t2, time factor, termination; and t3, time factor, 6-month follow-up.