CBT Intervention May Reduce Addictive Internet Use

A 15-week intervention based on principles of cognitive-behavioral therapy (CBT) effectively reduced addictive online behaviors in men, according to a study published last month in JAMA Psychiatry.

“This study is an important step forward as the authors have developed and successfully tested a behavioral therapy for people with gaming disorder,” said Marc Potenza, M.D., Ph.D., a professor of psychiatry at Yale University and director of the Yale Center of Excellence in Gambling Research. Potenza, who was not involved in the study, added that problem gaming and other online addictions will become increasingly relevant as the internet becomes a more central part of people’s lives.

Both APA and the World Health Organization have recognized that videogaming can become addictive, though other specific internet-based addictions are not yet mentioned in these organizations’ diagnostic guides—DSM and the International Classification of Diseases, 11th Revision, respectively. Despite the variety of internet-based addictions, the study authors support the theory that these unique addictions are broadly united by similar behaviors, which is why they chose to include participants with a diverse set of addictions versus focusing on a specific addiction.

This study was conducted at four outpatient mental health clinics in Germany and Austria (Mainz, Mannheim, and Tübingen, Germany, and Vienna) that specialize in behavioral addictions. Most of the 143 participants were seeking treatment for videogaming addiction, but men seeking treatment for online pornography and generalized internet addiction also were included. The study was limited to men as they made up over 90% of the patients seeking help for internet addiction at these clinics. (Population studies have suggested that internet addiction occurs roughly equally in men and women, but men currently make up most of the people seeking help.)

Participants were randomized into one of two groups: 72 received short-term treatment for internet and computer game addiction (STICA), a manual-guided psychotherapy that uses CBT principles to educate patients about their dysfunctional internet use and provides tools to help them regain control. The other 71 participants were placed on a wait list and received STICA after 15 weeks.

STICA involved 15 group-therapy sessions divided into three phases. First is the education phase, in which participants learn about their disorder and decide on a treatment goal. Next is the intervention phase, during which participants develop skills and awareness to facilitate functional internet use. Finally is the termination phase, which focuses on building a plan to prevent relapse and transitioning participants into everyday life.

The group sessions are interspersed with eight individual sessions designed to keep participants motivated and to monitor for any emergent distress.

Because addictive behaviors often mask underlying problems, part of STICA required the patient to think about these problems, lead study author Klaus Wölfling, Ph.D., head of the Outpatient Clinic for Behavioral Addictions at the University Medical Center of the Johannes Gutenberg-University in Mainz, explained in an interview with JAMA.

In some cases, the underlying problems were severe enough that the self-reflection destabilized the patient, Wölfling continued. As a result, a handful of participants receiving STICA had to be transferred to an inpatient psychiatric hospital for depression, showing that this treatment does come with some risks.

However, the STICA intervention also resulted in significant improvements. Nearly 70% of men who received STICA achieved remission of their addiction (defined as a score of 7 or less on the Assessment of Internet and Computer Game Addiction scale) compared with 24% of men on the wait list. The STICA group also reduced the amount of time spent online on both weekdays and weekends by more than half—from 6.5 hours/day to 3.0 hours/day on weekdays and from 8.4 hours/day to 3.6 hours/day on weekends.

“Despite the heterogeneity of the treatment group, we found that our CBT program was effective … regardless of age, comorbidity, or treatment center,” Wölfling and colleagues wrote in their article. “These findings support a unitary concept of [internet addiction] and point to the flexibility of the STICA.”

However, as knowledge about internet-related addictions grows, Yale’s Potenza believes researchers should look for more specific solutions to individual behaviors like gaming, pornography, and social media use. “Just as we approach the treatment of substance use disorders differently based on the substance, we need to focus on the behaviors and not only the online aspect.”

This study was supported by a grant from the German Research Foundation.  ■

“Efficacy of Short-Term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial” is posted here. The accompanying audio interview is posted here.