Preventive intervention may improve adolescent gaming disorder

Over the course of 1 year, a preventive group intervention program showed effectiveness in reducing symptoms of gaming disorder and unspecified internet use disorder in adolescents, according to a study published in JAMA Network Open.

“Gaming disorder and unspecified internet use disorder are associated with numerous impairments, such as comorbid psychiatric disorders, lower life satisfaction and lower academic achievements,” Katajun Lindenberg, PhD, child and adolescent psychotherapy professor at Goethe-University Frankfurt in Germany, and colleagues wrote.

“Prevention programs that target at-risk individuals must demonstrate incremental effectiveness beyond the expected effects of spontaneous remission and regression to the mean,” they added. “Therefore, it is of utmost necessity to design longitudinal, randomized clinical efficacy trials that allow the observation of natural symptom courses in a control group and that use clinically relevant end points (ie, reduction of first symptoms and prevention of illness onset).”

Lindenberg and colleagues aimed to study the effectiveness of PROTECT, a theory-driven, manualized, cognitive behavioral therapy–based indicated preventive group intervention, in the prevention of gaming disorder and internet use disorder in adolescents. The intervention is delivered in four sessions by a psychologist and targets changes in addictive reward processing and pathological cognitive mechanisms.

In a multicenter, cluster, randomized clinical trial, researchers recruited 422 adolescents (mean age, 15.11 years; 54.3% girls) across 33 high schools in Germany. Elevated symptoms of gaming disorder and unspecified internet use disorder were used as inclusion criteria for both the study and for symptom severity analyses. Participants were randomized to either the PROTECT intervention group or the assessment-only control group, with assessments at baseline, 1-month follow-up, 4-month follow-up and 12-month follow-up. The primary outcome was symptom severity along with incidence rates assessed after 12 months, and secondary outcomes included procrastination, depressive symptoms, social anxiety and problem behaviors.

Researchers found the PROTECT group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder (₁₁=–0.128; 95% CI, –0.246 - –0.011) compared with the control group, reflecting a 39.8% vs 27.7% reduction of symptoms over 12 months, respectively. The PROTECT group also demonstrated a significantly greater reduction in procrastination (₁₁=–0.458; 95% CI, –0.735 - –0.180) over 12 months.

Researchers did not observe statistically significant between-group differences in incidence rates or other secondary outcomes.

“This intervention effectively reduced symptoms of gaming disorder or unspecified internet use disorder over 12 months, which is a clinically, scientifically and politically important step in dealing with this newly recognized disorder,” the researchers concluded. “Knowledge gained from this trial could be used in follow-up studies with larger samples and high-risk participants to confirm the reduction in incidence rates. Further research is needed to investigate the effectiveness of the PROTECT intervention in a routine setting in which educators deliver the intervention.”