Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial
Open accessAbstract
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.
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Problem gaming can be a primary diagnosis, but in other cases it may be a secondary clinical issue, for example arising as a maladaptive coping strategy or compensatory mechanism.
“Studies examining problem gaming and co-occurring diagnoses have noted that the former can be a primary diagnosis 148,153,154 , but in other cases may be a secondary clinical issue, for example, arising as a maladaptive coping strategy or compensatory mechanism 155 .”
From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [154]
The Discussion (page unavailable) says that reducing addictive online behavior can destabilize emotional self-regulation, which supports the possibility that it serves a compensatory function. The paper does not establish that problem gaming is a secondary clinical issue arising from another diagnosis; the Limitations section notes comorbidity but does not specify that relationship. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIndividuals with gaming-related problems may seek assistance from gambling treatment services, units specializing in behavioural addictions, broader treatment providers dealing with addictive disorders, or non-specialized services.
“Other studies have shown that individuals with gaming-related problems may also seek assistance from gambling treatment services 199 , units that specialize in the treatment of behavioural addictions 151,154 , broader treatment providers dealing with addictive disorders in general 204 , or non-specialized services 200 .”
From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [154]
The Study Design and Implementation section (page unavailable) reports that patients with internet addiction were recruited at four specialized outpatient clinics, including one that treated both gambling disorder and subtypes of internet addiction. This supports seeking help from addiction-focused services, but it does not establish that these were broader providers treating addictive disorders in general. The other service types in the citing sentence have separate citations and are not attributed to this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA randomized controlled trial evaluating a manualized CBT program for gaming disorder found that 69% of patients who received the intervention showed remission compared with less than one-fourth (24%) of those in a waitlist control group.
“Recently, a randomized controlled trial evaluating the efficacy of a manualized CBT program for gaming disorder found that most patients (69%) who received the intervention showed remission compared with less than one-fourth (24%) of those in a waitlist control group 154 .”
From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [154]
The Discussion reports remission in 69.4% of the manualized CBT group versus 23.9% of the wait-list group. However, it says the trial included patients with gaming addiction or other forms of internet addiction; the reported remission rates are for the full sample, not specifically for patients with gaming disorder. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPsychological interventions designed to reduce gaming time and gaming disorder symptoms have demonstrated significant improvements in global measures of functional impairment.
“Psychological interventions designed to reduce gaming time and gaming disorder symptoms have demonstrated significant improvements in global measures of functional impairment 154,204 .”
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Self-citation
- Authors
- Wölfling, K., Müller, K. W., Dreier, M., Ruckes, C., Deuster, O., Batra, A., Mann, K., Musalek, M., Schuster, A., Lemenager, T., Hanke, S., & Beutel, M. E.
- Affiliations
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Universitätsklinikum Tübingen (DE)
- Heidelberg University (DE)
- Anton Proksch Institut (AT)
- Medical Faculty Mannheim, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- Corresponding author
- Wölfling, Klaus
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-10-01
- Volume
- 76
- Issue
- 10
- Pages
- 1018
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6624826
- OpenAlex
- W2958153714
- Cited by
- 200
- References
- 29
- Citations by year
- 2026: 19 · 2025: 33 · 2024: 28 · 2023: 26 · 2022: 32 · 2021: 34 · 2020: 25 · 2019: 3
- FWCI
- 47.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- internet addiction, gaming addiction, manualized treatment, remission, online time, psychosocial functioning, depression, men, waitlist control, adverse events, treatment efficacy
- MeSH terms
- Internet Addiction Disorder, Adolescent, Adult, Follow-Up Studies, Humans, Male, Psychotherapy, Brief, Remission Induction, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Video Games, Young Adult
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