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Original Investigation
July 10, 2019

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

Author Affiliations
  • 1Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
  • 2Interdisciplinary Center for Clinical Trials Mainz, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
  • 3University Hospital of Tübingen, Department of Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, Tübingen, Germany
  • 4Medical Faculty Mannheim, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
  • 5Department of Psychiatry, Anton Proksch Institute, Vienna, Austria
  • 6Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
JAMA Psychiatry. 2019;76(10):1018-1025. doi:10.1001/jamapsychiatry.2019.1676
Key Points

Question  Is manualized cognitive behavioral short-term therapy an efficient treatment of internet and computer game addiction?

Findings  In this randomized clinical trial of 143 men, a strong remission rate for internet and computer game addiction was noted with cognitive behavioral therapy in the treatment group vs a wait-list control group.

Meaning  Short-term CBT treatment in outpatient settings addressing internet and computer game addiction is effective.

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

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